We report here on a new technique using polymethylmethacrylate to manage vertebral osteoporotic compression fractures in three patients. These patients presented with acute back pain that manifested itself after minor trauma. Osteoporotic compression fractures were diagnosed via plain X-ray and magnetic resonance imaging studies. The patients were treated with absolute bed rest and non-steroidal anti-inflammatory drugs. Despite of the conservative treatment, the patients experienced severe, recalcitrant and progressive pain. The vertebrae were collapsed over 50% or kyphotic deformity was seen on the radiologic materials. We performed a new technique called lordoplasty, which is derived from percutaneous vertebroplasty. The patients experienced a reduction in pain after the procedure. The wedge and kyphotic angles of the fractured vertebrae were significantly restored.
Aged ; Female ; Fractures, Compression/radiography/*surgery ; Humans ; Magnetic Resonance Imaging ; Orthopedic Procedures/*methods ; Osteoporotic Fractures/radiography/*surgery ; Spinal Fractures/radiography/*surgery ; Thoracic Vertebrae/*injuries/radiography/surgery

PURPOSE: Surgical treatment in the case of thoracolumbar burst fractures is very controversial. Posterior instrumentation is most frequently used, however, but the number of levels to be instrumented still remains a matter of debate. MATERIALS AND METHODS: A total of 94 patients who had a single burst fracture between T11 and L2 were selected and were managed using posterior instrumentation with anterior fusion when necessary. They were divided into three groups as follows; Group I (n = 28) included patients who were operated by intermediate segment fixation, Group II (n = 32) included patients operated by long segment fixation, and Group III (n = 34) included those operated by intermediate segment fixation with a pair of additional screws in the fractured vertebra. The mean follow-up period was twenty one months. The outcomes were analyzed in terms of kyphosis angle (KA), regional kyphosis angle (RA), sagittal index (SI), anterior height compression rate, Frankel classification, and Oswestry Disability Index questionnaire. RESULTS: In Groups II and III, the correction values of KA, RA, and SI were much better than in Group I. At the final follow up, the correction values of KA (6.3 and 12.1, respectively) and SI (6.2 and 12.0, respectively) were in Groups II and III found to be better in the latter. CONCLUSION: The intermediate segment fixation with an additional pair of screws at the fracture level vertebra gives results that are comparable or even better than long segment fixation and gives an advantage of preserving an extra mobile segment.
Adolescent ; Adult ; Child ; Female ; Humans ; Male ; Spinal Fractures/radiography/*surgery ; Thoracic Vertebrae/injuries/radiography/*surgery ; Treatment Outcome ; Young Adult

OBJECTIVETo explore the operative approach and method of internal fixation for the treatment of type-C thoracolumbar fractures.

METHODST wenty-eight patients (male 20, female 8, ranging in age from 20 to 54 years, with an average of 38.5 years) with type-C thoracolumbar fractures were invovled in the study. Distributed segments involved T11 in 2 patients, T12 in 3 patients, L1 in 11 patients, L2 in 8 patient, L3 in 3 patients and L4 in 1 patient. Twenty-six patients were followed up (range from 12 to 20 months). According to the analysis of X-ray and CT image,height of vertebral body, Cobb angle on sagittal and coronal plane and the percentage of occupancy of vertebral canal were measured. The recovery of nerve, happening of back pain and the failure of internal fixation were observed.

RESULTSThe preoperative averaging height-loss decreased from 37.4% to 6.8% and the deformation of coronal plane was completely rectified. The preoperative averaging Cobb angle on sagittal plane recovered from 22.3 degrees to 5.6 degrees and the preoperative occupancy of vertebral canal averaging recovered from 33.7% to 5.9%. The difference was statistically significant (P < 0.05). Moreover, after 1 year follow-up, the changes of the above-mentioned index was no statistically significant (P > 0.05). Except for 8 patients with complete nerve damage losing the possibility of recovery, the others with incomplete nerve damage obtained 1 to 3 degree's improvement. The ratio of back pain occurrence was 19.2%. There was no failure of internal fixation.

