Radiological Outcome of Short Segment Posterior Instrumentation and Fusion for Thoracolumbar Burst Fractures

Abstract

Study DesignRetrospective study.PurposeTo evaluate the radiological outcome of the surgical treatment of thoracolumbar burst fractures by using short segment posterior instrumentation (SSPI) and fusion.Overview of LiteratureThe optimal surgical treatment of thoracolumbar burst fractures remains a matter of debate. SSPI is one of a number of possible choices, yet some studies have revealed high rates of poor radiological outcome for this SSPI.MethodsPatients treated using the short segment instrumentation and fusion technique at the Spinal Injuries Center (Iizuka, Fukuoka, Japan) from January 1, 2006 to July 31, 2012 were selected for this study. Radiographic parameters such as local sagittal angle, regional sagittal angle, disc angle, anterior or posterior height of the vertebral body at admission, postoperation and final observation were collected for radiological outcome evaluation.ResultsThere were 31 patients who met the inclusion criteria with a mean follow-up duration of 22.7 months (range, 12-48 months). The mean age of this group was 47.9 years (range, 15-77 years). The mean local sagittal angles at the time of admission, post-operation and final observation were 13.1°, 7.8° and 14.8°, respectively. There were 71% good cases and 29% poor cases based on our criteria for the radiological outcome evaluation. The correction loss has a strong correlation with the load sharing classification score (Spearman rho=0.64, p<0.001).ConclusionsThe loss of kyphotic correction following the surgical treatment of thoracolumbar burst fracture by short segment instrumentation is common and has a close correlation with the degree of comminution of the vertebral body. Patients with high load sharing scores are more susceptible to correction loss and postoperative kyphotic deformity than those with low scores.

Effect of loss of correction on functional outcomes in thoracolumbar burst fractures treated with short segment posterior instrumentation

“…During surgery, the distraction affects the bone, not the discs. As time goes by, the disc heights decrease in value, which is related with the post-traumatic degeneration [3,21,22]. Furthermore, overcorrection may affect the biomechanics of the posterior ligamentous complex and the whole vertebra.…”

“…Burst fractures are defined as vertebra fractures involving the anterior and middle columns and associated with kyphotic deformity and retropulsion of bone fragment into the spinal canal. They are usually related to high-energy traumas [1][2][3]. The incidence of burst fractures in the thoracolumbar junction, where most of the vertebral fractures occur since it is the transition zone from a mobile thoracic segment to a less mobile lumbar segment, is between 10-20% [1][2][3][4][5].…”

“…They are usually related to high-energy traumas [1][2][3]. The incidence of burst fractures in the thoracolumbar junction, where most of the vertebral fractures occur since it is the transition zone from a mobile thoracic segment to a less mobile lumbar segment, is between 10-20% [1][2][3][4][5]. In the literature, it is mentioned that late neurological deterioration is up to 17% after thoracolumbar vertebra burst fractures' conservative treatment, therefore these fractures are treated surgically [6].…”

Outcome of Short Same-segment Fixation in Thoracolumbar Junction Fractures

“…Instrumentation at the fractured pedicle in turn converts the distractive forces of flexion into compression and thus stabilizes the construct. 3,9,[12][13][14] Also by including the fractured vertebrae, we thereby increase the working length of the construct, which gives more biomechanical stability.…”

Outcome Evaluation of Patients with Burst Thoracolumbar Fractures: A Case Series

“…Thoracolumbar fracture is the most common type of spine fracture. 1,2 Falling and motor vehicle accidents are among the most common causes of thoracolumbar injuries. 3 Burst fracture of the spine is a serious injury that commonly occurs among young people.…”