J Neurol Surg A Cent Eur Neurosurg 2017; 78(03): 231-237
DOI: 10.1055/s-0036-1584886
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Treatment of Thoracolumbar Fractures by Percutaneous Pedicle Screw Fixation Technique Combined with Three-step Reduction

Linli Li
1   Department of Orthopaedics, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
,
Youhai Dong
1   Department of Orthopaedics, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
,
Yiqun He
1   Department of Orthopaedics, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
,
Xiangsheng Liu
1   Department of Orthopaedics, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
,
Wenqing Tong
1   Department of Orthopaedics, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
› Author Affiliations
Further Information

Publication History

25 November 2015

27 April 2016

Publication Date:
26 July 2016 (online)

Abstract

Purpose To evaluate the efficacy of percutaneous pedicle screw fixation technique combined with three-step reduction in the treatment of thoracolumbar fracture.

Methods This is a retrospective study, based on medical records from the archives of the Fifth People's Hospital of Fudan University, from January 2012 to January 2015. The 49 patients with thoracolumbar fracture were treated with percutaneous pedicle screw fixation technique combined with three-step reduction. The treatment plan was determined by the AO classification and the Thoracolumbar Injury Classification and Severity classification. Baseline data included patient demographics, mechanism of injuries, fracture level, and neurologic status. Kyphotic angle correction and vertebral body height (VBH) restoration were used to assess radiologic outcome. Blood loss, operative complications, hospital stay, and pain score on the visual analog scale (VAS) were used to assess safety and clinical outcomes.

Result A total of 49 patients with 51 thoracolumbar burst fractures were treated with percutaneous pedicle screw fixation technique combined with three-step reduction. There was significant improvement in kyphotic angle correction (p < 0.05) and restoration of anterior vertebral height (p < 0.05) after each reduction procedure. These improvements remained statistically significant at the latest follow-up for restoration of anterior VBH (p < 0.05) and kyphotic angle correction (p < 0.05). The preoperative VAS score was 8.2 ± 1.3, and the postoperative VAS score (3 days after the operation) was 3.5 ± 0.7.

Conclusion Percutaneous pedicle screw internal fixation technique combined with three-step reduction is a relatively safe and effective technique for treating selected thoracolumbar burst fractures, and it yields satisfactory results.

 
  • References

  • 1 Jiang XZ, Tian W, Liu B , et al. Comparison of a paraspinal approach with a percutaneous approach in the treatment of thoracolumbar burst fractures with posterior ligamentous complex injury: a prospective randomized controlled trial. J Int Med Res 2012; 40 (4) 1343-1356
  • 2 Yang WE, Ng ZX, Koh KM , et al. Percutaneous pedicle screw fixation for thoracolumbar burst fracture: a Singapore experience. Singapore Med J 2012; 53 (9) 577-581
  • 3 Court C, Vincent C. Percutaneous fixation of thoracolumbar fractures: current concepts. Orthop Traumatol Surg Res 2012; 98 (8) 900-909
  • 4 Ni WF, Huang YX, Chi YL , et al. Percutaneous pedicle screw fixation for neurologic intact thoracolumbar burst fractures. J Spinal Disord Tech 2010; 23 (8) 530-537
  • 5 Sihvonen T, Herno A, Paljärvi L, Airaksinen O, Partanen J, Tapaninaho A. Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome. Spine 1993; 18 (5) 575-581
  • 6 Thomsen K, Christensen FB, Eiskjaer SP, Hansen ES, Fruensgaard S, Bünger CE. 1997 Volvo Award winner in clinical studies. The effect of pedicle screw instrumentation on functional outcome and fusion rates in posterolateral lumbar spinal fusion: a prospective, randomized clinical study. Spine 1997; 22 (24) 2813-2822
  • 7 Hsieh PC, Koski TR, Sciubba DM , et al. Maximizing the potential of minimally invasive spine surgery in complex spinal disorders. Neurosurg Focus 2008; 25 (2) E19
  • 8 Kanter AS, Mummaneni PV. Minimally invasive spine surgery. Neurosurg Focus 2008; 25 (2) E1
  • 9 Mobbs RJ, Raley DA. Complications with K-wire insertion for percutaneous pedicle screws. J Spinal Disord Tech 2014; 27 (7) 390-394
  • 10 Kramer DL, Rodgers WB, Mansfield FL. Transpedicular instrumentation and short-segment fusion of thoracolumbar fractures: a prospective study using a single instrumentation system. J Orthop Trauma 1995; 9 (6) 499-506
  • 11 Lijun L, Mingjie Y, Jie P. Percutaneous pedicle screw fixation combined with mini-open anterior bone grafting for the treatment of thoracolumbar fracture. Chin J Bone Joint Surg 2012; 5 (2) 123-127
  • 12 Jixian Q, Zhengang J, Haoran G. Percutaneous pedicle screw fixation for the treatment of thoracolumbar fracture. Orthop J Chin 2013; 21 (16) 1591-1596
  • 13 He D, Wu L, Sheng X , et al. Internal fixation with percutaneous kyphoplasty compared with simple percutaneous kyphoplasty for thoracolumbar burst fractures in elderly patients: a prospective randomized controlled trial. Eur Spine J 2013; 22 (10) 2256-2263
  • 14 Xu Y, Zhou X, Yu C, Cheng M, Dong Q, Qian Z. Effectiveness of postural and instrumental reduction in the treatment of thoracolumbar vertebra fracture. Int Orthop 2008; 32 (3) 361-365
  • 15 Hongwei W, Changqing L, Yue Z. Progress of minimally invasive posterior pedicle screw fixation in thoracolumbar fracture. Orthop J Chin 2010; 02: 137-140