The Radiological Complications of Short-Segment Pedicle Screw Fixation Combined with Transforaminal Interbody Fusion in the Treatment of Unstable Thoracolumbar Burst Fracture: A Retrospective Case Series Study in Vietnam

Abstract

Background The radiological complications including correction loss and hardware failure of short segment posterior pedicle screw fixation in the treatment of unstable thoracolumbar burst fractures remain a main concern. Several procedures aiming to reinforce the anterior column have been introduced to solve these limitations, including transforaminal interbody fusion (TIF). The purposes of this study were to evaluate the radiological complications of short-segment pedicle screw fixation in combination with transforaminal interbody fusion in the treatment of unstable thoracolumbar burst fractures. Methods This retrospective case series study enrolled patients with isolated unstable thoracolumbar burst fractures, who were treated by posterior short fixation with TIF between January 2013 and January 2017. Patients were followed up for a minimum of one and half years. For evaluation of correction loss, % loss of anterior vertebral body height (%AVB), vertebral kyphotic angle (VA) and regional kyphotic angle (RA) were collected preoperatively, postoperatively and at the final follow-up. Hardware failure was assessed on radiological images at the last follow-up. Results There were 36 patients who met the inclusion criteria with a mean follow-up duration of 53 months. The mean correction loss of %AVB, VA and RA were 10.2%, 2.9 ° and 5.6 ° , respectively. There were 6 patients (16.7%) with hardware failure at the final follow-up. Conclusion Short-segment posterior pedicle screw fixation with TIF using bone chip grafts does not completely prevent hardware failure and progressive kyphosis in the treatment of unstable thoracolumbar burst fractures.

Surgical management of thoracolumbar junction fractures: An evidence-based algorithm

“…Of note, a persistent postoperative spinal deformity would be responsible for a fixed kyphosis or a flat-back deformity, leading to pain, vascular damage, instability, and neurological deterioration. 33 , 34 , 35 In 1999, Abel et al estimated the probability of long-lasting neurological deficits, post-traumatic syringomyelia, as proportional to the residual stenosis and kyphosis due to incorrect treatment of TLJ fractures. 36 Chiefs among these mechanisms are the direct impingement and obstruction of the subarachnoid space, the tethering of the cord at the fracture site, and the progressive cord ischemia due to direct compression.…”