Posterior short-segment instrumentation and limited segmental decompression supplemented with vertebroplasty with calcium sulphate and intermediate screws for thoracolumbar burst fractures.
OBJECTIVE
Thoracolumbar burst fractures treated with short-segment posterior instrumentation without anterior column support is associated with a high incidence of implant failure and correction loss. This study was designed to evaluate the clinical and radiographic results following posterior short-segment instrumentation and limited segmental decompression supplemented with vertebroplasty with calcium sulphate and intermediate screws for patients with severe thoracolumbar burst fractures.


METHODS
Twenty-eight patients with thoracolumbar burst fractures of LSC point 7 or more underwent this procedure. The average follow-up was 27.5 months. Demographic data, radiographic parameters, neurologic function, clinical outcomes and treatment-related complications were prospectively evaluated.


RESULTS
Loss of vertebral body height and segmental kyphosis was 55.3 % and 20.2° before surgery, which significantly improved to 12.2 % and 5.4° at the final follow-up, respectively. Loss of kyphosis correction was 2.2°. The preoperative canal encroachment was 49 % that significantly improved to 8.8 %. The preoperative pain and function level showed a mean VAS score of 9.2 and ODI of 89.9 % that improved to 1.4 and 12.9 % at the final follow-up, respectively. No implant failure was observed in this series, and cement leakage occurred in two cases without clinical implications.


CONCLUSIONS
Excellent reduction and maintenance of thoracolumbar burst fractures can be achieved with short-segment pedicle instrumentation supplemented with anterior column reconstruction and intermediate screws. The resultant circumferential stabilization combined with a limited segmental decompression resulted in improved neurologic function and satisfactory clinical outcomes, with a low incidence of implant failure and progressive deformity.
Department of Spinal Surgery, Tianjin Hospital, 406 Jiefang South Road, Tianjin, 300211, China, changbaochen@gmail.com.
Changbao
C
Chen
Gongyi
G
Lv
Baoshan
B
Xu
Xiaolin
X
Zhang
Xinlong
X
Ma
D000328:Adult; D001843:Bone Cements; D002133:Calcium Sulfate; D019299:Decompression, Surgical / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000601:surgery; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D065289:Pedicle Screws; D011446:Prospective Studies; D011859:Radiography; D020127:Recovery of Function; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D054854:Vertebroplasty; D064232:Visual Analog Scale; D055815:Young Adult
D001843:Bone Cements; D002133:Calcium Sulfate