Abstract
Objectives
Percutaneous pedicle screw fixation (PPSF) has been a common surgery for treating
thoracolumbar and lumbar fractures. Many studies have reported PPSF is associated
with poor reduction. We present a reliable method by using short-segment monoaxial
percutaneous screws and instrumentational maneuvers to reduce the spine. This study
aimed to evaluate radiological and clinical results of this method of reduction compared
to traditional polyaxial screws method in treating thoracolumbar and lumbar fractures.
Methods
From February 2015 to February 2021, 64 patients with thoracolumbar and lumbar fractures
in our department were retrospectively reviewed and divided into experimental group
and control group according to different treatment methods. The experimental group
was treated with short-segment monoaxial percutaneous screws (which were inserted
at the adjacent vertebrae one level above, one level below the fracture, and the fractured
vertebra) and instrumentational maneuvers method, while the control group was treated
with traditional polyaxial screws method. The operation time was recorded. Visual
analogue scale (VAS) and Oswestry disability index (ODI) were assessed as the clinical
outcomes. The anterior height of the injured vertebra (AVH), the kyphosis cobb angle
and the vertebral wedge angle were used to evaluate the fracture radiological reduction.
Results
A total of 64 patients were enrolled including 31 in the experimental group and 33
in the control group. There were no significant difference in operation time, AVH,
the kyphosis cobb angle,the wedge angle of injured vertebra,VAS and ODI score between
the two groups in preoperation. In each group, there were significant differences
in the AVH, the kyphosis cobb angle and wedge angle of injured vertebra between preoperation
and immediate postoperation. In each group, there were significant differences in
VAS and ODI score between the preoperation and last follow-up. The total correction
rates of AVH,the kyphosis cobb angle and the wedge angle of injured vertebra were
significantly higher in the experimental group than those in the control group, while
the loss of correction was significantly lower than the control.
Conclusions
The reduction technique using monoaxial percutaneous screws and instrumentational
maneuvers for thoracolumbar and lumbar fractures exhibited better radiological results
and satisfying functional outcomes when compared to traditional polyaxial screws.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to InjuryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Thoracolumbar fracture in blunt trauma patients: guidelines for diagnosis and imaging.Injury. 2003; 34: 426-433
- Incidence and risk factors for vertebral fracture in women and men: 25-year follow-up results from the population-based Framingham study.J Bone Miner Res. 2006; 21: 1207-1214
- Etiologies, incidence, and demographics of lumbar vertebral fractures in U.S. emergency departments.J Spine Surg. 2022; 8: 21-28
- Operative treatment of traumatic fractures of the thoracic and lumbar spinal column. Part I: epidemiology.Der Unfallchirurg. 2009; 112 (33–42): 44-45
- Functional outcomes after surgery for spinal fractures: return to work and activity.Spine (Phila Pa 1976). 2004; 29: 470-477
- [5] Robertson A, Branfoot T, Barlow IF, et al. Spinal injury patterns resulting from car and motorcycle accidents. Spine (Phila Pa 1976) 2002;27:2825–30.
- Percutaneous thoracolumbar pedicle screw fixation: is it time to revisit spinal fracture treatment?.World Neurosurg. 2010; 74: 570-571
- Acute thoracolumbar burst fractures in the absence of neurologic deficit. A comparison between operative and nonoperative treatment.Clin Orthop Relat Res. 1984; 8: 142-149
- Advances made in the treatment of thoracolumbar fractures: current trends and future directions.Injury. 2013; 44: 703-712
- Comparison of multifidus muscle atrophy and trunk extension muscle strength: percutaneous versus open pedicle screw fixation.Spine (Phila Pa 1976). 2005; 30: 123-129
- Effect of the percutaneous pedicle screw fixation at the fractured vertebra on the treatment of thoracolumbar fractures.Int Orthop. 2016; 40: 1103-1110
- Iatrogenic injury to the erector spinae during posterior lumbar spine surgery: underlying anatomical considerations, preventable root causes, and surgical tips and tricks.Eur J Orthop Surg Traumatol. 2014; 24: 127-135
- Surface electromyography-verified muscular damage associated with the open dorsal approach to the lumbar spine.Eur Spine J. 2001; 10: 414-420
- Minimally invasive spine surgery in the treatment of thoracolumbar and lumbar spine trauma.Neurosurg Focus. 2014; 37: E11
- Clinical and radiological outcomes of open versus minimally invasive transforaminal lumbar interbody fusion.Eur Spine J. 2012; 21 ([8]): 2265-2270
- Complication management with minimally invasive spine procedures.Neurosurg Focus. 2011; 31: E2
- The Oswestry low back pain disability questionnaire.Physiotherapy. 1980; 66: 271-273
- Comparison between percutaneous fluoroscopic-guided and conventional open pedicle screw placement techniques for the thoracic spine: a safety evaluation in human cadavers.Bone Joint J. 2015; 97b: 1555-1561
- Minimally invasive spine stabilisation with long implants.Eur Spine J. 2009; 18: 75-81
- Comparison of open versus percutaneous pedicle screw fixation using the sextant system in the treatment of traumatic thoracolumbar fractures.Clin Spine Surg. 2017; 30: E239-E246
- Percutaneous versus open pedicle screw fixation for treatment of thoracolumbar fractures: systematic review and meta-analysis of comparative studies.Clin Neurol Neurosurg. 2015; 135: 85-92
- Posterior monoaxial screw fixation combined with distraction-compression technology assisted endplate reduction for thoracolumbar burst fractures: a retrospective study.BMC Musculoskelet Disord. 2020; 21: 17
- The management of thoracolumbar burst fractures: a prospective study between conservative management, traditional open spinal surgery and minimally interventional spinal surgery.Springerplus. 2015; 4: 204
- Minimally invasive percutaneous fixation in the treatment of thoracic and lumbar spine fractures.Eur Spine J. 2009; 18: 71-74
- Minimally invasive reduction of thoracolumbar burst fracture using monoaxial percutaneous pedicle screws: Surgical technique and report of radiological outcome.J Orthop Surg. 2020; 28 (Hong KongJan-Apr)2309499019888977
- Short-segment fixation of lumbar burst fractures using pedicle fixation at the level of the fracture.Spine. 2007; 32: 1503-1507
- The use of screw at the fracture level in the treatment of thoracolumbar burst fractures.J Spinal Disord Tech. 2009; 22: 417-421
- Reduce the fractured central endplate in thoracolumbar fractures using percutaneous pedicle screws and instrumentational maneuvers: Technical strategy and radiological outcomes.Injury. 2021; 52 (Apr): 1060-1064
Article info
Publication history
Published online: September 21, 2022
Accepted:
September 16,
2022
Identification
Copyright
© 2022 Published by Elsevier Ltd.