Short segment fixation of thoracolumbar burst fractures without fusion

Sanderson, P. L.; Fraser, Robert D.; Hall, David J.; Cain, Christopher M.; Osti, Orso L.; Potter, G. R.

doi:10.1007/s005860050212

Cited by 144 publications

(142 citation statements)

References 18 publications

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“…However, in this study, only two cases of Schanz fractures were observed not affecting the results. Just as the results reported by Sanderson et al [46] and others, no proof of a statistically significant correlation between late clinical results (LBOS) and the evolution in time of radiological parameters was demonstrated.…”

Section: Discussionmentioning

confidence: 56%

“…Controversy still arises regarding the best treatment and the surgical indications of these fractures, specially when we deal with patients without neurological damage [3,27,43,46,47,49,52,53]. However, the indirect reduction and transpedicular posterior instrumentation is often regarded as the best procedure, since it offers great advantages and less health costs, better quality of life in the rehabilitation T11-T12 1°decrease T12-L1 5°decrease T12-L1 2°decrease L1-L2 2°NM T12-L1 5°decrease L1-L2 7°decrease T12-L1 2°decrease L2-L3 2°NM L1-L2 1°NM T12-L1 7°N L1-L2 6°decrease L1-L2 11°N L2-L3 11°decrease L1-L2 5°decrease L2-L3 2°NM T11-T12 3°N T12-L1 7°N L1-L2 1°NM T12-L1 4°decrease L1-L2 6°decrease T12-L1 4°decrease L1-L2 1°NM L2-L3 6°Decrease T11-T12 4°N T12-L1 6°N L3-L4 13°N T12-L1 0°NM Several studies of radiological follow-up showed some degree of loss in reduction and sagittal alignment achieved with posterior instrumentations [3,15,16,19,27,36,37,38,43,47,52,53].…”

Section: Discussionmentioning

confidence: 99%

“…There is still controversy and few studies available on clinical and imaging evolution, and on residual mobility of non-fused vertebral segments, which are temporarily included in instrumentations of TLF [5,30,34,38,46]. Recent reports observed the presence of healthy IVDs in non-fused segments once the instrumentation was removed [18,41,42,45].…”

Section: Introductionmentioning

confidence: 99%

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Residual mobility of instrumented and non-fused segments in thoracolumbar spine fractures

et al. 2006

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The surgical management of thoracolumbar fractures presents potential benefits. However, the surgery solve the instability by fusion of mobile segments. We incorporate in our treatment algorithms, the use of restricted arthrodesis at injured levels, regardless of longer instrumentations, as well as the use of non-fused transitory stabilizations, based on the conviction that in non-fused segments without traumatic disc injury, mobility persists once the instrumentation is removed. The goals of this study were to compare the mobility of non-fused segments after hardware removal to a normal range of motion and to find prognostic pre-op imaging patterns. We reviewed 21 consecutive patients who underwent surgery with preservation of mobile segments (nonfused segments included in the construction) in order to recover mobility after removal of instrumentation, performed between 1995 and 2001. All patients were treated by indirect reduction with posterior transpedicular instrumentation. Clinical and radiological outcome was analyzed after an average follow-up of 46.6 months. Satisfactory subjective outcome results were obtained in 94.7%. The dynamic radiological follow-up study showed 75% (21 segments) with normal or decreased range of motion (ROM) and 25% (7 segments) without mobility. The non-fused segments with hardware removal before 10 months of evolution presented a normal or decreased mobility in 83.2% while the segments with hardware removal after 10 months showed 68.8% of mobility. The intervertebral disc (IVD)'s with normal initial MRI morphology preserved their mobility in 81.9%. Complications occurred in four patients: two superficial wound infections and two patients presented a late fracture of one USS Schanz. The results of this study prove that in thoracolumbar fractures, non-fused spinal segments included in pedicular instrumentation maintained mobility in a high percentage once the hardware is removed. 75% of the segments presented a normal or decreased ROM.

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Residual mobility of instrumented and non-fused segments in thoracolumbar spine fractures

et al. 2006

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“…Operative treatment usually involves instrumented intervertebral fusion, with or without spinal decompression. The three major surgical approaches for stabilization are posterior, anterior, or combined AP [26,35,37,40,49,53].…”

mentioning

confidence: 99%

Nonoperative versus Operative Treatment for Thoracolumbar Burst Fractures Without Neurologic Deficit: A Meta-analysis

Gnanenthiran¹,

Adie²,

Harris³

2012

Clinical Orthopaedics &Amp; Related Research

145

121

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“…After its introduction, the exclusive dorsal pedicle screw instrumentation with or without transpedicular bone grafting became widely popular and a standard procedure for stabilizing the injured thoracolumbar spine [13]. But the long-term results of this approach today are controversial due to inconsistent reports and to a paucity of data on late outcome [2] and several authors reported increasing instability or a loss in kyphotic correction of the repaired spinal segment [12,20].…”

Section: Introductionmentioning

confidence: 99%

Is posterior fixation alone effective to prevent the late kyphosis after T-L fracture?

et al. 2013

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Introduction The posterior transpedicular fixation technique is a standard procedure for stabilizing the injured thoracolumbar spine but the long-term results of this approach are controversial. Clear guidelines are missing and the literature shows complete disagreement regarding indications, approaches, surgical techniques, and type of fixation. Material and method The objective of this study is to investigate if the surgical treatment by posterior approach alone is always enough to prevent the late kyphotic deformity through the retrospective analysis of 219 patients affected with a thoracolumbar injury. Follow-up examinations included radiographic measurements of the sagittal index (SI) and the sagittal plane kyphosis (SPK). Result Results show that, at the follow-up, the SI remains almost stable after the surgical correction, while the SPK (which describes the eventual injury of the affected intervertebral disc) decreases indicating a progressive regional kyphotic deformity. Thus, in some cases posterior fixation alone is not sufficient for long-term spinal stabilization and often can be not effective to prevent the late kyphotic deformity.

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Short segment fixation of thoracolumbar burst fractures without fusion

Cited by 144 publications

References 18 publications

Residual mobility of instrumented and non-fused segments in thoracolumbar spine fractures

Residual mobility of instrumented and non-fused segments in thoracolumbar spine fractures

Nonoperative versus Operative Treatment for Thoracolumbar Burst Fractures Without Neurologic Deficit: A Meta-analysis

Is posterior fixation alone effective to prevent the late kyphosis after T-L fracture?

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