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Thoracolumbar fracture dislocations treated by posterior reduction, interbody fusion and segmental instrumentation.

Wang XB, Yang M, Li J, Xiong GZ, Lu C, Lü GH - Indian J Orthop (2014)

Bottom Line: The mean preoperative kyphosis was 14.4° and reduced to -1.1° postoperatively.The loss of correction was small (1.3°) with no significant difference compared to postoperative kyphotic angle (P = 0.069).This procedure can achieve effective reduction, sagittal angle correction and solid fusion.

View Article: PubMed Central - PubMed

Affiliation: Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P. R. China.

ABSTRACT

Background: Literature describing the application of modern segmental instrumentation to thoracic and lumbar fracture dislocation injuries is limited and the ideal surgical strategy for this severe trauma remains controversial. The purpose of this article was to investigate the feasibility and efficacy of single-stage posterior reduction with segmental instrumentation and interbody fusion to treat this type of injury.

Materials and methods: A retrospective review of 30 patients who had sustained fracture dislocation of the spine and underwent single stage posterior surgery between January 2007 and December 2011 was performed. All the patients underwent single stage posterior pedicle screw fixation, decompression and interbody fusion. Demographic data, medical records and radiographic images were reviewed thoroughly.

Results: Ten females and 20 males with a mean age of 39.5 years were included in this study. Based on the AO classification, 13 cases were Type B1, 4 cases were B2, 4 were C1, 6 were C2 and 3 cases were C3. The average time of the surgical procedure was 220 min and the average blood loss was 550 mL. All of the patients were followed up for at least 2 years, with an average of 38 months. The mean preoperative kyphosis was 14.4° and reduced to -1.1° postoperatively. At the final followup, the mean kyphosis was 0.2°. The loss of correction was small (1.3°) with no significant difference compared to postoperative kyphotic angle (P = 0.069). Twenty seven patients (90%) achieved definitive bone fusion on X-ray or computed tomography imaging within 1 year followup. The other three patients were suspected possible pseudarthrosis. They remained asymptomatic without hardware failure or local pain at the last followup.

Conclusion: Single stage posterior reduction using segmental pedicle screw instrumentation, combined with decompression and interbody fusion for the treatment of thoracic or lumbar fracture-dislocations is a safe, less traumatic and reliable technique. This procedure can achieve effective reduction, sagittal angle correction and solid fusion.

No MeSH data available.


Related in: MedlinePlus

X-ray dorsolumbar spine anteroposterior view (a) showing a burst fracture of T12 (AO Type B1.2), T11 also had an impact fracture. Computed tomography (CT) (b) and magnetic resonance imaging (c) demonstrated posterior elements fracture and spinal cord injury. (d) X-ray dorsolumbar spine lateral view showing a single stage posterior segmental instrumentation, reduction and interbody fusion (e, f) Three dimensional CT scan at 1 year followup showing anatomical alignment and solid bony fusion in the T11-T12 disc space
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Figure 1: X-ray dorsolumbar spine anteroposterior view (a) showing a burst fracture of T12 (AO Type B1.2), T11 also had an impact fracture. Computed tomography (CT) (b) and magnetic resonance imaging (c) demonstrated posterior elements fracture and spinal cord injury. (d) X-ray dorsolumbar spine lateral view showing a single stage posterior segmental instrumentation, reduction and interbody fusion (e, f) Three dimensional CT scan at 1 year followup showing anatomical alignment and solid bony fusion in the T11-T12 disc space

Mentions: Preoperative radiographic assessment was done using posterior anterior and lateral plain radiographs of the region, three dimensional computed tomography (CT) and magnetic resonance imaging. There were anterior translation (n = 17) patients [Figure 1], lateral displacement (n = 7) and a combination of both (n = 6) [Figure 2]. In all patients, the ruptured disc fragments at the injured segments were found scattered and displaced both anteriorly and posteriorly entering the spinal canal and causing compression of the neural elements [Figure 1b and c].


