Accepted methods of treatment of lumbar burst fractures include conservative therapy, posterior reduction and instrumentation, and anterior decompression and instrumentation. Surgery aims at the correction of the kyphotic deformity and at the decompression of the spinal cord thereby reducing pain and allowing early patient mobilization. Posterior-only procedures usually rely on ligamentotaxis or manual tamping of bone fragments for decompression of the spinal canal. Transpedicular corpectomy allow for circumferential surgery through a single posterior approach. The authors use an expandable cage to restore the normal spinal curvature and to prevent the kyphotic deformity.
Congenital Abnormalities ; Decompression ; Humans ; Spinal Canal ; Spinal Cord ; Spinal Curvatures

STUDY DESIGN: A retrospective study. OBJECTIVES: The aim of this study was to examine the usefulness of axial and sagittal-reconstructed CT images in the evaluation of spinal canal encroachment by thoracolumbar burst fractures. SUMMARY OF LITERATURE REVIEW: The dimensions of spinal canal encroachment by burst fractures have been described using axial CT images in the thoracolumbar region and sagittal-reconstructed images in the lower cervical region. However, the validity and reliability, depending on the measuring method, have not been fully evaluated. MATERIALS AND METHODS: A hundred and ninety-nine patients, who had diagnosed as a thoracolumbar burst fracture, were included in this study. Three orthopedic surgeons independently measured the canal encroachment of the burst fragment in the axial CT images and the sagittal-reconstructed images using the ratio of spinal length (method 1) and the ratio of area (method 2). The validity for the evaluation of the deformity and fracture stability was evaluated. In addition, the reliability of each method was assessed. RESULTS: Sixty-seven stable burst fractures and 132 unstable burst fractures were assessed. The mean kyphotic angle of stable and unstable burst fracture were 11.89 +/- 8.49degreesand 15.90 +/- 9.63degrees(P=0.005). The mean canal encroachment ratios of stable fracture were 17.21 +/- 15.82 % (axial-method 1), 16.71 +/-16.49 % (axial-method 2), 19.54 +/- 17.03 % (sagittal reconstructed-method 1), and 11.75 +/- 12.33 % (sagittal reconstructed-method 2). The mean canal encroachment ratios of unstable fracture were 31.54 +/- 17.10 % (axial-method 1), 29.67 +/- 18.47 % (axial-method 2), 28.53 +/- 18.60 % (sagittal reconstructed-method 1), and 21.20 +/- 15.11 % (sagittal reconstructed-method 2). There was no relationship between the fracture deformity and the canal encroachment ratio in all 4 methods. All ratios in the 4 method showed significant differences in the evaluation of fracture stability. All methods except method 1 in the sagittal-reconstructed images showed significant differences in the assessment of neurologic compromise. CONCLUSIONS: The measurement of a canal encroachment area using axial and sagittal-reconstructed images was valid in the description of fracture stability.
Congenital Abnormalities ; Humans ; Orthopedics ; Reproducibility of Results ; Retrospective Studies ; Spinal Canal

Terminal myelocystocele is a rare form of occult spinal dysraphism in which the hydromyelic caudal spinal cord and the subarachnoid space are hemiated through a posterior spina bifida. A 1.5 month old boy presented with a large lumbosacral mass and urinary incontinence. The magnetic resonance imaging, operative findings and pathological findings revealed a low lying conus with a dilated central canal dorsally attached to the subcutaneous tissue. Ventral subarachnoid space was enlarged and herniated through the laminar defect of the sacrum. The lesion was typical of a terminal myelocystocele. The clinical features are different from those of myelomeningocele in many aspects. Though the incidence is low, terminal myelocystocele should be included in the differential diagnosis of congenital lesions presenting as a lumbosacral mass.
Arachnoid/abnormalities ; Case Report ; Human ; Infant ; Lumbosacral Region ; Male ; Meningomyelocele/diagnosis/pathology/surgery ; Spinal Canal/abnormalities ; Spinal Cord/abnormalities ; *Spinal Dysraphism/diagnosis/pathology/surgery ; Support, Non-U.S. Gov't

OBJECTIVE: The purpose of this study was to evaluate the results obtained in patients who underwent staged 360-degree fusion with posterior fusion following anterolateral fusion for unstable thoracolumbar burst fractures. METHODS: The authors performed 360-degree fusion for thoracolumbar burst fractures in 21 patients between 2006 and 2010. We reviewed the medical records and follow-up data including pre- and postoperative neurological status, spinal canal compromise, segmental kyphotic angulations, complications, visual analogue scale (VAS) pain scores, and revision surgery rates. RESULTS: The mean computed tomography-measured preoperative spinal canal compromise was 55.9+/-20.7%. The segmental kyphotic deformity measured 20.2+/-4.4degrees preoperatively and had been corrected to 4.5+/-2.8degrees postoperatively. The mean vertebral body height loss of 57.4+/-6.9% improved significantly to 1.2+/-0.7% at the final follow-up examination. The mean preoperative VAS pain score of 8.2+/-0.8 improved to 1.5+/-0.6 at discharge. There were no cases of vascular complication, neurological deterioration, or revision surgery. CONCLUSION: Unstable burst fracture of thoracolumbar spine managed by staged posterior fusion and anterolateral interbody fusionis effective for kyphosis correction, significant canal decompression, pain reduction, maintaining stabilization and neurological improvement.
Body Height ; Congenital Abnormalities ; Decompression ; Follow-Up Studies ; Humans ; Kyphosis ; Medical Records ; Spinal Canal ; Spinal Fractures ; Spinal Fusion ; Spine

