POSTEROLATERAL FUSION AND PEDICLE SCREW FIXATION FOR TREATING OLD THORACOLUMBAR FRACTURE COMBINED WITH KYPHOSIS IN ELDERLY PATIENTS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

NIUXingbang ¹ , ZHANGHaiping ² , HESimin ² , HUANGYansheng ¹ , ZHUZiqi ¹ , SHIShaoyan ¹ ,  HAODingjun ²

1. Xi'an Medical University, Xi'an Shaanxi, 710068, P. R. China;
2. Department of Spinal Surgery, Honghui Hospital Affiliated to Xi'an Jiaotong University College of Medicine;

Corresponding?author：

HAODingjun, Email: haodingjun@126.com

Keywords：

Thoracolumbar vertebra; Old fracture; Kyphosis; Bone graft fusion; Internal fixation

DOI：

10.7507/1002-1892.20160227

Video：

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Objective To investigate the clinical efficacy and the indications of posterolateral fusion and pedicle screw short-segment fixation via injured vertebra for treating old thoracolumbar fracture combined with kyphosis in elderly patients. Methods Between January 2012 and December 2014, 24 patients with old thoracolumbar fracture and kyphosis received posterolateral fusion and pedicle screw short-segment fixation via injured vertebra. Of 24 cases, 8 were male and 16 were female with an average age of 66.3 years (range, 56-79 years). The mean disease course was 17.5 months (range, 5-36 months). There were 13 cases of osteoporosis, 9 cases of osteopenia, and 2 cases of normal bone. The visual analogue scale (VAS) was 6.53±0.95, and Oswestry disability index (ODI) was 52.63%±5.74% preoperatively. The thoracolumbar kyphosis located at T₁₀ to L₂, and the kyphotic Cobb angle was (28.79±5.04)° before operation. Results The operation was completed successfully without related complications. The operative time was 1.2-2.3 hours (mean, 1.6 hours), and intraoperative blood loss was 80-210 mL (mean, 158 mL). No nerve injury occurred. Poor healing of incision was observed in 1 patient with diabetes, and primary healing of incision was obtained in the other patients. Nineteen patients were followed up 6-30 months (mean, 14.4 months), and there were 2 deaths. Pain relief and function recovery were obtained in 19 patients after operation. The VAS score and ODI were significantly decreased to 2.4±0.7 and 32.14%±5.12% at last follow-up (t=8.542, P=0.000; t=9.826, P=0.000). The kyphotic Cobb angle was significantly decreased to (21.23±4.30)° at immediate after operation (P < 0.05) and to (23.68±4.35)° at last follow-up (P < 0.05), but no significant difference was found between at immediate and last follow-up (P > 0.05). No loosening or breakage of internal fixation was observed during follow-up. Conclusion Posterolateral fusion and pedicle screw short-segment fixation via injured vertebra is a safe and effective treatment for elderly patients with old thoracolumbar fracture combined with kyphosis (Cobb angle less than 40°).

Citation： NIUXingbang, ZHANGHaiping, HESimin, HUANGYansheng, ZHUZiqi, SHIShaoyan, HAODingjun. POSTEROLATERAL FUSION AND PEDICLE SCREW FIXATION FOR TREATING OLD THORACOLUMBAR FRACTURE COMBINED WITH KYPHOSIS IN ELDERLY PATIENTS. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(9): 1118-1121. doi: 10.7507/1002-1892.20160227 Copy

