Biomechanical comparison of three fixation techniques for unstable thoracolumbar burst fractures. Laboratory investigation.
OBJECTIVE
Increased structural stability is considered sufficient justification for higher-risk surgical procedures, such as circumferential fixation after severe spinal destabilization. However, there is little biomechanical evidence to support such claims, particularly after traumatic lumbar burst fracture. The authors sought out to compare the biomechanical performance of the following 3 fixation strategies for spinal reconstruction after decompression for an unstable thoracolumbar burst fracture: 1) short-segment anterolateral fixation; 2) circumferential fixation; and 3) extended anterolateral fixation.


METHODS
Thoracolumbar spines (T10-L4) from 7 donors (mean age at death 64+/-6 years; 1 female and 6 males) were tested in pure moment loading in flexion-extension, lateral bending, and axial rotation. Thoracolumbar burst fractures were surgically induced at L-1, and testing was repeated sequentially for each of the following fixation techniques: short-segment anterolateral, circumferential, and extended anterolateral. Primary and coupled 3D motions were measured across the instrumented site (T12-L2) and compared across treatment groups.


RESULTS
Circumferential and extended anterolateral fixations were statistically equivalent for primary and off-axis range-of-motions in all loading directions, and short-segment anterolateral fixation offered significantly less rigidity than the other 2 methods.


CONCLUSIONS
The results of this study strongly suggest that extended anterolateral fixation is biomechanically comparable to circumferential fusion in the treatment of unstable thoracolumbar burst fractures with posterior column and posterior ligamentous injury. In cases in which an anterior procedure may be favored for load sharing or canal decompression, extension of the anterior instrumentation and fusion one level above and below the unstable segment can result in near equivalent stability to a 2-stage circumferential procedure.
Acosta
Frank L
FL
Department of Neurological Surgery, University of California, San Francisco, California 94143, USA.
Buckley
Jenni M
JM
Xu
Zheng
Z
Lotz
Jeffrey C
JC
Ames
Christopher P
CP
D000368:Aged; D001696:Biomechanical Phenomena; D002102:Cadaver; D019299:Decompression, Surgical; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D016268:Internal Fixators; D008159:Lumbar Vertebrae / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D013117:Spinal Cord Compression / Q000209:etiology / Q000601:surgery; D016103:Spinal Fractures / Q000150:complications / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000293:injuries*