Objective
To determine the feasibility, safety, and efficacy of common pedicle screw placement under direct vision combined with dome shaped decompression via small incision for double segment thoracolumbar fracture with nerve injury.
Methods
A retrospective analysis was performed on the clinical data of 32 patients with double segment thoracolumbar fracture with nerve injury undergoing common pedicle screw placement under direct vision combined with dome shaped decompression via small incision between November 2011 and November 2015 (combined surgery group), and another 32 patients undergoing traditional open pedicle screw fixation surgery (traditional surgery group). There was no significant difference in gender, age, cause of injury, time of injury-to-surgery, injury segments and Frankel classification of neurological function between two groups (P>0.05). The length of soft tissue dissection, the operative time, the blood loss during surgery, the postoperative drainage, the visual analogue scale (VAS) of incision after surgery, and recovery of neurological function after surgery were evaluated.
Results
All cases were followed up 9 to 12 months (mean, 10.5 months) in combined surgery group, and 8 to 12 months (mean, 9.8 months) in traditional surgery group. The length of soft tissue dissection, the operative time, the blood loss during surgery, the postoperative drainage, and the postoperative VAS score in the combined surgery group were significantly better than those in the traditional surgery group (P<0.05). Dural rupture during surgery and pedicle screw pulling-out at 6 months after surgery occurred in 2 cases and 1 case of the combined surgery group; dural rupture during surgery occurred in 1 case of the traditional surgery group. The X-ray films showed good decompression, and fracture healing; A certain degree of neurological function recovery was achieved in two groups.
Conclusion
Common pedicle screw placement under direct vision combined with dome shaped decompression via small incision can significantly reduce iatrogenic trauma and provide good nerve decompression. Therefore, it is a safe, effective, and minimally invasive treatment method for double segment thoracolumbar fracture with neurological injury.
ObjectiveTo evaluate the effectiveness of percutaneous monoplanar screw internal fixation via injured vertebrae for treatment of thoracolumbar fracture.MethodsBetween May 2015 and August 2017, 38 cases of thoracolumbar fractures without neurological symptom were treated with percutaneous monoplanar screw internal fixation via injured vertebrae. There were 22 males and 16 females, aged 25-52 years (mean, 32.5 years). There were 23 cases of AO type A3 and 15 cases of AO type A4. The injured vertebrae located at T11 in 4 cases, T12 in 9 cases, L1 in 11 cases, L2 in 10 cases, L3 in 3 cases, and L4 in 1 case. The mean interval between injury and operation was 4.5 days (range, 3-7 days). The pre- and post-operative degrees of lumbodorsal pain were estimated by the visual analogue scale (VAS) score. The X-ray film, CT three-dimensional reconstruction, and MRI were performed, and the ratio of anterior vertebral body height and sagittal Cobb angle were measured to assess the kyphosis of the fractured area.ResultsAll operations in 38 patients successfully completed without complications such as dural sac, nerve root, or vascular injury. The operation time was (56.2±3.7) minutes and the intraoperative blood loss was (42.3±3.5) mL. All incisions healed by first intention without redness, swelling, or exudation. All patients were followed up 17-33 months, with an average of 21.5 months. The VAS score at each time point after operation significantly improved when compared with that before operation (P<0.05), and significantly improved at 3 months and last follow-up when compared with that at 1 week (P<0.05); there was no significant difference between 3 months and last follow-up (P>0.05). There was no internal fixator loosening, breakage, or delayed kyphosis in all patients. The ratio of anterior vertebral body height and sagittal Cobb angle significantly improved postoperatively (P<0.05), and no significant difference was found between the different time points after operation (P>0.05).ConclusionPercutaneous monoplanar screw internal fixation via injured vertebrae is an easy approach to treat thoracolumbar fracture without neurological symptom, which can effectively restore vertebral body height and correct kyphosis, and avoid long-term segmental kyphosis.