CONCLUSIONThe treatment of thoracolumbar type-C fractures with simple posterior long-segment internal fixation or posterior long-segmental fixation added by anterior autograft fusion is a reliable and effective method. The short-term therapeutic effect is satisfactory and the long-term therapeutic effect is to be further observed.

Adult ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Lumbar Vertebrae ; injuries ; surgery ; Male ; Middle Aged ; Radiography ; Spinal Fractures ; diagnostic imaging ; surgery ; Thoracic Vertebrae ; injuries ; surgery

OBJECTIVETo explore the feasibility of percutaneous vertebroplasty for the treatment of acute burst thoracolumbar fracture.

METHODSFifty-eight patients (male 38 and female 20, ranging in age from 38 to 70 years, with an average of 56.8 years) with acute burst thoracolumbar fracture were treated by percutaneous vertebroplasty. The injuried vertebrae were T11 in 3 cases, T12 18 cases, L1 29 cases, L2 5 cases and L3 3 cases. All suited cases were classified into 3 types according to injuried vertebral shapes,type I (safe type 26 cases), type II (risk type 21 cases), and type III (marginal type 11 cases).

RESULTSAll the patients were followed up ranging from 1 to 2.5 years (mean 1.6 years). Fifty-three patients could walk in 1 to 3 days after operation. Among 55 patients who obtained complete recovery (CR), 39 patients could do daily works and 16 patients could do houseworks. The CR rate was 95%. Three patients who obtained partial recovery (PR), could live by themselves and felt slight lumbago after movements. The PR rate was 5%.

CONCLUSIONPercutaneous vertebroplasty for the treatment of acute burst thoracolumbar fracture is a feasible and effective method even for particular risks.

Acute Disease ; Adult ; Aged ; Female ; Humans ; Lumbar Vertebrae ; injuries ; surgery ; Male ; Middle Aged ; Radiography ; Spinal Fractures ; diagnostic imaging ; surgery ; Thoracic Vertebrae ; injuries ; surgery ; Vertebroplasty ; methods

OBJECTIVETo evaluate the accuracy of computer-assisted pedicle screw installation and its clinical benefit as compared with conventional pedicle screw installation techniques.

METHODSTotal 176 thoracic pedicle screws placed in 42 thoracic fracture patients were involved in the study randomly, 20 patients under conventional fluoroscopic control (84 screws) and 22 patients had screw insertion under three dimensional (3D) computer-assisted navigation (92 screws). The 2 groups were compared for accuracy of screw placement, time for screw insertion by postoperative thin-cut CT scans and statistical analysis by X(2) test. The cortical perforations were then graded by 2-mm increments: Grade I (good, no cortical perforation), Grade II (screw outside the pedicle less than 2 mm), Grade III (screw outside the pedicle larger than 2 mm).

RESULTSIn computer assisted group, 88 (95.65%) were Grade I (good), 4 (4.35%) were Grade II (less than 2mm), no Grade III (larger than 2 mm) violations. In conventional group, there were 14 cortical violations (16.67%), 70 (83.33%) were Grade I (good), 11 (13.1%) were Grade II (less than 2 mm), and 3 (3.57%) were Grade III (larger than 2 mm) violations (P less than 0.001). The number (19.57%) of upper thoracic pedicle screws ( T(1)-T(4) ) inserted under 3D computer-assisted navigation was significantly higher than that (3.57%) by conventional fluoroscopic control (P less than 0.001). Average screw insertion time in conventional group was (4.56+/-1.03) min and (2.54+/-0.63) min in computer assisted group (P less than 0.001). In the conventional group, one patient had pleura injury and one had a minor dura violation.

CONCLUSIONSThis study provides further evidence that 3D computer-assisted navigation placement of pedicle screws can increase accuracy, reduce surgical time, and be performed safely and effectively at all levels of the thoracic spine, particularly upper thoracic spine.

