Surgical outcomes of temporary short-segment instrumentation without augmentation for thoracolumbar burst fractures

Aono, Hiroyuki; Tobimatsu, Hidekazu; Ariga, Kenta; Kuroda, Masayuki; Nagamoto, Yukitaka; Takenaka, Shota; Furuya, Masayuki; Iwasaki, Motoki

doi:10.1016/j.injury.2016.03.003

Cited by 46 publications

(58 citation statements)

References 20 publications

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“…Some scholars have applied the USS pedicle screw system in clinical practice, and a lot of research has been conducted. Aono et al . used the USS screw system to treat 27 patients with thoracolumbar burst fractures.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Thoracolumbar Fractures Through Different Short Segment Pedicle Screw Fixation Techniques: A Finite Element Analysis

Wang

Duan

et al. 2020

Orthopaedic Surgery

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Objective: To compare the von Mises stresses of the pedicle screw system and the displacement of injured vertebrae using 3-D finite element analysis, and to evaluate the curative effect of the pedicle screw system. Methods:Finite element methods were used for biomechanical comparison of four posterior short segment pedicle screw fixation techniques. The different pedicle screw models are traditional trajectory (TT), Universal Spine System (USS), cortical bone trajectory (CBT), and CBT at the cranial level and pedicle screw (PS) at the caudal level (UP-CBT). The stress distribution of the screws and connecting rods under different working conditions and the displacement of the injured vertebrae were compared and analyzed.Results: After the pedicle screw system was fixed, the stress under vertical compression was mainly concentrated at the proximal end of the screw, while the stress was mainly concentrated on the connecting rod during flexion, extension, lateral flexion, and rotation. The TT group had the greatest stress during the flexion, extension, and left and right rotation. The UP-CBT group was most stressed when the left and right sides were flexed; the stress of the USS screw system was less than that of the other three models during flexion, lateral flexion, and rotation. The maximum von Mises stress values of pedicle screws in all exercise states were 556.2, 340.7, 458.1, and 533.4 MPa, respectively. In the USS group, the displacement of the injured vertebra was small in the flexion, and the left and right lateral flexion and the right rotation were higher than in the TT group and the CBT group. The maximum displacements of the injured vertebrae in all motion states were 1.679, 1.604, 1.752, and 1.777 mm, respectively.Conclusion: Universal Spine System pedicle screws are relatively less stressed under different working conditions, the risk of breakage is small, and the model is relatively stable; CBT screws do not exhibit better mechanical properties than conventional pedicle screws and USS pedicle screws.

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Section: Discussionmentioning

confidence: 99%

Treatment of Thoracolumbar Fractures Through Different Short Segment Pedicle Screw Fixation Techniques: A Finite Element Analysis

Wang

Duan

et al. 2020

Orthopaedic Surgery

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“…Aono et al and Wang et al described a loss of postoperative correction of the Cobb angle when shortsegment pedicle screws were used without cement injection, possibly due to intrusion of the intervertebral disc (IVD) through the fractured endplates into the vertebral body [23,24]. Progressive deterioration of the Cobb angle with a concurrent stable wedge angle, as viewed on plain lateral radiographs, is suggestive of this phenomenon.…”

Section: Discussionmentioning

confidence: 99%

Clinical, radiological, and patient-reported outcomes 13 years after pedicle screw fixation with balloon-assisted endplate reduction and cement injection

et al. 2020

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Purpose In management of traumatic thoracolumbar burst fractures, short-segment pedicle screw fixation with balloonassisted endplate reduction (BAER) and cement injection is a safe, feasible, and effective technique to maintain radiological alignment with minimum spinal segments involved. However, 20% of patients report daily discomfort despite good spinal alignment and fusion after this technique. This study provides clinical, radiological, and patient-reported outcomes after a minimum 13 years of follow-up. Methods Eighteen patients were invited at the outpatient clinic for clinical/radiological examinations. The cohort (originally 20 patients) was treated 13-14 years earlier with pedicle screw fixation, BAER, and cement injection for traumatic thoracolumbar burst fractures. Patient-reported outcome measures were obtained at time of examinations. Current data were compared with data obtained at 6 years of follow-up. Results Seventeen patients (median age 50; range 32-80) cooperated. No/minimal back pain was reported by 15 patients, and 12 patients returned to their previous heavy labor work. Median visual analog score of health (80%; 50-100%) was similar to results at 6 years (80%; 60-100% p = 0.259). An Oswestry Disability Index score of less than 20% (reflecting minimal disability) was reported by 14 patients, compared with 15 patients at 6 years of follow-up. No significant differences were found in wedge or Cobb angle between the time points. Intravertebral cement resorption was not observed. Conclusion Results from this study suggest that, 13 years after pedicle screw fixation with BAER and cement injection for traumatic thoracolumbar burst fractures, functional performance, pain and radiological outcomes of the current cohort were stable or had slightly improved.

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“…Of the 12 articles that found no effect of the LSC on loss of correction or implant failure, 6 reported no significant relation between the LSC and instrumentation failure. [12][13][14][15][16][17] Four did not find instrumentation failure at all. [18][19][20][21] One reported no instrumentation failure but recommended to use long-segment posterior instrumentation (LSPI) instead of short-segment posterior instrumentation (SSPI) for patients with a high LSC score.…”

Section: No Relation Between Lsc and Instrumentation Failurementioning

confidence: 99%

The Predictive Value of the Load Sharing Classification Concerning Sagittal Collapse and Posterior Instrumentation Failure: A Systematic Literature Review

Stam

Deunk

Elzinga

et al. 2019

Global Spine Journal

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Study design: Systematic review. Objective: In 1994, the Load Sharing Classification (LSC) was introduced to aid the choice of surgical treatment of thoracolumbar spine fractures. Since that time this classification system has been commonly used in the field of spine surgery. However, current literature varies regarding its use and predictive value in relation to implant failure and sagittal collapse. The objective of this study is to assess the predictive value of the LSC concerning the need for anterior stabilization to prevent sagittal collapse and posterior instrumentation failure. Methods: An electronic search of PubMed, Medline, Embase, and the Cochrane Library was performed. Inclusion criteria were (1) cohort or clinical trial (2) including patients with thoracolumbar burst fractures (3) whose severity of the fractured vertebrae was assessed by the LSC. Results: Five thousand eighty-two articles have been identified, of which 21 articles were included for this review. Twelve studies reported no correlation between the LSC and sagittal collapse or instrumentation failure in patients treated with short-segment posterior instrumentation (SSPI). Seven articles found no significant relation; 5 articles found no instrumentation failure at all. The remaining 9 articles experienced failure in patients with a high LSC or recommended a different surgical technique. Conclusions: Although the LSC was originally developed to predict the need for anterior stabilization in addition to SSPI, many studies show that SSPI only can be sufficient in treating thoracolumbar fractures regardless of the LSC. The LSC might have lost its value in predicting sagittal collapse and posterior instrumentation failure.

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Surgical outcomes of temporary short-segment instrumentation without augmentation for thoracolumbar burst fractures

Cited by 46 publications

References 20 publications

Treatment of Thoracolumbar Fractures Through Different Short Segment Pedicle Screw Fixation Techniques: A Finite Element Analysis

Treatment of Thoracolumbar Fractures Through Different Short Segment Pedicle Screw Fixation Techniques: A Finite Element Analysis

Clinical, radiological, and patient-reported outcomes 13 years after pedicle screw fixation with balloon-assisted endplate reduction and cement injection

The Predictive Value of the Load Sharing Classification Concerning Sagittal Collapse and Posterior Instrumentation Failure: A Systematic Literature Review

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