ObjectiveTo explore the effectiveness percutaneous monoaxial screw combined with polyaxial pedical screw for treating thoracolumbar fracture by comparing with simple polyaxial pedicle screw fixation.
MethodsBetween January 2012 and June 2014, 56 cases of thoracolumbar fractures were treated by percutaneous pedicle screw fixation, the clinical data were retrospectively analyzed. Of 56 cases, 30 were treated with percutaneous monoaxial screw combined with percutaneous polyaxial pedical screw fixation (group A), 26 patients with only percutaneous polyaxial pedicle screw fixation (group B). There was no significant difference in gender, age, body mass index, injury causes, time from injury to admission, involved segments, fracture type, and preoperative American Spinal Injury Association (ASIA) stage, visual analogue scale (VAS), the anterior height of the injured vertebrae, Cobb angle, and sagittal index between 2 groups (P>0.05). The operation time, intraoperative blood loss, and complications were recorded and compared between the 2 groups. The VAS score was used to evaluate the improvement of the pain. The sagittal kyphosis Cobb angle, the anterior height of the injured vertebrae, sagittal index, and the average correction (difference between 3 days after oeration and preoperation) and loss degrees (difference between last follow-up and 3 days after operation) were measured on the X-ray films at preoperation, 3 days after operation, and last follow-up.
ResultsIncision healing at stage I was obtained, no related complications occurred. The operation time and intraoperative blood loss showed no significant difference between 2 groups (P>0.05). The patients were followed up 20-42 months (mean, 32 months) in group A and 21-44 months (mean, 30 months) in group B. VAS score of group A was significantly lower than that of group B at 3 days after operation (t=-2.277, P=0.027), but no significant difference was found at last follow-up (t=-0.289, P=0.774). X-ray examination showed good position of internal fixation, with no broken nails or exit of nail. There were significant differences in the anterior height of the injured vertebrae, Cobb angle, and sagittal index between at preoperation and at 3 days and last follow-up, and between at 3 days and last follow-up in 2 groups (P<0.05). The anterior height of the injured vertebrae, Cobb angle, and sagittal index of group A were significantly better than those of group B at 3 days and last follow-up (P<0.05), and correction degree were significantly higher than those of group B (P<0.05), but loss degree was not significant between 2 groups (P>0.05).
ConclusionPercutaneous monoaxial screw combined with polyaxial pedicle screw fixation is better than simply polyaxial pedicle screw in effects of treating thoracolumbar fracture under the premise of strictly holding indications.
Objective
To investigate the effectiveness of posterior non-decompression surgery in the treatment of thoracolumbar fractures without neurological symptoms by comparing with the conventional posterior decompression surgery.
Methods
Between October 2008 and October 2015, a total of 97 patients with thoracolumbar fractures with intraspinal occupying 1/3-1/2 and without neurological symptoms were divided into the decompression surgery group (51 cases) and the non-decompression surgery group (46 cases). There was no significant difference in gender, age, cause of injury, injury segment, the thoracolumbar injury severity score (TLICS), combined injury, disease duration, and preoperative relative anterior vertebral height, kyphosis Cobb angle, intraspinal occupying percentage, visual analogue scale (VAS), Oswestry disability index (ODI), and Japanese Orthopaedic Association (JOA) score between 2 groups (P>0.05). The operation time, intraoperative blood loss volume, postoperative drainage, bed rest time, hospitalization time, and relative anterior vertebral height, kyphosis Cobb angle, intraspinal occupying percentage, and VAS score, ODI, JOA score at preoperative and postoperative 3 days and 1 year were recorded and compared.
