多节段胸腰椎脊柱骨折的手术治疗

目的探讨椎弓根钉棒系统治疗多节段胸腰椎脊柱骨折的手术方式与疗效。方法采用后路切开复位、椎弓根钉棒系统内固定、选择性椎管减压及后外侧植骨融合手术治疗44例多节段胸腰椎骨折患者,对患者术前与随访时的ASIA分级、伤椎椎体高度矫正率进行分析。结果全部患者平均随访12个月,未发现内固定物松动、断裂,椎体高度由术前平均49.3%恢复至术后平均92.5%。ASIA分级较术前平均提高1.2级。结论后路切开复位、椎弓根钉棒系统内固定基础上选择性椎管减压＋植骨融合是治疗多节段胸腰椎脊柱骨折的理想选择。     

An analysis of burst fractures of the spine in adolescents

Burst fractures are less common in children than in adults because of the greater mobility and elasticity of the pediatric spine. Because of these spine characteristics, these fractures may behave differently in childhood than in adulthood. To try to address these differences, we reviewed our experience with 11 children (5 boys, 6 girls) treated for burst fractures. Average age at time of injury was 14.4 years. Follow-up averaged 9 years. All fractures were categorized using the Denis classification system for burst fractures. Three children had associated spinal cord injury. Five children were treated with nonoperative bedrest and casting; the other 6 children, who had the most severe burst fractures, were treated with posterior spinal fusion and instrumentation. Satisfactory functional results were found in 90% of the children at follow-up. Radiological evaluation at initial and follow-up examination showed that children treated operatively improved or maintained their fracture kyphosis (range, 12 degrees - 19 degrees). Anterior vertebral compression improved an average of 15% (range, 24%-39%). In the children treated nonoperatively, kyphosis progressed an average of 9 degrees (range, 15 degrees - 24 degrees), and anterior vertebral compression increased a further 8% (range, 36%-44%). Our results showed that (a) the children who sustained burst fractures tended to develop mild progressive angular deformity at the site of the fracture, (b) operative stabilization prevented further kyphotic deformity as well as decreased the length of hospitalization without contributing to further cord compromise, and (c) nonoperative treatment of burst fracture was a viable option in neurologically intact children, but progressive angular deformity occurred during the first year after the fracture.     

“Outcome of thoracolumbar compression fractures following non-operative treatment”

Axial compressive/flexion moderate forces on the anterior spinal elements may cause vertebral compression fractures (VCF), compromising the anterior column of the spine, reducing vertebral body height and leading to characteristic wedge-shaped deformity. 60% to 75% of VCFs are located in the thoracolumbar junction (T12 – L2) due to mechanical forces upon the transition from the relatively fixed thoracic to the relatively mobile lumbar spine. Compression force spinal fractures vary in literature according to the classification system in use, resulting in controversial treatment options. Type A fracture patterns of AO classification are eligible for non-operative treatment provided the posterior complex is intact and there are no neurologic complications. That includes both simple compressive and burst fractures. The aim of this study is to investigate the long-term consequences of non-operative treated compressive thoracolumbar fractures regarding posttraumatic deformity, chronic back pain, and functional status. A retrospective study of 75 patients with stable (compressive and burst type A AO) spinal fractures of the thoracolumbar spine (T12-L2) without neurological symptoms and treated non-operatively was conducted. Post traumatic regional kyphosis, Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI) were used to evaluate deformity progression, pain and alteration of the quality of life during follow up. There was no significant correlation between magnitude of posttraumatic regional kyphosis, sex, pain score and disability index. Statistically significant correlation between patients age and disability index was revealed.     

Treatment of acute thoracolumbar burst fractures with kyphoplasty and short pedicle screw fixation: Transpedicular intracorporeal grafting with calcium phosphate: A prospective study

Background:

In the surgical treatment of thoracolumbar fractures, the major problem after posterior correction and transpedicular instrumentation is failure to support the anterior spinal column, leading to loss of correction and instrumentation failure with associated complaints. We conducted this prospective study to evaluate the outcome of the treatment of acute thoracolumbar burst fractures by transpedicular balloon kyphoplasty, grafting with calcium phosphate cement and short pedicle screw fixation plus fusion.

