Short Segment Screw Fixation without Fusion for Unstable Thoracolumbar and Lumbar Burst Fracture : A Prospective Study on Selective Consecutive Patients

Abstract

ObjectiveThe purpose of this prospective study was to evaluate the efficacy and safety of screw fixation without bone fusion for unstable thoracolumbar and lumbar burst fracture.MethodsNine patients younger than 40 years underwent screw fixation without bone fusion, following postural reduction using a soft roll at the involved vertebra, in cases of burst fracture. Their motor power was intact in spite of severe canal compromise. The surgical procedure included postural reduction for 3 days and screw fixations at one level above, one level below and at the fractured level itself. The patients underwent removal of implants 12 months after the initial operation, due to possibility of implant failure. Imaging and clinical findings, including canal encroachment, vertebral height, clinical outcome, and complications were analyzed.ResultsPrior to surgery, the mean pain score (visual analogue scale) was 8.2, which decreased to 2.2 at 12 months after screw fixation. None of the patients complained of worsening of pain during 6 months after implant removal. All patients were graded as having excellent or good outcomes at 6 months after implant removal. The proportion of canal compromise at the fractured level improved from 55% to 35% at 12 months after surgery. The mean preoperative vertebral height loss was 45.3%, which improved to 20.6% at 6 months after implant removal. There were no neurological deficits related to neural injury. The improved vertebral height and canal compromise were maintained at 6 months after implant removal.ConclusionShort segment pedicle screw fixation, including fractured level itself, without bone fusion following postural reduction can be an effective and safe operative technique in the management of selected young patients suffering from unstable burst fracture.

Short Segment Fixation for Thoracolumbar Burst Fracture Accompanying Osteopenia : A Comparative Study

“…Therefore, screw loosening or vertebral collapse may occur more frequently after screw fixation without bone fusion in osteoporotic or osteopenic spines. However, insertion of pedicle screws at the fracture level results in a segmental construct that improves biomechanical stability by protecting the fractured body and by supporting the anterior column indirectly3). In addition, the insertion of bone cement to augment pedicle screws at the fracture level probably results in a segmental construct with improved biomechanical stability by providing protection to the fractured vertebral body and indirectly supporting the anterior column3).…”

“…However, insertion of pedicle screws at the fracture level results in a segmental construct that improves biomechanical stability by protecting the fractured body and by supporting the anterior column indirectly3). In addition, the insertion of bone cement to augment pedicle screws at the fracture level probably results in a segmental construct with improved biomechanical stability by providing protection to the fractured vertebral body and indirectly supporting the anterior column3). Furthermore, Bone cement augmentation at fractured level itself and adjacent vertebrae can significantly reduce pedicle screw bending and increase initial stiffness in the flexion-extension plane.…”

A Comparative Analysis of the Efficacy of Short-Segment Pedicle Screw Fixation with that of Long-Segment Pedicle Screw Fixation for Unstable Thoracolumbar Spinal Burst Fractures

“…Kim et al suggested that short-segment pedicle screw fixation without bone fusion following postural reduction can be an effective and safe operative technique in the management of selected young patients with unstable burst fracture [21]. A 10-year follow-up study by Toyone et al suggested that the benefit of short-segment fixation without fusion for burst fractures involving neurological deficit is that it can preserve thoracolumbar motion without resulting in post-traumatic disc degeneration [22].…”

Anterior decompression with single segmental spinal interbody fusion for Denis type B thoracolumbar burst fracture: a midterm follow-up study

“…The kyphosis angle (Cobb angle [9]) was measured from the superior end plate of the vertebral body just above the fracture to the inferior end plate of the fractured vertebral body. The percentage of vertebral body height loss was reported as fractions of anterior height between fractured vertebra and normal height of the adjacent vertebra below the fractured vertebra [10]. Other parameters of interest were the visual analogue scale (VAS) pain score [11], Frankel grade and adjacent segment degeneration (University of California at Los Angeles Grading Scale [12]), which were also evaluated at final follow-up.…”