Pedicle screw instrumentation of thoracolumbar burst fractures: Biomechanical evaluation of screw configuration with pedicle screws at the level of the fracture

Bolesta, Michael J.; Caron, Troy; Chinthakunta, Suresh; Vazifeh, Pedram Niknam; Khalil, Saif

doi:10.1016/j.ijsp.2012.09.002

Cited by 36 publications

(32 citation statements)

References 28 publications

(44 reference statements)

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“…Since a study of pedicle screw fixation at fractured vertebrae was first reported in 1994, a series of biomechanical studies [8–11] also showed that pedicle screw fixation combined with screws at the fractured vertebrae could significantly improve the spinal stability and decrease the stress of pedicle screws in the upper and lower normal vertebrae. The similar advantages have also been reported for treatment of TL fractures, however, the evidence is mainly limited to low-quality observational studies.…”

Section: Introductionmentioning

confidence: 99%

Pedicle screw fixation combined with intermediate screw at the fracture level for treatment of thoracolumbar fractures

Li¹,

Zhang

Liú

et al. 2016

Medicine

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Background:Use of a pedicle screw at the level of fracture, also known as an intermediate screw, has been shown to improve clinical results in managing thoracolumbar(TL) fractures, but there is a paucity of powerful evidence to support the claim. The aim of this study was to compare outcomes between pedicle screw fixation combined with intermediate screw at the fracture level and conventional pedicle screw fixation (one level above and one level below the fracture level) for thoracolumbar (TL) fractures.Methods:A meta-analysis of cohort studies was conducted between pedicle screw fixation combined with intermediate screw at the fracture level (combined screw group) and conventional pedicle screw fixation (conventional group) for the treatment of TL fractures from their inception to December 2015. An extensive search of studies was performed in PubMed, Medline, Embase, and the Cochrane library. The following outcome measures were extracted: visual analogue scale (VAS), operation time and intraoperative blood loss, Cobb angle and anterior vertebral height (AVH), and complications. Data analysis was conducted with RevMan 5.3.5.Results:From 10 relevant studies identified, 283 patients undergoing pedicle screw fixation combined with intermediate screw at the fracture level were compared with 285 conventional pedicle screw procedures. The pooled analysis showed that there was statistically significant difference in terms of postoperative Cobb angle (95% confidence interval (CI), −3.00, −0.75; P = 0.001) and AVH (95% CI, 0.04, 12.23; P = 0.05), correction loss (Cobb angle: P < 0.0001; AVH: P < 0.0001) and implant failure rate (95% CI, 0.06, 0.62; P = 0.006), and blood loss (W 95% CI, 2.22, 23.60; P = 0.02) between 2 groups. But in terms of other complications, there were no differences between 2 groups (95% CI, 0.23, 2.04; P = 0.50). No difference was found in operation time (95% CI, −5.36, 14.67; P = 0.36) and VAS scores (95% CI, −0.44, 0.01; P = 0.06).Conclusions:The combined screw fixation technique was associated with better reduction of the fractured vertebrae, less correction loss in the follow-up, and lower implant failure rate. Given the lack of robust clinical evidence, these findings warrant verification in large prospective registries and randomized trials with long-term follow-up.

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Section: Introductionmentioning

confidence: 99%

Pedicle screw fixation combined with intermediate screw at the fracture level for treatment of thoracolumbar fractures

Li¹,

Zhang

Liú

et al. 2016

Medicine

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“…Research has con rmed the bene cial therapeutic effect of short-segment posterior xation with pedicle screws in the injured vertebra as treatment for thoracolumbar fractures [6][7][8][9][10][11][12][13]. Biomechanically, the screws at the fracture level function as a push point with an anterior vector, creating a "lordorizing" force that restores the anterior vertebral height and corrects the kyphosis [17].…”

Section: Discussionmentioning

confidence: 99%

“…Inserting monoaxial or polyaxial pedicle screws at the level of vertebral fractures, as well as segmental xation of burst fractures, improves biomechanical stability. [6,7] In addition, several studies have shown that enhanced fracture-grade screws can improve the biomechanical stability of the construct [8][9][10][11], and some authors [7,12,13] have also suggested that pedicle screw xation combined with an intermediate screw in the fractured vertebra improves biomechanical stability with better reduction, less loss of correction, fewer instrument failures, and comparable or better clinical outcomes. However, it has not yet been ascertained whether inserting a monoaxial or polyaxial pedicle screw at a vertebral fracture yields better clinical results.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Therapeutic Effects of Short-Segment Posterior Fixation With Monoaxial Pedicle Screws or Polyaxial Pedicle Screws via Injured Vertebra on Thoracolumbar Fracture

