Heui-Jeon Park; Young-Jun Shim; Wan-Ki Kim; Tae-Yeon Cho; Sung-Min Kwon

doi:10.4184/jkss.2011.18.3.103

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Park, Shim, Kim, Cho, and Kwon: Efficiency of Implant Removal for Treatment of the Thoracolumbar Unstable Fractures - Multi Segments Fixation ∙ Single Segment Fusion -

Original Article

Journal of Korean Spine Surg 2011;18(3):103-110.

Published online: 21 September 2011

DOI: https://doi.org/10.4184/jkss.2011.18.3.103

Efficiency of Implant Removal for Treatment of the Thoracolumbar Unstable Fractures - Multi Segments Fixation ∙ Single Segment Fusion -

Heui-Jeon Park, M.D., Young-Jun Shim, M.D., Wan-Ki Kim, M.D., Tae-Yeon Cho, M.D., Sung-Min Kwon, M.D.

Department of Orthopedic Surgery Yonsei University, Wonju College of Medicine, Wonju, Korea

Corresponding author: Heui-Jeon Park, M.D. Department of Orthopaedic Surgery, Wonju College of Medicine, Yonsei University, 162 Ilsan-dong, Wonju, Kangwon-do, Korea TEL: 82-33-741-1352, FAX: 82-33-746-7326 E-mail:par73@yonsei.ac.kr

Received 14 April 2010 Revised 15 August 2011 Accepted 30 August 2011

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

Study Design

A retrospective study.

Objectives

To evaluate the safety and usefulness of implant removal based on fusion by radiological change analyses and non-fused segment motion angle after open reduction, multi-segment fixation, and single segment fusion.

Summary of Literature Review

There have been reports that discuss possible fracture of fixator, loss of reduction, or failure of fixation in certain cases of single segment fixation consistent with thoracolumbar fracture.

Materials and Methods

We analyzed 83 patients who had undergone treatment by fixation of the top 2 segments and the bottom segment. The posterolateral fusions were performed for the top segment for thoracolumbar fractures. The mean followup was 21.3 months. Wedge and local kyphotic angles, anterior, and posterior heights of the vertebral body were measured on plain radiograph. The range of motion of each segment was recorded by flexion-extension lateral radiographs at 6 month after the removal of implants.

Results

Radiologic assessments performed on 83 patients demonstrated preoperative mean wedge angle, kyphotic angle, mean anterior body height of 20.1°, 18.5° and 62.0%, respectively, and, postoperatively, these were corrected by 9.0°, 9.3° and 24.6%, respectively. In the 44 cases that had the implants removed, the correction losses were 0.4°(P=0.258) and 3.7°(P=0.000), 0.5 % (P=0.756), and at the last followup, compared to measurements prior to the removal. There was no statistical significance in wedge angle or anterior body height. The range of motion measured on the non-fused segment was 3.9°on average at 6-months after the hardware removal.

Conclusions

The multi-segments fixation and single-segment fusion for the thoracolumbar fracture can preserve correction and the motion of non-fusion segment. Although the implant removal after union can sustain motion, further studies regarding degenerative change of the non-fused segment are necessary.

Keywords: Thoracolumbar spine, Fracture, Pedicular screw, Implant removal

REFERENCES

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Figures and Tables%

Fig. 1.

Radiography showing linear and angular measurement. : Wedge angle(∠ CD°), Local kyphotic angle(∠ AE°), Sagittal index(∠ BD°: if T11,∠ BD-5 and if L2,∠ BD+10), Anterior body height(200ⅹ b/(a+c) %), Posterior body height(200× e/(d+f) %)

Fig. 2.

A 41-year old male with flexion-distraction injury on L2. (A) Preoperative lateral roentgenogram shows fracture of L1 spinous process (B) Lateral radiograph, immediately after surgery, shows anatomical reduction. (C,D,E) Lateral roentgenogram of neutral/flexion/extension views that show range of motion of no fusion segment

Fig. 3.

The radiologic change of angular measurement

Fig. 4.

The radiologic change of linear measurement

Table 1.

The radiologic change e of linear and angular measu urement

			Measurement	Delta(Δ)	P-value
Wedge angle (°)	Pre-op		20.1±6.6
	Postop		11.1±5.1	-9.0±6.8+1.1±3.0	0.000 0.001
	Pre-removal	(Total case)	12.2±5.6	-9.0±6.8+1.1±3.0	0.001
		(Removal case)	11.9±5.8	+0.4±2.4	0.258
	Last followup		12.4±5.8
Local kyphotic angle (°)	Pre-op		18.5±10.2	-9.3±7.9+1.8±4.1	0.000 0.000
	Post op		9.3±7.9	-9.3±7.9+1.8±4.1	0.000 0.000
	Pre-removal	(Total case)	11.7±8.8
		(Removal case)	12.5±10.5
	Last followup		16.1±11.6	+3.7±4.8	0.000
Anterior body height (%)	Pre-op		62.0±17.9	+24.6±17.5-1.6±9.7	0.000 0.131
	Post op		86.6±12.1	+24.6±17.5-1.6±9.7	0.000 0.131
	Pre-removal	(Total case)	85.0±13.5
		(Removal case)	84.0±11.6	-0.5±11.3	0.756
	Last followup		83.5±15.2	-0.5±11.3	0.756
Posteror body height (%)	Pre-op		92.7±10.7	+3.8±7.0-0.6±3.3	0.000
	Post op		96.5±10.6	+3.8±7.0-0.6±3.3	0.000 0.138
	Pre-removal	(Total case)	96.0±10.5
		(Removal case)	96.4±7.4	-0.1±4.6	0.875
	Last followup		96.3±6.8	-0.1±4.6	0.875

Table 2.

Range of motion of each segment

	T10-11	2.8˚(0.5-6.5)
	T11-12	4.4˚(1.0-12.5)
Unfused segment	T12-L1	2.9˚(0.5-8.0)
Unfused segment	L1-2	3.3˚(1.0-11.0)
	L2-3	6.1˚(2.0-12.5)
	Average	3.9˚(0.5-12.5)
Fused segment	Average	0.4˚(0.0-1.0)

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