Risk Factors for Postoperative Loss of Correction in Thoracolumbar Injuries Caused by High-Energy Trauma Treated via Percutaneous Posterior Stabilization without Bone Fusion

Abstract

Background and Objectives: Percutaneous pedicle screws were first introduced in 2001, soon becoming the cornerstone of minimally invasive spinal stabilization. Use of the procedure allowed adequate reduction and stabilization of spinal injuries, even in severely injured patients. This decreased bleeding and shortened surgical time, thereby optimizing outcomes; however, postoperative correction loss and kyphosis still occurred in some cases. Thus, we investigated cases of percutaneous posterior fixation for thoracolumbar injury and examined the factors affecting the loss of correction. Materials and Methods: Sixty-seven patients who had undergone percutaneous posterior fixation for thoracolumbar injury (AO classifications A3, A4, B, and C) between 2009 and 2016 were included. Patients with a local kyphosis angle difference ≥10° on computed tomography at the postoperative follow-up (over 12 months after surgery) or those requiring additional surgery for interbody fusion were included in the correction loss group (n = 23); the no-loss group (n = 44) served as the control. The degree of injury (injury level, AO classification, load-sharing score, local kyphosis angle, cuneiform deformity angle, and cranial and caudal disc injury) and surgical content (number of fixed intervertebral vertebrae, type of screw used, presence/absence of screw insertion into the injured vertebrae, and presence/absence of vertebral formation) were evaluated as factors of correctional loss and compared between the two groups. Results: Comparison between each group revealed that differences in the wedge-shaped deformation angle, load-sharing score, degree of cranial disc damage, AO classification at the time of injury, and use of polyaxial screws were statistically significant. Logistic regression analysis showed that the differences in wedge-shaped deformation angle, AO classification, and cranial disc injury were statistically significant; no other factors with statistically significant differences were found. Conclusion: Correction loss was seen in cases with damage to the cranial intervertebral disc as well as the vertebral body.

Comparative finite element analysis of posterior short segment fixation constructs with or without intermediate screws in the fractured vertebrae for the treatment of type a thoracolumbar fracture

“…Traumatic thoracolumbar/lumbar fractures disrupt the structural integrity of anterior and middle columns, which directly decreases their ability to withstand longitudinal compressive loads, whereas the short-segment posterior internal xation system lacks effective support for the anterior column, resulting in loss of reduction and undesirable rates of implant failure. Alanay (Hirota et al 2022). On the other hand, patients are allowed full weight-bearing ambulation and rehabilitation immediately after the surgery, though, increases the risk of loss of correction in comparison to conventional open surgery with posterolateral fusion.…”

“…Percutaneous pedicle screw-rod xation has been developed to restore stability, alignment while promoting early mobilization of the patients with thoracolumbar/lumbar fractures (Neeley et al 2022;Pannu et al 2019). As a consequence, more correction loss could be observed in thoracolumbar/lumbar fractures treated by percutaneous four-screw xation technique as compared with conventional open short segment xation with posterolateral fusion (Hirota et al 2022; Lorente et al 2019). Therefore, six-screw short-segment posterior xation, which involves additional augmentation at the fractured vertebrae has been proposed to reduce the rates of kyphosis recurrence and implant failure (Kapoen et al 2020).…”

Short-Segment Schanz Pedicle Screw Oblique Downward Fixation for Thoracolumbar Burst Fractures: A New Method for the Reduction of Intraspinal Bone Fragments

“…This slight movement may be one of the reasons for the re-collapse of the injured vertebra after Schanz screw fixation [8,19,24]. TLSO braces can keep the thoracolumbar and lumbar vertebrae upright, thereby reducing the micro movement of the injured vertebrae bone defect area and avoiding the re-injury of PLC and intervertebral disc caused by flexion and extension activities [24][25][26]. Early functional exercise (within 3 months) after short-segment pedicle screw fixation for severe thoracolumbar fractures requires TLSO assistance [8,12,19].The time of wearing TLSO was adjusted according to the size of bone defect area and the growth of new bone during follow-up.…”