Effect of manual reduction and indirect decompression on thoracolumbar burst fracture: a comparison study

Huang, Jinkun; Zhou, Limin; Zhao-dong, Yan; Zhou, Zongbo; Gou, Xuejian

doi:10.1186/s13018-020-02075-w

Cited by 9 publications

(9 citation statements)

References 13 publications

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“…Huang 11 et al showed that three days after operation, the bladder function of patients with MR is signi cantly higher than that of the control group, but the defect of this study is to group patients according to whether there is manual reduction or not, and the grouping of our study is based on whether the reduction is successful or not. Under the premise of such grouping, the results of the study can more truly re ect the effect of manual reduction.…”

Section: Discussionmentioning

confidence: 95%

“…Several studies have shown that manual reduction can improve vertebral collapse and kyphosis. [10][11][12] Unfortunately, the patients who failed in manual reduction before operation are prone to secondary collapse of vertebral body in a few months after operation. At present, no study has compared the effect of successful preoperative manual reduction on the prognosis of AO Type A3 thoracolumbar fractures treated with Wiltse approach pedicle screw xation.…”

Section: Introductionmentioning

confidence: 99%

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Effect of Manual Reduction Combined with Internal Fixation Through Wiltse Paraspinal Approach in the Treatment of Thoracolumbar Fracture (AO type A3)

Yang

Gao

et al. 2023

Preprint

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Background: Thoracolumbar fractures (TF) are the most frequent fractures of the spine, and the current treatment for TF (AO Type A3) is the Wiltse approach with pedicle screw fixation or percutaneous pedicle screw fixation. However, secondary collapse often occurs after operation. To reduce the incidence of such events, preoperative manual reduction (MR) is an efficient method. The purpose of this study is to investigate the impact of successful PMR on prognosis of patients with TF. Methods: From 2018 to 2022, 97 patients are enrolled to the study. Patients are divided into three groups, MR failure (MRF), succeeded (MRS) and instrument reduction (IR). The different time of the Cobb angel (CA) and vertebral body height ratio (VBHR) are obtained for three groups. The visual analog scale (VAS) is used to help patients assess the intensity of their pain, and oswestry disability index (ODI) is regarded as the gold standard for evaluating the degree of dysfunction caused by TF. Results: The recovery of CA and VBHR, MRS and IR is significantly better than MRF at 2 days and 6 months after operation. The CA and VBHR are found to be different between preoperative and 2 days, 6 months after operation. The CA and VBHR in MRF are decreased at 6 months after surgery compared with 2 days after surgery. In the results of VBHR 6 months after operation, there is significant difference between MRS and IR. Conclusion: Successful preoperative manual reduction can greatly improve and maintain vertebral height and spinal physiological curvature. In addition, according to the success of manual reduction, TF of AO Type A3 can be divided into A3a and A3b.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Effect of Manual Reduction Combined with Internal Fixation Through Wiltse Paraspinal Approach in the Treatment of Thoracolumbar Fracture (AO type A3)

Yang

Gao

et al. 2023

Preprint

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“…Для оценки поврежденного сегмента позвоночника и декомпрессии позвоночного канала после ручной редукции и непрямой декомпрессии используют различные категории: переднюю высоту поврежденного позвонка, угол клина тела поврежденного позвонка и процент стеноза позвоночного канала [27]. Изучено влияние прогностических факторов, связанных с постуральной и инструментальной редукцией, на восстановление высоты позвонков и угла кифоза при переломах грудопоясничного отдела [28].…”

Section: Discussionunclassified

Retrospective analysis of restoration of the anatomy of the damaged thoracic and lumbar spinal motion segment using transpedicular repositioning device

Усиков¹,

Kuftov²,

Monashenko

2022

Hir. pozvonoč.

