Posterior arthrodesis and short instrumentation in thoracolumbar spine fracture: clinical and radiological evaluation
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EVALUACION CLINICA Y RADIOLOGICA DE LA INTRUMENTACION Y ARTRODESIS CORTA POR VIA POSTERIOR EN FRACTURAS TORACOLUMBARES (Español (España))
EVALUACION CLINICA Y RADIOLOGICA DE LA INTRUMENTACION Y ARTRODESIS CORTA POR VIA POSTERIOR EN FRACTURAS TORACOLUMBARES (Español (España))
EVALUACION CLINICA Y RADIOLOGICA DE LA INTRUMENTACION Y ARTRODESIS CORTA POR VIA POSTERIOR EN FRACTURAS TORACOLUMBARES (Español (España))
Published:
Jan 22, 2015
Keywords:
Burst fracture, Short instrumentation, Posterior arthrodesis
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Abstract
Background: Surgical treatment of thoracolumbar fractures is controversial. The approach and number of levels of instrumentation are debated. The aim of this study is to assess the clinical and radiological outcomes of burst fractures.Methods: Retrospective study. Consecutive series of patients treated with short instrumentation and posterior fusion between 2004 and 2008, with a minimum follow-up of 12 months. Type A3 and B fractures of AO classification were included. Clinical, neurological and radiological outcomes were analyzed.Results: Twenty-five patients were included and 22 completed the follow-up. The average of age was 37 years. The most common cause was fall from high, followed by road accident and the most affected region was L1. The average of kyphosis was 14° before surgery and 4° in the remote follow-up. Clinical evaluation was excellent in 10 patients, good in 10 and regular in 2. Twenty-one patients had no neurological compromise.Conclusions: Short instrumentation and posterior arthrodesis offer very good clinical and functional result in most patients. Patient selection must be strict, excluding those with severe kyphosis, significant comminution or other factor that would suggest the need for an anterior approach. Long-term follow-up did not show significant loose of kyphosis.
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Nicolino, T. I., Petracchi, M., Sola, C., Valacco, M., & Gruenberg, M. (2015). Posterior arthrodesis and short instrumentation in thoracolumbar spine fracture: clinical and radiological evaluation. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 80(1), 20-29. https://doi.org/10.15417/267
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Clinical Research
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19. Roy-Camille R, Saillant G, Berteaux D, Salgado V. Osteosynthesis of thoraco-lumbar spine fractures with metal plates screwed
through the vertebral pedicles. Reconstr Surg Traumatol 1976;15:2-16.
20. McAfee PC, Bohlman HH. Complications following Harrington instrumentation for fractures of the thoracolumbar spine. J
Bone Joint Surg Am 1985;67:672-86.
21. Sjostrom L, Olerud S, Karlstrom G. Experiences with transpedicular internal fixation and transpedicular grafting of unstable
thoracolumbar fractures. Acta Orthop Scand 1988;59(Suppl 227):20-1.
22. Slosar PJ Jr, Patwardham AG, Lorenz M, Havey R, Sartori M. Instability of the lumbar burst fracture and limitations of
transpedicular instrumentation. Spine 1995;20:1452-61.
23. Willen J, Lindahl S, Nordwall A. Unstable thoracolumbar fractures: a comparative clinical study of conservative treatment and
Harrington instrumentation. Spine 1985;10:111-22.
24. Frankel HL, Hancock PO, Hyslop G, Melzak J, Michaelis LS, Ungar GH, et al. The value of postural reduction in the initial
management of closed injuries of the spine with paraplegia and tetraplegia. Part I. Paraplegia 1969;7:179-92.
25. Chan DP, Seng NK, Kaan KT. Nonoperative treatment in burst fractures of the lumbar spine (L2-L5) without neurologic deficits.
Spine 1993;18:320-5.
26. Davies WE, Morris JH, Hill V. An analysis of conservative (non surgical) management of thoracolumbar fractures and fracture
dislocations. J Bone Joint Surg Am 1980;62:1324-7.
27. Denis F. The three column spine and its significance in the classification of acute thoracolumbar spine injuries. Spine 1983;8:817-
31.
