title: Two additional augmenting screws with posterior short-segment instrumentation without fusion for unstable thoracolumbar burst fracture - Comparisons with transpedicular grafting techniques.
abstract: BACKGROUND
  Transpedicular grafting techniques with posterior short-segment instrumentation have demonstrated to prevent high implant failure in unstable thoracolumbar burst fractures. We tested our hypothesis that short-segment instrumentation with two additional augmenting screws in the injured vertebra could provide stability and was similar to those of the transpedicular grafting technique.
  
  
  METHODS
  Twenty patients belonged to group A; treated with short-segment pedicle screw fixation and reinforced by two augmenting screws at the fractured vertebra. Group B had thirty-one patients; the fractured vertebra was augmented with transpedicular autogenous bone graft. Group C had twenty patients; the injured vertebra was strengthened with calcium sulfate cement. Clinical outcome and radiographic parameters were compared.
  
  
  RESULTS
  Group A had the least blood loss (101.7 ± 72.5 vs. 600 ± 403.1 vs. 247.5 ± 164.2 ml, p < 0.001) and the least operation time (142.0 ± 57.2 vs. 227.2 ± 43.6 vs. 161.6 ± 28.5 min, p < 0.001). However, group A had the highest collapsed rate of the body height at the 18-month follow-up (10.5 ± 7.0 vs. 4.6 ± 4.8 vs. 7.2 ± 8.5%, p = 0.002). The failure rate, include implant failure or loss of 10° or more of correction, group B had the lowest failure rate (10% vs. 3.2% vs. 10%, p = 0.542). The group A had the highest rate of return to their previous employment (50% vs. 38% vs. 35%, p = 0.265).
  
  
  CONCLUSIONS
  Compared with transpedicular grafting techniques, additional two "augmenting screws" in the fracture vertebra with short-segment instrumentation are sufficient for one-level thoracolumbar burst fracture.
authors.affiliation: Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Yu-Chih
authors.initials: YC
authors.lastname: Lin
authors.affiliation: Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Kuo-Fon
authors.initials: KF
authors.lastname: Fan
authors.affiliation: Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan. Electronic address: jcl1265@adm.cgmh.org.tw.
authors.forename: Jen-Chung
authors.initials: JC
authors.lastname: Liao
mesh_terms: D000328:Adult; D000368:Aged; D001843:Bone Cements / Q000627:therapeutic use; D001863:Bone Screws; D016025:Bone Transplantation / Q000379:methods; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016103:Spinal Fractures / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements
keywords: Augmenting screw; Posterior short-segment instrumentation; Thoracolumbar burst fracture; Transpedicular grafting