Mechanical Stability of the AO Internal Spinal Fixation System Compared With That of the Hartshill Rectangle and Sublaminar Wiring in the Management of Unstable Burst Fractures of the Thoracic and Lumbar Spine

Cresswell, Tim; Marshall, Paul; Smith, Richard F.

doi:10.1097/00007632-199801010-00022

Cited by 23 publications

(17 citation statements)

References 4 publications

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“…Surgeons today have the option of either an anterior or a posterior approach. Some authors recommend posterior instrumentation with or without decompression because of the excellent results obtained in terms of spinal stability, anatomical alignment, postoperative neurological improvement and low patient morbidity [11][12][13]. In contrast, advocates of the anterior approach cite predictable decompression of the spinal canal, improvement in postoperative neurological function and no significant increase in surgical morbidity [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Anterior versus posterior approach for treatment of thoracolumbar burst fractures: a meta-analysis

Xiong

et al. 2013

Eur Spine J

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Purpose To critically review and summarize the literature comparing the results of surgery via an anterior approach and that via a posterior approach for the treatment of thoracolumbar burst fractures to identify the better approach. Methods In this meta-analysis, we conducted electronic searches of MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and other databases using the search terms ''thoracolumbar fractures'', ''anterior'', ''posterior'', ''controlled clinical trials''. Relevant journals or conference proceedings were also searched manually. Data extraction and quality assessment were in accordance with Cochrane Collaboration guidelines. The analysis was performed on individual patient data from all the trials that met the selection criteria. Sensitivity analysis was performed when there was significant heterogeneity. Results were expressed as risk difference for dichotomous outcomes and mean difference for continuous outcomes with 95 % confidence interval. Results Four randomized clinical trials and three controlled clinical trials comparing the results of the anterior versus posterior approach in the treatment of thoracolumbar burst fractures were retrieved; these studies included 179 and 152 patients in the anterior and posterior approach groups, respectively. There were no differences in terms of neurological recovery, return to work, complications and Cobb angle between the two groups. The anterior approach was associated with longer operative time, greater blood loss and higher cost than the posterior approach. Conclusions The posterior approach may be more effective than the anterior approach. However, more highquality, randomized controlled trials are required to compare these approaches and guide clinical decision-making. Level of Evidence Level II, therapeutic study. See the Guidelines for Authors for a complete description of level of evidence.

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Section: Introductionmentioning

confidence: 99%

Anterior versus posterior approach for treatment of thoracolumbar burst fractures: a meta-analysis

Xiong

et al. 2013

Eur Spine J

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“…The anterior approach offers good visualization of the fracture and allows a direct restoration of the defect. Disadvantages compared with pedicle screw instrumentation are a longer duration of the procedure, higher blood loss, and an increase in postoperative morbidity [8][9][10][11][12][13]. Combined anterior/posterior approaches are major surgical undertakings for the patient and do not seem to provide any real advantages over the anterior procedure alone [9,[14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Short segment pedicle screw instrumentation and augmentation vertebroplasty in lumbar burst fractures: an experience

Afzal¹,

Saleem²,

Dhar³

2008

Eur Spine J

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To assess the efficacy and feasibility of vertebroplasty and posterior short-segment pedicle screw fixation for the treatment of traumatic lumbar burst fractures. Short-segment pedicle screw instrumentation is a well described technique to reduce and stabilize thoracic and lumbar spine fractures. It is relatively a easy procedure but can only indirectly reduce a fractured vertebral body, and the means of augmenting the anterior column are limited. Hardware failure and a loss of reduction are recognized complications caused by insufficient anterior column support. Patients with traumatic lumbar burst fractures without neurologic deficits were included. After a short segment posterior reduction and fixation, bilateral transpedicular reduction of the endplate was performed using a balloon, and polymethyl methacrylate cement was injected. Pre-operative and post-operative central and anterior heights were assessed with radiographs and MRI. Sixteen patients underwent this procedure, and a substantial reduction of the endplates could be achieved with the technique. All patients recovered uneventfully, and the neurologic examination revealed no deficits. The postoperative radiographs and magnetic resonance images demonstrated a good fracture reduction and filling of the bone defect without unwarranted bone displacement. The central and anterior height of the vertebral body could be restored to 72 and 82% of the estimated intact height, respectively. Complications were cement leakage in three cases without clinical implications and one superficial wound infection. Posterior short-segment pedicle fixation in conjunction with balloon vertebroplasty seems to be a feasible option in the management of lumbar burst fractures, thereby addressing all the three columns through a single approach. Although cement leakage occurred but had no clinical consequences or neurological deficit.

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“…As the loading mechanism is attached to the construct at its proximal end, the most proximal levels are subjected to maximum load, and the torsional load decreases as it is transmitted to the lower levels of the construct. However, in vivo, the stability of the construct at the distal end is usually not an issue of concern, as it is now customary to use pedicle screws at the lower levels, which impart much greater stability [3,6,11]. Secondly we could not devise, or find in literature, a satisfactory method to apply torsional load evenly at all levels in a long fusion construct.…”

Section: Discussionmentioning

confidence: 99%

A study of the mechanical stability of scoliosis constructs using variable numbers of sublaminar wires

et al. 2002

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Mechanical Stability of the AO Internal Spinal Fixation System Compared With That of the Hartshill Rectangle and Sublaminar Wiring in the Management of Unstable Burst Fractures of the Thoracic and Lumbar Spine

Abstract: The AO internal spinal skeletal fixation systems is associated with significantly superior maintenance of spinal anatomy 2 years after surgery.

Cited by 23 publications

References 4 publications

Anterior versus posterior approach for treatment of thoracolumbar burst fractures: a meta-analysis

Anterior versus posterior approach for treatment of thoracolumbar burst fractures: a meta-analysis

Short segment pedicle screw instrumentation and augmentation vertebroplasty in lumbar burst fractures: an experience

A study of the mechanical stability of scoliosis constructs using variable numbers of sublaminar wires

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