Results
The operation time, intraoperative blood loss volume, and postoperative drainage in non-decompression surgery group were significantly less than those in decompression surgery group (P<0.05). There was no significant difference in the postoperative bed rest time and hospitalization time between 2 groups (P>0.05). In decompression surgery group, 4 cases had cerebrospinal fluid leakage and healed after conservative treatment. All incisions healed by first intention, and no nerve injury or infection of incision occurred. All patients were followed up 10-18 months (mean, 11.7 months). The recovery of vertebral body height was satisfactory in 2 groups, without secondary kyphosis and secondary nerve symptoms. The imaging indexes and effectiveness scores of 2 groups at 3 days and 1 year after operation were significantly improved when compared with preoperative ones (P<0.05). The intraspinal occupying percentage, VAS score, and ODI at 1 year after operation were significantly lower than those at 3 days after operation in 2 groups (P<0.05), and JOA score at 1 year after operation was significantly higher than that at 3 days after operation (P<0.05). Relative anterior vertebral height at 1 year after operation was significantly higher than that at 3 days after operation in non-decompression surgery group (P<0.05); and there was no significant difference in decompression surgery group (P>0.05). At 3 days, the intraspinal occupying percentage and JOA score in non-decompression surgery group were higher than those in decompression surgery group (P<0.05), and VAS score and ODI at 3 days in non-decompression surgery group were lower than those in decompression surgery group (P<0.05). No significant difference was found in the other indexes between 2 groups at 3 days and 1 year after operation (P>0.05).
Conclusion
Compared with the posterior decompression surgery, posterior non-decompression surgery has the advantages of less bleeding, less trauma, less postoperative pain, and so on. It is an ideal choice for the treatment of thoracolumbar fractures with intraspinal occupying 1/3-1/2 and without neurological symptoms under the condition of strict indication of operation.
Objective To study the feasibil ity and rel iabil ity of the multi-plannar reformation (MPR) of multispiral CT (MSCT) in measuring the kyphosis angle (KA) after thoracolumbar fracture. Methods From December 2007 to December 2009, 45 thoracolumbar fracture patients who underwent computed radiology (CR) and MSCT were recruited. There were 32 males and 13 females with a mean age of 48 years (range, 24-63 years), including 36 simple compression fractures and 9 burst fractures. The fracture locations were T11 in 6 cases , T12 in 11 cases, L1 in 20 cases, and L2 in 8 cases. Fracture was caused by trafffic accident in 25 cases, by fall ing from height in 12 cases, and by others in 8 cases. The imaging examination was performed after 2 hours to 7 days of injury in 22 cases and after more than 7 days in 23 cases. The KA was measured on the lateral X-ray films of CR and MPR by two observers, then the measurements were done again after three weeks. The data were statistically analyzed. Results The average KA values on CR by two observers were (20.75 ± 8.31)° and (22.49 ± 9.07)°, respectively; showing significant difference (P lt; 0.05), and the correlation was good (r=0.882, P lt; 0.05). The average KA values on MPR by two observers were (16.65 ± 8.62)° and (17.08 ± 7.88)°, respectively, showing no significant difference (P gt; 0.05), the correlation was excellent (r=0.976, P lt; 0.05). The average KA values on CR and MPR were (21.61 ± 8.43)° and (16.87 ± 8.20)°, respectively; showing significant difference (P lt; 0.05), the correlation was good (r=0.852, P lt; 0.05). Conclusion It is more feasible and rel iable in measuring the KA on MRP of MSCT than CR, but the value is larger on CR.
ObjectiveTo explore the effectiveness and safety of tranexamic acid (TXA) in anterior approach surgery for thoracolumbar fractures.MethodsFrom January 2017 to January 2020, a total of 68 thoracolumbar fracture patients undergoing anterior approach surgery were included and randomly divided into TXA group (n=33) and control group (n=35). Patients in the TXA group were given a dose of 15 mg/kg of TXA by intravenous infusion during 30 min before skin incision and an additional 15 mg/kg of TXA intravenously at 8 h after the first infusion, while the ones in the control group were given 15 mg/kg of normal saline at the same time. Basic data of the patients were collected. The hemoglobin concentration, hematocrit, coagulation and fibrinolysis indexes of the patients were monitored preoperatively, 24-hour postoperatively, and 72-hour postoperatively. The intraoperative blood loss and wound drainage of the patients were recorded. The incidence of blood transfusion and thrombotic events were collected. Statistical analysis was performed.ResultsThere was no significant difference in age, sex, body mass index, operation time, fracture location distribution, anesthesia classification of American Society of Anesthesiologists, neurologic grade of American Spinal Injury Association, injury time, or length of hospital stay between the two groups (P>0.05). Compared with those in the control group, the total blood loss [(1 398.49±312.24) vs. (1 642.30±357.78) mL, P=0.003], intraoperative blood loss [(432.83±74.76) vs. (486.31±86.51) mL, P=0.008], and wound drainage [(276.73±89.42) vs. (389.24±125.71) mL, P<0.001] in the TXA group reduced. No statistically significant difference was found between the two groups in the preoperative hemoglobin or hematocrit (P>0.05), but the 24-hour postoperative hemoglobin concentration [(112.67±20.59) vs. (102.64±19.41) g/L, P=0.042] and hematocrit [(32.25±4.12)% vs. (30.13±4.28)%, P=0.042] in the TXA group were higher than those in the control group. The incidence of allogeneic blood transfusion in the TXA group was lower than that in the control group (6.1% vs. 25.7%, P<0.05). There was no statistically significant difference in preoperative, 24-hour postoperative, or 72-hour postoperative prothrombin time, international standardized ratio, activated partial prothrombin time, platelet count, fibrinogen, d-dimer, or fibrinogen degradation products between the two groups (P>0.05), and no thrombotic complications were found.ConclusionTXA has good efficacy and safety in the anterior approach surgery for thoracolumbar fractures.