Materials and Methods:

Twenty-three consecutive patients of thoracolumbar (T₉ to L₄) burst fracture with or without neurologic deficit with an average age of 43 years, were included in this prospective study. Twenty-one from the 23 patients had single burst fracture while the remaining two patients had a burst fracture and additionally an adjacent A1-type fracture. On admission six (26%) out of 23 patients had neurological deficit (five incomplete, one complete). Bilateral transpedicular balloon kyphoplasty with liquid calcium phosphate to reduce segmental kyphosis and restore vertebral body height and short (three vertebrae) pedicle screw instrumentation with posterolateral fusion was performed. Gardner kyphosis angle, anterior and posterior vertebral body height ratio and spinal canal encroachment were calculated pre- to postoperatively.

Results:

All 23 patients were operated within two days after admission and were followed for at least 12 months after index surgery. Operating time and blood loss averaged 45 min and 60 cc respectively. The five patients with incomplete neurological lesions improved by at least one ASIA grade, while no neurological deterioration was observed in any case. The VAS and SF-36 (Role physical and Bodily pain domains) were significantly improved postoperatively. Overall sagittal alignment was improved from an average preoperative 16° to one degree kyphosis at final followup observation. The anterior vertebral body height ratio improved from 0.6 preoperatively to 0.9 (P<0.001) postoperatively, while posterior vertebral body height improved from 0.95 to 1 (P<0.01). Spinal canal encroachment was reduced from an average 32% preoperatively to 20% postoperatively. Cement leakage was observed in four cases (three anterior to vertebral body and one into the disc without sequalae). In the last CT evaluation, there was a continuity between calcium phosphate and cancellous vertebral body bone. Posterolateral radiological fusion was achieved within six months after index operation. There was no instrumentation failure or measurable loss of sagittal curve and vertebral height correction in any group of patients.

Conclusions:

Balloon kyphoplasty with calcium phosphate cement secured with posterior short fixation in the thoracolumbar spine provided excellent immediate reduction of posttraumatic segmental kyphosis and significant spinal canal clearance and restored vertebral body height in the fracture level.     

后路短节段椎弓根内固定治疗无神经损伤胸腰段爆裂骨折

目的　探讨后路短节段椎弓根内固定、经椎弓根椎体内植骨对无神经损伤胸腰段爆裂骨折的治疗效果。方法　对 2 2例无神经损伤的胸腰段爆裂骨折 ,采用短节段椎弓根内固定器复位固定、经椎弓根椎体内植骨 ,术前、后摄X线片、CT扫描。结果　术后伤椎高度明显恢复 ,后凸显著矫正 (P <0 0 5 ) ;术后 1年 ,后凸矫正度数大量丢失 (P <0 0 5 )。结论　后路短节段椎弓根内固定是治疗无神经损伤胸腰段爆裂骨折的一种理想方法 ,经椎弓根椎体内植骨不能阻止后凸矫正度数的丢失。     

Transpedicular short-segment fusions for treatment of lumbar burst fractures.

A retrospective review of 13 patients who underwent decompression and transpedicular instrumentation for lumbar burst fractures is presented. Average follow-up was 22.5 months. Eighty-four percent of patients reported little or no pain at follow-up. Sixty-nine percent of patients returned to full preinjury activity. Radiographic review demonstrated an average postoperative progression of kyphosis of 8.7%. Anterior vertebral body height was unchanged between preoperative evaluation and follow-up. Although short-segment posterior transpedicular instrumentation with VSP plates did not reestablish or maintain anatomic alignment of the lumbar spine after burst fractures, the clinical outcome was excellent.     

