title: Posterior fixation including the fractured vertebra for severe unstable thoracolumbar fractures.
abstract: BACKGROUND
  Traditional short-segment fixation of unstable thoracolumbar injuries can be associated with progressive kyphosis and implant failure. Load sharing classification (LSC) recommends supplemental anterior reconstruction for fractures of score 7 or greater. Posterior fixation including the fractured vertebra (PFFV) has biomechanical advantages over conventional short-segment fixation. However, its efficacy in severe thoracolumbar injuries (LSC≥7) has not been studied.
  
  
  OBJECTIVE
  To study the clinical, functional, and radiologic results of PFFV for severe, unstable thoracolumbar injuries (LSC≥7) at a minimum of 2 years.
  
  
  METHODS
  A retrospective review of case records.
  
  
  METHODS
  Thirty-two patients with an unstable burst fracture of LSC≥7 treated with PFFV were included.
  
  
  METHODS
  They included clinical outcomes: American Spinal Injury Association grade, visual analog scale (VAS), Oswestry Disability Index (ODI); and radiologic measures: segmental kyphosis angle, vertebral wedge angle, and percentage loss of anterior and posterior vertebral height.
  
  
  METHODS
  Thirty-two patients with LSC≥7 who had undergone PFFV, with a minimum follow-up of 2 years were studied for demographic, injury, and surgical details. Clinical and radiologic outcomes were measured before surgery and at 6, 12, and 24 months postoperatively. The presence of screw breakage, screw pullout, peri-implant loosening, and rod breakage were considered as criteria for implant failure.
  
  
  RESULTS
  None of the patients had postoperative implant failure at the final follow-up. The mean preoperative kyphosis angle was 22.9°±7.6°. This improved significantly to 9.2°±6.6° after surgery (p=.000). There was a loss of mean 2.4° (mean kyphosis angle of 11.6°±6.3°) at the final follow-up. The mean preoperative wedge angle was 23.0°±8.1°. This was corrected to 9.7°±6.2° (p=.000). There was a loss of kyphosis (mean 1.2°) in the follow-up period. The mean anterior and posterior vertebral height also showed significant improvements postoperatively, which were maintained at the final follow-up. The mean ODI and VAS scores at the end of 2 years were 17.5% and 1.6, respectively.
  
  
  CONCLUSIONS
  Reduction of unstable thoracolumbar injuries even with LSC≥7 can be achieved and maintained with the use of short-segment pedicle screw fixation including the fractured vertebra, avoiding the need for anterior reconstruction. In the current era of evolving concepts of fracture fixation, the relevance of LSC in the management of unstable burst fractures is questionable.
authors.affiliation: Department of Orthopaedics and Spine Surgery, Ganga Hospital, 313, Mettupalayam Rd, Coimbatore 641043, Tamil Nadu, India.
authors.forename: Rishi M
authors.initials: RM
authors.lastname: Kanna
authors.affiliation: Department of Orthopaedics and Spine Surgery, Ganga Hospital, 313, Mettupalayam Rd, Coimbatore 641043, Tamil Nadu, India.
authors.forename: Ajoy Prasad
authors.initials: AP
authors.lastname: Shetty
authors.affiliation: Department of Orthopaedics and Spine Surgery, Ganga Hospital, 313, Mettupalayam Rd, Coimbatore 641043, Tamil Nadu, India. Electronic address: sr@gangahospital.com.
authors.forename: S
authors.initials: S
authors.lastname: Rajasekaran
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D007738:Kyphosis / Q000601:surgery; D008159:Lumbar Vertebrae / Q000293:injuries* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D065289:Pedicle Screws; D011184:Postoperative Period; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000293:injuries* / Q000601:surgery
keywords: Intermediate screw; Kyphosis; Load sharing classification; Posterior; Short segment; Thoracolumbar; Trauma