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Fulltext Thoracolumbar fracture--dislocation results of surgical treatment

Razak M, Mahmud M, Mokhtar SA, Omar A

Med J Malaysia, 2000 Sep;55 Suppl C:14-7.
PMID: 11200038

Fifteen cases of unstable fracture-dislocation of the thoracolumbar spine have been treated by open reduction, short segment transpedicular fixation and fusion in Universiti Unit, Kuala Lumpur Hospital from January 1994 until December 1997. Twelve male and three female patients were injured; their age ranged from 18 to 45 years. Five fracture-dislocations occurred in the lower thoracic spine (T8 to T11), eight at the thoracolumbar junction (T12 to L2) and two in the lumbar spine (L3 to L5). All the patients had neurological deficit. Seven patients with incomplete or cauda equina lesions regained some neural function, while all eight with complete lesions remained unchanged. Ten of the fifteen cases were grossly unstable and translated beyond 50% of the width of the spinal column. At the time of follow up (more than one year in all patients), no loss of reduction or of fixation was noted in any patient. Solid fusion was achieved in all patients. The advantages of this method of treatment include stable fixation, with maintenance of sagittal and coronal spinal alignments, to allow early rehabilitation.

Matched MeSH terms: Thoracic Vertebrae/injuries*
Fulltext Short segment posterior instrumentation, reduction and fusion of unstable thoracolumbar burst fractures--a review of 26 cases

Razak M, Mahmud MM, Hyzan MY, Omar A

Med J Malaysia, 2000 Sep;55 Suppl C:9-13.
PMID: 11200050

From January 1994 to January 1998, 26 patients of unstable thoracolumbar burst fracture were treated by a short segment posterior instrumentation (pedicular screw plate/rod system), reduction and fusion in Kuala Lumpur and Universiti Kebangsaan Malaysia Hospital. Majority of them were young and in a productive age group (mean age were 30 year-old). The mean duration of follow-up was 24.4 months. The injuries were caused by fall from height (69%) and motor vehicle accident (31%). Most of the fracture occurred at 1st and 2nd lumbar vertebrae (24/26). Twelve of the patients did not have neurological deficits. Out of 14 patients with neurological deficits, 64.4% of them showed an improvement of at least one Frankel's grade. There was no defect correlation between canal compromise and neurological deficit. Kyphotic angle improved from 20 degrees to 7 degrees immediately after surgery. In the last follow-up average kyphotic angle was 9 degrees with average lost of 2 degrees. The average length of hospitalization following surgery was 24 days. A posterolateral bony fusion was achieved in all cases at an average of 3 months. Complication included 2 loosening and 3 misplacement of pedicle screw fixation. We concluded that short-segment fixation with posterolateral decompression and fusion is effective in the treatment of unstable thoracolumbar burst fracture.

Matched MeSH terms: Thoracic Vertebrae/injuries*
Dislocation of cervico-thoracic spine with no neurological deficit--a case report

Saw A, Sengupta S

Injury, 2001 Jun;32(5):430-2.
PMID: 11382432
Matched MeSH terms: Thoracic Vertebrae/injuries*
Fulltext Minimally invasive reduction of thoracolumbar burst fracture using monoaxial percutaneous pedicle screws: Surgical technique and report of radiological outcome

Chung WH, Eu WC, Chiu CK, Chan CYW, Kwan MK

J Orthop Surg (Hong Kong), 2019 12 27;28(1):2309499019888977.
PMID: 31876259 DOI: 10.1177/2309499019888977

PURPOSE: To describe the reduction technique of thoracolumbar burst fracture using percutaneous monoaxial screws and its radiological outcomes compared to polyaxial screws.
METHODS: All surgeries were performed by minimally invasive technique with either percutaneous monoaxial or percutaneous polyaxial screws inserted at adjacent fracture levels perpendicular to both superior end plates. Fracture reduction is achieved with adequate rod contouring and distraction maneuver. Radiological parameters were measured during preoperation, postoperation, and follow-up.
RESULTS: A total of 21 patients were included. Eleven patients were performed with monoaxial pedicle screws and 10 patients performed with polyaxial pedicle screws. Based on AO thoracolumbar classification system, 10 patients in the monoaxial group had A3 fracture type and 1 had A4. In the polyaxial group, six patients had A3 and four patients had A4. Total correction of anterior vertebral height (AVH) ratio was 0.30 ± 0.10 and 0.08 ± 0.07 in monoaxial and polyaxial groups, respectively (p < 0.001). Total correction of posterior vertebral height (PVH) ratio was 0.11 ± 0.05 and 0.02 ± 0.02 in monoaxial and polyaxial groups, respectively (p < 0.001). Monoaxial group achieved more correction of 13° (62.6%) in local kyphotic angle compared to 8.2° (48.0%) in polyaxial group. Similarly, in regional kyphotic angle, 16.5° (103.1%) in the monoaxial group and 8.1° (76.4%) in the polyaxial group were achieved.
CONCLUSIONS: Monoaxial percutaneous pedicle screws inserted at adjacent fracture levels provided significantly better fracture reduction compared to polyaxial screws in thoracolumbar fractures.