A new method of anterior decompression for thoracolumbar fractures with paralysi s in six cases was reported. In a follw-up of one to five months, was shown that the neurological functions in all six cases has improved ⅡⅢ rank in Frankl classification. The author believe that the method has the following advantages, such as: less trauma from operation; the level and the limit of decompression could be made without Xray during the operation; usually only 1/5 to 1/4 of the vertebral body was excised so that the stability of the spine was not disturbed, and the obvious favourable results.
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.
Objective To review the latest progress in classification system of thoracolumbar fractures and its surgical treatment with posterior approaches. Methods Recent l iterature about classification system of thoracolumbar fractures and its surgical treatment was reviewed. Results For the treatment of thoracolumbar fracture, the surgeon first should decide whether the surgical treatment was necessary. Recently, a new classification system had been developed to help the surgeon make the right decision. The surgical methods included short segment internal fixation and long segment internalfixation with or without fusion, and minimally invasive internal fixation. Conclusion The progress in the surgical treatmentof thoracolumbar fracture will help spinal surgeon decide the necessary surgery beneficial for the patients. The most appropriate and effective surgical method with the minimum damage should be used to treat the fracture. The advantages of non-fusion surgical treatment still need a further study.
ObjectiveTo investigate the security of pedicle screw fixation in fractured vertebra in treatment of thoracolumbar fractures by comparing with routine fixation cross fractured vertebra.
MethodsA total of 101 cases of single segmental thoracolumbar fracture were selected between June 2008 and June 2011. Of them, 56 cases underwent pedicle screw fixation in fractured vertebra (group A), and 45 cases received routine fixation cross fractured vertebra (group B). There was no significant difference in gender, age, causes of injury, fracture type, fracture segment, Frankel grading, time of injury to operation, and the preoperative anterior vertebral height compression ratio and the canal occupation rate between 2 groups (P>0.05). There were 34 cases of junction fracture of pedicle and vertebra (type I), 2 cases of pedicle waist fracture (type Ⅱ), and 20 cases of junction fracture of pedicle and lamina (type Ⅲ) in group A. The position of fractured vertebral pedicle screw was observed; the anterior vertebral height compression ratio, canal occupation rate, and surgical complications were compared between 2 groups.
ResultsA total of 103 pedicle screws were placed in 54 patients of group A, except 2 patients of type Ⅱ fracture; 96 screws were placed in the bone cortex completely and 7 screws deviated. The operation time of group A was significantly longer than that of group B (t=4.339, P=0.000), but there was no significant difference in intraoperative blood loss between 2 groups (t=-0.089, P=0.929). All 101 patients were followed up 6-16 months (mean, 8.5 months). The patients of 2 groups achieved nerve functional recovery. Fixation-related complications occurred in 1 case of 2 groups respectively, showing no significant difference (P=1.000). At last follow-up, according to Denis lumbago classification, 51 cases were rated as P1 level and 5 cases as P2 level in group A; 35 cases were rated as P1 level, 8 cases as P2 level, and 2 cases as P3 level in group B; and there was no significant difference between 2 groups (Z=-1.836, P=0.066). There was no significant difference between 2 groups in canal occupation rate at immediate after operation and at last follow-up (P>0.05), and in the anterior vertebral height compression ratio at immediate after operation (P>0.05), but the anterior vertebral height compression ratio of group B was significantly higher that of group A at last follow-up (P<0.05).