Recurrence of kyphosis and its functional implications after surgical stabilization of dorsolumbar unstable burst fractures

Background contextTreatment of unstable burst fractures in the dorsolumbar spine still remains controversial. Surgical stabilization has been aimed to prevent long-term back pain and progression of deformity.PurposeThis study was aimed to analyze the degree of loss of correction of the angle of kyphosis with pedicle screw instrumentation in place and the components responsible for the recurrence of kyphosis after surgical stabilization of dorsolumbar A3 fractures and to assess the return of functional capacity in these patients.Study designRetrospective study.Patient sampleThis study involves 26 patients who had dorsolumbar unstable burst fractures (Arbeitsgemeinschaft für Osteosynthesefragen type A3).Outcome measuresRadiological assessment at injury, immediate postoperative period, and most recent follow-up along with functional assessment using short form 36 (SF-36) and return to work.MethodsAll the patients had posterior pedicle screw instrumentation without fusion for unstable dorsolumbar burst compression (A3) fractures. The mean follow-up period was 25.5 months. All of them had their fractures stabilized with Universal Spinal System (Synthes, Welwyn Garden City, UK) Fracture System. Serial standing lateral radiographs were taken from the immediate postoperative period to the most recent follow-up. The angle of kyphosis; the heights of the discs above and below the fractured vertebra; and the heights of the vertebral bodies above, at, and below the fractured level were measured. The height at each level was measured in three segments (anterior, middle, and posterior). The values were normalized to avoid discrepancies while comparing radiographs. The difference in the height of each segment measured between the immediate postoperative period and the most recent follow-up was computed.ResultsThe mean angle of kyphosis was 6.3±8.9 in the immediate postoperative period and 15.7±6.7 at the most recent follow-up (p<.001). The mean patient function score from SF-36 was 52.3%, and the mean pain score was 44.9%. There was no relationship to the loss of correction angle of kyphosis to the patient function score (r=0.06, p=.76) and the pain score (r=0.11, p=.58). The correlation between the corresponding difference in the height of each segment and the degree of loss of correction of the angle of kyphosis showed positive correlation to the decrease in the anterior and middle segment heights at the fractured vertebral level.ConclusionThere is a progressive loss of correction of the angle of kyphosis after posterior stabilization with instrumentation even without implant removal that mainly corresponds to the decrease in the anterior segment height of the fractured vertebral body.     

Short-segment pedicle instrumentation of thoracolumbar burst fractures: does transpedicular intracorporeal grafting prevent early failure?

STUDY DESIGN: A prospective, randomized study comparing two treatment methods for thoracolumbar burst fractures: short-segment instrumentation with transpedicular grafting and the same procedure without transpedicular grafting. OBJECTIVE: To evaluate the efficacy of transpedicular grafting in preventing failure of short-segment fixation for the treatment of thoracolumbar burst fractures. SUMMARY OF BACKGROUND DATA: Short-segment pedicle instrumentation for thoracolumbar burst fractures is known to fail early because of the absence of anterior support. Additional transpedicular grafting has been offered as an alternative to prevent this failure. However, there is controversy about the results of transpedicular grafting. METHODS: Twenty patients with thoracolumbar burst fractures were included in the study. The inclusion criterion was the presence of fractures through the T11-L3 vertebrae without neurologic compromise. The patients were randomized by a simple method into two groups. Group 1 patients were treated using short-segment instrumentation with transpedicular grafting (TPG) (n = 10), and Group 2 patients were treated by short-segment fixation alone (NTPG) (n = 10). Clinical (Likert's questionnaire) and radiologic (sagittal index, percentage of anterior body height compression, and local kyphosis) outcomes were analyzed. RESULTS: The two groups were similar in age, follow-up period, and severity of the deformity and fracture. The postoperative and follow-up sagittal index, percentage of anterior body height compression, and average correction loss in local kyphosis in both groups were not significantly different. The failure rate, defined as an increase of 10 degrees or more in local kyphosis and/or screw breakage, was also not significantly different (TPG = 50%, NTPG = 40%, P = 0.99). CONCLUSIONS: Short-segment transpedicular instrumentation of thoracolumbar burst fractures is associated with a high rate of failure that cannot be decreased by additional transpedicular intracorporeal grafting.     