Yao¹,

Guo²,

Lai³

et al. 2020

Preprint

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Purpose: To evaluate the therapeutic effects of short-segment posterior fixation with monoaxial pedicle screw or polyaxial pedicle screw via injured vertebra on thoracolumbar fracture.Methods: All patients who underwent short-segment posterior fixation with monoaxial pedicle screws or polyaxial pedicle screws in the injured vertebra of a thoracolumbar fracture (T12-L2). The clinical and radiological data such as the correction of deformity, sagittal profle and record of the perioperative morbidity of the patients were analyzed.Results: There were 63 patients (21 males and 42 females) with an average age of 44.7 years and were categorised into two groups: monoaxial pedicle screws group (group A) and polyaxial pedicle screws group (group B). There were no significant differences in age, gender, fracture site, TLISS Score, ASIA Score, AO Classification, hospital stay, Injury-to-operation intereval, and associated injury between the two groups (P>0.05). Howere, compared with group B, the injury vertebral endplate centre ratio significantly increased postoperatively and at the final follow-up (P<0.05) in group A.Conclusion: Short-segment posterior fixation with monoaxial or polyaxial pedicle screws via the fracture level for thoracolumbar fracture can achieve kyphosis correction, reduce sagittal alignment correction failure, and maintain anterior vertebral height. The insertion of monoaxial pedicle screws at the fracture level after thoracolumbar vertebral fracture has a flick up ffect on the central vertebral body of the injured vertebrae, which is beneficial to the recovery of the vertebral endplate.

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“…This may be achieved by use of long-segment constructs, but this requires fusing of multiple motion segments and larger incisions, with an increased risk of complications. An alternative method is to include screws at the level of the fracture [21].…”

Section: Discussionmentioning

confidence: 99%

“…Subsequently, Guven et al [23] clinically showed increased stability and long-term maintenance with short same-segment fixation. Bolesta et al [21] documented that a short segment construct with pedicle screws at the fracture site showed equivalent biomechanical stability compared with a conventional long-segment construct in any of the loading conditions.…”

Section: Discussionmentioning

confidence: 99%

Posterior short-segment fixation with implanting pedicle screw in the fractured level as a feasible method for treatment of thoracolumbar fracture

et al. 2019

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Background: The thoracolumbar spine is vulnerable to fracture in falls or motor vehicle accidents. Thoracolumbar spine fracture can be associated with neurological deficits, long-term pain and disability. The optimal management for these injuries remains a considerable subject for research. Objectives: To evaluate short-term surgical and functional outcome of posterior short-segment fixation with implanting pedicle screw in the fractured level (short same-segment fixation) for treatment of recent single-level traumatic thoracolumbar fracture. Methods: This prospective study included 36 patients with radiologically confirmed single-level thoracolumbar fracture. Patients were evaluated preoperatively, at time of discharge, and at follow-up visit after 1 year clinically using the Low-Back Outcome Scale of Greenough and Fraser Score, the American Spinal Injury Association (ASIA) for neurological evaluation, and the AO fracture classification for injury severity evaluation. Radiological evaluation included calculation of the sagittal index (SI) of injured vertebral body, anterior body compression (ABC) according to Mumford's equation, and regional kyphosis using Cobb angle. All patients underwent posterior trans-pedicular screw insertions into a vertebral body one level above and below the fracture site, and an additional pedicle screw was inserted at the level of the fracture. Postoperative clinical and radiological evaluations were compared to the preoperative. Results: All surgeries were conducted uneventfully within 129.7 ± 33.9 min with mean operative blood loss of 351.4 ± 140.5 ml. Wound infection was encountered in two patients and responded to conservative treatment. Mean duration of postoperative hospital stay and follow-up were 17.7 ± 4.4 days and 26.5 ± 5.1 months, respectively. After 1 year, mean low-back pain scores were significantly higher than preoperative and early postoperative scores and frequency of patients with excellent-good postoperative status was significantly higher at early postoperative evaluation and after 1 year compared to the preoperative status. Eight patients had neurological deficit, after 1-year follow-up; six patients were improved by one grade, while the other two cases remained stationary. Mean SI and ABC calculated at discharge and after 1 year were significantly higher compared to the preoperative measures. Mean Cobb angle was significantly decreased compared to the preoperative angle. Mean improvement of kyphosis angle at discharge and after 1 year was 60.9% and 48.1%, respectively; however, there was loss of kyphosis correction by about 4.2°after 1-year follow-up compared to the early postoperative finding.

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Pedicle screw instrumentation of thoracolumbar burst fractures: Biomechanical evaluation of screw configuration with pedicle screws at the level of the fracture

Cited by 36 publications

References 28 publications

Pedicle screw fixation combined with intermediate screw at the fracture level for treatment of thoracolumbar fractures

Pedicle screw fixation combined with intermediate screw at the fracture level for treatment of thoracolumbar fractures

Comparison of the Therapeutic Effects of Short-Segment Posterior Fixation With Monoaxial Pedicle Screws or Polyaxial Pedicle Screws via Injured Vertebra on Thoracolumbar Fracture

Posterior short-segment fixation with implanting pedicle screw in the fractured level as a feasible method for treatment of thoracolumbar fracture

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