Temporary short-segment pedicle screw fixation for thoracolumbar burst fractures: comparative study with or without vertebroplasty

Aono, Hiroyuki; Ishii, Keisuke; Tobimatsu, Hidekazu; Nagamoto, Yukitaka; Takenaka, Shota; Furuya, Masayuki; Horii, Chiaki; Iwasaki, Motoki

doi:10.1016/j.spinee.2017.03.022

Cited by 36 publications

(66 citation statements)

References 27 publications

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“…In this present study, there was also a “cohesive” displacement/micro-motion of the bone defect area; however, the change of the oblique angle did not change the displacement/micro-motion of the bone defect area. By the combined use of Schanz pedicle screw and thoraco-lumbo-sacral orthosis (TLSO) brace in our previous study [ 1 ] and the study of Aono et al [ 2 ], we not only ensured the clinical efficacy but also prevented the re-collapse of the injured vertebra. We speculated that TLSO brace could limit the thoracolumbar sacral movement to reduce the injured vertebra displacement and thus avoid the re-collapse of the injured vertebrae [ 1 ]; however, further biomechanical and clinical studies are needed to confirm this statement.…”

Section: Discussionmentioning

confidence: 96%

“…Despite no screw breakage occurred in Schanz pedicle screw fixation for the treatment of severe fracture [ 1 , 2 ], it still has the disadvantages of postoperative re-collapse of the injured vertebra [ 22 ]. Jang et al retrospectively analyzed 208 cases of thoracolumbar burst fracture using conventional open pedicle screw fixation and found that age at operation (> 43 years old) and preoperative body height loss (> 54%) were independent predictors of re-collapse [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

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The feasibility of short-segment Schanz screw implanted in an oblique downward direction for the treatment of lumbar 1 burst fracture: a finite element analysis

et al. 2020

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Background To evaluate the biomechanical properties of short-segment Schanz screw implanted in an oblique downward direction for the treatment of lumbar 1 burst fracture using a finite element analysis. Methods The Universal Spine System (USS) fixation model for adjacent upper and lower vertebrae (T12 and L2) of lumbar 1 vertebra burst fracture was established. During flexion/extension, lateral bending, and rotation, the screw stress and the displacement of bone defect area of the injured vertebrae were evaluated when the downward inserted angle between the long axis of the screws and superior endplate of the adjacent vertebrae was set to 0° (group A), 5° (group B), 10° (group C), and 15°(group D). There were 6 models in each group. Results There were no significant differences in the maximum screw stress among all the groups during flexion/extension, lateral bending, and rotation (P > 0.05). There were no significant differences in the maximum displacement of the bone defect area of the injured vertebrae among all the groups during flexion/extension, lateral bending, and rotation (P > 0.05). Conclusion Short-segment Schanz screw implanted in an oblique downward direction with different angles (0°/parellel, 5°, 10°, and 15°) did not change the maximum stress of the screws, and there was a lower risk of screw breakage in all groups during flexion/extension, lateral bending, and rotation. In addition, the displacement of the injured vertebra defect area had no significant changes with the change of angles.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

The feasibility of short-segment Schanz screw implanted in an oblique downward direction for the treatment of lumbar 1 burst fracture: a finite element analysis

et al. 2020

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“…9 Other studies comparing unilateral with bilateral screw fixation showed no difference in using unilateral or bilateral screw fixation. 10 And a large Meta-analysis of 365 patients did not show any difference between short segments as compared to long segment pedicle screw fixation, in our study we utilized the short segment pedicle screw fixation technique for our patients.…”

Section: Discussionmentioning

confidence: 96%

Fracture of Spine: Unstable Fracture of the Thoracolumbar Spine, to Determine the Effectiveness of Pedicle Screw and Rod Fixation for Management