钉棒及钩棒系统治疗胸腰椎多节段脊柱骨折

目的评价钉棒及钩棒系统治疗胸腰椎多节段脊柱骨折的临床疗效。方法23例多节段胸腰椎骨折患者，后路切开复位，选择性椎管减压．钉棒或钩棒系统内固定及后外侧植骨融合进行手术治疗。其中相邻多节段型13例，非相邻多节段型8例，混合型2例。结果全组病例平均随访14个月，未发现内固定物松动、断离，无继发性脊柱后凸畸形加重。椎体高度由术前平均48．4％恢复至术后平均92．4%。2例完全性及11例不完全性脊髓损伤者．脊髓神经功能获改善。结论在椎管进行充分减压的基础上．钉棒及钩棒系统能有效复位椎体骨折，重建脊柱稳定性，是多节段胸腰椎不稳定性骨折合并脊髓神经损伤后路手术的理想选择。     

一期经后路三柱重建技术治疗胸腰椎爆裂骨折

目的 探讨严重胸腰椎爆裂骨折应用经后路进行脊柱三柱重建技术的临床效果.方法 对24例胸腰椎爆裂骨折采用经后路椎体次全切除、钛网置入及椎弓根钉重建术治疗.采用Frankel评定标准评定术后神经功能恢复情况.通过影像学变化评价后凸畸形矫正情况和椎管减压程度.结果 本组获随访13～46个月,平均24个月.椎体高度术后恢复至正常高度的97.8％.椎体后凸畸形角度矫正至术后3.5°.椎管容积矫正至术后椎管压迫完全解除.所有患者神经症状均有不同程度恢复.结论 经后路进行脊柱三柱重建技术,能有效矫正胸腰椎爆裂骨折的后凸畸形、解除椎管内压迫,达到术后即刻稳定,具有骨折复位满意,手术创伤较小及并发症少等特点.     

经椎弓根植骨和椎体成形术治疗胸腰椎爆裂性骨折

目的 探讨经椎弓根植骨和椎体成形术治疗胸腰椎爆裂性骨折的方法和效果。方法 采用经椎弓根植骨椎体成形术治疗胸腰椎爆裂骨折24例并与同期同类骨折31例作比较性研究。结果 治疗组24例有1例螺钉松动,松动率4％,无断钉。对照组31例有8例内固定不同程度松动,松动率25％,2例断钉,断钉率6％。治疗组,对照组在前后缘高度的恢复,术前术后Cobb角的纠正,螺钉松动,断钉率等项指标中均存在着显著性差异(P<0.05)。结论 经椎弓根椎体植骨成形术重建了椎体高度,增加了脊柱前柱的抗压稳定性,使病人能早期活动,减少内固定物因应力过大造成的断钉、松动、椎体再压缩等并发症。     

Loss of correction after dorsal stabilization of burst fractures of the thoracolumbar junction. The role of transpedicular spongiosa plasty

Short segment pedicle instrumentation for thoracolumbar burst fracture is known to fail due to lack of anterior support. Additional transpedicular grafting and dorsolateral fusion were offered to prevent its failure. The purpose of this study was to analyse the clinical and radiological outcome in two identical groups of patients treated with short segment pedicle instrumentation and posterolateral fusion with and without inter- and intracorporal transpedicular bone grafting. The clinical and radiological results of two identical groups of patients with thoracolumbar burst fractures were analysed. 15 patients (2 f, 13 m), mean age 35 years, were treated with bisegmental fixation with the fixateur interne and unisegmental fusion. Further 15 patients (3 f, 12 m), mean age 34 years, obtained additional intra- and intercorporal bone grafting. The implants were removed 15 resp. 13 months post surgery. Latest clinical and radiological follow-up was at 61/24 months. The clinical results were identical in both groups. Radiological measurements showed a significant loss of correction for all three measured angles (vertebral kyphosis, unisegmental kyphosis and bisegmental kyphosis) in both groups. However, patients with transpedicular bone grafting showed less loss of bony, vertebral kyphosis. Neither dorsolateral fusion nor dorsolateral fusion with transpedicular bone grafting could prevent loss of angular corrections.     

