Posterior short segment pedicle screw fixation and TLIF for the treatment of unstable thoracolumbar/lumbar fracture

Abstract

BackgroundCurrently, Posterior Short Segment Pedicle Screw Fixation is a popular procedure for treating unstable thoracolumbar/lumbar burst fracture. But progressive kyphosis and a high rate of hardware failure because of lack of the anterior column support remains a concern. The efficacy of different methods remains debatable and each technique has its advantages and disadvantages.MethodsA consecutive series of 20 patients with isolated thoracolumbar/lumbar burst fractures were treated by posterior short segment pedicle screw fixation and transforaminal thoracolumbar/lumbar interbody fusion (TLIF) between January 2005 and December 2007. All patients were followed up for a minimum of 2 years. Demographic data, neurologic status, anterior vertebral body heights, segmental Cobb angle and treatment-related complications were evaluated.ResultsThe mean operative time was 167 minutes (range, 150–220). Blood loss was 450 ~ 1200 ml, an average of 820 ml. All patients recovered with solid fusion of the intervertebral bone graft, without main complications like misplacement of the pedicle screw, nerve or vessel lesion or hard ware failure. The post-operative radiographs demonstrated a good fracture reduction and it was well maintained until the bone graft fusion. Neurological recovery of one to three Frankel grade was seen in 14 patients with partial neurological deficit, three grades of improvement was seen in one patient, two grades of improvement was observed in 6 patients and one grade of improvement was found in 6 patients. All the 6 patients with no paraplegia on admission remained neurological intact, and in one patient with Frankel D on admission no improvement was observed.ConclusionPosterior short-segment pedicle fixation in conjunction with TLIF seems to be a feasible option in the management of selected thoracolumbar/lumbar burst fractures, thereby addressing all the three columns through a single approach with less trauma and good results.

Outcome of Long Segment Transpedicular Screw Fixation in Unstable Thoracolumbar Spine Injury with Incomplete Neurological Deficit

“…Their mean age was 33.12 ± 8.57 years (range 20 -60 years). Wang et al .studied on 20 patients with traumatic fracture of the thoracolumbar spine underwent spinal surgery and found that their mean age was 38.4 years (range 17 -66 years) which was similar to this study [17]. It was reported that thoracolumbar spine fractures were one of the most common fractures in the young healthy population [3] [17].…”

Magnetic Resonance Neurography in Analysis of Operative Safety of Transforaminal Lumbar Interbody Fusion in Chinese Subjects

“…And it is associated with shorter operating time, less blood loss, shorter hospital stay, and lower incidence of complications [6][7][8][9][10][11] . In recent years, TLIF also received a good clinical application in treatment of degenerative lumbar scoliosis, recurrent lumbar disc herniation, thoracolumbar fracture or degenerative diseases, and so on [12][13][14][15][16] . And with the continuous development of minimally invasive operating techniques, minimally invasive TLIF gained wide clinical popularity, even became a same-day discharge or outpatient operation 17,18 .…”

Posterior short segment spinal fixation in unstable fractures of the thoraco lumbar spine: radiological and neurological outcome assessment

“…Despite the various controversies associated with management of unstable fractures of the thoracolumbar region, whether to use posterior or anterior approach; posterior approach is one of the common approaches to the fracture management. 9 There are apprehensions regarding the high rate of hardware failure due to lack of anterior support and progressive kyphosis. [10][11][12][13][14][15] Inspite of the mentioned complications, the clinical prognosis is satisfactory.…”