The Impact on Clinical Results by Sagittal Imbalance in Posterior Fixation for Thoraco-lumbar Burst Fractures

Seung-Wook Baek; Kyu-Dong Shim; Ye-Soo Park

doi:10.12671/jkfs.2011.24.4.354

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Baek, Shim, and Park: The Impact on Clinical Results by Sagittal Imbalance in Posterior Fixation for Thoraco-lumbar Burst Fractures

Original Article

Journal of the Korean Fracture Society

Journal of the Korean Fracture Society 2011; 24(4): 354-360.

Published online: 30 October 2011

DOI: https://doi.org/10.12671/jkfs.2011.24.4.354

The Impact on Clinical Results by Sagittal Imbalance in Posterior Fixation for Thoraco-lumbar Burst Fractures

Seung-Wook Baek, M.D., Kyu-Dong Shim, M.D., Ye-Soo Park, M.D.

Department of Orthopaedic Surgery, Guri Hospital, Hanyang University College of Medicine, Guri, Korea.

Address reprint requests to: Ye-Soo Park, M.D. Department of Orthopaedic Surgery, Guri Hospital, Hanyang University College of Medicine, 249-1, Gyomun-dong, Guri 471-701, Korea. Tel: 82-31-560-2317, Fax: 82-31-557-8781, hyparkys@hanyang.ac.kr

Received 18 February 2011 Revised 28 March 2011 Accepted 5 July 2011

(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

Evaluate the effects of sagittal imbalance on the clinical outcomes in thoracolumbar burst fractures.

Materials and Methods

We evaluated 11 patients who had received posterior fixation for unstable burst fractures. Radiologic assessment including the compression ratio, focal kyphotic angle and sagittal balance were obtained. The clinical outcomes were assessed by ODI, VAS and SF-36. We subdivided the patients into sagittal balance and imbalance group, and compared with clinical outcomes. The relationship between radiologic and clinical outcomes was examined using correlation analysis.

Results

The radiologic assessment were changed on preoperative and postoperative as follows: mean compression ratio: 15.2%, 4.9%, mean focal kyphotic angle: 43.2°, 20.9°. The mean sagittal balance was 11.5 cm. The mean score of VAS, ODI, Physical and Mental Component Summary of SF-36 were 3.7, 45.8, 43.3 and 39.8, respectively. The ODI was significantly higher in sagittal imbalance group, and SF-36 was significantly higher in sagittal balance group (p<0.05). The VAS was correlated with compression ratio and focal kyphotic angle. The ODI and Mental Component Summary of SF-36 were correlated with sagittal imbalance.

Conclusion

Sagittal balance effects on the functions of spine, surgical treatment should be carefully considered with unstable burst fractures.

Keywords: Unstable burst fracture, Posterior fixation, Sagittal imbalance

Figures and Tables

Fig. 1

A 80-year-old female with L1 burst fracture.

(A) Preoperative lateral plain radiographs shows a loss of anterior height of L1.

(B) Lateral radiograph after operation shows correction of the compression ratio and focal kyphotic angle.

(C) Standing lateral whole spine radiographs obtained 1 years after operation shows loss of reduction in sagittal imbalance.

Fig. 2

A 42-year-old male with L1 burst fracture.

(A) Preoperative lateral plain radiographs shows a loss of anterior height of L1.

(B) Lateral radiograph after operation shows correction of the compression ratio and focal kyphotic angle.

(C) Standing lateral whole spine radiographs obtained 1 years after operation shows no reduction loss in normal sagittal alignment.

Table 1

Main clinical and radiographic characteristics of 11 patients with thoracolumbar burst fracture

Mos.: Months, Pre-op.: Preoperative, Post-op.: Postoperative, TKA: Thoracic kyphotic angle, LLA: Lumbar lordotic angle, ODI: Oswestry disability index.

Table 2

Score of VAS, ODI and SF-36

PCS: Physical component summary, MCS: Mental component summary. ^*Independent t-test.

Table 3

Correlations between radiological and clinical outcomes

The table shows correlations between each radiological and clinical outcome. Correlations between variables were using Spearman's rank correlations (rs). PCS: Physical component summary, MCS: Mental component summary. ^*p<0.05, ^†p<0.01.

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