Objective To evaluate the effectiveness of spinal canal decompression assisted by unilateral biportal endoscopy (UBE) and percutaneous uniplanar pedicle screw internal fixation in the treatment of lumbar burst fractures with neurological symptoms. Methods Between June 2021 and December 2022, 10 patients with single level lumbar burst fracture with neurological symptoms were treated with spinal canal decompression assisted by UBE and percutaneous uniplanar pedicle screw internal fixation. There were 7 males and 3 females with an average age of 43.1 years (range, 21-57 years). The injured vertebrae located at L1 in 2 cases, L2 in 4 cases, L3 in 3 cases, and L4 in 1 case. There were 7 cases of AO type A3 fractures and 3 cases of AO type A4 fractures. The total operation time, the time of operation under endoscopy, and complications were recorded. Pre- and post-operative visual analogue scale (VAS) score and American Spinal Injury Association (ASIA) scale (grading A-E corresponding to assigning 1-5 points for statistical analysis) were used to evaluate effectiveness. X-ray film and CT were performed to observe the fracture healing, and the ratio of anterior vertebral body height, Cobb angle, and rate of spinal canal invasion were measured to evaluate the reduction of fracture.Results All operations was successfully completed, and the spinal canal decompression and the bone fragment in spinal canal reduction completed under the endoscopy. Total operation time was 119 minutes on average (range, 95-150 minutes), and the time of operation under endoscopy was 46 minutes on average (range, 35-55 minutes). There was no complication such as dural sac, nerve root, or blood vessel injury during operation. All incisions healed by first intention. All patients were followed up 18.7 months on average (range, 10-28 months). The VAS score after operation significantly decreased when compared with that before operation (P<0.05), and further improved at last follow-up (P<0.05). The ASIA scale after operation significantly improved when compared with that before operation (P<0.05), and there was no significant difference (P>0.05) in the ASIA scale between at 1 week after operation and at last follow-up. The imaging examination showed that the screw position was good and the articular process joint was preserved. During follow-up, there was no loosening, fracture, or fixation failure of the internal fixation. The ratio of anterior vertebral body height and Cobb angle significantly improved, the rate of spinal canal invasion significantly decreased after operation (P<0.05), and without significant loss of correction during the follow-up (P>0.05). Conclusion Spinal canal decompression assisted by UBE and percutaneous uniplanar pedicle screw fixation is a feasible minimally invasive treatment for lumbar burst fractures with neurological symptoms, which can effectively restore the vertebral body sequence, as well as relieve the compression of spinal canal, and improve the neurological function.
目的 观察后路环形减压治疗胸腰椎爆裂骨折术后2～5年的临床疗效及并发症发生情况。 方法 回顾性分析2007年1月－2011年3月23例胸腰椎椎体爆裂骨折患者资料，23例患者存在骨折压迫硬膜合并神经症状，均予后路环形减压。术后定期随访，采用日本骨科协会评估治疗分数、美国脊髓损伤协会脊髓损伤分级评定临床疗效及神经功能改善情况，通过影像学资料观察脊柱Cobb角变化情况。 结果 23例患者手术顺利，经过2～5年的随访，出现术后脑脊液漏3例，尿路感染5例，经对症处理后好转。 结论 经椎弓根内侧行椎体后壁切除，可良好减压，避免神经挤压继发加重损伤，有利于神经功能恢复。
Objective To evaluate the cl inical outcomes of anterior decompression, bone graft and internal fixation in treating fourth lumbar burst fractures with il iac fenestration. Methods From February 2001 to May 2006, 8 cases of fourth lumbar burst fractures were treated by anterior decompression, correction, reduction, il iac autograft, Z-plate internal fixation with il iac fenestration. Of them, there were 7 males and 1 female, aging 24-46 years with an average of 29.3 years, including 3 cases of Denis type A and 5 cases of Denis type B. The decompression, intervertebral height were compared betweenpreoperation and postoperation by CT scanning. According to Frankel assessment for neurological status, 2 cases were at grade C, 5 at grade D and 1 at grade E before operation. Four cases had different degrees of disturbance of sphincter. Time from injury to operation was 8 hours to 11 days. The preoperative height of the anterior border of the L4 vertebral body was (13.8 ± 2.3) mm, the Cobb angel of fractured vertebral body was (13.2 ± 2.5)°, the vertebral canal sagittal diameter of L4 was (10.6 ± 3.5) mm. The bone graft volume was (7.5 ± 1.3) cm3 during operation. Results Operations were performed successfully. The mean operative time was (142 ± 25) minutes and the mean amount of blood loss was (436 ± 39) mL. The incisions obtained heal ing by first intention after operation. Two cases suffered donor site pain and recevied no treatment. The follow-up time of 8 cases was from 21 months to 52 months (mean 24.5 months). At one week after operation, the height of the anterior border of the L4 vertebral body was (32.5 ± 2.6) mm, the Cobb angel of fractured vertebral body was (6.8 ± 3.7)°, and the vertebral canal sagittal diameter of L4 was (19.8 ± 5.1) mm, showing significant difference when compared with those of preoperation (P lt; 0.01). At the final follow-up, the results showed that the pressure was reduced sufficiently, all autograft fused well, the neurological status improved at Frankel grade from C to D in 1 patient, from D to E in 3 patients, but the others had no improvement. In 4 patients who had disturbance of sphincter, 3 restored to normal and 1 was better off. Conclusion Cl inical outcomes of anterior surgery for fourth lumbar burst fractures with il iac fenestration are satisfactory. It can facil icate operation, reduce the pressure sufficiently, maintenance intervertebral height and recover the neurological function.