Reduction of the intracanal fragment in experimental burst fractures

An experimental investigation was carried out to create burst fractures and to evaluate the mechanisms and degree of reduction of the intracanal fragment with posterior instrumentation techniques in multisegmental human cadaver specimens. Reduction of the spinal fragment through kyphosis correction and distraction was evaluated using CT imaging. With kyphosis correction alone there was no decrease in canal compromise; in some cases there was a slight increase in canal compromise. Distraction, whether applied before or after kyphosis correction was the effective mechanism in reducing the fracture fragment. Kyphosis correction applied after distraction did not reduce the fragment further. Posterior devices that are used to treat burst fractures of the thoracolumbar spine with intracanal fragments should provide some form of distraction.     

Percutaneous vertebroplasty for the treatment of osteoporotic burst fractures

Background  Vertebroplasty is a minimally invasive surgical procedure which involves injecting polymethylmethacrylate into the compressed vertebral body. At present the indications include the treatment of osteoporotic compression fractures, vertebral myeloma, and metastases. The value of vertebroplasty in osteoporotic compression fracture has been discussed comprehensively. The surgical operation for burst fractures without neurological deficit remains controversial. Some authors have asserted that vertebroplasty is contraindicated in patients with burst fracture. However, we performed the procedure, after considering the patents general condition, to reduce surgical risks and the duration of immobilisation. The purpose of this study is to investigate clinical outcomes, kyphosis correction, wedge angle, and height restoration of thoraco-lumbar osteoporotic burst fractures treated by percutaneous vertebroplasty. Materials and methods  Twenty-five patients with osteoporotic burst fracture were treated with postural reduction followed by vertebroplasty. We measured the kyphosis, wedge angle, spinal canal compromise and the height of the fractured vertebral body initially, after postural reduction, and after vertebroplasty. Findings  The average height of the collapsed vertebral bodies was 24.8% of the original height. Average kyphosis angle was 19.4° and average wedge angle was 19.8° at first. Mean canal encroachment was initially 25.1%. Kyphosis angle, wedge angle, and anterior, middle, and posterior height improved significantly after the procedure. The mean amelioration of the spinal canal encroachment after vertebroplasty was 23.3%. The average increase in anterior vertebral body height was 7.5 mm, central was 5.8 mm, and posterior was 0.9 mm. The mean reduction in kyphosis angle was 6.8° and the mean reduction in wedge angle was 9.7°. Conclusion  Although vertebroplasty has been considered as contraindicated in thoraco-lumbar burst fractures, we successfully used the procedure as a safe treatment in patients with osteoporotic burst fracture without neurologic deficit. This method could eliminate the need for and risks of major spinal surgery. We would like to offer it as a relatively safe and effective methods of management in thoraco-lumbar burst fractures.     

Posterior instrumentation for thoracolumbar fractures

Thoracolumbar fractures are relatively common injuries. Numerous classification systems have been developed to characterize these fractures and their prognostic and therapeutic implications. Recent emphasis on short, rigid fixation has influenced surgical management. Most compression and stable burst fractures should be treated nonsurgically. Neurologically intact patients with unstable burst fractures that have >25 degrees of kyphosis, >50% loss of vertebral height, or >40% canal compromise often can be treated with short, rigid posterior fusions. Patients with unstable burst fractures and neurologic deficits require direct or indirect decompression. Posterior stabilization can be effective with Chance fractures and flexion-distraction injuries that have marked kyphosis, and in translational or shear injuries. Advances in understanding both biomechanics and types of fixation have influenced the development of reliable systems that can effectively stabilize these fractures and permit early mobilization.     