Thoracolumbar fracture dislocations treated by posterior reduction, interbody fusion and segmental instrumentation.

Wang XB, Yang M, Li J, Xiong GZ, Lu C, Lü GH - Indian J Orthop (2014)

X-ray dorsolumbar spine anteroposterior view (a) showing a burst fracture of T12 (AO Type B1.2), T11 also had an impact fracture. Computed tomography (CT) (b) and magnetic resonance imaging (c) demonstrated posterior elements fracture and spinal cord injury. (d) X-ray dorsolumbar spine lateral view showing a single stage posterior segmental instrumentation, reduction and interbody fusion (e, f) Three dimensional CT scan at 1 year followup showing anatomical alignment and solid bony fusion in the T11-T12 disc space
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4232825&req=5

Figure 1: X-ray dorsolumbar spine anteroposterior view (a) showing a burst fracture of T12 (AO Type B1.2), T11 also had an impact fracture. Computed tomography (CT) (b) and magnetic resonance imaging (c) demonstrated posterior elements fracture and spinal cord injury. (d) X-ray dorsolumbar spine lateral view showing a single stage posterior segmental instrumentation, reduction and interbody fusion (e, f) Three dimensional CT scan at 1 year followup showing anatomical alignment and solid bony fusion in the T11-T12 disc space
Mentions: Preoperative radiographic assessment was done using posterior anterior and lateral plain radiographs of the region, three dimensional computed tomography (CT) and magnetic resonance imaging. There were anterior translation (n = 17) patients [Figure 1], lateral displacement (n = 7) and a combination of both (n = 6) [Figure 2]. In all patients, the ruptured disc fragments at the injured segments were found scattered and displaced both anteriorly and posteriorly entering the spinal canal and causing compression of the neural elements [Figure 1b and c].

Bottom Line: The mean preoperative kyphosis was 14.4° and reduced to -1.1° postoperatively.The loss of correction was small (1.3°) with no significant difference compared to postoperative kyphotic angle (P = 0.069).This procedure can achieve effective reduction, sagittal angle correction and solid fusion.

View Article: PubMed Central - PubMed

Affiliation: Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P. R. China.

ABSTRACT

Background: Literature describing the application of modern segmental instrumentation to thoracic and lumbar fracture dislocation injuries is limited and the ideal surgical strategy for this severe trauma remains controversial. The purpose of this article was to investigate the feasibility and efficacy of single-stage posterior reduction with segmental instrumentation and interbody fusion to treat this type of injury.

Materials and methods: A retrospective review of 30 patients who had sustained fracture dislocation of the spine and underwent single stage posterior surgery between January 2007 and December 2011 was performed. All the patients underwent single stage posterior pedicle screw fixation, decompression and interbody fusion. Demographic data, medical records and radiographic images were reviewed thoroughly.

Results: Ten females and 20 males with a mean age of 39.5 years were included in this study. Based on the AO classification, 13 cases were Type B1, 4 cases were B2, 4 were C1, 6 were C2 and 3 cases were C3. The average time of the surgical procedure was 220 min and the average blood loss was 550 mL. All of the patients were followed up for at least 2 years, with an average of 38 months. The mean preoperative kyphosis was 14.4° and reduced to -1.1° postoperatively. At the final followup, the mean kyphosis was 0.2°. The loss of correction was small (1.3°) with no significant difference compared to postoperative kyphotic angle (P = 0.069). Twenty seven patients (90%) achieved definitive bone fusion on X-ray or computed tomography imaging within 1 year followup. The other three patients were suspected possible pseudarthrosis. They remained asymptomatic without hardware failure or local pain at the last followup.

Conclusion: Single stage posterior reduction using segmental pedicle screw instrumentation, combined with decompression and interbody fusion for the treatment of thoracic or lumbar fracture-dislocations is a safe, less traumatic and reliable technique. This procedure can achieve effective reduction, sagittal angle correction and solid fusion.

No MeSH data available.


Related in: MedlinePlus