Objective To investigate the amount of bone grafting, bone defect gap residual rates, and biomechanical stability of the injured vertebral body after reduction of thoracolumbar burst fractures, pedicle screw-rods fixation, and bone graft by bilateral pedicle or unilateral spinal canal. Methods Eighteen fresh lumbar spine (L1-5) specimens of calves (aged 4-6 months) were collected to establish the burst fracture model at L3 and divided into 3 groups randomly. After reduction and fixation with pedicle screws, no bone graft was given in group A (n=6), and bone graft was performed by bilateral pedicles in group B (n=6) and by unilateral spinal canal in group C (n=6). The amount of bone grafting in groups B and C was recorded. The general situation of bone defect gaps was observed by the DR films and CT scanning, and the defect gap residual rates of the injured vertebrae were calculated with counting of grids. The compression stiffness was measured by ElectreForce-3510 high precision biological material testing machines. Results The amount of bone grafting was (4.58 ± 0.66) g and (5.72 ± 0.78) g in groups B and C respectively, showing signficant difference (t=2.707, P=0.022). DR films and CT scanning observation showed large bone defect gap was seen in injured vertebrae specimens of group A; however, the grafting bone grains was seen in the “eggshell” gap of the injured vertebral body, which were mainly located in the posterior part of the vertebral body, but insufficient filling of bone graft in the anterior part of the vertebral body in group B; better filling of the grafting bone grains was seen in injured vertebral body of group C, with uniform distribution. The bone defect gap residual rates were 52.0% ± 5.5%, 39.7% ± 2.5%, and 19.5% ± 2.5% respectively in groups A, B, and C; group C was significantly lower than groups A and B (P lt; 0.05), and group B was significantly lower than group A (P lt; 0.05). Flexion compressive stiffness of group C was significantly higher than that of groups A and B (P lt; 0.05), but no significant difference was found between groups A and B (P gt; 0.05). Extension compressive stiffness in group C was significantly higher than that in group A (P lt; 0.05), but no significant difference was found between groups A and B, and between groups B and C (P gt; 0.05). The compression stiffness of left bending and right bending had no significant difference among 3 groups (P gt; 0.05). Conclusion Thoracolumbar burst fracture pedicle screws fixation with bone grafting by unilateral spinal canal can implant more bone grains, has smaller bone defect gap residual rate, and better recovery of flexion compression stiffness than by bilateral pedicles.
Objective To assess the effectiveness of percutaneous pedicle screw fixation and minimally invasive decompression in the same incision for type A3 thoracolumbar burst fracture. Methods Between May 2014 and February 2016, 43 cases of type A3 thoracolumbar burst fracture with or without nerve symptoms were treated with pedicle screw fixation and neural decompression. Of them, 21 patients underwent percutaneous pedicle screw fixation and minimally invasive decompression in the same incision (percutaneous group), and the other 22 patients underwent traditional open surgery (open group). There was no significant difference in gender, age, cause of injury, fractures level, preoperative American Spinal Injury Association (ASIA) grade, thoracolumbar injury classification and severity (TLICS) score, load-sharing classification, height of injury vertebrae, kyphotic Cobb angle, and spinal canal encroachment between 2 groups (P>0.05). The length of soft tissue dissection, operation time, intraoperative blood loss, postoperative drainage, X-ray exposure times, and incision visual analogue scale (VAS) score at 1 day after operation were recorded and compared. At last follow-up, Japanese Orthopaedic Association (JOA) score and low back pain VAS score were recorded and compared respectively. The ASIA grade recovery was evaluated; the height of injury vertebrae, kyphotic Cobb angle, and spinal canal encroachment were assessed postoperatively. Results Percutaneous group was significantly better than open group in the length of soft tissue dissection, intraoperative blood loss, postoperative drainage, and incision VAS at 1 day after operation (P<0.05), but no significant difference was found in operation time between 2 groups (P>0.05); however, X-ray exposure times of open group were significantly better than that of percutaneous group (P<0.01). The patients were followed up 12 to 19 months (mean, 15.1 months) in 2 groups. All patients achieved effective decompression. No complications of iatrogenic neurological injury and internal fixation failure occurred. The height of injury vertebrae, kyphotic Cobb angle, and spinal canal encroachment of the fractured vertebral body were significantly improved at 3 days after operation when compared with preoperative ones (P<0.05), but no significant difference was found between 2 groups (P>0.05). At last follow-up, JOA score and low back pain VAS score of percutaneous group were significantly better than those of open group (P<0.05). The neurological function under grade E was improved at least one ASIA grade in 2 groups, but no significant difference was shown between 2 groups (Z=0.480, P=0.961). Conclusion Percutaneous pedicle screw fixation and minimally invasive decompression in the same incision for type A3 thoracolumbar burst fracture has satisfactory effectiveness. And it has the advantages of minimal trauma, quick recovery, safeness, and reliableness.
