COMPARISON OF SHORT SEGMENTAL FIXATION WITH AND WITHOUT FUSION IN TREATMENT OF THORACOLUMBAR BURST FRACTURE BY POSTERIOR APPROACH_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LEIFei , YEFei , ZHOUQingzhong , YANGHan , YANGJian ,  FENGDaxiong , KANGJianping

Department of Spine Surgery, Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P. R. China;

Corresponding?author：

FENGDaxiong, Email: fdxlz2002@163.com

Keywords：

Thoracolumbar burst fracture; Short segment fixation; Autogenous iliac bone; Bone graft fusion

DOI：

10.7507/1002-1892.20160226

Video：

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Objective To compare the effectiveness of short segmental pedicle screw fixation with and without fusion in the treatment of thoracolumbar burst fracture. Methods A retrospective analysis was made on the clinical data of 57 patients with single segment thoracolumbar burst fractures, who accorded with the inclusion criteria between February 2012 and February 2014. The patients underwent posterior short segmental pedicle screw fixation with fusion in 27 cases (fusion group) and without fusion in 30 cases (non-fusion group). There was no significant difference in gender, age, cause of injury, time between injury and admission, fracture segment and classification, and neurologic function America Spinal Injury Association (ASIA) classification between 2 groups, which had the comparability (P > 0.05). The operative time, blood loss, and hospitalization days were compared between 2 groups. The height of the injured vertebra, the kyphotic angle, and the range of motion (ROM) were measured on the X-ray film. The functional outcomes were evaluated by using the Greenough low-back outcome score and the visual analogue scale (VAS) for back pain. The neurologic functional recovery was assessed by ASIA grade. Results The operative time was significantly shortened and the blood loss was significantly reduced in the non-fusion group when compared with the fusion group (P < 0.05), but no significant difference was found in hospitalization days between 2 groups (P > 0.05). The patients were followed up for 2.0-3.5 years (mean, 3.17 years) in the fusion group and for 2-4 years (mean, 3.23 years) in the non-fusion group. X-ray films showed that 2 cases failed bone graft fusion, the fusion time was 12-17 weeks (mean, 15.6 weeks) in the other 25 cases. Complication occurred in 2 cases of the fusion group (1 case of incision deep infection and 1 case of hematoma at iliac bone donor site) and in 1 case of the non-fusion group (fat liquefaction); primary healing of incision was obtained in the others. The Cobb angle, the height of injured vertebrae showed no significant difference between 2 groups at pre-operation, immediate after operation, and last follow-up (P > 0.05). The ROM of injured vertebrae showed no significant difference between 2 groups at 1 year after operation (before implants were removed) (P > 0.05). The implants were removed at 1 year after operation in all cases of the non-fusion group, and in 11 cases of the fusion group. At last follow-up, the ROM of injured vertebrae in the non-fusion group was significantly higher than that in the fusion group (P < 0.05), but no significant difference was found in Greenough low-back outcome score, VAS score, and ASIA grade between 2 groups (P > 0.05). Conclusion Fusion is not necessary when thoracolumbar burst fracture is treated by posterior short segmental pedicle screw fixation, which can preserve regional segmental motion, shorten the operative time, decrease blood loss, and eliminate bone graft donor site complications.

Citation： LEIFei, YEFei, ZHOUQingzhong, YANGHan, YANGJian, FENGDaxiong, KANGJianping. COMPARISON OF SHORT SEGMENTAL FIXATION WITH AND WITHOUT FUSION IN TREATMENT OF THORACOLUMBAR BURST FRACTURE BY POSTERIOR APPROACH. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(9): 1111-1117. doi: 10.7507/1002-1892.20160226 Copy

