To evaluate the outcome of single screw-rod anterior instrumentation for thoracolumbar burst fractures with incomplete neurological deficit.
Methods.
16 men and 5 women aged 22 to 55 (mean, 34) years underwent single screw-rod anterior instrumentation for thoracolumbar burst fractures with incomplete neurological deficit. The vertebrae involved were T10 (n=2), T11 (n=2), T12 (n=7), L1 (n=8), and L2 (n=2). No patient had disruption of the posterior ligament complex. Postoperatively, a thoracolumbar sacral orthosis was used until solid fusion. Outcome measures included neurological recovery, degree of kyphosis, complications, and pain and functional status of the patients.
Results.
The mean follow-up duration was 36 (range, 13–50) months. All patients recovered neurologically by at least one grade. Of the 21 patients, 6 improved from grade B to grade C (n=4) or grade D (n=2), 13 from grade C to grade D, and 2 from grade D to grade E. The mean degree of kyphosis improved from 23°±5° to 7°±3°. Seven patients had complications including ipsilateral basal atelectasis (n=3), urinary tract infection (n=1), haematuria (n=1), postoperative ileus (n=1), and superficial wound infection (n=1). None had iatrogenic visceral or vascular injury, pseudoarthrosis or hardware-related complications. Only one patient had severe back pain persistently.
Conclusion.
Single screw-rod anterior instrumentation supplemented with an orthosis can be an alternative for double screw-rod anterior instrumentation for thoracolumbar burst fractures in patients with smaller vertebral bodies.
DenisF. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976)1983;8:817–31.
2.
McCormackTKaraikovicEGainesRW. The load sharing classification of spine fractures. Spine (Phila Pa 1976)1994;19:1741–4.
3.
DashtiHLeeHCKaraikovicEEGainesRWJr. Decision making in thoracolumbar fractures. Neurol India2005;53:534–41.
4.
WhangPGVaccaroAR. Thoracolumbar fractures: Anterior decompression and interbody fusion. J Am Acad Orthop Surg2008;16:424–31.
5.
MarchesiDG. Stabilization and reconstruction techniques for the thoracolumbar spine (fractures, tumors, degenerative). In: AebiMArletVWebbJK, editors. AOSpine Manual Principles and techniques. Thieme; 2007:371–90.
6.
AcostaFLJrBuckleyJMXuZLotzJCAmesCP. Biomechanical comparison of three fixation techniques for unstable thoracolumbar burst fractures. Laboratory investigation. J Neurosurg Spine2008;8:341–6.
7.
ParkWMParkYSKimKKimYH. Biomechanical comparison of instrumentation techniques in treatment of thoracolumbar burst fractures: A finite element analysis. J Orthop Sci2009;14:443–9.
8.
AebiM. Classification of thoracolumbar fractures and dislocations. Eur Spine J2010;19(Suppl 1):S2–7.
9.
KeynanOFisherCGVaccaroAFehlingsMGOnerFCDietzJ. Radiographic measurement parameters in thoracolumbar fractures: A systematic review and consensus statement of the spine trauma study group. Spine (Phila Pa 1976)2006;31:E156–65.
DenisFArmstrongGWSearlsKMattaL. Acute thoracolumbar burst fractures in the absence of neurologic deficit. A comparison between operative and nonoperative treatment. Clin Orthop Relat Res1984;189:142–9.
12.
EastlackRKBonoCM. Fractures and dislocations of the thoracolumbar spine. In: BucholzRWHeckmanJDCourt-BrownCM, editors. Rockwood and Green's Fractures in Adults, 6th ed.Philadelphia: Lippincott Williams & Wilkins; 2006:1544–80.
13.
ButtMFFarooqMMirBDharASHussainAMumtazM. Management of unstable thoracolumbar spinal injuries by posterior short segment spinal fixation. Int Orthop2007;31:259–64.
14.
CarlALTromanhauserSGRogerDJ. Pedicle screw instrumentation for thoracolumbar burst fractures and fracture-dislocations. Spine (Phila Pa 1976)1992;17(8 Suppl):S317–24.
15.