28. Denis F, Armstrong GWD, Searls K, Matta L. Acute thoracolumbar burst fractures in the absence of neurologic deficit. Clin
Orthop 1984;189:142-9.
29. Gertzbein SD, Crowe PJ, Fazl M, Schwartz M, Rowed D. Canal clearance in burst fractures using the AO internal fixator.
Spine 1992;17:558-60.
30. Iborra González M, Roca Burniol J, Ubierna Garces MT, Ruíz Calavia JA, Aliaga Orduña F. Remodelación del canal
medular en fracturas toracolumbares. Rev Ortop Traumatol 1997;41:210-2.
31. Day LY. Remodeling of the spinal canal after thoracolumbar burst fractures. Clin Orthop 2001;382:119-23.
32. Vornanen MJ, Bostman OM, Myllynen PJ. Reduction of bone retropulsed into the spinal canal in thoracolumbar vertebral
body compression burst fractures. Spine 1995;20:1699-703.
33. Petracchi M, Gruenberg M, Solá C, Ortolán E. Fracturas por estallido en columna dorsolumbar instrumentadas con tornillos
pediculares. Rev Asoc Arg Ortop Traumatol 2003; 68(4): 273-83.
34. Baños Clemente A, Ramirez Villaescusa J, Martinez Castroverde J, Martinez Arnaiz E, Andreés Gonzalez JM. Tratamiento
quirúrgico de fracturas toracolumbares por vía posterior con instrumentación y fusión bisegmentaria. Rev Esp Traumatol 2002;
37(210):84-88.
35. Parker JW. Successful short-segment instrumentation and fusion of thoracolumbar spine fracture. Spine 2000;25(9):1157-69.
2. Denis F. Spinal instability as defined by three-column spine concept in acute spinal trauma. Clin Orthop 1984;189:65-76.
3. Ferguson RL, Allen BL. A mechanistic classification of thoracolumbar spine fractures. Clin Orthop 1984;189:77- 88.
4. Arregui A, Pedernera H, Berro C. Fracturas vertebrales de la charnela dorsolumbar con lesión neurológica. Rev Asoc Argent
Ortop Traumatol 1992; 57:370-4.
5. Dunn HK. Anterior stabilization of thoracolumbar injuries. Clin Orthop 1984;(189):116-24.
6. Kaneda K, Abumi K, Fujiya M. Burst fractures with neurologic deficits of the thoracolumbar-lumbar spine: results of anterior
decompression and stabilization with anterior instrumentation. Spine 1984; 9:788-95.
7. Kostuik JP. Anterior spinal cord decompression for lesions of the thoracic and lumbar spine: techniques, new methods of internal
fixation results. Spine 1983;8:512-31.
8. Bloise de Napolitano N. Utilización del instrumental de Harrington en el tratamiento de deformidades vertebrales traumáticas.
Acta Ortop Latinoam 1976;3:47-56.
9. Yuan HA, Mann KA, Found EM, Helbig TE, Fredrickson BE, Lubicky JP, et al. Early clinical experience with the Syracuse
I-plate: an anterior spinal fixation device. Spine 1988;13:278-85.
10. Allende B, Borda Marquez C. Osteosíntesis en fracturas luxaciones inestables de columna lumbar con lesión neurológica. Rev
Asoc Argent Ortop Traumatol 1984;49:248-61.
11. Bradford DS, Akbarnia BA, Winter RB, Seljeskog EL. Surgical stabilization of fracture and fracture dislocation of the thoracic
spine. Spine 1977; 2:185-95.
12. Carrasco MR. Fracturas por compresión lumbotorácicas: tratamiento con barras de Harrington y alambrado sublaminar. Rev
Asoc Argent Ortop Traumatol 1990;55:145-9.
13. Cook SD, Barrack RL, Georgette FS, Whitecloud TS 3rd, Burke SW, Skinner HB, et al. An analysis of failed Harrington
rods. Spine 1985;10:313-6.
14. Dick W, Kluger P, Magerl F, Woersdorfer O, Zach G. A new device for internal fixation of thoracolumbar and lumbar spine
fractures: the fixateur interne. Paraplegia 1985;23:225-32.
15. Dickson JH, Harrington PR, Erwin WD. Results of reduction and stabilization of the severely fractured thoracic and lumbar
spine. J Bone Joint Surg Am 1978;60:799-805.
