Short device fixation and early mobilization for burst fractures of the thoracolumbar junction

Abstract

The authors present a retrospective study based on a homogeneous series of 34 patients with burst fractures of the thoracolumbar junction, fixed using Cotrel-Dubousset instrumentation. These patients underwent instrumentation using a short construct of hooks and screws gripping the two vertebrae above the lesion (2HS) and screws and hooks gripping the first vertebra below the lesion (1SH). This construct was therefore called "2HS-1SH". In order to evaluate just the material resistance after getting up, only the patients who were upright on the 4th day without a body cast and with no secondary anterior osteosynthesis were included in this study. Four patients showed some neurological symptoms on admission but recovery was so quick that they could be included in this study. Mean follow-up was 4 years 1 month (range 3 years 1 month and 6 years 2 months). Vertebral and regional kyphosis angles were measured preoperative, postoperatively and at the final follow-up. Functional recovery and complications were analyzed. Mean vertebral kyphosis was 21.2 degrees preoperatively, 3.8 degrees postoperatively and 5.3 degrees at the final follow-up. Regional kyphosis angles were respectively 19.2, 0.2, and 2.7 degrees. We had two cases of deep suppuration, one early and the other late. None of the patients required analgesics for more than 6 months after the operation. Patients returned to work after 5 months on average. The authors concluded that fixation by screw-and-hook constructs is an effective way to stabilize thoracolumbar junction burst fractures.

Avaliação do tratamento cirúrgico das fraturas da coluna toracolombar com material de terceira geração tipo fixador interno

“…Comparing our data with the literature (6,7) , there was no neurological worsening in any case. There were improvements on the Frankel scale among the patients assessed as B, C and D, but we did not observe any improvement in the patients with Frankel A.…”

“…They reported that postoperative orthoses did not need to be used for any of their patients. Our range of Cobb angles was 4° during the immediate postoperative period, for evolution over six months with an internal fixator, and remaining one degree lower than the mean shown in the American and European literature (6,7) . Siebenga et al (8) presented some data showing that instrumentation with pedicle screws preserved the fractured vertebra but was unable to preserve the disc space.…”

Treatment of Thoracolumbar Burst Fractures with Variable Screw Placement or Isola Instrumentation and Arthrodesis

“…These findings have been supported clinically by other larger series. 59,60 To preserve motion segments, we found in this series, and in patients with other pathologies, that pedicle screw anchorage with preservation of pedicle facet joints and capsules and subsequent construct shortening at 6-8 months postoperatively seemed to provide the needed load sharing to prevent implant fatigue, while offering eventual retention of motion. Others have reported preserved motion following this sequence.…”

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

“…de Peretti et al [24] suggested that fixation by screw and hook constructs, gripping the two vertebrae above the lesion and screws and hooks gripping the first vertebra below the lesion were effective ways to stabilize thoracolumbar junction BFs. Carl et al [22] also recommended using transpedicular segmental fixation two-levels above the fracture site.…”