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Hybrid Stabilization of Thoracic Spine Fractures with Sublaminar Bands and Transpedicular Screws: Description of a Surgical Alternative and Review of the Literature.

Unterweger MT, Kandziora F, Schnake KJ - Case Rep Orthop (2015)

Bottom Line: No complications occurred.Follow-up was 12 months with clinically uneventful postoperative courses.No signs of implant failure or loss of reduction could be detected.

View Article: PubMed Central - PubMed

Affiliation: Center of Spinal Therapy, Schön Klinik Nürnberg Fürth, 90763 Fürth, Germany.

ABSTRACT
Stabilization of unstable thoracic fractures with transpedicular screws is widely accepted. However, placement of transpedicular screws can cause complications, particularly in the thoracic spine with physiologically small pedicles. Hybrid stabilization, a combination of sublaminar bands and pedicle screws, might reduce the rate of misplaced screws and can be helpful in special anatomic circumstances, such as preexisting scoliosis and osteoporosis. We report about two patients suffering from unstable thoracic fractures, of T5 in one case and T3, T4, and T5 in the other case, with preexisting scoliosis and extremely small pedicles. Additionally, one patient had osteoporosis. Patients received hybrid stabilization with pedicle screws adjacent to the fractured vertebral bodies and sublaminar bands at the level above and below the pedicle screws. No complications occurred. Follow-up was 12 months with clinically uneventful postoperative courses. No signs of implant failure or loss of reduction could be detected. In patients with very small thoracic pedicles, scoliosis, and/or osteoporosis, hybrid stabilization with sublaminar bands and pedicle screws can be a viable alternative to long pedicle screw constructs.

No MeSH data available.


Related in: MedlinePlus

(a) CT scans showing the preexisting scoliosis and the fracture of T5. Cobb angle (T3–7): 12°, kyphosis angle (T3–7): 40°. (b) CT scan showing the fragment narrowing the spinal canal. (c) CT scan showing the small pedicles (blind on the right side, 2.5 mm on the left).
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fig1: (a) CT scans showing the preexisting scoliosis and the fracture of T5. Cobb angle (T3–7): 12°, kyphosis angle (T3–7): 40°. (b) CT scan showing the fragment narrowing the spinal canal. (c) CT scan showing the small pedicles (blind on the right side, 2.5 mm on the left).

Mentions: An 18-year-old woman fell from a horse and sustained an unstable rotation-flexion-burst fracture of the 5th thoracic vertebra (C 2.2 according to AO-Magerl classification [13]; Figure 1(a)) with narrowing of the spinal canal (Figure 1(b)). The patient had a preexisting idiopathic adolescent scoliosis.


Hybrid Stabilization of Thoracic Spine Fractures with Sublaminar Bands and Transpedicular Screws: Description of a Surgical Alternative and Review of the Literature.

Unterweger MT, Kandziora F, Schnake KJ - Case Rep Orthop (2015)

(a) CT scans showing the preexisting scoliosis and the fracture of T5. Cobb angle (T3–7): 12°, kyphosis angle (T3–7): 40°. (b) CT scan showing the fragment narrowing the spinal canal. (c) CT scan showing the small pedicles (blind on the right side, 2.5 mm on the left).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663301&req=5

fig1: (a) CT scans showing the preexisting scoliosis and the fracture of T5. Cobb angle (T3–7): 12°, kyphosis angle (T3–7): 40°. (b) CT scan showing the fragment narrowing the spinal canal. (c) CT scan showing the small pedicles (blind on the right side, 2.5 mm on the left).
Mentions: An 18-year-old woman fell from a horse and sustained an unstable rotation-flexion-burst fracture of the 5th thoracic vertebra (C 2.2 according to AO-Magerl classification [13]; Figure 1(a)) with narrowing of the spinal canal (Figure 1(b)). The patient had a preexisting idiopathic adolescent scoliosis.

Bottom Line: No complications occurred.Follow-up was 12 months with clinically uneventful postoperative courses.No signs of implant failure or loss of reduction could be detected.

View Article: PubMed Central - PubMed

Affiliation: Center of Spinal Therapy, Schön Klinik Nürnberg Fürth, 90763 Fürth, Germany.

ABSTRACT
Stabilization of unstable thoracic fractures with transpedicular screws is widely accepted. However, placement of transpedicular screws can cause complications, particularly in the thoracic spine with physiologically small pedicles. Hybrid stabilization, a combination of sublaminar bands and pedicle screws, might reduce the rate of misplaced screws and can be helpful in special anatomic circumstances, such as preexisting scoliosis and osteoporosis. We report about two patients suffering from unstable thoracic fractures, of T5 in one case and T3, T4, and T5 in the other case, with preexisting scoliosis and extremely small pedicles. Additionally, one patient had osteoporosis. Patients received hybrid stabilization with pedicle screws adjacent to the fractured vertebral bodies and sublaminar bands at the level above and below the pedicle screws. No complications occurred. Follow-up was 12 months with clinically uneventful postoperative courses. No signs of implant failure or loss of reduction could be detected. In patients with very small thoracic pedicles, scoliosis, and/or osteoporosis, hybrid stabilization with sublaminar bands and pedicle screws can be a viable alternative to long pedicle screw constructs.

No MeSH data available.


Related in: MedlinePlus