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Risk factors of kyphosis recurrence after implant removal in thoracolumbar burst fractures following posterior short-segment fixation

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Abstract

Purpose

Our aim was to evaluate the results of short-segment pedicle instrumentation with screw insertion in the fracture level and find factors predicting kyphosis recurrence in thoracolumbar burst fractures.

Methods

We retrospectively analysed 122 patients with thoracolumbar burst fracture who were divided into two groups: kyphosis recurrence and no kyphosis recurrence. Pre-operative radiographic data comprising Cobb angle (CA), regional angle, anterior vertebra height (AVH), upper intervertebral angle, vertebral wedge angle (VWA), pre-anteroposterior A/P approach, superior endplate fracture, load-sharing classification (LSC) score and clinical data including age, visual analogue scale (VAS) score, thoracolumbar injury classification and severity score were compared between groups. T test, Pearson's chi-square and multivariate logistic regression were calculated for variables.

Results

CA, VWA and AVH were significantly corrected after surgery. CA changed from 23.7 to 3.0 (p <0.001), VWA from 38.7 to 9.6 (p <0.001) and AVH from 48.8 % to 91.2 % (p <0.001). These parameters were well maintained during the follow-up period with a mild, tolerant loss of correction. Neurological function and pain were significantly improved without deterioration. Age, pre-A/P and pre-AVH < 50 % influenced kyphosis recurrence (p = 0.032, 0.026, 0.011, respectively).

Conclusions

Short-segment pedicle instrumentation including the fractured vertebra was effective in treating thoracolumbar burst fractures. The loss of correction at follow-up after implant removal was associated with age, A/P ratio and anterior vertebral height < 50 %.

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Acknowledgments

This work is supported by grant from National Nature Foundation of China (Grant No. 81371988), Natural Science Foundation of Zhejiang Province for Distinguished Young Scholars (Grant No. LR12H06001), and Major Science and Technology Program for medical and health of Zhejiang Province (Grant No. WKJ-ZJ-1527).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, The Second Affiliated Hospital of Wenzhou Medical University, 109 Xueyuanxi Road, Wenzhou, 325000, China

    Jiao-Xiang Chen, Dao-Liang Xu, Sun-Ren Sheng, Amit Goswami, Jun Xuan, Hai-Ming Jin, Jian Chen, Yu Chen, Zeng-Ming Zheng, Xi-Bang Chen & Xiang-Yang Wang

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  1. Jiao-Xiang Chen
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  2. Dao-Liang Xu
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Correspondence to Xiang-Yang Wang.

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Chen, JX., Xu, DL., Sheng, SR. et al. Risk factors of kyphosis recurrence after implant removal in thoracolumbar burst fractures following posterior short-segment fixation. International Orthopaedics (SICOT) 40, 1253–1260 (2016). https://doi.org/10.1007/s00264-016-3180-9

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  • DOI: https://doi.org/10.1007/s00264-016-3180-9

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