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Abstract
Study Design
A prospective study of posterior instrumentation without fusion for the stable thoracolumbar fracture.
Objectives
To confirm vertebral body collapse by roentgenography and computerized tomography after removing posterior instrumentation at 6 months postoperatively in stable thoracolumbar burst fractures.
Summary of literature review
Many authors have reported that vertebral body collapse occurs after instrumentation removal.
Materials & Method
Sixty patients admitted between March 1999 and March 2001with thoracolumbar junction fractures were included. Patients were divided into 3 groups: Group I - the Conservative management group (20 patients), Group II -Reduction and posterior fixation with fusion group (20 patients), Group III - Reduction and temporary posterior fixation group (20 patients). The patients were aged between 21 and 49 years (mean 38), and the follow- up period exceeded 1 year (mean 13.3 months). We studied vertebral height, kyphotic angle, disc height and facet hypertrophy by roentgenography, and the continuity of the anterior cortical connection, cavity formation, sclerotic bone formation and new bone formation by CT.
Results
The loss of vertebral height was 7.9% (from 21.5 to 29.4%) in Group I, 3.7% in Group II (preop 35%, postop 12.7%, postop 1Y r. 16.4%), and 3.5% in Group III (preop. 35.2%, postop 5.6%, postop 1Y r. 9.1%). Loss of angulation was 4.2。(from 9.6。 to 13.8。) in Group I, 3.0。in Group II (preop 15.3。, postop 7.2。, postop. 1Y r. 10.2。), and 3.0。in Group III (preop 14.6。, postop. 5.9。, postop 1Y r. 8.9。). Loss of disc height was not statistically different for the 3 groups. Degenerative changes of the posterior facet were seen 3 patients of Group I, 11 patients of Group II, and in 5 patients of group III. On CT scan of Group III, all cases showed cavity formation and sclerosis, and continuity of the anterior cortical connection and of new bone formation into the cavity were seen in 18 cases.
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Fig. 1. A.
Case1:Simple radiograph of a 31 years old female. From the left, at injury, at Postop., at POD 6M., at POD 1Yr. degrees of comperssion was 45.5%, 2%,3%,5% respectively. The angle of kyphosis was 22。, 5。, 7。, 8。 respectively. At POD 1Yr, the loss of reduction was 2%, and the loss of kyphosis was 3 degrees. Fig. 1. B. CT findings at injury (above) & POD 1Yr. (below). Removal of instrumentation at 7 months. With Preop. CT, burst fracture was seen. At POD 1Yr., cavity formation, sclerosis around the cavity, new bone formation in the cavity, and boney connection of anterior vertebral body are seen.
Fig. 2. A.
Case2:Simple radiograph of a 41 years old female with 48.7% comperession & 20。 kyphosis. From the left, at injury, at Postop., at POD 6M., at POD 1Yr. degrees of comperssion was 48.7%, 3%, 4%, 6% respectively. The angle of kyphosis was 20。, 6。, 8。, 11。 respectively. At POD 1Yr,, the loss of reduction was 3%, and the loss of kyphosis was 5 degrees. Fig. 2. B. CT findings at injury (above) & POD 1Yr. (below). Removal of instrumentation was done at postop.6 months. Collapse of vertebral body is prevented.
Table 1.
Height of vertebral body : degrees of compression (％):P-value >0.05
| At trauma | Postop. | F/U 1Yr. | Loss of reduction | |
|---|---|---|---|---|
| Conservative | 21.5 | 29.4 | 7.9 | |
| Post.instrumentation with fusion | 35.0 | 12.7 | 16.4 | 3.7 |
| Temporary fixation | 35.2 | 05.6 | 09.1 | 3.5 |
Table 2.
Angles of kyphosis (degrees):P-value >0.05
| At trauma | Postop. | F/U 1Yr. | Loss of angle | |
|---|---|---|---|---|
| Conservative | 09.6 | 13.8 | 4.2 | |
| Post.instrumentation with fusion | 15.3 | 7.2 | 10.2 | 3.0 |
| Temporary fixation | 14.6 | 5.9 | 08.9 | 3.0 |
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