STUDY DESIGN: This is a case report. OBJECTIVE: We report here on three cases of late spinal cord compression without bone cement leakage after kyphoplasty from the view point of the common characteristics, the suspected etiologies and the performed treatments, and we propose a technique to prevent this kind of complication. SUMMARY OF THE LITERATURE REVIEW: Kyphoplasty is widely accepted as an effective and safe treatment for osteoporotic vertebral compression fracture (VCF). Complicated compression fractures and even bursting fractures with a compromised spinal canal are currently indicated for kyphoplasty. The wide spread application of kyphoplasty may be mainly due to reducing the complication rates associated with cement leakage and possible restoration, even though partially, of a vertebral kyphotic deformity. MATERIALS AND METHODS: we experienced three cases of newly emerged complications that caused delayed neurologic compromise after uneventful kyphoplasty without any immediate neurologic deficits. MR imaging was done to find the pathologic regions and surgical treatment was performed. RESULTS: Refracture of an augmented vertebra at the conus medullaris level can cause late occurring spinal cord compression without compromising the spinal canal. Posterior instrumentation and posterior fusion with posterior decompression were effective treatments. CONCLUSION: The anatomical peculiarity of the conus medullaris and the dynamic irritation of the spinal cord by a bone cement mass after refracture of an augmented vertebral body can be the causes of late spinal cord compression after kyphoplasty. The neurologic symptoms were treated by posterior decompression and fusion. This kind of complication can be prevented by injecting a sufficient amount of bone cement with a shape to support both endplates.
Congenital Abnormalities ; Conus Snail ; Decompression ; Fractures, Compression ; Kyphoplasty ; Neurologic Manifestations ; Spinal Canal ; Spinal Cord ; Spinal Cord Compression ; Spine

STUDY DESIGN: We retrospectively reviewed the cervical myelopathy patients who underwent anterior or posterior surgery. OBJECTIVES: This study was undertaken to analyze the preoperative radiologic evaluation and the results of the treatment of cervical myelopathy. SUMMARY OF LITERATURE REVIEW: The surgical treatment of cervical myelopathy consisted of anterior/posterior or combined surgery according to lesion site, symptoms, number of involved sequents or prevalence of the surgeon. Material and METHODS: We reviewed the clinical and radiological aspects of 28 patients Preoperative plain radiographs and MRI were evaluated with clinical symptoms. Postoperative clinical evaluation was performed according to the Robinson's criteria. RESULTS: On plain lateral radiographs, spinal canal diameter were 13.4+/-2.6/12.5+/- 1.7mm, Pavlovratios were 0.78+/-0.09/0.66+/-0.08, spondylosis indices were 1.70/1.80mm, and the antero-posterior compression ration of spinal cord were 42.4+/-8/44.0+/-6% for anterior surgery and posterior surgery group each. The results of 15 patients who received anterior decompression and interbody fusion were excellent in 11, good in 2, and fair in 2 cases. The results of 13 patients who underwent laminoplasty were excellent in 9, good in 3, and fair in one case. CONCLUSIONS: The patients who have Pavlov ratio less than 0.8 and spondylosis index more than 1.5mm on plain radiograph are vulnerable to developing myelopathy. It is better to do anterior decom pression and interbody fusion in patients who have one or two segments involved and kyphotic deformity of the cervical spine. Otherwise, patients who involve more than 3 segments and narrow spinal canal can be managed using laminoplasty posteriorly.
Congenital Abnormalities ; Decompression ; Humans ; Magnetic Resonance Imaging ; Prevalence ; Retrospective Studies ; Spinal Canal ; Spinal Cord ; Spinal Cord Diseases* ; Spine ; Spondylosis

