[Complications of a transpedicular stabilization of thoraco-lumbar burst fractures].
Complications of transpedicular stabilizations of thoraco-lumbar burst fractures are presented on the basis of literature review and own experiences. Unstable thoraco-lumbar burst fractures create the most difficult biomechanical conditions for a stabilizer. A literature review was done to estimate the effectiveness of vertebral body height restoration and its maintenance, the effectiveness of transpedicular grafting, the fusion rate and the implant-related complications rate. Transpedicular stabilization systems demonstrate a marked stiffness in all directions which is greater than in the case of other posterior stabilization systems. During the postero-lateral spondylodesis the transpedicular stabilizer is gradually unburdened but it is still loaded even after the completion of the bone fusion. A support of the anterior spinal column markedly diminishes the loads of the stabilizer and improves the segmental stability. Long-term follow-up studies of transpedicularly stabilized burst fractures reveal a deterioration of primarily good corrections. In some cases the correction returns to the level from before the operation in spite of transpedicular bone grafting. The implant-related complications rate (screw or rod breakages and a loss of interconnections) reaches up to 28 % of cases. In order to improve the anterior column stability and limit late kyphotization, as well as avoid implant-related complications, some authors additionally recommend performing a posterior interbody fusion (PLIF) or an anterior corpectomy with stabilization. Posterior transpedicular stabilization of thoraco-lumbar burst fractures does not provide a complete stabilization of the anterior spinal column, which results in a recurrence of spine kyphotization and implant-related complications. In selected cases, the application of an additional anterior column support markedly relieves the transpedicular fixator and reduces the pseudoarthrosis rate, late kyphotization and implant-related complications simultaneously.
Hakalo
Jerzy
J
Orthopedic Deprtment of Polokwane/Mankweng Hospital Complex, MEDUNSA Polokwane Campus (RSA), Konarskiego 16, 66-200 Swiebodzin. hakalo@poczta.onet.pl
Wroński
Jerzy
J
D001863:Bone Screws / Q000009:adverse effects*; D019299:Decompression, Surgical / Q000009:adverse effects; D005593:Fracture Fixation, Internal / Q000009:adverse effects*; D006801:Humans; D007593:Joint Instability / Q000209:etiology* / Q000628:therapy*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D011859:Radiography; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D016896:Treatment Outcome