title: The successful short-term treatment of flexion-distraction injuries of the thoracic spine using posterior-only pedicle screw instrumentation.
abstract: METHODS
  In this retrospective study, the results of treating unstable flexion-distraction injuries (FDI) of the thoracic spine with posterior-only thoracic pedicle screw (P/TPS) instrumentation were investigated.
  
  
  OBJECTIVE
  The objective was to determine the ability of P/TPS to correct and maintain the focal kyphosis of the injured spine. Clinical outcome and complications of the surgical procedure were also a focus of the study.
  
  
  BACKGROUND
  The treatment of FDI of the thoracic spine remains controversial. There continues to be difficulty in maintaining the corrected kyphosis angle regardless of the surgical approach used.
  
  
  METHODS
  Eighteen patients with FDI of thoracic spine who underwent P/TPS were identified. The initial and corrected focal kyphosis was evaluated radiographically. Failure of treatment was defined as a >5-degree progression of corrected kyphosis from initial to latest follow-up. Clinical evaluation included complication rate, Injury Severity Score, and Frankel grade.
  
  
  RESULTS
  Of the 18 eligible patients, 15 (83%) had adequate follow-up for evaluation. The mean length of follow-up care was 16.1 months. The average Injury Severity Score was 23. The average number of instrumented levels was 6.8. The focal kyphosis of the injury was reduced from a mean of 19.60 to 5.73 degrees (P<0.001), with an average progression of only 2.27 degrees (P=0.128) at final follow-up. Complications were limited to wound infections and occurred in 2 study participants. Neurologic status returned to normal in all patients with incomplete cord injuries.
  
  
  CONCLUSIONS
  FDI of the thoracic spine may be amendable to a uniform surgical approach with P/TPS. This procedure carried a relatively low complication rate and allowed for reduction and restoration of the posterior tension band with a biomechanically rigid construct.
authors.affiliation: Department of Orthopaedics, Stony Brook University Medical Center, Spine and Scoliosis Center, T-18 Health Sciences Center, Stony Brook, NY 11794-8181, USA.
authors.forename: Samuel Abraham
authors.initials: SA
authors.lastname: Joseph
authors.forename: Mark
authors.initials: M
authors.lastname: Stephen
authors.forename: Bruce P
authors.initials: BP
authors.lastname: Meinhard
mesh_terms: D000328:Adult; D001863:Bone Screws; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D013124:Spinal Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome