Is fusion necessary for thoracolumbar burst fracture treated with spinal fixation? A systematic review and meta-analysis

Diniz, Juliete Melo; Botelho, Ricardo Vieira

doi:10.3171/2017.1.spine161014

Cited by 32 publications

(33 citation statements)

References 23 publications

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“…The purpose of treatment for spinal fractures is to restore the original sagittal and coronal planes. Especially in the case of thoracolumbar burst fractures, the method most commonly used to achieve this goal is the pedicle screw system for posterior surgery.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Thoracolumbar Fractures Through Different Short Segment Pedicle Screw Fixation Techniques: A Finite Element Analysis

Wang

Duan

et al. 2020

Orthopaedic Surgery

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Objective: To compare the von Mises stresses of the pedicle screw system and the displacement of injured vertebrae using 3-D finite element analysis, and to evaluate the curative effect of the pedicle screw system. Methods:Finite element methods were used for biomechanical comparison of four posterior short segment pedicle screw fixation techniques. The different pedicle screw models are traditional trajectory (TT), Universal Spine System (USS), cortical bone trajectory (CBT), and CBT at the cranial level and pedicle screw (PS) at the caudal level (UP-CBT). The stress distribution of the screws and connecting rods under different working conditions and the displacement of the injured vertebrae were compared and analyzed.Results: After the pedicle screw system was fixed, the stress under vertical compression was mainly concentrated at the proximal end of the screw, while the stress was mainly concentrated on the connecting rod during flexion, extension, lateral flexion, and rotation. The TT group had the greatest stress during the flexion, extension, and left and right rotation. The UP-CBT group was most stressed when the left and right sides were flexed; the stress of the USS screw system was less than that of the other three models during flexion, lateral flexion, and rotation. The maximum von Mises stress values of pedicle screws in all exercise states were 556.2, 340.7, 458.1, and 533.4 MPa, respectively. In the USS group, the displacement of the injured vertebra was small in the flexion, and the left and right lateral flexion and the right rotation were higher than in the TT group and the CBT group. The maximum displacements of the injured vertebrae in all motion states were 1.679, 1.604, 1.752, and 1.777 mm, respectively.Conclusion: Universal Spine System pedicle screws are relatively less stressed under different working conditions, the risk of breakage is small, and the model is relatively stable; CBT screws do not exhibit better mechanical properties than conventional pedicle screws and USS pedicle screws.

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Section: Introductionmentioning

confidence: 99%

Treatment of Thoracolumbar Fractures Through Different Short Segment Pedicle Screw Fixation Techniques: A Finite Element Analysis

Wang

Duan

et al. 2020

Orthopaedic Surgery

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“…If one takes a general look at thoracolumbar fractures, then open instrumentations without fusion are quicker and associated with less blood loss than open instrumented spondylodesis [44,45]. Unfortunately, there are no published clinical and radiological data available which have distinguished between posterior instrumentations and posterior fusions specifically at the level of the ThSp.…”

Section: Instrumentation Versus Fusionmentioning

confidence: 99%

Traumatic Fractures of the Thoracic Spine

et al. 2020

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The majority of traumatic vertebral fractures occur at the thoracolumbar junction and the lumbar spine and less commonly at the mid-thoracic and upper thoracic spine. In accordance, a high number of articles are dealing with thoracolumbar fractures focusing on the thoracolumbar junction. Nonetheless, the biomechanics of the thoracic spine differ from the thoracolumbar junction and the lumbar vertebral spine. The aim of this review is to screen the literature dealing with acute traumatic thoracic vertebral fractures in patients with normal bone quality. Thereby, the diagnostic of thoracic vertebral body fractures should include a CT examination. Ideally, the CT should include the whole thoracic cage particularly in patients suffering high energy accidents or in those with clinical suspicion of concomitant thoracic injuries. Generally, concomitant thoracic injuries are frequently seen in patients with thoracic spine fractures. Particularly sternal fractures cause an increase in fracture instability. In case of doubt, long segment stabilization is recommended in patients with unstable mid- und upper thoracic fractures, particularly in those patients with a high grade of instability.

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“…While there has been some contention regarding the need for posterior arthrodesis, several studies comparing fixation without fusion to traditional techniques have demonstrated similar outcomes at long-term follow-up (6)(7)(8)(9)(10)(11). It is thought that posterior arthrodesis allows for preserved kyphosis that cannot be achieved with fixation alone, however, it seems likely that many patients with fixation alone likely fuse though this has not been directly assessed.…”

Section: Percutaneous Posterior Spinal Fixationmentioning

confidence: 99%

Minimally invasive surgery for thoracolumbar spinal trauma

Walker¹,

Xu²,

Godzik³

et al. 2018

Ann. Transl. Med.

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The indications for operative intervention after thoracolumbar spine trauma have been well described. Advances in minimally invasive techniques, including percutaneous pedicle screw fixation and mini-open anterolateral retractor-based approaches can improve surgical outcomes when appropriately applied by reducing blood loss, operative duration and post-operative pain. Moreover, they allow for theoretical advantages by preservation of muscular and skeletal blood supply and innervation that is typically lost during the muscular dissection of open approaches. For thoracolumbar spine fractures, percutaneous fixation allows for internal bracing of unstable fractures during healing while maintaining sagittal alignment. In instances of neurological compromise from fracture retropulsion, corpectomies may be required, and mini-open lateral approaches adopted from degenerative disease applications allow for a minimally invasive manner to treat the defect. These further allow for placement of wide rectangular-footprint expandable vertebral body replacement devices to provide anterior column support. We believe this allows for lower rates of subsidence and helps to maintain the biomechanical integrity necessary to prevent post-traumatic malalignment and kyphosis. Together, these minimally invasive techniques combined supply the spine surgeon with a minimally invasive armamentarium to treat nearly all thoracolumbar spine trauma. Surgeons should be comfortable with the strengths and shortcomings of these approaches in order to successfully apply them for this pathology.

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Is fusion necessary for thoracolumbar burst fracture treated with spinal fixation? A systematic review and meta-analysis

Cited by 32 publications

References 23 publications

Treatment of Thoracolumbar Fractures Through Different Short Segment Pedicle Screw Fixation Techniques: A Finite Element Analysis

Treatment of Thoracolumbar Fractures Through Different Short Segment Pedicle Screw Fixation Techniques: A Finite Element Analysis

Traumatic Fractures of the Thoracic Spine

Minimally invasive surgery for thoracolumbar spinal trauma

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