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Abstract
Study Design
Nineteen of 20 cases that underwent a mono- segment pedicle-screw instrumentation and fusion, following vertebroplasty for lumbar and thoracolumbar fractures, were reviewed retrospectively.
Objectives
To assess the effectiveness of a mono- segment pedicle-screw instrumentation and fusion, following an anterior column reconstruction, using bone cement for a fractured lumbar and thoracolumbar spine.
Summary of Literature Review
With lumbar and thoracolumbar fractures, the untreated anterior instability and pre- stressing of the screws, following reduction, resulted in a high failure rate of the hardware, and posterior screw fixation alone may be not adequate.
Materials and Methods
W e reviewed 19 of 20 cases that underwent a mono- segment pedicle-screw instrumentation and fusion, following vertebroplasty for lumbar and thoracolumbar fractures, between Feb. 2000 and Mar. 2002, with an average follow-up of 1.6 years. The mean age of the patients was 39.2 years, and the male female ratio as 10:9. The criteria for inclusion to the study (McA fee classification) were flexion- distraction injury, burst fracture, translational injury and burst conversion after an osteoporotic compression fracture, in 9, 7, 2 and 2 cases, respectively. We assessed the radiographic results of the local kyphotic angle correction of the fused segment and anterior body height restoration, preoperative, postoperative and at the last follow up, from the lateral views of the spine. The clinical results were evaluated according to Kumano's criteria.
Results
The mean local kyphotic angles of the instrumented segment, preoperatively, postoperatively and at the last follow-up were 16.5, 1.1 and 2.1°, with a mean correction gain of 15.4° (p<0.05) and a gain loss of 1.0° (p>0.05). The mean anterior body heights for each period were 60.4, 89.6 and 85.0%, with a mean restoration gain of 29.2% (p<0.05) and a gain loss of 4.6%(p>0.05). The clinical results were assessed as good in 18 patients (19 cases) and fair in the other one. There were 3 cases of asymptomatic leakage of the bone cement, but no fixation failures during the follow-up.
Conclusions
A mono- segment pedicle-screw instrumentation and fusion, following the treatment of anterior instability, using vertebroplasty for lumbar and thoracolumbar fractures, can be an effective alternative for preserving the maximal motion segment, without fixation loss through the restoration of the immediate postoperative weight- bearing capability.
REFERENCES
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Fig. 1.
A 64-year-old female with burst conversion after compression fracture at L2 body. Preoperative AP and lateral radiographs show significant anterior & middle column failure with 38% of L2 anterior height and 17° of local L1/L2 kyphosis (A). Sagittal T-2 & T-1 MR images show neural compromise through fragmentation of the posterior wall of L2 body (B). Postoperative radiographs after L1/L2 instrumented fusion reinforced by PMMA for Rt L2 body(white arrow) and Rt L1 screw (black arrow) show satisfactory restoration of the anterior body height (90.3%) and kyphosis(0°) and show extracorporeal PMMA leakege (small white arrow) (C). The 14-month follow-up examination shows no fixation loss or kyphotic reversal even though 12.9% loss of L2 anterior height and 3° loss of L1/L2 kyphosis (D).
Fig. 2.
A 35-year-old male with L1/L2 flexion-distraction injury associated with L4/L5 translational injury. Preoperative AP and lateral radiographs show compression of L2 superior end-plate and separation of L1/L2 facets (arrow), and show anterosuperior wedging of L5 body and anterior slip of L4 body (A). Sagittal T-2 MR image confirms L1/L2 flexion-distraction injury (arrow signifies disruption of the posterior ligamentous complex) and L4/L5 translational injury (B). Postoperative radiographs after L1/L2 posterior fusion and L4/L5 cage-PLIF show reinforcement by PMMA for Rt L2 and L5 bodies (arrows) (C). The 1-year follow-up films show successful maintenance of the correction and no device-related problems (D).
Fig. 3.
A 40-year-old male with T10/T11 flexion-distraction injury associated with T12 compression fracture (A). Postoperative radiographs show T10/T11 PMMA-reinforced mono-segment fusion and show unilateral T12 vertebroplasty(arrow) through Lt pedicle for early return to the original job (B). Intraoperative photograph demonstrates full-thickness disruption of T10/T11 posterior ligamentous complex (C). The 1-year follow-up radiographs show only a minimal loss of corrected T11 anterior body height and local kyphosis of the fused segment (D).
Table 1.
Inclusion criteria (McAfee classification) and level of injury
Table 2.
Kyphotic angle correction
| Pre-Op | Post-Op | Last F/U | |||
|---|---|---|---|---|---|
| Mean KA∗ | 16.5° | 1.1° | 2.1° | ||
| KAC∗∗ Gain | (15.4°) | ||||
| KAC Loss | (1.0°) |
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