McLainRFBurkusJKBensonDR. Segmental instrumentation for thoracic and thoracolumbar fractures: Prospective analysis of construct survival and five-year follow-up. Spine J2001;1:310–23.
16.
McLainRFSparlingEBensonDR. Early failure of short-segment pedicle instrumentation for thoracolumbar fractures. A preliminary report. J Bone Joint Surg Am1993;75:162–7.
ShonoYMcAfeePCCunninghamBW. Experimental study of thoracolumbar burst fractures. A radiographic and biomechanical analysis of anterior and posterior instrumentation systems. Spine (Phila Pa 1976)1994;19:1711–22.
19.
HitchonPWTornerJEichholzKMBeelerSN. Comparison of anterolateral and posterior approaches in the management of thoracolumbar burst fractures. J Neurosurg Spine2006;5:117–25.
LoweTGEnguidanosSTSmithDAHashimSEuleJMO'BrienMF. Single-rod versus dual-rod anterior instrumentation for idiopathic scoliosis: A biomechanical study. Spine (Phila Pa 1976)2005;30:311–7.
22.
VollmerDGSimmonsNE. Transthoracic approaches to thoracic disc herniations. Neurosurg Focus2000;9:e8.
VaccaroAR. Combined anterior and posterior surgery for fractures of the thoracolumbar spine. Instr Course Lect1999;48:443–9.
25.
HuitemaGCCornipsEMCastelijnsMHvan OoijAvan SantbrinkHvan RhijnLW. The position of the aorta relative to the spine: Is it mobile or not?Spine (Phila Pa 1976)2007;32:1259–64.
26.
HsiehPHChenWJChenLHNiuCC. An unusual complication of anterior spinal instrumentation: Hemothorax contralateral to the side of the incision. A case report. J Bone Joint Surg Am1999;81:998–1001.
27.
FaciszewskiTWinterRBLonsteinJEDenisFJohnsonL. The surgical and medical perioperative complications of anterior spinal fusion surgery in the thoracic and lumbar spine in adults. A review of 1223 procedures. Spine (Phila Pa 1976)1995;20:1592–9.
28.
KukloTRLehmanRAJrLenkeLG. Structures at risk following anterior instrumented spinal fusion for thoracic adolescent idiopathic scoliosis. J Spinal Disord Tech2005;18(Suppl):S58–64.
29.
HuitemaGCvan RhijnLWvan OoijA. Screw position after double-rod anterior spinal fusion in idiopathic scoliosis: An evaluation using computerized tomography. Spine (Phila Pa 1976)2006;31:1734–9.
30.
SucatoDJKassabFDempseyM. Analysis of screw placement relative to the aorta and spinal canal following anterior instrumentation for thoracic idiopathic scoliosis. Spine (Phila Pa 1976)2004;29:554–9.
31.
PanjabiMMGoelVOxlandTTakataKDuranceauJKragM. Human lumbar vertebrae. Quantitative three-dimensional anatomy. Spine (Phila Pa 1976)1992;17:299–306.
32.
PanjabiMMTakataKGoelVFedericoDOxlandTDuranceauJ. Thoracic human vertebrae. Quantitative three-dimensional anatomy. Spine (Phila Pa 1976)1991;16:888–901.
33.
FangDCheungKMRuanDChanFL. Computed tomographic osteometry of the Asian lumbar spine. J Spinal Disord1994;7:307–16.
34.
SinghRSrivastvaSKPrasathCSRohillaRKSiwachRMaguNK. Morphometric measurements of cadaveric thoracic spine in Indian population and its clinical applications. Asian Spine J2011;5:20–34.
35.
TanSHTeoECChuaHC. Quantitative three-dimensional anatomy of cervical, thoracic and lumbar vertebrae of Chinese Singaporeans. Eur Spine J2004;13:137–46.
36.
HurfordRKJrLenkeLGLeeSSChengISidesBBridwellKH. Prospective radiographic and clinical outcomes of dual-rod instrumented anterior spinal fusion in adolescent idiopathic scoliosis: Comparison with single-rod constructs. Spine (Phila Pa 1976)2006;31:2322–8.