ObjectiveTo investigate the effectiveness of limited middle and posterior column osteotomy via transvertebral space approach in treatment of old thoracolumbar compression fracture.MethodsA clinical data of 47 patients with old thoracolumbar compression fractures, who met the selection criteria between January 2010 and March 2018, was retrospectively analyzed. Twenty-five patients (group A) underwent the limited middle and posterior column osteotomy via transvertebral space approach, and 22 patients (group B) underwent the pedicle subtraction osteotomy (PSO). There was no significant difference in gender, age, cause of injury, time from injury to operation, fracture segment, and preoperative Cobb angle, sagittal vertical axis (SVA), visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, and Oswestry disability index (ODI) between the two groups (P>0.05). The operation time, intraoperative blood loss, and postoperative complications, as well as postoperative Cobb angle, SVA, VAS score, JOA score, ODI and the differences of all indexes between pre- and post-operation were recorded and compared between the two groups. The neurological function was evaluated by Frankel scale.ResultsThe operations of both groups were successfully completed. The operation time and intraoperative blood loss in group A were significant lower than those in group B (P<0.05). All incisions healed by first intetion. All patients were followed up 23-27 months (mean, 24.2 months) in group A and 24-28 months (mean, 24.8 months) in group B. At last follow-up, the VAS score, JOA score, ODI, Cobb angle, and SVA of the two groups were compared with those before operation, and the differences were significant (P<0.05). There was no significant difference between the two groups (P>0.05) in the indexes at last follow-up and the difference between pre- and post-operation. The lower extremity neurological symptoms (Frankel grade D) in 3 patients of group A before operation relieved (Frankel grade E) at last follow-up. The other patients were Frankel grade E. At last follow-up, CT showed bony fusion in the grafted area without any complications such as failure of internal fixation or pseudarthrosis.ConclusionFor patients with old thoracolumbar compression fractures, the limited middle and posterior column osteotomy via transvertebral space approach has a satisfactory effectiveness. Compared with PSO, it can reduce surgical trauma on the basis of achieving the same degree of deformity correction.
Objective
To study the effectiveness of long segment fixation combined with vertebroplasty (LSF-VP) for severe osteoporotic thoracolumbar compressive fractures with kyphosis deformity.
Methods
Between March 2006 and May 2012, a retrospective analysis was made on the clinical data of 48 cases of severe osteoporotic thoracolumbar compressive fractures with more than 50% collapse of the anterior vertebral body or more than 40
°
of sagittal angulation, which were treated by LSF-VP in 27 cases (LSF-VP group) or percutaneous kyphoplasty (PKP) in 21 cases (PKP group). All patients suffered from single thoracolumbar vertebral compressive fracture at T11 to L2. There was no significant difference in gender, age, spinal segment, and T values of bone mineral density between 2 groups (P gt; 0.05). The effectiveness of the treatment was appraised by visual analogue scale (VAS), Cobb angle of thoracolumbar kyphosis, height of anterior/posterior vertebral body, and compressive ratio of vertebrae before and after operations.
Results
The LSF-VP group had longer operation time, hospitalization days, and more bone cement injection volume than the PKP group, showing significant differences (P lt; 0.05). Intraoperative blood loss in LSF-VP group ranged from 220 to 1 050 mL (mean, 517 mL). No pulmonaryor cerebral embolism or cerebrospinal fluid leakage was found in both groups. Asymptomatic bone cement leakage was found in 3 cases of LSF-VP group and 2 cases of PKP group. The patients were followed up for 16-78 months (mean, 41.1 months) in LSF-VP group, and 12-71 months (mean, 42.1 months) in PKP group. No fixation failure such as loosened or broken pedicle screw was found in LSF-VP group during the follow-up, and no re-fracture or adjacent vertebral body fracture was found. Two cases in PKP group at 39 and 56 months after operation respectively were found to have poor maintenance of vertebral height and loss of rectification (Cobb angle was more than 40o) with recurrence of pain, which were treated by second surgery of LSF-VP; another case had compressive fracture of the adjacent segment and thoracolumbar kyphosis at 16 months after operation, which was treated by second surgery of LSF-VP. There were significant differences in the other indexes between each pair of the three time points (P lt; 0.05), except the Cobb angle of thoracolumbar kyphosis, and the height of posterior vertebral body between discharge and last follow-up in LSF-VP group, and except the Cobb angle of thoracolumbar kyphosis and compressive ratio of bertebrae between discharge and last follow-up in PKP group (P gt; 0.05). After operation, the other indexes of LSF-VP group were significantly better than those of PKP group at each time point (P lt; 0.05), except the VAS score and the height of posterior vertebral body at discharge (P gt; 0.05).