ObjectiveTo investigate the efficacy and safety of over-bending rod reduction and fixation technique via posterior approach in the treatment of unstable fresh thoracolumbar burst fracture.MethodsA clinical data of 27 patients with unstable fresh thoracolumbar burst fracture, who were met the inclusive criteria and admitted between January 2018 and October 2019, was retrospectively analyzed. There were 15 males and 12 females with an average age of 41.8 years (range, 26-64 years). The fractures were caused by falling from height in 14 cases, traffic accident in 8 cases, and crushing by a heavy objective in 5 cases. The interval between injury and operation was 1-7 days (mean, 3.2 days). The injured fracture was located at T10 in 1 case, T11 in 3 cases, T12 in 6 cases, L1 in 7 cases, L2 in 7 cases, and L3 in 3 cases. According to AO classification, there were 11 cases of type A3, 7 cases of type B, and 9 cases of type C. Neurological function was rated as grade A in 3 cases, grade B in 7 cases, grade C in 5 cases, and grade D in 12 cases according to the American Spinal Injury Association (ASIA) grading. All cases were treated by over-bending rod reduction and fixation technique via posterior approach, and 16 cases were combined with limited fenestration decompression. The evaluation indicators consisted of operation time, intraoperative blood loss, the compression ratio of the anterior vertebral height, the invasion rate of the injured vertebra into the spinal canal, the Cobb angle of segmental kyphosis, visual analogue scale (VAS) score, and Oswestry Disability Index (ODI).ResultsThe operation time was 67-128 minutes (mean, 81.6 minutes), and the intraoperative blood loss was 105-295 mL (mean, 210 mL). All patients were followed up 12-23 months (mean, 17.2 months). A total of 178 pedicle screws were implanted during operation, and the accuracy of the implantation was 98.9% (176/178). The compression ratios of the anterior vertebral height at the early postoperatively and last follow-up were significantly increased when compared with preoperative one (P<0.05), and the invasion rate of the injured vertebra into the spinal canal, Cobb angle, VAS score, and ODI were significantly lower than those preoperatively (P<0.05). Except that the ODI at last follow-up was significantly lower than that of the early postoperative period (P<0.05), there was no significant difference between the last follow-up and the early postoperative period for other indicators (P>0.05). At last follow-up, the neurological function was rated as grade A in 1 case, grade B in 2 cases, grade C in 4 cases, grade D in 9 cases, and grade E in 11 cases according to the ASIA grading, showing significant difference when compared with that before operation (Z=–3.446, P=0.001).ConclusionOver-bending rod reduction and fixation technique can effectively restore vertebral height, reset the invaded vertebral block, and selectively perform limited decompression and posterolateral bone grafting to ensure the completeness of intravertebral decompression and stability, which is one of the effective methods to treat unstable fresh thoracolumbar burst vertebral fracture.
ObjectiveTo compare the effectiveness of short segmental pedicle screw fixation with and without fusion in the treatment of thoracolumbar burst fracture. MethodsA 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. ResultsThe 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). ConclusionFusion 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.
Objective To explore the injury mechanism of the severethoracolumbar burst fracture and the necessity of anterior decompression and reconstruction with internal fixation. Methods From January 1999 to January 2004, 21 patients were treated with anterior decompression and reconstruction. The fractures were located at T12 in 6 patients, L1 in12, L2 in 4, L3 in 3,and L4 in 1. Four patients were treated with the “anterior approach” and “posterior approach” surgeries for severe column fractures.Results All the patients were restored to the normal physiological radian, and the spinal canal was decompressed completely. They werefollowed up for 1-6 years, and the bony fusion was observed radiologically.The spinal cord function was improved to the 1-3 Frankel grade in all the patients except 2. There were no such complications as leakage of the cerebrospinal fluid, platescrew loosening or breaking, or segment instability. The clinical effects were satisfactory. Conclusion The operation of the anterior decompression and reconstruction with internal fixation for severe thoracolumbar burst fracture has advantages of complete decompression, full bonegrafting, and firm internal fixation. It canrestore the spinal height and improve the spinal cord function.