ConclusionSingle segmental thoracolumbar fracture treated by pedicle screw fixation in fractured vertebra through posterior approach is safe and feasible according to different pedicle fracture types to guide fixation.
Objective
To compare the effectiveness of long- and short-segment posterior pedicle screw fixation for thoracolumbar fracture.
Methods
Between January 2007 and December 2009, 58 patients with AO type B thoracolumbar fracture underwent posterior pedicle screw fixation. Of 58 patients, 36 received short-segment pedicle fixation (1 upper and 1 lower vertebral bodies of the fractured vertebral body) in group A, and 22 received long-segment pedicle fixation (2 upper and 2 lower vertebral bodies of the fractured vertebral body) in group B. There was no significant difference in age, gender, injury cause, fracture site, preoperative Frankel grade, and disease duration between 2 groups (P gt; 0.05). The operation time, blood loss, complication, anterior vertebra compression rate (AVCR), and Cobb angle were compared between 2 groups. Frankel grade was used to evaluate the neurological function.
Results
The operation time and blood loss of group B were significantly higher than those of group A (P lt; 0.05). All incisions obtained primary healing. The patients were followed up 17.2 months on average (range, 12-32 months). No complication occurred in the other patients except 1 case having internal fixation failure and 1 case having aggravated kyphosis deformity in group A. The neurological function recovered in a certain degree; Frankel grade at 3 months was significantly improved when compared with preoperative one (P lt; 0.05) in 2 groups, but no significant difference was found between 2 groups (Z=0.09, P=0.36). The AVCR and Cobb angle were significantly lower in 2 groups at immediately after operation and last follow-up than those before operation (P lt; 0.05). The correction rates of AVCR and Cobb angle in group B were significantly higher than those in group A (P lt; 0.05); whereas the correction losses of AVCR and Cobb angle in group B were significantly less than those in group A (P lt; 0.05).
Conclusion
Long-segment pedicle screw fixation is better than short-segment pedicle screw fixation in the correction of kyphosis and recovery of vertebra body height, especially in the prevention of correction loss in long-term follow-up although it will increase the blood loss and operation time.
ObjectiveTo systematically review the efficacy of at the fracture level (AFL) versus cross the fracture level (CFL) short-segment pedicle screw fixation for thoracolumbar fractures.
MethodsWe electronically search PubMed, The Cochrane Library (Issue 8, 2015), EMbase, CBM, CNKI, VIP and WanFang data to collect randomized controlled trials (RCTs) of AFL versus CFL short segment pedicle screw fixation for thoracolumbar fractures from inception to Aug. 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was performed using RevMan 5.3 software.
ResultsA total of 11 RCTs involving 730 patients were included. The results of meta-analysis indicated that: compared with the CFL group, the AFL group had more blood loss (MD=9.8, 95%CI 7.40 to 12.20), less implant failure rate (RR=0.19, 95%CI 0.07 to 0.48), lower long term postoperative VAS score of thoracolumbar pain (MD=-1.20, 95%CI -1.85 to -0.56), higher correction in short term postoperative kyphotic Cobb angle (MD=3.56, 95%CI 2.25 to 4.87), smaller value in long term postoperative kyphotic Cobb angle and its loss of correction (MD=-3.95, 95%CI -7.78 to -0.12; MD=-4.65, 95%CI -6.91 to -2.40), smaller degree of anterior vertebral height compression in short and long term postoperative (MD=-3.51, 95%CI -5.23 to -1.80; MD=-8.28, 95%CI -12.22 to -4.33), better result in long term postoperative anterior vertebral height and its loss of correction (MD=8.00, 95%CI 3.85 to 12.15; MD=-6.06, 95%CI -7.68 to -4.44). There were no significant differences between two groups regarding operation time, infectious complications and short term postoperative kyphotic Cobb angle (MD=0.11, 95%CI -5.36 to 5.57; RR=0.55, 95%CI 0.11 to 2.85; MD=-0.66, 95%CI -2.19 to 0.87).
ConclusionCurrent evidence shows that AFL short-segment pedicle screw fixation for thoracolumbar fractures is superior to CFL fixation. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
