Pedicle Screw Configuration for Thoracolumbar Burst Fracture Treatment: Short versus Long Posterior Fixation Constructs with and without Anterior Column Augmentation

Peters, Todd; Chinthakunta, Suresh; Hussain, Mir; Khalil, Saif

doi:10.4184/asj.2014.8.1.35

Cited by 10 publications

(5 citation statements)

References 30 publications

(56 reference statements)

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“…Peters et al [ 40 ], in their biomechanical study comparing short segment versus long segment fixation, found that long posterior fixation was the stiffest with and without anterior column augmentation in all loading conditions. The use of screws two above and two below has shown to not only enhance the stability but also allow effective reduction of kyphotic deformity [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Short Segment versus Long Segment Pedicle Screws Fixation in Management of Thoracolumbar Burst Fractures: Meta-Analysis

Aly

2017

Asian Spine J

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Posterior pedicle screw fixation has become a popular method for treating thoracolumbar burst fractures. However, it remains unclear whether additional fixation of more segments could improve clinical and radiological outcomes. This meta-analysis was performed to evaluate the effectiveness of fixation levels with pedicle screw fixation for thoracolumbar burst fractures. MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Springer, and Google Scholar were searched for relevant randomized and quasirandomized controlled trials that compared the clinical and radiological efficacy of short versus long segment for thoracolumbar burst fractures managed by posterior pedicle screw fixation. Risk of bias in included studies was assessed using the Cochrane Risk of Bias tool. Based on predefined inclusion criteria, Nine eligible trials with a total of 365 patients were included in this meta-analysis. Results were expressed as risk difference for dichotomous outcomes and standard mean difference for continuous outcomes with 95% confidence interval. Baseline characteristics were similar between the short and long segment fixation groups. No significant difference was identified between the two groups regarding radiological outcome, functional outcome, neurologic improvement, and implant failure rate. The results of this meta-analysis suggested that extension of fixation was not necessary when thoracolumbar burst fracture was treated by posterior pedicle screw fixation. More randomized controlled trials with high quality are still needed in the future.

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Section: Discussionmentioning

confidence: 99%

Short Segment versus Long Segment Pedicle Screws Fixation in Management of Thoracolumbar Burst Fractures: Meta-Analysis

Aly

2017

Asian Spine J

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“…Kim et al 21,22 suggested that short segment pedicle screw fixation without bone fusion following postural reduction can be an effective and safe operative technique in the management of selected young patients with unstable burst fracture. Peters et al, 23 in their biomechanics study comparing short segment versus long segment fixation, found that long posterior fixation was the stiffest .The use of screws two above and two below has shown to not only enhance the stability but also allow effective reduction of kyphotic deformity. However, short posterior fixation alone has also shown to provide good clinical and radiological outcomes for certain fractures, particularly in the more lordotic middle and lower lumbar spine.…”

Section: Discussionmentioning

confidence: 99%

A comparative study between functional and radiological outcome of short and long segment transpedicular fixation for unstable thoracolumbar vertebral fractures

Jha,

Zacarias,

Gogoi

et al. 2023

JSAS

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: Management of unstable thoracolumbar fracture remains controversial between short segment and long segment pedicle screw fixation. Surgical stabilization is indicated to adequately decompress the spinal canal, maximizing neurological recovery and creating spinal stability. : A comparative study in unstable thoracolumbar fractures fixed with short and long segment transpedicular screw fixation was done and followed up for 6 months. For functional assessment Modified MACNAB criteria, Oswestry disability index and Visual analogue scale scoring system used. Neurological status, radiological kyphotic angle correction were analyzed.: A total of 30 cases were included in the study of which 23 were male and 7 females. The mean age was 36.77 years. Younger individuals were more susceptible to road traffic accident. L1 was the most common vertebral level involved. Cases with a higher ASIA grade had a better improvement post operatively compared to one with a lesser ASIA grade preoperatively (P Value 0.003). Cases with lesser number of transfers had a better outcome at final followup. (P value 0.018). At all months of followup both short and long segment fixation groups have statistically significant kyphotic deformity correction, but long segment have better correction with 19.86 degrees pre-operative to 8.8 degrees at the end of 6 month of followup. : Short segment transpedicular fixation gives better functional outcome than long segment transpedicular fixation, but long segment transpedicular stabilization gives better radiological results in the form of kyphotic deformity correction.

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“…However, it has several limitations. First, long-segment fixation is required to provide adequate stability [14]. There is also a risk of lower fusion rates owing to the inability to insert a larger cage, unlike the anterior and lateral approaches [6].…”

Section: Discussionmentioning

confidence: 99%

Three-column reconstruction through the posterior approach alone for the treatment of a severe lumbar burst fracture: a case report

2023

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Generally, patients with severe burst fractures, instability, or neurological deficits require surgical treatment. In most cases, circumferential reconstruction is performed. Surgical methods for three-column reconstruction include anterior, lateral, and posterior approaches. In cases involving an anterior or lateral approach, collaboration with general or thoracic surgeons may be necessary because the adjacent anatomical structures are unfamiliar to spinal surgeons. Risks include vascular or lumbar plexus injuries and cage displacement, and in most cases, additional posterior fusion surgery is required. However, the posterior approach is the most common and anatomically familiar approach for surgeons performing spinal surgery. We present a case in which three-column reconstruction was performed using only the posterior approach to treat a patient with a severe lumbar burst fracture.

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Pedicle Screw Configuration for Thoracolumbar Burst Fracture Treatment: Short versus Long Posterior Fixation Constructs with and without Anterior Column Augmentation

Cited by 10 publications

References 30 publications

Short Segment versus Long Segment Pedicle Screws Fixation in Management of Thoracolumbar Burst Fractures: Meta-Analysis

Short Segment versus Long Segment Pedicle Screws Fixation in Management of Thoracolumbar Burst Fractures: Meta-Analysis

A comparative study between functional and radiological outcome of short and long segment transpedicular fixation for unstable thoracolumbar vertebral fractures

Three-column reconstruction through the posterior approach alone for the treatment of a severe lumbar burst fracture: a case report

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