OBJECTIVE: The purpose of this study was to determine the efficacy of short segment fixation following postural reduction for the re-expansion and stabilization of unstable burst fractures in patients with osteoporosis. METHODS: Twenty patients underwent short segment fixation following postural reduction using a soft roll at the involved vertebra in cases of severely collapsed vertebrae of more than half their original height. All patients had unstable burst fracture with canal compromise, but their motor power was intact. The surgical procedure included postural reduction for 2 days and bone cement-augmented pedicle screw fixations at one level above, one level below and the fractured level itself. Imaging and clinical findings, including the level of the vertebra involved, vertebral height restoration, injected cement volume, local kyphosis, clinical outcome and complications were analyzed. RESULTS: The mean follow-up period was 15 months. The mean pain score (visual analogue scale) prior to surgery was 8.1, which decreased to 2.8 at 7 days after surgery. The kyphotic angle improved significantly from 21.6+/-5.8degrees before surgery to 5.2+/-3.7degrees after surgery. The fraction of the height of the vertebra increased from 35% and 40% to 70% in the anterior and middle portion. There were no signs of hardware pull-out, cement leakage into the spinal canal or aggravation of kyphotic deformities. CONCLUSION: In the management of unstable burst fracture in patients with severe osteoporosis, short segment pedicle screw fixation with bone cement augmentation following postural reduction can be used to reduce the total levels of pedicle screw fixation and to correct kyphotic deformities.
Congenital Abnormalities ; Follow-Up Studies ; Humans ; Kyphosis ; Osteoporosis ; Spinal Canal ; Spine

STUDY DESIGN: Prospective study. 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. CONCLUSIONS: Through an operative procedure, we could achieve better results in restoration of anterior vertebral height and canal clearance with the AO internal fixator system. Further study is necessary to keep the reduced state of vertebral height.
Body Height ; Congenital Abnormalities ; Humans ; Internal Fixators ; Prospective Studies ; Spinal Canal ; Surgical Procedures, Operative ; Transplants

OBJECTIVE: To elucidate postoperative clinical and radiologic efficacy of unilateral kyphoplasty compared for percutaneous bilateral vertebroplasty. METHODS: One hundred patients with osteoporotic compression fracture at thoracolumbar junction were enrolled in this study. The kyphotic angle and reduction rate were measured to evaluate the vertebral restoration. Visual analog scale (VAS) for pain and short form-36 (SF-36) and Oswestry Disability Index (ODI) for functional outcome were recorded by 1 year postoperatively. Cement extravasation and adjacent vertebral fractures were monitored. RESULTS: Visual analog scale for pain was not statistically different through the follow up in both groups (p=0.38). The preoperative SF-36 and ODI scores were similar (p>0.05) but the difference in ODI score and standardized physical component scale reached statistical significance (p=0.04, p=0.03) and unilateral kyphoplasty group was getting better functional status. Reduction rate of vertebral body was 42.5+/-7.8% for the vertebroplasty group and 66.3+/-8.1% for the unilateral kyphoplasty group (p<0.001) and loss of reduction was 4.5+/-3.5% and 1.7+/-2.5% (p<0.0001) respectively. There were six complications of cement extraosseous leakage into the spinal canal in vertebroplasty only. CONCLUSION: Unilateral kyphoplasty in compare with vertebroplasty is safer for cement leakage and immediately reduces back pain and restore kyphotic deformities in addition to the prevention of subsequent compression fracture.
Back Pain ; Congenital Abnormalities ; Follow-Up Studies ; Fractures, Compression ; Humans ; Kyphoplasty ; Osteoporotic Fractures ; Spinal Canal ; Vertebroplasty

STUDY DESIGN: A retrospective study. PURPOSE: To analyze the treatment outcome of patients with lower thoracic and lumbar fractures combined with neurological deficits. OVERVIEW OF LITERATURE: Although various methods of the surgical treatment for lower thoracic and lumbar fractures are used, there has been no surgical treatment established as a superior option than others. METHODS: Between March 2001 and August 2009, this study enrolled 13 patients with lower thoracic and lumbar fractures who underwent spinal canal decompression by removing posteriorly displaced bony fragments via the posterior approach and who followed up for more than a year. We analyzed the difference between the preoperative and postoperative extents of canal encroachment, degrees of neurologic deficits and changes in the local kyphotic angle. RESULTS: The average age of the patients was 37 years. There were 10 patients with unstable burst factures and 3 patients with translational injuries. Canal encroachment improved from preoperative average of 84% to 9% postoperatively. Local kyphosis also improved from 20.5degrees to 1.5degrees. In 92% (12/13) of the patients, neurologic deficit improved more than Frankel grade 1 and an average improvement of 1.7 grade was observed. Deterioration of neurologic symptoms was not observed. Although some loss of reduction of kyphotic deformity was observed at the final follow-up, serious complications were not observed. CONCLUSIONS: When posteriorly displaced bony fragments were removed by the posterior approach, neurological recovery could be facilitated by adequate decompression without serious complications. The posterior direct decompression could be used as one of treatments for lower thoracic and lumbar fractures combined with neurologic injuries.
Congenital Abnormalities ; Decompression ; Follow-Up Studies ; Humans ; Kyphosis ; Neurologic Manifestations ; Retrospective Studies ; Spinal Canal ; Treatment Outcome