Open Access, Peer-reviewed
pISSN 2093-4378
eISSN 2093-4386
    J Korean Soc Spine Surg. 2014 Dec;21(4):139-145. Korean.
    Published online Dec 31, 2014.
    https://doi.org/10.4184/jkss.2014.21.4.139
    © Copyright 2014 Korean Society of Spine Surgery
    Original Article

    The Analysis of the Outcome of Short- and Long-Segment Posterior Instrumentation for Thoracolumbar Bursting Fractures

    Woo Chul Kim, M.D., Kyu Yeol Lee, M.D., Lih Wang, M.D., Young Hoon Lim, M.D., Jung Mo Kang, M.D. and Hyun Su Do, M.D.
      • 1Department of Orthopedic Surgery, College of Medicine, Dong-A University, Busan, Korea.
      • 2Department of Orthopedic Surgery, Busan Bumin Hospital, Busan, Korea.
    • Corresponding author: Kyu Yeol Lee, M.D. Department of Orthopedic Surgery, College of Medicine, Dong-A University, 1, Dongdaesin-dong 3-ga, Seo-gu, Busan 602-715, Korea. TEL: +82-51-240-2867, FAX: +82-51-243-9764, Email: gylee@dau.ac.kr
    Received December 16, 2013; Revised January 24, 2014; Accepted November 28, 2014.

    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.

    Summary of the Literature Review

    The reports comparing short- and long-segment instrumentation are insufficient.

    Objectives

    To determine the postoperative results and to analyze relative factors affecting results between short- and long-segment instrumentation in thoracolumbar fractures.

    Materials and Methods

    From March 2006 to March 2012, 97 patients with thoracolumbar fracture were treated with posterior instrumentation. They were divided into 2 groups, the short- (Group I) and long-segment groups (Group II). To analyze factors affecting results, several factors including age, anterior column height (ACH), and the kyphotic angle were reviewed. For radiologic evaluation, postoperative and follow-up radiographs were evaluated by measuring the kyphotic angle and ACH. Additionally, the presence of complications was reviewed.

    Results

    Groups I and II consisted of 45, 52 cases and had mean ages of 50.3, 55.8 years, respectively. In Group I, the ACH increased from 44.2% to 75.3% postoperatively, and remained 72.8% at follow-up. The kyphotic angle decreased from 19.4° to 10.6° postoperatively, and remained at 12.8° at follow-up. In Group II, the ACH recovered from 41.6% to 76.4% postoperatively, and was 74.8% at follow-up. The kyphotic angle decreased from 21.6° to 12.6° postoperatively, and was 13.9° at follow-up. The canal compromise, age, and comminution were not directly related with results. However, the mean age of the 7 cases showing complications was 72 years, and the 7 cases had severe comminuted fractures.

    Conclusions

    The short- and long-segment instrumentations of thoracolumbar fractures are not significantly different with respect to the results attained. However, in order to decrease complications, we should pay attention to age and fracture comminution.

    Keywords
    Thoraolumbar; Burst fracture; Pedicle screw; Long segment; Short segment

    Figures

    Fig. 1
    A 60-year-old female patient with L1 burst fracture treated by short segment pedicle screw fixation. (A) Preoperative X-ray (B) Postoperative X-ray (C) Preoperative CT scan.

    Fig. 2
    A 31-year-old female patient with T12 burst fracture treated by long segment pedicle screw fixation. (A) Preoperative X-ray (B) Postoperative X-ray (C) Preoperative CT A B scan.

    Tables

    Table 1
    Analysis of postoperative results between short and long segment screw fixation groups

    Table 2
    Risk factors in patients showing complications

    Table 3
    Univariate Logistic regression analysis of risk factors in patients showing complications

