Change of Kyphotic Angle in Posterior Pedicle Screw Fixation for Thoracic and Lumbar Burst Fractures: Comparison Study by the Screw Fixation Level

Jeong-Gook Seo; Jong-Ho Park; Jeong-Seok Moon; Woo-Chun Lee

doi:10.12671/jkfs.2009.22.1.39

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Seo, Park, Moon, and Lee: Change of Kyphotic Angle in Posterior Pedicle Screw Fixation for Thoracic and Lumbar Burst Fractures: Comparison Study by the Screw Fixation Level

Original Article

Journal of the Korean Fracture Society 2009; 22(1): 39-44.

Published online: 31 January 2009

DOI: https://doi.org/10.12671/jkfs.2009.22.1.39

Change of Kyphotic Angle in Posterior Pedicle Screw Fixation for Thoracic and Lumbar Burst Fractures: Comparison Study by the Screw Fixation Level

Jeong-Gook Seo, M.D., Jong-Ho Park, M.D., Jeong-Seok Moon, M.D., Woo-Chun Lee, M.D.

Department of Orthopedic Surgery, Seoul Paik Hospical, College of Medicine, Inje University, Seoul, Korea.

Address reprint requests to: Jeong-Gook Seo, M.D. Department of Orthopedic Surgery, Seoul Paik Hospical, College of Medicine, Inje University, 85, Jeo-dong 2-ga, Jung-gu, Seoul 100-032, Korea. Tel: 82-2-2270-0028, Fax: 82-2-2270-0023, hd1404@hanafos.com

Received 18 November 2008 Revised 8 December 2008 Accepted 7 January 2009

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the relationship between the level of screw fixation and the stability of the segment of endplate fracture after posterior pedicle screw instrumentation for thoracic and lumbar burst fractures.

Materials and Methods

The 41 patients of burst fractures who had been operated with pedicle screw instrumentation were retrospectively evaluated. The patients were divided into two groups by the levels of screw fixation. One group was treated with screws fixed by one-level to the direction of fractured endplate (One-level group, 16 cases). The other group was treated with screws fixed by two-level to the direction of endplate fracture (Two-level group, 25 cases). The two groups were compared by the radiographic changes of kyphotic angle between the day of surgery and 6 months after surgery.

Results

At the 6 months, one-level group showed the change of kyphotic angle of 17.5±2.4 degrees, which was different from two-level group of 5.2±0.8 degrees (p=0.000).

Conclusion

In posterior pedicle screws fixation for thoracic and lumbar burst fractures, 2 vertebrae to the direction of the endplate fracture should be included to prevent the postoperative kyphotic change.

Keywords: Endplate, Burst fracture, Pedicle screw

Figures and Tables

Fig. 1

Denis classification. Asterisk (*) indicates unstable segment.

Fig. 2

Measurement methods of kyphotic angle and vertebral body height.

(A) Kyphotic angle (a) measured by the Cobbs' method.

(B) Anterior vertebral height loss (%) measured by {1-b/(a+c/2)}×100.

Fig. 3

A 47 year old woman sustained Denis type A burst fracture of L1.

(A) Immediately postoperative lateral view shows 7 degree of kyphotic angle and 20% of anterior vertebral height loss.

(B) Postoperative 6 months lateral view shows unstable fixation of 25.7 degree of kyphotic angle and 41% of anterior vertebral height loss.

Fig. 4

A 54 year old man sustained Denis type B burst fracture of L2.

(A) Immediately postoperative lateral view shows 0 degree of kyphotic angle and 11% of anterior vertebral height loss.

(B) Postoperative 6 months lateral view shows stable fixation of 2.3 degree of kyphotic angle and 13% of anterior vertebral height loss.

Table 1

Numbers of the patients by the level of fracture and Denis type

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