Management of unstable thoracolumbar spinal injuries by posterior short segment spinal fixation

Abstract

Fifty patients with thoracolumbar fractures were treated operatively between July 2000 and December 2001. The average age of the patients was 33.6 years (range: 20-50 years), 36 were males and 14 were females and the follow-up averaged 59 months (range: 49-68 months). A fall from a height, usually a tree, was the most common cause of injury. Twenty six patients had unstable burst fractures and 13 had translational injury. There were 15 patients with complete neurological deficit, 17 had partial neurological lesions, while 18 had no neurological deficit. All patients were treated by posterior short segment fixation (Steffee VSP). The average pre-operative kyphotic angle was 21.48°, which improved to 12.86°in the immediate post-operative period. The loss of kyphosis averaged 3.46°(0-26°) at the final follow-up. The average pre-operative anterior vertebral body height was 44.7% (range: 36-90%), which improved to 72.0% (range: 55-97%) in the immediate post-operative period. The loss of body height averaged 3.0% (range: 1-15%) at the final follow-up. No neurological deterioration was seen, and in 24 cases a one grade or better improvement was observed. The mean pain score was 1.6, and the mean functional score was 2.8. We found that the application of posterior instrumentation resulted in a reasonable correction of the deformity with a significant reduction in recumbency-associated complications; there were, however, significant other complications. (1-15) au suivi final. Aucune dégradation neurologique n'a été constatée. Une amélioration a été retrouvée dans 24 cas le score douleur moyen a été de 1.6 le score fonction de 2.8. Une instrumentation postérieure permet une correction raisonnable de la déformation avec une réduction significative des complications.

Management of unstable thoracolumbar spinal injuries by posterior short segment spinal fixation: reply to comments by Singh

“…Instrumentation failure is a known complication of this type of treatment. We mentioned this as an adverse outcome in our series [1]. We concur with the observation that posterior instrumentation is weaker in compression and is liable to fatigue and fail in the presence of a coexisting weak anterior column.…”

A comparison of three different surgical procedures in the treatment of type A thoracolumbar fractures: a randomized controlled trial

“…It is considered that a vertebral height loss of more than 50 %, a local sagittal angle (LSA) (Fig. 4) of more than 20 degrees or posterior ligamentous complex (PLC) injury may be unstable findings for traumatic thoracolumbar fractures [7]. Type A thoracolumbar fractures are without PLC injury.…”

“…Surgical fixation provides not only better fracture reduction, but also initial stability which enables early mobilization. Thus, it can effectively decrease complications associated with prolonged recumbence [1,7]. Although the outcomes of traditional open surgery for patients who had indications are generally favourable, the extensive damage of soft tissue unavoidably results in a relatively high incidence of failed back surgery syndromes [10,11].…”

159. Outcome of Thoracolumbar Burst Fractures Treated with Indirect Reduction and Fixation without Fusion

“…Short-segment pedicle screw instrumentation and indirect reduction is not a new technique in the management of thoracolumbar burst fractures [2,8,11]. Recently, shortsegment pedicle screw instrumentation has been used without fusion but the inclusion criteria in that study included only Dennis Type-B fractures [4,5].…”