Journal List > J Korean Orthop Assoc > v.27(2) > 1114504

Chung, Yoo, and Oh: Segmental Short Segment Transpedicular Fixation of Unstable Thoracic, Lumbar Vertebral Fractures

Abstract

The primary goals of surgical stabilization of unstable thoracic, lumar vertebral fractures are to achieve reduction and stability. This allows early painless mobilization, prevention of spinal deformity and protection of neural element by decompression and stable fracture fixation. Recently C-D pedicle screw system has been applied in the treatment of unstable lower thoracic and lumbar vertebral fractures with fixation of shorter construct, one above and one below the injured vertebra. Subsequently, increasing incidence of failure of pedicle screw, loosening of rod and loss of correction of deformity have been reported. Authors introduced Segmental Short Segment Transpedicular Fixation (SSSTF) and operated 42 cases of unstable thoracic and lumbar fractures from March 1987 to October 1990 by the technique of SSSTF. The follow up period was from 1 to 3 years with average duration of 18 months. Measurement of correction of the anterior compression angle, local kyphosis and anteroposterior offset were 17.5°, 13.2°and 2.5 mm and loss of correction of these were 1.7°, 1.8°and negligible loss of anteroposterior offset respectively. At final follow up, 19 cases out of 22 (86.4%) gained neurologic improvement. No patient with hardware failure was noted. And the following conclusion was obtained. 1. SSSTF will provide increased stability of the entire instrument-spine complex by increasing the number of fixation point in lower thoracic and lumbar fractures. 2. Increasing the number of screws will reduce the hardware failure and loss of correction by reducing the load that each support must carry independently. 3. The additional screws inserted to the pedicles of injured vertebra provides midpoint of fixation facilitating reduction of spinal deformity.
4. The reduction of retropulsed bony fragment into the spinal canal with impacter after limited laminectomy will lessen the necessity of anterior decompression afterward.

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