Tag Archives: kyphosis

The Loss of Correction in Thoracolumbar Burst Fracture Treated by Surgery. Can We Predict It?

DOI: 10.2478/amma-2014-0020

Objective: This paper aims to differentially depict potential patterns of the loss of correction in surgically treated thoraco-lumbar burst fractures. These may eventually serve to foreseeing and even forestalling loss of correction.
Methods: The study focused on 253 patients with surgically treated thoraco-lumbar fractures. This cohort of patients was clustered in four subgroups according to the fracture spine segment (T11–L1 or L1–L2) and surgery type (short segment fixation or anterior approach). Relevant recorded and processed data were the fracture level, post-operative (Kpo) and last follow-up (Kf) kyphosis angle values. Correlation, regression and determination testing were performed for the last follow-up kyphosis angle and post-operative kyphosis angle, and regression equations were determined for each subgroup of patients.
Results: The patterns of loss of correction were described through the following equations: Kf = 0.95*Kpo + 3.2° for the T11–L1 level fractured vertebrae treated by posterior short segment fixation; Kf = 0.98*Kpo + 3.4° for the L1–L2 level fractured vertebrae treated by posterior short segment fixation; Kf = 1.1*Kpo + 1.6° for the T11–L1 level fractured vertebrae treated by anterior approach; and Kf = 0.7*Kpo + 2.8° for the L1–L2 level fracture vertebrae treated by anterior approach.
Conclusions: The loss of correction may be predicted, to a certain extent, for thoraco-lumbar fractured vertebrae treated surgically. The best-fit equations depicted for both type of surgery (short segment fixation and anterior approach) and both spinal segments (T11–L1 and L2–L3) are significantly different than the equations delineated for the collapse of non-surgically treated fractures.

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Short Segment Fixation Versus Short Segment Fixation With Pedicle Screws at the Fracture Level for Thoracolumbar Burst Fracture

DOI: 10.2478/amma-2014-0011

Objective: The most prevailing surgical procedure in the treatment of thoracolumbar burst fractures, Short Segment Fixation (SSF), is often followed by loss of correction or hardware failure which may be significant enough to require another surgical intervention. In order to take advantage of its benefits but to avoid or diminish the risk and impact of associated drawbacks, some other alternatives have been lately developed among which we refer to short segment fixation with intermediate screws (SSF+IS). This article provides a comparative picture over the effectiveness of the two above-mentioned surgical treatments, focusing on their potential to prevent the loss of correction.

Methods: After a systematic literature review over research papers published between 2000 and 2012, 14 articles which met the criteria were included in the meta-analysis. The relevant data extracted and compared for each subgroup of patients treated either with SSF or SSF+IS, were the weighted averages for the pre-operative, post-operative and last follow up kyphosis angles. We also considered common associated complications, operation time, and blood loss values for each surgical subgroups.
Results: The values for the loss of correction at the last follow-up were: 5.5° for SS and 7.4° for SSF+IS, which didn’t prove to be statistically different. With reference to other parameters, such as operation time, blood loss and correction attainment, the values did not present statistically significant differences, either. Regarding complications, we noticed that both SSF and SSF+IS display a similar incidence for hardware failure, screw breakages, superficial infections, deep venous thrombosis.
Conclusions: This paper concludes that, adding one or two screws at the fractured vertebra level (SSF+IS) does not bring forth a significant improvement compared to the traditional approach (SSF). Apparently, the blood loss depends mostly on the approach type (open or percutaneous) and less on the surgery type.

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