title: Posterior pedicle screw fixation with supplemental laminar hook fixation for the treatment of thoracolumbar burst fractures.
abstract: Surgical treatment of thoracolumbar burst fractures with posterior short-segment pedicle fixation usually provides excellent initial correction of kyphotic deformity, but a significant amount of correction can be lost afterwards. This study evaluates the clinical relevance of the short-segment pedicle fixation supplemented by laminar hooks (2HS-1SH) construct in the surgical treatment of thoracolumbar burst fractures. Twenty-five patients with a single-level thoracolumbar burst fracture were assessed in this retrospective study. All patients were followed for a minimum of 1 year (mean 2.9 [standard deviation {SD}] 1.5 y). Preoperative vertebral height loss and local kyphosis were 35% (SD 14%) and 19 degrees (SD 9 degrees ), respectively. Mean corrections of vertebral height and kyphosis were 10% (SD 16%) and 12 degrees (SD 9 degrees ), respectively. Mean loss of correction at last follow-up was 2% (SD 6%) and 4 degrees (SD 3 degrees ) for vertebral height and kyphosis, respectively. Loss of correction was significant for local kyphosis (p 0.001) but not for vertebral height (p = 0.20). Despite the significant loss of correction for local kyphosis, it remained improved at latest follow-up when compared with the preoperative value (p 0.001). For patients with more than 2 years of follow-up, most of the loss of correction in local kyphosis occurred during the first postoperative year. There was no evidence of instrumentation failure or pseudarthrosis in any patient. The 2HS-1SH construct provides significant correction of vertebral body height and local kyphosis. It also preserves the initial correction and minimizes the risk of instrumentation failure.
authors.affiliation: University of Montreal, Division of Orthopaedic Surgery, Hopital du Sacré-Coeur, Montréal, Canada.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Leduc
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Mac-Thiong
authors.forename: Gilles
authors.initials: G
authors.lastname: Maurais
authors.forename: Alain
authors.initials: A
authors.lastname: Jodoin
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D006801:Humans; D007738:Kyphosis / Q000209:etiology; D008159:Lumbar Vertebrae / Q000293:injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009984:Orthopedic Fixation Devices; D011183:Postoperative Complications; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000293:injuries / Q000601:surgery*; D016896:Treatment Outcome