Bone Screws ; Fluoroscopy ; Fracture Fixation, Internal ; Humans ; Imaging, Three-Dimensional ; Radiography, Interventional ; Spinal Fractures ; surgery ; Surgery, Computer-Assisted ; Thoracic Vertebrae ; injuries ; surgery

INTRODUCTIONThe optimal management of thoracolumbar spine fractures remains a matter of controversy. The current literature implies that the use of short-segment pedicle screw fixation may be inappropriate because of its high reported failure rate. The purpose of this study is to report the short-term results of thoracolumbar burst and compression fractures treated with short-segment pedicle instrumentation.

MATERIALS AND METHODSFrom 2002 to 2007, 19 patients with thoracolumbar acute traumatic fractures were instrumented with posterior short-segment pedicle screws. The patients' case notes, operation records, preoperative and postoperative radiographs (sagittal index, anterior body compression and regional kyphosis), computed tomography scans, neurological findings (Frankel functional classification), and follow-up records up to 18 months were reviewed.

RESULTSA statistically significant difference was found between the patients' preoperative, postoperative and follow-up sagittal index, anterior body compression and regional kyphosis measurement. One case resulted in screw pedicle screw pullout and subsequently, kyphotic deformity. The patient underwent revision surgery to long-segment posterior instrumentation and fusion. None of the patients showed an increase in neurological deficit.

CONCLUSIONIn conclusion, the short-term follow-up results suggest a favourable outcome for short-segment instrumentation. Load shearing classification is essential for the selection of patient for short-segment instrumentation. However, the long-term follow-up evaluation will be needed to verify our findings.

Acute Disease ; Adult ; Analysis of Variance ; Bone Screws ; Female ; Health Status Indicators ; Humans ; Kyphosis ; diagnostic imaging ; surgery ; Lumbar Vertebrae ; injuries ; surgery ; Male ; Middle Aged ; Radiography ; Retrospective Studies ; Spinal Fractures ; surgery ; Spinal Fusion ; methods ; Thoracic Vertebrae ; injuries ; surgery ; Time Factors ; Treatment Outcome

BACKGROUNDAmong the various treatments of neurologically involved unstable thoracolumbar burst fractures, the combination of anterior and posterior instrumentation provides the most stable reconstruction. However, the use of both approaches on a trauma patient may increase the morbidity. This study is a retrospective matched cohort study to evaluate the advantages of a single stage posterior approach for spinal canal decompression in combination with circumferential reconstruction by comparing the clinical and radiographic results.

METHODSFrom March 2005 to September 2009, patients with matched type spinal fracture, ages at surgery, and involved levels in our institute underwent either a single stage posterior approach (group one, n = 12) or traditional combined approach (group two, n = 14) for spinal canal decompression and circumferential reconstruction were reviewed. Pre- and post-operative X-ray flms were reviewed and changes in Cobb angle of thoracolumbar spine were documented. Intra-operative, post-operative, and general complications were registered.

RESULTSThe mean follow-up was (27.7 ± 9.6) months (range, 14 to 56 months) in group one and (29.2 ± 7.4) months (range, 20 to 60 months) in group two (P > 0.05). The mean operation time was 214 minutes (range, 186 ± 327 minutes) in group one and 284 minutes (range, 219 ± 423 minutes) in group two (P < 0.05). The average volume of intraoperative blood loss was 1856 ml (range, 1250 ± 3480 ml) in group one and 2453 ml (range, 1600 ± 3680 ml) in group two (P < 0.05). There was no statistical difference between the groups one and two in average vertebral body height loss at the injured level and the average Cobb angle in sagittal plane before and immediately after surgery. Postoperatively, there was an epidural hematoma in one patient in group one and two patients in group two. Bony union after stabilization was obtained in all patients, without loosening or breakage of screws. Loss of correction (5°) was seen in 1 patient in group one at the 6th month owing to the subsidence of the Titanium mesh cages into the vertebra. In group two, totally four patients suffered respiratory-related complication, including pneumonia in two, severe atelectasis in one and pleural effusions in one. Importantly, there were no intraoperative or postoperative deaths in any group. All patients with incomplete neurologic deficits improved at least 1 Frankel grade.