Objective To evaluate the method of the allogenous boneplate reconstructing the spinal channel and grafting in treatment of thoracolumbar burst fracture with paraplegia. Methods Thirty-six patients with thoracolumbar burst fracture with paraplegia were included in this study. Their ages ranged from 18 to 56 (average, 38). The vertebral injury involvedT11 in 3 patients，T12 in 10 patients，L1 in 14 patients，L2 in 7 patients，and L3 in 2 patients. Neurological deficits were classified by the Frankel grading. There were 9 patients in grade A, 11 patients in grade B, 13 patients in grade C, and 3 patients in grade D. All the patients were treatedwith the anterior approach, decompression of the spinal channel, interbody graft, and internal fixation. The grafting materials consisted of the allogenous femoral bone plate that was degreased in advance and implanted in the intervertebral posterior region, with cut ribs and bone mills during the decompression. Results Postoperative CT scanning showed clearance of the spinal cord compression and expansion of the spine channel. During the follow-up period averaged 2 years, almost all the patients showed an improvement in the neurological function. Spinal fusion occurred in 32 patients. There was no screw loosened or broken. Only 1 patient failed to achieve the fusion. Conclusion The anterior approach, allograft bone plate reconstructing the spine channel is a safe and effective method in treatment of the thoracolumbar burst fracture with paraplegia, which may be a replacement of the autogenous illiac bone graft.
ObjectiveTo evaluate the feasibility and the effectiveness of minimally invasive passage in posterior laminotomy decompression and intervertebral bone grafting combined with percutaneous pedicle screw fixation for the treatment of Denis type B thoracolumbar burst fractures. MethodsBetween January 2013 and March 2015, 53 patients with Denis type B thoracolumbar burst fractures were treated by minimally invasive passage in posterior laminotomy decompression and intervertebral bone grafting combined with percutaneous pedicle screw fixation. There were 37 males and 16 females with a mean age of 43 years (range, 16-57 years). The causes included falling injury from height in 23 cases, traffic accident injury in 15 cases, heavy pound injury in 7 cases, and falling injury in 8 cases. The time between injury and operation was 7 hours to 12 days (mean, 6.7 days). The involved segments included T11 in 2 cases, T12 in 7 cases, L1 in 20 cases, L2 in 18 cases, and L3 in 6 cases; based on the neurological classification of spinal cord injury by American Spinal Injury Association (ASIA), 3 cases were rated as grade A, 5 cases as grade B, 12 cases as grade C, 24 cases as grade D, and 9 cases as grade E. The operation time, bleeding volume, and postoperative drainage were recorded; postoperative visual analogue scale (VAS) was used for pain evaluation, and ASIA for neurological function assessment; CT and X-ray films were taken to observe fracture healing, bone fusion, and grafted bone absorption; The vertebral canal patency rate was calculated; the relative height of fractured vertebrae and Cobb angle were measured. ResultsThe operation was successfully completed in all patients; the average operation time was 150 minutes (range, 90-240 minutes); the average bleeding volume was 350 mL (range, 50-500 mL); the average postoperative drainage was 80 mL (range, 20-150 mL); and the average VAS score was 2.3 (range, 1.5-4.7) at 3 days after operation. The incisions healed primarily. All the patients were followed up 12-19 months (mean, 15 months). All fractures healed at 3-9 months (mean, 6 months). No complications of broken nails, broken rod, and screw loosening occurred. At last follow-up, the vertebral canal patency rate was significantly improved when compared with preoperative value (t=27.395, P=0.000). The Cobb angle, and the anterior and posterior heights of of traumatic vertebra were significantly improved at 1 week, 1 year, and last follow-up when compared with preoperative ones (P < 0.05), but there was no significant difference between different time points after operation (P > 0.05). The neurological function was improved in different degrees; 1 case was rated as grade A, 4 cases as grade B, 7 cases as grade C, 15 cases as grade D, and 26 cases as grade E, showing significant difference when compared with preoperative one (Z=-5.477, P=0.000). ConclusionMinimally invasive passage in posterior laminotomy decompression, bone graft in the injured vertebrae combined with percutaneous pedicle screw fixation is an effective method to treat Denis type B thoracolumbar burst fractures, which not only can fully decompression, but also can effectively maintain the postoperative injured vertebral height, reduce the postoperative failure risk of internal fixation and decrease operation trauma.