Evaluation of surgical treatment for burst fractures

The authors instituted a prospective, randomized study of patients presenting with acute burst fractures of the thoracolumbar and lumbar spine. Patients were alternately treated by posterior distraction using pedicle instrumentation (AO fixateur interne) or anterior decompression and instrumentation (Kostuik-Harrington device). Forty patients are presented with a mean follow-up of 20 months. Preoperatively, there was significant canal compromise in 39 patients. This measured 44.5% in those patients undergoing posterior surgery and 58% in those patients undergoing anterior surgery. Postoperatively, this was reduced to 16.5% and 4%, respectively. There is a statistically significant difference between these two groups (P less than 0.0001). The mean preoperative kyphotic deformity was 18.7 degrees in those patients treated by anterior surgery and 18.2 degrees in the group treated by posterior surgery. At last follow-up, the mean improvement in kyphotic deformity was 9.3 degrees in the anterior group and 11.3 degrees in the posterior group. There is no statistically significant difference between these two groups. There were two implant failures of the anterior Kostuik-Harrington construct and two implant failures of the AO fixateur interne. Blood loss was significantly higher in the patients undergoing anterior surgery, but there were no complications from thoracotomy and anterior decompression of the dural sac. This study supports the hypothesis that posterior distraction instrumentation can effectively decompress the canal and correct kyphosis in patients sustaining burst-type injuries. Anterior surgery, however, results in a more complete and reliable decompression of the canal.     

The effect of transpedicular intracorporeal grafting in the treatment of thoracolumbar burst fractures on canal remodeling

Short-segment posterior instrumentation for the treatment of thoracolumbar burst fractures has been reported with a high rate of failure. Transpedicular intracorporeal grafting in combination with short-segment instrumentation has been offered as an alternative to prevent failure. However, concern still remains about the potential complication of further canal narrowing or failure of remodeling with this technique. The purpose of this prospective, randomized, controlled study is to evaluate the effect of transpedicular intracorporeal grafting on spinal canal restoration and remodeling in a group of patients treated with short-segment instrumentation for thoracolumbar burst fractures. Twenty-one patients with thoracolumbar burst fractures were randomised into transpedicular grafting (TPG) (n=11) and non-transpedicular grafting (NTPG) (n=10) groups, and were prospectively followed for an average of 50 months (range 25-85 months). Groups were similar in age, type of fracture, load sharing classification and kyphotic deformity. Preoperative, postoperative and follow-up computed tomographic (CT) images through the level of pedicles were obtained, corrected for differences in magnification, and digitized. Areas of the spinal canals were measured and normalized by the estimated area at that level (average of adjacent levels). Average kyphosis was 19.7 degrees+/-6.2 degrees at presentation, was corrected to 1.9 degrees+/-4.9 degrees by operation, but was found to have deteriorated to 9.1 degrees+/-6.4 degrees at final follow-up. There were no differences between groups regarding the evolution of sagittal deformity. Spinal canal narrowing was 38.5+/-18.2% at presentation, 22.1+/-19.8% postoperatively, and it further improved to -2.5+/-16.7% at follow-up, similar for both groups. Our results demonstrate that transpedicular intracorporeal grafting in the treatment of burst fractures does not have a detectable effect on the rate of reconstruction of the canal area or on remodeling. Spinal canal remodeling was observed to occur in all patients regardless of grafting.     

Nonoperatively treated burst fractures of the thoracic and lumbar spine in adults: a 23- to 41-year follow-up

BACKGROUND CONTEXT: Several studies report a favorable short-term outcome after nonoperatively treated two-column thoracic or lumbar burst fractures in patients without neurological deficits. Few reports have described the long-term clinical and radiological outcome after these fractures, and none have, to our knowledge, specifically evaluated the long-term outcome of the discs adjacent to the fractured vertebra, often damaged at injury and possibly at an increased risk of height reduction and degeneration with subsequent chronic back pain. PURPOSE: To evaluate the long-term clinical and radiological outcome after nonoperatively treated thoracic or lumbar burst fractures in adults, with special attention to posttraumatic radiological disc height reduction. STUDY DESIGN: Case series. PATIENT SAMPLE: Sixteen men with a mean age of 31 years (range, 19-44) and 11 women with a mean age of 40 years (range, 23-61) had sustained a thoracic or lumbar burst fracture during the years 1965 to 1973. Four had sustained a burst fracture Denis type A, 18 a Denis type B, 1 a Denis type C, and 4 a Denis type E. Seven of these patients had neurological deficits at injury, all retrospectively classified as Frankel D. OUTCOME MEASURES: The clinical outcome was evaluated subjectively with Oswestry score and questions regarding work capacity and objectively with the Frankel scale. The radiological outcome was evaluated with measurements of local kyphosis over the fractured segment, ratios of anterior and posterior vertebral body heights, adjacent disc heights, pedicle widths, sagittal width of the spinal canal, and lateral and anteroposterior displacement. METHODS: From the radiographical archives of an emergency hospital, all patients with a nonoperatively treated thoracic or lumbar burst fracture during the years 1965 to 1973 were registered. The fracture type, localization, primary treatment, and outcome were evaluated from the old radiographs, referrals, and reports. Twenty-seven individuals were clinically and radiologically evaluated a mean of 27 years (range, 23-41) after the injury. RESULTS: At follow-up, 21 former patients reported no or minimal back pain or disability (Oswestry Score mean 4; range, 0-16), whereas 6 former patients (of whom 3 were classified as Frankel D at baseline) reported moderate or severe disability (Oswestry Score mean 39; range, 26-54). Six former patients were classified as Frankel D, and the rest as Frankel E. Local kyphosis had increased by a mean of 3 degrees (p<.05), whereas the discs adjacent to the fractured vertebrae remained unchanged in height during the follow-up. CONCLUSIONS: Nonoperatively treated burst fractures of the thoracic or lumbar spine in adults with or without minor neurological deficits have a predominantly favorable long-term outcome, and there seems to be no increased risk for subsequent disc height reduction in the adjacent discs.     