16. Krag MH, Beynnon BD, Pope MH, Frymoyer JW, Haugh LD, Weaver DL. An internal fixator for posterior application to
short segments of the thoracic, lumbar, or lumbosacral spine. Design and testing. Clin Orthop 1986;(203):75-98.
17. Maiman DJ, Sypert GW. Management of trauma of the thoracolumbar junction: I and II. Contemp Neurosurg 1989;11:1-6.
18. Moreno T. Tratamiento de las fracturas inestables del raquis dorso-lumbar. Rev Soc Platense Ortop Traumatol 1988;1:16-23.
19. Roy-Camille R, Saillant G, Berteaux D, Salgado V. Osteosynthesis of thoraco-lumbar spine fractures with metal plates screwed
through the vertebral pedicles. Reconstr Surg Traumatol 1976;15:2-16.
20. McAfee PC, Bohlman HH. Complications following Harrington instrumentation for fractures of the thoracolumbar spine. J
Bone Joint Surg Am 1985;67:672-86.
21. Sjostrom L, Olerud S, Karlstrom G. Experiences with transpedicular internal fixation and transpedicular grafting of unstable
thoracolumbar fractures. Acta Orthop Scand 1988;59(Suppl 227):20-1.
22. Slosar PJ Jr, Patwardham AG, Lorenz M, Havey R, Sartori M. Instability of the lumbar burst fracture and limitations of
transpedicular instrumentation. Spine 1995;20:1452-61.
23. Willen J, Lindahl S, Nordwall A. Unstable thoracolumbar fractures: a comparative clinical study of conservative treatment and
Harrington instrumentation. Spine 1985;10:111-22.
24. Frankel HL, Hancock PO, Hyslop G, Melzak J, Michaelis LS, Ungar GH, et al. The value of postural reduction in the initial
management of closed injuries of the spine with paraplegia and tetraplegia. Part I. Paraplegia 1969;7:179-92.
25. Chan DP, Seng NK, Kaan KT. Nonoperative treatment in burst fractures of the lumbar spine (L2-L5) without neurologic deficits.
Spine 1993;18:320-5.
26. Davies WE, Morris JH, Hill V. An analysis of conservative (non surgical) management of thoracolumbar fractures and fracture
dislocations. J Bone Joint Surg Am 1980;62:1324-7.
27. Denis F. The three column spine and its significance in the classification of acute thoracolumbar spine injuries. Spine 1983;8:817-
31.
28. Denis F, Armstrong GWD, Searls K, Matta L. Acute thoracolumbar burst fractures in the absence of neurologic deficit. Clin
Orthop 1984;189:142-9.
29. Gertzbein SD, Crowe PJ, Fazl M, Schwartz M, Rowed D. Canal clearance in burst fractures using the AO internal fixator.
Spine 1992;17:558-60.
30. Iborra González M, Roca Burniol J, Ubierna Garces MT, Ruíz Calavia JA, Aliaga Orduña F. Remodelación del canal
medular en fracturas toracolumbares. Rev Ortop Traumatol 1997;41:210-2.
31. Day LY. Remodeling of the spinal canal after thoracolumbar burst fractures. Clin Orthop 2001;382:119-23.
32. Vornanen MJ, Bostman OM, Myllynen PJ. Reduction of bone retropulsed into the spinal canal in thoracolumbar vertebral
body compression burst fractures. Spine 1995;20:1699-703.
33. Petracchi M, Gruenberg M, Solá C, Ortolán E. Fracturas por estallido en columna dorsolumbar instrumentadas con tornillos
pediculares. Rev Asoc Arg Ortop Traumatol 2003; 68(4): 273-83.
34. Baños Clemente A, Ramirez Villaescusa J, Martinez Castroverde J, Martinez Arnaiz E, Andreés Gonzalez JM. Tratamiento
quirúrgico de fracturas toracolumbares por vía posterior con instrumentación y fusión bisegmentaria. Rev Esp Traumatol 2002;
37(210):84-88.
35. Parker JW. Successful short-segment instrumentation and fusion of thoracolumbar spine fracture. Spine 2000;25(9):1157-69.