Conclusion
The effectiveness of LSF-VP is satisfactory in treating severe osteoporotic thoracolumbar compressive fractures with kyphosis deformity. LSF-VP can acquire better rectification of kyphosis and recovery of vertebral body height than PKP.
Objective To investigate the effectiveness of injured vertebra fixation with inclined-long pedicle screws combined with interbody fusion for thoracolumbar fracture dislocation with disc injury. Methods Between January 2017 and June 2022, 28 patients with thoracolumbar fracture dislocation with disc injury were underwent posterior depression, the injured vertebra fixation with inclined-long pedicle screws, and interbody fusion. There were 22 males and 6 females, with a mean age of 41.4 years (range, 22-58 years). The causes of injury included falling from height in 18 cases, traffic accident in 5 cases, and bruise in 5 cases. Fracture segment included 1 case of T11, 7 cases of T12, 9 cases of L1, and 11 cases of L2. According to the American Spinal Injury Association (ASIA) scale, the spinal injuries were graded as grade A in 4 cases, grade B in 2 cases, grade C in 11 cases, and grade D in 11 cases. Preoperative spinal canal encroachment ratio was 17.7%-75.3% (mean, 44.0%); the thoracolumbar injury classification and severity score (TLICS) ranged from 9 to 10 (mean, 9.9). Seventeen patients were associated with other injuries. The time from injury to operation ranged from 1 to 4 days (mean, 2.3 days). The perioperative indicators (operation time, intraoperative blood loss, and the occurrence of complications), clinical evaluation indicators [visual analogue scale (VAS) score and Oswestry Disability Index (ODI)], radiologic evaluation indicators [anterior vertebral height ratio (AVHR), kyphosis Cobb angle (KCA), intervertebral space height (ISH), vertebral wedge angle (VWA), displacement angle (DA), and percent fracture dislocation displacement (PFDD)], neurological function, and interbody fusion were recorded. Results The operation time was 110-159 minutes (mean, 130.2 minutes). The intraoperative blood loss was 200-510 mL (mean, 354.3 mL). All incisions healed by first intention, and no surgical complications such as wound infection or hematoma occurred. All patients were followed up 12-15 months (mean, 12.7 months). The chest and lumbar pain significantly relieved, VAS scores and ODI after operation were significantly lower than those before operation, and further decreased with the extension of postoperative time, with significant differences (P<0.05). At last follow-up, the ASIA classification of neurological function of the patients was grade A in 3 cases, grade B in 1 case, grade C in 1 case, grade D in 10 cases, and grade E in 13 cases, which was significantly different from preoperative one (Z=?4.772, P<0.001). Imaging review showed that AVHR, KCA, ISH, VWA, DA, and PFDD significantly improved at 1 week, 3 months and last follow-up (P<0.05). There was no significant difference between different time points after operation (P>0.05). At last follow-up, according to the modified Brantigan score, all patients achieved good intervertebral bone fusion, including 22 complete fusion and 6 good intervertebral fusion with a few clear lines. No complications such as internal fixation failure or kyphosis occurred during follow-up.Conclusion The injured vertebra fixation with inclined-long pedicle screws combined with interbody fusion is an effective treatment for thoracolumbar fracture dislocation with disc injury, which can correct the fracture dislocation, release the nerve compression, restore the injured vertebral height, and reconstruct spinal stabilization.