Jabbar

Hashim

Khan

et al. 2017

TPMJ

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ABSTRACT… Objectives:In this study we analyze and study the effectiveness of pedicle screw and rod fixation for the management of unstable fractures of the thoracolumbar spine. The type of study is a Study Design: Case series. Period: 1.5 year duration from April 2014 to September 2015. Setting: Tertiary Care Centre in Karachi, Pakistan. Materials and methods: N= 35 patients were operated at our institute and included in the study. The inclusion criteria was all those patients who presented to us with unstable fractures of the thoracolumbar spine via the accident and emergency department of the hospital, and were operated upon and gave full informed consent to partake in the research were included in this study. All the patients were operated under general anesthesia. The short segment fixation with pedicle screw rod fixation using the posterior approach was the technique utilized for treatment. Rehabilitation was started immediately after the surgical procedure. Data was analyzed using SPSS version 23. Results: The study population consisted of n= 35 patients of which n= 25 (71.42%) were males and n= 10 (28.57%) were females, the mean age of the study population was 33.5 years. A history of fall from height was the most common cause of injury in n= 26 (74.28%) of the patients, next was automobile accidents in n= 9 patients (25.71%). Burst fracture was the most common type of injury. The sagittal angle was 23.5O pre operatively and 10.75 O post operatively, and at follow up the loss of angle was found to be 4.80 respectively. The sagittal index values were as follows, pre-operative 0.53, post-operative 0.75 and 0.72 at follow up (final follow up). N= 30 (85.71%) patients showed improvement in their ASIA status, n= 19 (54.28%) showed single grade improvement, n= 10 (28.57%) showed double grade improvement, n= 1 (2.85%) showed triple grade improvement, while n= 5 (14.28%) cases did not show any improvement. The mean duration between injury and surgical intervention was 5.5 days with a range of 1 to 23 days, the major cause of this delay was delay in reaching the hospital. The most common complication observed was pressure sores in n= 4 (11.42%) and urinary tract infections (UTI) seen in n= 5 (14.28%) of patients, followed by implant failure in n=3 (8.57%) patients. Conclusion: According to the results of our study unstable burst fractures was the most prevalent type of fracture observed, there was a marked improvement in the radiological parameters post operatively, while the neurological improvement was decent. The technique of pedicle screw rod and fixation using the posterior approach provides good surgical outcome and better stabilization, with a fair amount of neurological improvement for these patients. Key words:Fractures; Pedicle screw fixation; rod instrumentation; thoracolumbar spine; traumatic injury. Article Citation: Jabbar FA, Hashim M, Khan AA, Ahmed S, Shah RA. Fracture of spine; Unstable fracture of the thoracolumbar spine, to determine the effectiveness of pedicle screw and rod fixation for manag...

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“…The problem of choosing the surgical approach for such injuries remains unsolved. According to the literature, short-segment transpedicular fixation characterized by a minimal number of blocked spinal-motor segments and low intraoperative blood loss is the gold standard for this type of injury [5][6][7][8]. However, the advantages of such fixation system arrangement are partially offset by the risk of instability of short-segment hardware (almost 54% of cases) and subsequent relapse of post-traumatic kyphotic deformity [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Optimization of Spondylosynthesis for Certain Thoracolumbar Burst Fractures

Likhachev¹,

Арсениевич

Ostrovskiy

et al. 2020

Sovrem Tehnol Med

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Intermediate transpedicular fixation, i.e. additional insertion of transpedicular screws into the injured vertebrae, is an improvement to the most popular surgical intervention for spinal injuries, currently gaining widespread use in clinical practice. Unilateral insertion of transpedicular screws into the injured vertebrae allows combining the advantages of intermediate transpedicular fixation with the possibility to perform anterior column support without remounting the transpedicular system. The aim of the study was to use biomechanical computer modeling for evaluating the stability of intermediate transpedicular fixation components, which allow performing anterior column support if necessary. Materials and Methods. DICOM files obtained during CT scan of a patient with intermediate thoracolumbar spine injury and the ANSYS software were used. Stability of the transpedicular system and supportability of the complementary Mesh implant installed with unilateral intermediate transpedicular screws were evaluated using computer modeling based on the finite element method. Results. The values of stress and displacement fields for spine-hardware systems with various arrangements have been obtained. The maximum loads exceeding bone tissue strength (153-161 MPa) were registered for standard 4-screw system (190 MPa) when modeling the load equivalent for walking and falling from a standing position. The use of the proposed fixation system arrangement supplemented with intermediate screws allows obtaining loads in the spine-hardware system not exceeding these thresholds. Complementary eccentric Mesh implant enhances fixation stability of the transpedicular system with intermediate screws. Conclusion. The results show the high degree of mechanical stability of the proposed hardware arrangement and its potential efficacy for thoracolumbar transitional vertebra stabilization.

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Temporary short-segment pedicle screw fixation for thoracolumbar burst fractures: comparative study with or without vertebroplasty

Cited by 36 publications

References 27 publications

The feasibility of short-segment Schanz screw implanted in an oblique downward direction for the treatment of lumbar 1 burst fracture: a finite element analysis

The feasibility of short-segment Schanz screw implanted in an oblique downward direction for the treatment of lumbar 1 burst fracture: a finite element analysis

Fracture of Spine: Unstable Fracture of the Thoracolumbar Spine, to Determine the Effectiveness of Pedicle Screw and Rod Fixation for Management

Optimization of Spondylosynthesis for Certain Thoracolumbar Burst Fractures

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