1.	?Rajasekaran S, Kanna RM, Shetty AP. Management of thoracolumbar spine trauma:An overview. Indian J Orthop, 2015, 49(1):72-82.
2.	Vaccaro AR, Silber JS. Post-traumatic spinal deformity. Spine (Phila Pa 1976), 2001, 26(24 Suppl):S111-S118.
3.	Zeng Y, Chen Z, Sun C, et al. Posterior surgical correction of posttraumatic kyphosis of the thoracolumbar segment. J Spinal Disord Tech, 2013, 26(1):37-41.
4.	Schoenfeld AJ, Wood KB, Fisher CF, et al. Posttraumatic kyphosis:current state of diagnosis and treatment:results of a multinational survey of spine trauma surgeons. J Spinal Disord Tech, 2010, 23(7):e1-8.
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6.	Curfs I, Grimm B, van der Linde M, et al. Radiological prediction of posttraumatic kyphosis after thoracolumbar fracture. Open Orthop J, 2016, 10:135-142.
7.	邱勇, 朱鋒, 錢邦平, 等.胸腰椎骨折術后并發遲發性后凸畸形的危險因素和后路脊柱縮短術.中華創傷雜志, 2006, 22(1):11-14.
8.	Koller H, Acosta F, Hempfing A, et al. Long-term investigation of nonsurgical treatment for thoracolumbar and lumbar burst fractures:an outcome analysis in sight of spinopelvic balance. Eur Spine J, 2008, 17(8):1073-1095.
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10.	Kawahara N, Tomita K, Kobayashi T, et al. Influence of acute shortening on the spinal cord:an experimental study. Spine (Phila Pa 1976), 2005, 30(6):613-620.
11.	Buchowski JM, Bridwell KH, Lenke LG, et al. Neurologic complications of lumbar pedicle subtraction osteotomy:a 10-year assessment. Spine (Phila Pa 1976), 2007, 32(20):2245-2252.
12.	Lü G, Wang B, Li Y, et al. Posterior vertebral column resection and intraoperative manual traction to correct severe post-tubercular rigid spinal deformities incurred during childhood:minimum 2-year follow-up. Eur Spine J, 2015, 24(3):586-593.
13.	付松, 邵詩澤, 孫秀琛, 等.后路經傷椎置釘短節段固定椎間撐開cage植骨治療陳舊性胸腰椎骨折伴后凸畸形.中國脊柱脊髓雜志, 2013, 23(10):951-952.
14.	姜宇, 郭昭慶, 陳仲強, 等.陳舊性骨質疏松椎體壓縮骨折繼發胸腰椎后凸畸形的手術治療.中國矯形外科雜志, 2015, 23(14):1249-1253.
15.	Masharawi Y, Rothschild B, Peled N, et al. A simple radiological method for recognizing osteoporotic thoracic vertebral compression fractures and distinguishing them from Scheuermann disease. Spine (Phila Pa 1976), 2009, 34(18):1995-1999.
16.	王洪偉, 李長青, 周躍, 等.脊柱骨折經傷椎椎弓根置釘附加橫連短節段固定的穩定性測試.中國脊柱脊髓雜志, 2010, 20(9):745-748.
17.	Kang SH, Cho YJ, Kim YB, et al. Pullout strength after expandable polymethyl methacrylate transpedicular screw augmentation for pedicle screw loosening. J Korean Neurosurg Soc, 2015, 57(4):229-234.
18.	Knop C, Bastian L, Lange U, et al. Complications in surgical treatment of thoracolumbar injuries. Eur Spine J, 2002, 11(3):214-226.
19.	崔立強, 謝世明, 彭伍四, 等. Ponte截骨矯形固定治療老年骨質疏松性多節段陳舊性胸腰椎骨折伴后凸畸形.中國修復重建外科雜志, 2015, 29(3):321-325.