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Objective. To carry out a retrospective analysis of the restoration of the anterior and posterior vertebral body heights and the elimination of deformation of the anterior spinal canal wall caused by thoracic and lumbar spine injury, based on the data of spiral computed tomography (SCT).Material and Methods. The study analyzed SCT data and case histories of 50 patients with thoracolumbar spinal cord injury operated on at different times after injury: up to 10 days – Group 1 and 11–30 days – Group 2. All patients underwent spinal reposition using a transpedicular device. The preoperative and postoperative SCT parameters were compared with the initial ones, which were calculated. The restoration of vertebral body heights and the elimination of deformation of the anterior spinal canal wall were compared in two groups depending on the distraction of interbody spaces and changes in the angle of segmental deformity.Results. In Group 1, the anterior and posterior dimensions of the vertebral body were restored, on average, by 95.3 ± 1.9 and 96.9 ± 1.4 % of the initial height; in Group 2 – by 87.4 ± 4.2 and 96.6 ± 1.8 %, respectively. The maximum restoration of the anterior dimensions of the vertebral bodies was achieved with distraction of the anterior interbody spaces closer to 100 % of the original size in the first and second groups. The maximum recovery of the posterior dimensions of the vertebral bodies was obtained by distraction of the posterior interbody spaces by 97 % or more of the original dimensions. The maximum elimination of the displacement of bone fragments from the spinal canal was obtained by distraction of the interbody spaces to a distance close to 100 % of the initial one, and when the obtained angle of segmental deformity coincided with the initial one.Conclusion. In the first 10 days after the injury, a greater percentage of the restoration of the anterior and posterior vertebral body heights and a decrease in the deformation of the anterior wall of the spinal canal were obtained. It was possible to maximally eliminate the deformation of the anterior wall of the spinal canal and restore the height of the anterior and posterior walls of the damaged vertebra by approaching the obtained dimensions of interbody spaces and the angle of segmental deformity to the initial ones.

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“…Therefore, indirect reduction can be used in patients with complete neurological function or mild neurological dysfunction, wherein the bone occupies less than 50% of the spinal canal and the posterior longitudinal ligament structure is intact. [ 14 , 15 ]…”

Section: Introductionmentioning

confidence: 99%

Finite element analysis of the indirect reduction of posterior pedicle screw fixation for a thoracolumbar burst fracture

2022

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Because burst fractures often involve damage to the column and posterior structures of the spine, the fracture block may invade the spinal canal and compress the spinal cord or the cauda equina, causing corresponding neurological dysfunction. When a thoracolumbar burst fracture is accompanied by the presence of bone in the spinal canal, whether posterior surgery requires spinal canal incision decompression is still controversial. Computed tomography images of the thoracolumbar spine of a 31-year-old male with an L1 burst fracture and Mimics 10.0 were used to establish a three-dimensional fracture model for simulating the indirect reduction process. The model was imported into Ansys 10.0 (ANSYS, Inc., Canonsburg, PA), and a 1 to 10 mm displacement was loaded 10° behind the Z-axis on the upper endplate of the L1 vertebral body to simulate position reduction and open reduction. The displacement and stress changes in the intervertebral disc, fractured vertebral body and posterior longitudinal ligament were observed during reduction. Under a displacement loaded 10° behind the Z-axis, the maximum stress in the vertebral body was concentrated on the upper disc of the injured vertebrae. The maximum displacement was in the anterior edge of the vertebral body of the injured vertebrae, and the vertebral body height and the anterior lobes were essentially restored. When the displacement load was applied in the positive Z-axis direction, the maximum displacement was in the posterior longitudinal ligament behind the injured vertebrae. Under a 6 mm load, the posterior longitudinal ligament displacement was 11.3 mm. Under an 8 mm load, this displacement significantly increased to 15.0 mm, and the vertebral stress was not concentrated on the intervertebral disc. A reduction in the thoracolumbar burst fractures by positioning and distraction allowed the injured vertebrae to be restored to normal height and kyphosis. The reduction in the posterior longitudinal ligament can push the bone block in the spinal canal into the reset space and achieve a good reset.

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Effect of manual reduction and indirect decompression on thoracolumbar burst fracture: a comparison study

Cited by 9 publications

References 13 publications

Effect of Manual Reduction Combined with Internal Fixation Through Wiltse Paraspinal Approach in the Treatment of Thoracolumbar Fracture (AO type A3)

Effect of Manual Reduction Combined with Internal Fixation Through Wiltse Paraspinal Approach in the Treatment of Thoracolumbar Fracture (AO type A3)

Retrospective analysis of restoration of the anatomy of the damaged thoracic and lumbar spinal motion segment using transpedicular repositioning device

Finite element analysis of the indirect reduction of posterior pedicle screw fixation for a thoracolumbar burst fracture

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