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Abstract
Objectives
To analyze the outcome of posterior reduction and fixation with the AO internal fixator and with the screw-rod system in unstable thoracolumbar fractures and to investigate differences in effectiveness between the two methods.
Summary of literature review
In unstable thoracolumbar fractures, fixation with the AO internal fixator is an effective method for posterior reduction. However, the results of correction are quite variable.
Materials and methods
We analyzed 51 patients with unstable thoracolumbar fractures who underwent correction through posterior approach between 1997 and 2003. We divided the patients into two groups: Patients in Group A (25 cases) were treated with the AO internal fixator, and patients in Group B (26 cases) were treated with the screw-rod system. We added transpedicular bone grafts for 17 patients in Group A. We evaluated correction of deformity (anterior and posterior height of vertebral body, sagittal index, disc height), loss of correction, spinal canal clearance, and neurological recovery.
Results
Comparing correction of deformity, we saw better results in Group A than in Group B in regards to sagittal index and anterior height of vertebral body. However, we saw a higher degree of correction loss in the anterior height of the vertebral body in Group A. We grafted autogenous bone into the fracture site by transpedicular approach for 17 patients in Group A. We saw less correction loss in the anterior vertebral body height and sagittal index. In regard to spinal canal clearance, we saw better results in Group A (18%) than in Group B (10%). As for neurological recovery, we could not find any statistically significant difference between the two groups.
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Table 1.
Epidemiology in group A and group B
Table 2.
Correction of sagittal index
| Sagittal index | Group A | Group B |
|---|---|---|
| Preop | 25.4 | 26.1 |
| Postop | 11 | 16.5 |
| Correction | 14.4(56.7%) | 9.6(36.8%) |
| Last F/U | 16 | 20.2 |
| Loss of correction | 5.0(34.7%) | 3.7(38.5%) |
Table 3.
Correction of anterior height of body
| Ant. Height of Body (%) | Goup A | Group B |
|---|---|---|
| Preop | 55.6 | 56.7 |
| Postop | 85.7 | 77.1 |
| Correction | 30.1(54.1%) | 20.4(36.0%) |
| Last F/U | 73.8 | 72.3 |
| Loss of correction | 11.9(39.5%) | 4.8(23.5%) |
Table 4.
Correction of disc height
| Height of Disc (%) | Goup A | Group B |
|---|---|---|
| Preop | 83.3 | 85.8 |
| Postop | 96.5 | 95.7 |
| Correction | 13.2(15.8%) | 9.9(11.5%) |
| Last F/U | 89.5 | 90.1 |
| Loss of correction | 7.0(53.0%) | 5.6(56.6%) |
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