Kyphoplasty as an alternative treatment of traumatic thoracolumbar burst fractures Magerl type A3

IntroductionTraumatic thoracolumbar spine fractures are frequently classified as burst fractures Magerl type A3. There still are many controversies regarding the treatment of this fracture. The therapeutic spectrum ranges from conservative to invasive operative methods with attendant morbidities. The minimal-invasive technique of kyphoplasty has established itself as a common treatment of osteoporotic vertebral compression fractures and is associated with a low complication rate. The aim of this study is to evaluate the functional and radiological results after kyphoplasty of traumatic thoracolumbar burst fractures.Patients and methodsPatients with traumatic thoracolumbar fractures type A3.1, A3.2 and A3.3, who were treated with kyphoplasty, were included in this study. The clinical outcome was measured at follow up with a neurological assessment, the visual analogue pain scale (VAS), the Oswestry Disability Score (ODI) and the SF-36 Health Survey. The radiological measurements, performed on preoperative, postoperative and follow up radiographs, included the sagittal index, the wedge angle and the modified Cobb angle of Daniaux.Results26 patients with 23 A3.1, one A3.2 and five A3.3 fractures were treated between 2004 and 2007, including five patients with multiple vertebral fractures. At follow up the Oswestry Disability Score (26.2%) and the SF-36 score (60.1%) assessed a moderately limitation of functional outcome and quality of life without any neurological deficits. Radiological measurements showed a postoperative height restoration and reduction of kyphosis, but at follow up a secondary loss of correction except in five cases. Six minor ventrocranial cement leakages without further clinical consequence were observed.ConclusionsThe present study showed that kyphoplasty is a safe and feasible method for the treatment of burst fractures. It allowed the correction of the kyphosis, stabilisation of the facture, pain reduction and early mobilisation.     

A review of the management of thoracolumbar burst fractures

BACKGROUND: Burst fractures account for more than half of all thoracolumbar fractures, which often cause a neurologic deficit and present a significant economic burden to the family and society. Accepted methods of treatment of thoracolumbar burst fractures include conservative therapy, posterior reduction and instrumentation, and anterior decompression and instrumentation. However, the management of thoracolumbar burst fractures has been the subject of much controversy. METHODS: Publications reporting clinical data relating to the thoracolumbar burst fractures were reviewed. These articles were determined via review of the results of PubMed searches and articles gathered through compilation of references from those articles. RESULTS: There exist different criteria for the choice of the management based on the severity of kyphotic deformity, canal compromise, vertebral height loss, and neurologic status. To our knowledge, none of the existing criteria for the treatment of thoracolumbar burst fractures are generally accepted. CONCLUSIONS: In thoracolumbar burst fractures without a neurologic deficit, there is no superiority of conservative therapy over operative therapy. When the neurologic involvement is significant, the choice of operative management is advised. Also, there is no obvious superiority of one approach over the other.