CONCLUSIONSingle-stage posterior vertebra resection in combination with circumferential reconstruction is a new option to manage severe thoracolumbar burst fractures.

Decompression, Surgical ; adverse effects ; methods ; Humans ; Lumbar Vertebrae ; injuries ; surgery ; Operative Time ; Radiography ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Rotation ; Spinal Canal ; surgery ; Spinal Fractures ; diagnostic imaging ; surgery ; Thoracic Vertebrae ; injuries ; surgery

OBJECTIVETo evaluate the efficacy and safety of percutaneous balloon kyphoplasty as a new therapy for patients with painful osteoporotic vertebral compressive fractures of the lumbar and thoracic spine.

METHODSA retrospective analysis was conducted in 38 consecutive patients (28 females, 10 males), whose ages ranged from 56 to 82 years (mean age 72 years). The symptom- and sign-positive spinal segment was identified by MRI. The time between onset of symptoms and surgical intervention ranged from 2 days to 1 year. 62 segments (36 thoracic, 26 lumbar) were treated in this cohort. The pain score estimated by Visual Analog Scale and activity degree were assessed immediately after operation and at 1-, 6-, and 12-month postoperative follow-up. Preoperative and postoperative anterior, midline vertebral heights in fractured vertebrae were measured on lateral radiographs to evaluate the effect of the procedure.

RESULTSThe method achieved a swift pain relief associated with an evidently increased weight-bearing ability. The pain score was reduced from 8.2 to 2.4 points. The anterior and midline vertebral heights in 62 fractured vertebral bodies increased up to 82.76%+/-26.84%, 88.82%+/-21.75% and the wedge decreased from 15 to 8 degrees. This effect persisted at least over a period of two years. The procedure did not induce narrowing of the spinal canal and no severe complications occurred.

CONCLUSIONSBalloon kyphoplasty can result in immediate clinical improvement of mobility and pain relief, increase vertebral body height, and quickly return patient's activity. The short-term results are approved excellent, and the long-term results need further judgment.

Aged ; Aged, 80 and over ; Female ; Humans ; Lumbar Vertebrae ; diagnostic imaging ; injuries ; surgery ; Male ; Middle Aged ; Osteoporosis ; complications ; diagnostic imaging ; Pain Measurement ; Radiography ; Spinal Fractures ; diagnostic imaging ; etiology ; surgery ; Thoracic Vertebrae ; diagnostic imaging ; injuries ; surgery ; Treatment Outcome

OBJECTIVETo prospectively evaluate the feasibility, safety and efficacy of the percutaneous pedicle screw fixation through the pedicle of fractured vertebra in the treatment of type A thoracolumbar fractures using Sextant system in the retrospective non-randomized case-control study.

METHODSA total of 38 consecutive non-randomized patients with type A thoracolumbar fractures, which had been stabilized posteriorly from December 2006 to March 2009, were examined retrospectively more than 9 months after surgery. Twenty-one patients had been treated conventionally with open pedicle screw fixation (OPSF) and 17 patients received minimally invasive treatment with Sextant percutaneous pedicle screw fixation (SPPSF). As a method of evaluation, the incision size, the intraoperation and postoperative volume of blood loss, operation time, postoperative hospital stay, blood transfusion, the radiological assessment of the sagittal Cobb;s angle, vertebral body angle and vertebral body height were recorded and compared.