1.	?Denis F. Spinal instability as defined by the three-column spine concept in acute spinal trauma. Clin Orthop Relat Res, 1984, (189):65-76.
2.	Vu TT, Morishita Y, Yugue I, et al. Radiological outcome of short segment posterior instrumentation and fusion for thoracolumbar burst fractures. Asian Spine J, 2015, 9(3):427-432.
3.	Kim YM, Kim DS, Choi ES, et al. Nonfusion method in thoracolumbar and lumbar spinal fractures. Spine (Phila Pa 1976), 2011, 36(2):170-176.
4.	Dai LY, Jiang LS, Jiang SD. Conservative treatment of thoracolumbar burst fractures:a long-term follow-up results with special references to the load sharing classification. Spine, 2008, 33(23):2536-2544.
5.	Cho DY, Lee WY, Sheu PC. Treatment of thoracolumbar burst fractures with polymethyl methacrylate vertebroplasty and short-segment pedicle screw fixation. Neurosurgery, 2003, 53(6):1354-1361.
6.	Mumford J, Weinstein JN, Spratt KF, et al. Thoracolumbar burst fractures. The clinical efficacy and outcome of nonoperative management. Spine (Phila Pa 1976), 1993, 18(8):955-970.
7.	Greenough CG, Fraser RD. Assessment of outcome in patients with low-back pain. Spine (Phila Pa1976), 1992, 17(1):36-41.
8.	李建軍, 王方永, 脊髓損傷神經學分類國際標準(2011年修訂).中國康復理論與實踐, 2011, 17(10):963-970.
9.	Gelb D, Ludwig S, Karp JE, et al. Successful treatment of thoracolumbar fractures with short-segment pedicle instrumentation. J Spinal Disord Tech, 2010, 23(5):293-301.
10.	Guven O, Kocaoglu B, Bezer M, et al. The use of screw at the fracture level in the treatment of thoracolumbar burst fractures. J Spinal Disord Tech, 2009, 22(6):417-421.
11.	Lee JK, Jang JW, Kim TW, et al. Percutaneous short-segment pedicle screw placement without fusion in the treatment of thoracolumbar burst fractures:is it effective?:comparative study wim open short-segment pedide screw fixation with posterolateral fusion. Acta Neurochir (Wien), 2013, 155(12):2305-2312.
12.	Grossbach AJ, Dahdaleh NS, Abel TJ, et al. Flexion-distraction injuries of the thoracolumbar spine:open fusion versus percutaneous pedicle screw fixation. Neurosurg Focus, 2013, 35(2):E2.
13.	Jeon CH, Lee HD, Lee YS, et al. Is it beneficial to remove the pedicle screw instrument after successful posterior fusion of thoracolumbar burst fractures? Spine, 2015, 40(11):E627-E633.
14.	Chou PH, Ma HL, Wang ST, et al. Fusion may not be a necessary procedure for surgically treated burst fractures of the thoracolumbar and lumbar spines:follow-up of at least ten years. J Bone Joint Surg (Am), 2014, 96(20):1724-1731.
15.	Banwart JC, Asher MA, Hassanein RS. Iliac crest bone graft harvest donor site morbidity. A statistical evaluation. Spine (Phila Pa 1976), 1995, 20(9):1055-1060.
16.	Kim JY, Ryu DS, Paik HK, et al. Paraspinal muscle, facet joint, and disc problems:risk factors for adjacent segment degeneration after lumbar fusion. Spine J, 2016, 16(7):867-875.
17.	Lakshmanan P, Jones A, Mehta J, et al. Recurrence of kyphosis and its functional implications after surgical stabilization of dorsolumbar unstable burst fractures. Spine J, 2009, 9(12):1003-1009.
18.	Tang J, Liu Y, Cao Z, et al. Short segment screw fixation without fusion in treatment for unstable thoracolumbar burst fracture. Int J Clin Exp Med, 2014, 7(12):5681-5685.
19.	Haschtmann D, Stoyanov JV, Gédet P, et al. Vertebral endplate trauma induces disc cell apoptosis and promotes organ degeneration in vitro. Eur Spine J, 2008, 17(2):289-299.
20.	Tian NF, Wu YS, Zhang XL, et al. Fusion versus nonfusion for surgically treated thoracolumbar burst fractures:a meta-analysis. PLoS One, 2013, 8(5):e63995.