1. ?Rajasekaran S, Kanna RM, Shetty AP. Management of thoracolumbar spine trauma:An overview. Indian J Orthop, 2015, 49(1):72-82.
2. Vaccaro AR, Silber JS. Post-traumatic spinal deformity. Spine (Phila Pa 1976), 2001, 26(24 Suppl):S111-S118.
3. Zeng Y, Chen Z, Sun C, et al. Posterior surgical correction of posttraumatic kyphosis of the thoracolumbar segment. J Spinal Disord Tech, 2013, 26(1):37-41.
4. Schoenfeld AJ, Wood KB, Fisher CF, et al. Posttraumatic kyphosis:current state of diagnosis and treatment:results of a multinational survey of spine trauma surgeons. J Spinal Disord Tech, 2010, 23(7):e1-8.
5. Yagi M, Hasegawa A, Takemitsu M, et al. Incidence and the risk factors of spinal deformity in adult patient after spinal cord injury:a single center cohort study. Eur Spine J, 2015, 24(1):203-208.
6. Curfs I, Grimm B, van der Linde M, et al. Radiological prediction of posttraumatic kyphosis after thoracolumbar fracture. Open Orthop J, 2016, 10:135-142.
7. 邱勇, 朱鋒, 錢邦平, 等.胸腰椎骨折術后并發遲發性后凸畸形的危險因素和后路脊柱縮短術.中華創傷雜志, 2006, 22(1):11-14.
8. Koller H, Acosta F, Hempfing A, et al. Long-term investigation of nonsurgical treatment for thoracolumbar and lumbar burst fractures:an outcome analysis in sight of spinopelvic balance. Eur Spine J, 2008, 17(8):1073-1095.
9. Carroll AM, Brackenridge P. Post-traumatic syringomyelia:a review of the cases presenting in a regional spinal injuries unit in the north east of England over a 5-year period. Spine (Phila Pa 1976), 2005, 30(10):1206-1210.
10. Kawahara N, Tomita K, Kobayashi T, et al. Influence of acute shortening on the spinal cord:an experimental study. Spine (Phila Pa 1976), 2005, 30(6):613-620.
11. Buchowski JM, Bridwell KH, Lenke LG, et al. Neurologic complications of lumbar pedicle subtraction osteotomy:a 10-year assessment. Spine (Phila Pa 1976), 2007, 32(20):2245-2252.
12. Lü G, Wang B, Li Y, et al. Posterior vertebral column resection and intraoperative manual traction to correct severe post-tubercular rigid spinal deformities incurred during childhood:minimum 2-year follow-up. Eur Spine J, 2015, 24(3):586-593.
13. 付松, 邵詩澤, 孫秀琛, 等.后路經傷椎置釘短節段固定椎間撐開cage植骨治療陳舊性胸腰椎骨折伴后凸畸形.中國脊柱脊髓雜志, 2013, 23(10):951-952.
14. 姜宇, 郭昭慶, 陳仲強, 等.陳舊性骨質疏松椎體壓縮骨折繼發胸腰椎后凸畸形的手術治療.中國矯形外科雜志, 2015, 23(14):1249-1253.
15. Masharawi Y, Rothschild B, Peled N, et al. A simple radiological method for recognizing osteoporotic thoracic vertebral compression fractures and distinguishing them from Scheuermann disease. Spine (Phila Pa 1976), 2009, 34(18):1995-1999.
16. 王洪偉, 李長青, 周躍, 等.脊柱骨折經傷椎椎弓根置釘附加橫連短節段固定的穩定性測試.中國脊柱脊髓雜志, 2010, 20(9):745-748.
17. Kang SH, Cho YJ, Kim YB, et al. Pullout strength after expandable polymethyl methacrylate transpedicular screw augmentation for pedicle screw loosening. J Korean Neurosurg Soc, 2015, 57(4):229-234.
18. Knop C, Bastian L, Lange U, et al. Complications in surgical treatment of thoracolumbar injuries. Eur Spine J, 2002, 11(3):214-226.
19. 崔立強, 謝世明, 彭伍四, 等. Ponte截骨矯形固定治療老年骨質疏松性多節段陳舊性胸腰椎骨折伴后凸畸形.中國修復重建外科雜志, 2015, 29(3):321-325.

Chinese Journal of Reparative and Reconstructive Surgery

POSTEROLATERAL FUSION AND PEDICLE SCREW FIXATION FOR TREATING OLD THORACOLUMBAR FRACTURE COMBINED WITH KYPHOSIS IN ELDERLY PATIENTS

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