Matched MeSH terms: Thoracic Vertebrae/injuries*
Comparison between percutaneous fluoroscopic-guided and conventional open pedicle screw placement techniques for the thoracic spine: a safety evaluation in human cadavers

Kwan MK, Chiu CK, Lee CK, Chan CY

Bone Joint J, 2015 Nov;97-B(11):1555-61.
PMID: 26530660 DOI: 10.1302/0301-620X.97B11.35789

Percutaneous placement of pedicle screws is a well-established technique, however, no studies have compared percutaneous and open placement of screws in the thoracic spine. The aim of this cadaveric study was to compare the accuracy and safety of these techniques at the thoracic spinal level. A total of 288 screws were inserted in 16 (eight cadavers, 144 screws in percutaneous and eight cadavers, 144 screws in open). Pedicle perforations and fractures were documented subsequent to wide laminectomy followed by skeletalisation of the vertebrae. The perforations were classified as grade 0: no perforation, grade 1: < 2 mm perforation, grade 2: 2 mm to 4 mm perforation and grade 3: > 4 mm perforation. In the percutaneous group, the perforation rate was 11.1% with 15 (10.4%) grade 1 and one (0.7%) grade 2 perforations. In the open group, the perforation rate was 8.3% (12 screws) and all were grade 1. This difference was not significant (p = 0.45). There were 19 (13.2%) pedicle fractures in the percutaneous group and 21 (14.6%) in the open group (p = 0.73). In summary, the safety of percutaneous fluoroscopy-guided pedicle screw placement in the thoracic spine between T4 and T12 is similar to that of the conventional open technique.

Matched MeSH terms: Thoracic Vertebrae/injuries
Fulltext The use of X-shaped cross-link in posterior spinal constructs improves stability in thoracolumbar burst fracture: a finite element analysis

Alizadeh M, Kadir MR, Fadhli MM, Fallahiarezoodar A, Azmi B, Murali MR, et al.

J Orthop Res, 2013 Sep;31(9):1447-54.
PMID: 23640802 DOI: 10.1002/jor.22376

Posterior instrumentation is a common fixation method used to treat thoracolumbar burst fractures. However, the role of different cross-link configurations in improving fixation stability in these fractures has not been established. A 3D finite element model of T11-L3 was used to investigate the biomechanical behavior of short (2 level) and long (4 level) segmental spine pedicle screw fixation with various cross-links to treat a hypothetical L1 vertebra burst fracture. Three types of cross-link configurations with an applied moment of 7.5 Nm and 200 N axial force were evaluated. The long construct was stiffer than the short construct irrespective of whether the cross-links were used (p < 0.05). The short constructs showed no significant differences between the cross-link configurations. The XL cross-link provided the highest stiffness and was 14.9% stiffer than the one without a cross-link. The long construct resulted in reduced stress to the adjacent vertebral bodies and screw necks, with 66.7% reduction in bending stress on L2 when the XL cross-link was used. Thus, the stability for L1 burst fracture fixation was best achieved by using long segmental posterior instrumentation constructs and an XL cross-link configuration. Cross-links did not improved stability when a short structure was used.

Matched MeSH terms: Thoracic Vertebrae/injuries*
Do the dynamic stress mobility radiographs predict the postoperative vertebral height restoration, kyphosis correction, and cement volume injected after vertebroplasty for osteoporotic thoracolumbar vertebral fractures with intravertebral cleft?

Chiu CK, Lisitha KA, Elias DM, Yong VW, Chan CYW, Kwan MK

J Orthop Surg (Hong Kong), 2018 10 26;26(3):2309499018806700.
PMID: 30352524 DOI: 10.1177/2309499018806700

BACKGROUND: This prospective clinical-radiological study was conducted to determine whether the dynamic mobility stress radiographs can predict the postoperative vertebral height restoration, kyphosis correction, and cement volume injected after vertebroplasty.
METHODS: Patients included had the diagnosis of significant back pain caused by osteoporotic vertebral compression fracture secondary to trivial injury. All the patients underwent routine preoperative sitting lateral spine radiograph, supine stress lateral spine radiograph, and supine anteroposterior spine radiograph. The radiological parameters recorded were anterior vertebral height (AVH), middle vertebral height (MVH), posterior vertebral height (PVH), MVH level below, wedge endplate angle (WEPA), and regional kyphotic angle (RKA). The supine stress versus sitting difference (SSD) for all the above parameters were calculated.
RESULTS: A total of 28 patients (4 males; 24 females) with the mean age of 75.6 ± 7.7 years were recruited into this study. The mean cement volume injected was 5.5 ± 1.8 ml. There was no difference between supine stress and postoperative radiographs for AVH ( p = 0.507), PVH ( p = 0.913) and WEPA ( p = 0.379). The MVH ( p = 0.026) and RKA ( p = 0.005) were significantly less in the supine stress radiographs compared to postoperative radiographs. There was significant correlation ( p < 0.05) between supine stress and postoperative AVH, MVH, PVH, WEPA, and RKA. The SSD for AVH, PVH, WEPA, and RKA did not have significant correlation with the cement volume ( p > 0.05). Only the SSD-MVH had significant correlation with cement volume, but the correlation was weak ( r = 0.39, p = 0.04).
CONCLUSIONS: Dynamic mobility stress radiographs can predict the postoperative vertebral height restoration and kyphosis correction after vertebroplasty for thoracolumbar osteoporotic fracture with intravertebral clefts. However, it did not reliably predict the amount of cement volume injected as it was affected by other factors.

Matched MeSH terms: Thoracic Vertebrae/injuries*