    References

      1. McLain RF. The biomechanics of long versus short fixation for thoracolumbar spine fractures. Spine (Phila Pa 1976) 2006;31:S70–S79.
      1. Lee CS, Chung SS, Jung HW, Kim ES. Decision of posterior fixation level by load-sharing classification in thoracolumbar and lumbar burst fracture. J Korean Soc Spine Surg 2001;8:27–38.
      1. Arlet V, Orndorff DG, Jagannathan J, Dumont A. Reverse and pseudoreverse cortical sign in thoracolumbar burst fracture: radiologic description and distinction-a propos of three cases. Eur Spine J 2009;18:282–287.
      1. Cortrel Y, Dubousset J, Guillaumat M. New universal instrumentation in spinal surgery. Clin Orthop 1988;227:10–23.
      1. Roy-Camille R, Saillant G, Mazel C. Internal fixation of the lumbar spine with pedicle screw plating. Clin Orthop 1986;203:7–17.
      1. Steffee AD, Biscup RS, Sitkowski DJ. Segmental spine plates with pedicle screw fixation. A new internal fixation device for disorder of the lumbar and thoracolumbar spine. Clin Orthop 1986;203:45–53.
      1. Been HD, Bouma GJ. Comparison of two types of surgery for thoracolumbar burst fractures : combined anterior and posterior stabilization vs. posterior instrumentation only. Neurochirugica 1999;141:349–357.
      1. Sjostrom L, Jakobsson O, Karlstrom G, Pech P, Rauschning W. Spinal canal remodeling after stabilization of thoracolumbar burst fractures. Eur Spine J 1994;3:312–317.
      1. Sjostrom L, Karlstrom G, Pech P, Rauschning W. Indirect spinal canal decompression in burst fractures treated with pedicle screw instrumentation. Spine (Phila Pa 1976) 1996;21:113–123.
      1. Esses SI, Botsford DJ, Kostuik JP. Evaluation of surgical treatment for burst fractures. Spine (Phila Pa 1976) 1990;15:667–673.
      1. McLain RF, Sparling E, Benson DR. Early failure of short segment pedicle instrumentation for thoracolumbar fractures. J Bone Joint Surg 1993;75:162–167.
      1. Shono Y, McAfee PC, Cunningham BW. Experimental study of thoracolumbar burst fractures. Spine (Phila Pa 1976) 1994;19:1711–1722.
      1. Zindrick MR. The role of transpedicular fixation system for stabilization of the lumbar spine. Orthop Clin North Am 1991;22:333–343.
      1. Holt BT, McCormack T, Gaines RW. Short segment fusion - anterior or posterior approach? The load-sharing classification of spinal fractures. Spine (Phila Pa 1976) 1993;7:277–285.
      1. Robert FM, Edward S, Daniel RB. Early failure of short segment pedicle instrumentation for thoracolumbar fractures. J Bone Joint Surg 1993;75:162–167.
      1. McCormack T, Karaikovic E, Gaines RW. The load sharing classification of spine fractures. Spine (Phila Pa 1976) 1994;19:1741–1744.
      1. Lee YS, Sung JK. Long-term Follow-up Results of Short-segment Posterior Screw Fixation for Thoracolumbar Burst Fractures. J Korean Neurosurg Soc 2005;37:416–421.
      1. Chung JY, Rhym IS. Short segment transpedicular Cotrel-Dubousset instrumentation including involved vertebra for fractures of thoracic and lumbar spine. J Korean Orthop Assoc 1994;29:940–948.
      1. Wei FX, Liu SY, Liang CX, et al. Transpedicular fixation in management of thoracolumbar burst fractures: monosegmental fixation versus short-segment instrumentation. Spine (Phila Pa 1976) 2010;35:714–720.
      1. Willen J, Anderson J, Toomoka K, Singer K. The natural history of burst fractures at the thoracolumbar junction. J Spinal Disord 1990;3:39–46.
      1. Pau A, Silvestro C, Carta F. Can lacerations of the thoracolumbar dura be predicteed on the basis of radiological patterns of the spinal fractures? Acta Neurochir 1994;129:186–187.
      1. Silvestro C, Francaviglia N, Bragazzi R, Piatelli G, Viale GL. On the predictive value of radiological signs for the presence of dural lacerations related to fractures of the lower thoracic or lumbar spine. J Spinal Disord 1991;4:49–53.
      1. Haluk A, Kayali C, Arslantas M. Nonoperative treatment of burst-type thoracolumbar vertebra fractures: clinical and radiological results of 29 patients. Eur Spine J 2005;14:536–540.
      1. Jeong ST, Cho SH, Song HR, Koo KH, Park HB, Chung UH. Comparison of short and long segment fusion in thoracic and lumbar fracture. J Korean Soc Spine Surg 1999;6:73–80.
    Cited by
    Crossref 1
    Google Scholar 
    MeSH Terms
    Follow-Up Studies
    Fractures, Comminuted
    Humans
    Retrospective Studies
    Metrics
    Share
    Figures
    slide
    slide

    1 / 2

    Tables
    slide
    slide
    slide

    1 / 3

    PERMALINK