Objective To evaluate the effectiveness of percutaneous puncture of thoracolumbar vertebral pedicle assisted by mixed reality technology based on multi-point registration algorithm. Methods The operator used two methods, namely MR-assisted puncture (a self-developed MR calibration method based on multi-point registration algorithm combined with MR head mounted equipment) and manual puncture, to perform percutaneous puncture of the thoracolumbar pedicle on the spinal prosthesis model. The distance between the first blind puncture point and the preset nail center point, and single registration and puncture time were compared among different puncture methods. Results Four operators completed a total of 48 MR-assisted punctures and 48 manual punctures. The deviation distance of MR-assisted puncture [(1.69±0.29) vs. (4.99±2.06) mm], registration and puncture time [(131.41±5.35) vs. (475.98±65.26) s] were all better than manual puncture (P<0.05). Conclusion The prosthetic model data shows that MR technology-assisted puncture based on multi-point registration algorithm can improve the accuracy and efficiency of percutaneous puncture of thoracolumbar vertebral pedicle compared to traditional manual puncture.
Objective To explore the clinical effect of PSIS-A robot-assisted percutaneous screw in the treatment of thoracolumbar fracture. Methods Patients with thoracolumbar fracture who were hospitalized in Mianyang Orthopedic Hospital between August 2022 and January 2024 and required percutaneous pedicle screw f ixation were selected. Patients were divided into robot group and free hand group by random number table. Operative time, intraoperative bleeding, intraoperative radiation dose and time, implant accuracy rate, small joint invasion rate, Visual Analogue Scale score for pain and other indexes were compared between the two groups. Results A total of 60 patients were included. Among them, there were 28 cases in the robot group and 32 cases in the free hand group. On the third day after surgery, the Visual Analogue Scale score of the robot group was better than that of the free hand group (P=0.003). Except for intraoperative bleeding and radiation frequency (P>0.05), the surgical time, average nail implantation time, and intraoperative radiation dose in the robot group were all lower than those in the free hand group (P<0.05). The accuracy and excellence rate of nail planting in the robot group were higher than those in the free hand group (94.6% vs. 84.9%; χ2=7.806, P=0.005). There was no statistically significant difference in the acceptable accuracy rate (96.4% vs. 91.1%; χ2=3.240, P=0.072) and the incidence of screw facet joint invasion (7.2% vs.14.1%; χ2=3.608, P=0.058) between the two groups. Conclusion The application of PSIS-A type robot assisted percutaneous minimally invasive pedicle screw fixation in the treatment of thoracolumbar fr actures is promising.
Objective To evaluate the effectiveness of pedicle subtraction osteotomy (PSO) and non-osteotomy techniques in treatment of medium-to-severe kyphoscoliosis by retrospective studies. Methods Between January 2005 and January 2009, 99 patients with medium-to-severe kyphoscoliosis were treated by PSO (PSO group, n=46) and non-osteotomytechnique (non-osteotomy group, n=53) separately. There was no significant difference in sex, age, Cobb angle of scol iosis on coronal plane, and Cobb angle of kyphosis on saggital plane between 2 groups (P gt; 0.05). The operation time and blood loss were recorded; the Cobb angle of scol iosis on coronal plane and kyphosis on sagittal plane were measured at pre- and postoperation to caculate the rates of correction on both planes. Results The operation was successfully completed in all the patients. The operation time and blood loss of the patients in PSO group were significantly greater than those of the patients in non-osteotomy group (P lt; 0.05). All patients were followed up 12-56 months (mean, 22.4 months); no spinal cord injury occurred, and bone fusion was achieved at last follow-up. The Cobb angles of scol iosis and kyphosis at 2 weeks and last follow-up were significantly improved when compared with the preoperative angles in the patients of 2 groups (P lt; 0.05). There was no significant difference in Cobb angle of scol iosis and the rate of correction between 2 groups (P gt; 0.05), but the correction loss of PSO group was significantly smaller than that of non-osteotomy group (P lt; 0.05) at last follow-up. At 2 weeks and last follow-up, the Cobb angle of kyphosis, the rate of correction, and correction loss were significantly better in PSO group than in non-osteotomy group (P lt; 0.05). Conclusion There is no signifcant difference in scol iosis correction between PSO and non-osteotomy techniques.PSO can get better corrective effect in kyphosis correction than non-osteotomy technique, but the operation time and blood losswould increase greatly.
