title: Short segment pedicle screw instrumentation with an index level screw and cantilevered hyperlordotic reduction in the treatment of type-A fractures of the thoracolumbar spine.
abstract: The purpose of this study was to evaluate and compare the effect of short segment pedicle screw instrumentation and an intermediate screw (SSPI+IS) on the radiological outcome of type A thoracolumbar fractures, as judged by the load-sharing classification, percentage canal area reduction and remodelling. We retrospectively evaluated 39 patients who had undergone hyperlordotic SSPI+IS for an AO-Magerl Type-A thoracolumbar fracture. Their mean age was 35.1 (16 to 60) and the mean follow-up was 22.9 months (12 to 36). There were 26 men and 13 women in the study group. In total, 18 patients had a load-sharing classification score of seven and 21 a score of six. All radiographs and CT scans were evaluated for sagittal index, anterior body height compression (%ABC), spinal canal area and encroachment. There were no significant differences between the low and high score groups with respect to age, duration of follow-up, pre-operative sagittal index or pre-operative anterior body height compression (p = 0.217, 0.104, 0.104, and 0.109 respectively). The mean pre-operative sagittal index was 19.6° (12° to 28°) which was corrected to -1.8° (-5° to 3°) post-operatively and 2.4° (0° to 8°) at final follow-up (p = 0.835 for sagittal deformity). No patient needed revision for loss of correction or failure of instrumentation. Hyperlordotic reduction and short segment pedicle screw instrumentation and an intermediate screw is a safe and effective method of treating burst fractures of the thoracolumbar spine. It gives excellent radiological results with a very low rate of failure regardless of whether the fractures have a high or low load-sharing classification score.
authors.affiliation: Sakarya University, Faculty of Medicine, Department of Orthopedics and Traumatology, Sakarya, Turkey.
authors.forename: K C
authors.initials: KC
authors.lastname: Kose
authors.forename: M E
authors.initials: ME
authors.lastname: Inanmaz
authors.forename: C
authors.initials: C
authors.lastname: Isik
authors.forename: H
authors.initials: H
authors.lastname: Basar
authors.forename: I
authors.initials: I
authors.lastname: Caliskan
authors.forename: E
authors.initials: E
authors.lastname: Bal
mesh_terms: D000293:Adolescent; D000328:Adult; D001863:Bone Screws; D004867:Equipment Design; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
keywords: Burst fracture; Cantilever Hyperlordotic Reduction; Intermediate Screw Fixation; Load sharing classification; Short Segment Instrumentation; Thoracolumbar fracture