RESULTSAll patients were followed up for 8-24 months (average 11.6 months). There were significant differences in the incision size, surgical blood loss, surgical draining loss, operation time, hospital stay after operation, blood transfusion, the proportion of antalgic supplement and postoperative incisional VAS between the two groups (P less than 0.05). Mean preoperative kyphotic deformity was 16.0 degree and improved by 9.3 degree after surgery in OPSF group, but 15.2 degree and 10.3 degree respectively in SPPSF group. Mean preoperative angle of the fractured vertebral body was 15.9 degree and improved by 7.9 degree after surgery in OPSF group, but 14.9 degree and 6.6 degree respectively in SPPSF group. Mean anterior vertebral body height (% of normal) was 67.3% before surgery and 95.8% after surgery, but 69.1% and 90.1% respectively in SPPSF group. Mean posterior vertebral body height (% of normal) was 93.3% before surgery and 99.5% after surgery, but 88.9% and 93.3% respectively in SPPSF group. Among the patients whose 9-month follow-up films were available, 3.0 degree of kyphosis correction was lost in OPSF group, but 3.2 degree in SPPSF group. And 1.0 degree of the angle of the fractured vertebral body correction was lost in OPSF group, but 1.5 degree in SPPSF group. Then 3.0% of the anterior vertebral body height correction was lost in OPSF group, but 2.2% in SPPSF group. And 3.0% of the posterior vertebral body height correction was lost in OPSF group, but 2.5% in SPPSF group. The sagittal Cobb's angle, vertebral body angle and anterior height of the fractured vertebra were all significantly different in each group before and after operation (P less than 0.05). There were no significant differences in the postoperative sagittal Cobb's angle, vertebral body angle and the improvement of the vertebral body height and the kyphotic deformity correction between OPSF and SPPSF groups (P larger than 0.05), but there was significant difference in the postoperative anterior height of the fractured vertebra between the two groups (P less than 0.05).

CONCLUSIONThe percutaneous pedicle screw fixation through the pedicle of fractured vertebra using Sextant system is a good minimally-invasive surgical therapeutic choice for patients with type A thoracolumbar fracture except for that the SPPSF has a little insufficiency in resuming the anterior height of the fractured vertebra compared with OPSF.

Adult ; Biomechanical Phenomena ; Bone Screws ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Lumbar Vertebrae ; diagnostic imaging ; injuries ; surgery ; Male ; Middle Aged ; Prospective Studies ; Radiography ; Spinal Fractures ; surgery ; Thoracic Vertebrae ; diagnostic imaging ; injuries ; surgery

OBJECTIVETo study the clinical results of posterior pedicle screw fixation, transpedicular bone grafting and vertebral canaloplasty with ilium autografting in treating serious burst thoracolumbar fracture.

METHODSFrom March 2004 to March 2008,10 patients with serious burst thoracolumbar fracture, including 7 males and 3 females with age for 24-58 years (mean 41 years)were treated by posterior pedicle screw fixation, transpedicular bone grafting and total laminectomy with preservation of spinal process and vertebral canaloplasty with ilium autografting. The operative effects were assessed according to Frankel classification and radiologic results.

RESULTSAll patients were followed up from 1 to 4 years. There was no loosening or broken in instrumentation. The anterior edge height of the fractured vertebrae body was restored from (21.00 +/- 12.00)% to (95.00 +/- 4.20)%, and the posterior edge height of the fractured vertebrae body was restored from (70.00 +/- 15.00)% to (96.00 +/- 3.20)% postoperatively, which both demonstrated improvement compared with preoperative instance (P < 0.01). The Cobb angle was restored from (32.80 +/- 8.20) degrees to (4.20 +/- 1.60) degrees which also demonstrated improvement compared with the preoperative Cobb angle (P < 0.01). At least one grade recovery was observed in all cases except one patient with preoperative Frankel A degree. The result of Denis classification, P1, had 4 cases, P2 had 4, P3 had 1, P4 had 1.

CONCLUSIONPosterior pedicle screw fixation, transpedicular bone grafting and vertebral canaloplasty can obtain satisfactory results treating serious burst thoracolumbar fractures. It is a feasible method with advantages of simple operation, good efficacy, preservation of structure of posterior column which should be applied clinically.

Adult ; Bone Screws ; Bone Transplantation ; Female ; Fracture Fixation, Internal ; Humans ; Lumbar Vertebrae ; injuries ; surgery ; Male ; Middle Aged ; Radiography ; Spinal Fractures ; diagnostic imaging ; surgery ; Thoracic Vertebrae ; injuries ; surgery ; Young Adult