1. ?Denis F. Spinal instability as defined by the three-column spine concept in acute spinal trauma. Clin Orthop Relat Res, 1984, (189):65-76.
2. Vu TT, Morishita Y, Yugue I, et al. Radiological outcome of short segment posterior instrumentation and fusion for thoracolumbar burst fractures. Asian Spine J, 2015, 9(3):427-432.
3. Kim YM, Kim DS, Choi ES, et al. Nonfusion method in thoracolumbar and lumbar spinal fractures. Spine (Phila Pa 1976), 2011, 36(2):170-176.
4. Dai LY, Jiang LS, Jiang SD. Conservative treatment of thoracolumbar burst fractures:a long-term follow-up results with special references to the load sharing classification. Spine, 2008, 33(23):2536-2544.
5. Cho DY, Lee WY, Sheu PC. Treatment of thoracolumbar burst fractures with polymethyl methacrylate vertebroplasty and short-segment pedicle screw fixation. Neurosurgery, 2003, 53(6):1354-1361.
6. Mumford J, Weinstein JN, Spratt KF, et al. Thoracolumbar burst fractures. The clinical efficacy and outcome of nonoperative management. Spine (Phila Pa 1976), 1993, 18(8):955-970.
7. Greenough CG, Fraser RD. Assessment of outcome in patients with low-back pain. Spine (Phila Pa1976), 1992, 17(1):36-41.
8. 李建軍, 王方永, 脊髓損傷神經學分類國際標準(2011年修訂).中國康復理論與實踐, 2011, 17(10):963-970.
9. Gelb D, Ludwig S, Karp JE, et al. Successful treatment of thoracolumbar fractures with short-segment pedicle instrumentation. J Spinal Disord Tech, 2010, 23(5):293-301.
10. Guven O, Kocaoglu B, Bezer M, et al. The use of screw at the fracture level in the treatment of thoracolumbar burst fractures. J Spinal Disord Tech, 2009, 22(6):417-421.
11. Lee JK, Jang JW, Kim TW, et al. Percutaneous short-segment pedicle screw placement without fusion in the treatment of thoracolumbar burst fractures:is it effective?:comparative study wim open short-segment pedide screw fixation with posterolateral fusion. Acta Neurochir (Wien), 2013, 155(12):2305-2312.
12. Grossbach AJ, Dahdaleh NS, Abel TJ, et al. Flexion-distraction injuries of the thoracolumbar spine:open fusion versus percutaneous pedicle screw fixation. Neurosurg Focus, 2013, 35(2):E2.
13. Jeon CH, Lee HD, Lee YS, et al. Is it beneficial to remove the pedicle screw instrument after successful posterior fusion of thoracolumbar burst fractures? Spine, 2015, 40(11):E627-E633.
14. Chou PH, Ma HL, Wang ST, et al. Fusion may not be a necessary procedure for surgically treated burst fractures of the thoracolumbar and lumbar spines:follow-up of at least ten years. J Bone Joint Surg (Am), 2014, 96(20):1724-1731.
15. Banwart JC, Asher MA, Hassanein RS. Iliac crest bone graft harvest donor site morbidity. A statistical evaluation. Spine (Phila Pa 1976), 1995, 20(9):1055-1060.
16. Kim JY, Ryu DS, Paik HK, et al. Paraspinal muscle, facet joint, and disc problems:risk factors for adjacent segment degeneration after lumbar fusion. Spine J, 2016, 16(7):867-875.
17. Lakshmanan P, Jones A, Mehta J, et al. Recurrence of kyphosis and its functional implications after surgical stabilization of dorsolumbar unstable burst fractures. Spine J, 2009, 9(12):1003-1009.
18. Tang J, Liu Y, Cao Z, et al. Short segment screw fixation without fusion in treatment for unstable thoracolumbar burst fracture. Int J Clin Exp Med, 2014, 7(12):5681-5685.
19. Haschtmann D, Stoyanov JV, Gédet P, et al. Vertebral endplate trauma induces disc cell apoptosis and promotes organ degeneration in vitro. Eur Spine J, 2008, 17(2):289-299.
20. Tian NF, Wu YS, Zhang XL, et al. Fusion versus nonfusion for surgically treated thoracolumbar burst fractures:a meta-analysis. PLoS One, 2013, 8(5):e63995.

Chinese Journal of Reparative and Reconstructive Surgery

COMPARISON OF SHORT SEGMENTAL FIXATION WITH AND WITHOUT FUSION IN TREATMENT OF THORACOLUMBAR BURST FRACTURE BY POSTERIOR APPROACH

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