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Comparing the efficacy of short-segment pedicle screw instrumentation with and without intermediate screws for treating unstable thoracolumbar fractures.

Abstract It is generally acknowledged that short-segment pedicle screw instrumentation is the preferred surgical method for thoracolumbar fractures. However, the use of short-segment instrumentation with or without intermediate screws at the fracture level remains controversial.We retrospectively evaluated 44 patients (28 men, 16 women) with unstable thoracolumbar fractures. The patients were divided into 2 groups according to the surgical method used. In group 1, 24 patients underwent surgery with a posterior approach via short-segment pedicle screw instrumentation (1 level above and 1 level below the fractured level). In group 2, 20 patients received an additional 2 screws at the fractured vertebrae. Clinical and radiologic parameters were evaluated before surgery and at 1 week, 6 months, and 1 year after surgery.We found no significant difference in the demographic characteristics between the 2 groups. No significant difference was observed in the operative time and intraoperative blood loss between the 2 groups. Clinical outcomes also showed no significant differences between the groups preoperatively or at all follow-up periods. The correction of the Cobb angle (CA) 1 week after surgery was better in group 2, whereas the anterior vertebral body height of the fractured level (AVHF) and compression ratio of the AVHF (AVHFCR) were not significantly different between the 2 groups 1 week after surgery. Moreover, group 2 had better maintenance of restored CA, AVHF, and AVHFCR at the fractured level than did group 1 at 6 months and 1 year postoperatively. In addition, the reduction of mid-sagittal diameter (MSD) of spinal canal 1 week and 1 year after surgery was better in group 2. Besides, bone fragments in the spinal canal have a tendency to be less in group 2 1 week and 1 year after surgery.Reinforcement with intermediate screws for a single thoracolumbar fracture not only enhanced the stability of the internal fixation system, but it was also conducive to the correction of kyphosis and the maintenance of the reduction effects. Furthermore, this method is helpful to restore the spinal canal and reduce the bone fragments in the spinal canal. However, more long-term follow-up studies are needed.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 28834906
OWN - NLM
STAT- In-Process
DA  - 20170823
LR  - 20170823
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 34
DP  - 2017 Aug
TI  - Comparing the efficacy of short-segment pedicle screw instrumentation with and
      without intermediate screws for treating unstable thoracolumbar fractures.
PG  - e7893
LID - 10.1097/MD.0000000000007893 [doi]
AB  - It is generally acknowledged that short-segment pedicle screw instrumentation is 
      the preferred surgical method for thoracolumbar fractures. However, the use of
      short-segment instrumentation with or without intermediate screws at the fracture
      level remains controversial.We retrospectively evaluated 44 patients (28 men, 16 
      women) with unstable thoracolumbar fractures. The patients were divided into 2
      groups according to the surgical method used. In group 1, 24 patients underwent
      surgery with a posterior approach via short-segment pedicle screw instrumentation
      (1 level above and 1 level below the fractured level). In group 2, 20 patients
      received an additional 2 screws at the fractured vertebrae. Clinical and
      radiologic parameters were evaluated before surgery and at 1 week, 6 months, and 
      1 year after surgery.We found no significant difference in the demographic
      characteristics between the 2 groups. No significant difference was observed in
      the operative time and intraoperative blood loss between the 2 groups. Clinical
      outcomes also showed no significant differences between the groups preoperatively
      or at all follow-up periods. The correction of the Cobb angle (CA) 1 week after
      surgery was better in group 2, whereas the anterior vertebral body height of the 
      fractured level (AVHF) and compression ratio of the AVHF (AVHFCR) were not
      significantly different between the 2 groups 1 week after surgery. Moreover,
      group 2 had better maintenance of restored CA, AVHF, and AVHFCR at the fractured 
      level than did group 1 at 6 months and 1 year postoperatively. In addition, the
      reduction of mid-sagittal diameter (MSD) of spinal canal 1 week and 1 year after 
      surgery was better in group 2. Besides, bone fragments in the spinal canal have a
      tendency to be less in group 2 1 week and 1 year after surgery.Reinforcement with
      intermediate screws for a single thoracolumbar fracture not only enhanced the
      stability of the internal fixation system, but it was also conducive to the
      correction of kyphosis and the maintenance of the reduction effects. Furthermore,
      this method is helpful to restore the spinal canal and reduce the bone fragments 
      in the spinal canal. However, more long-term follow-up studies are needed.
FAU - Ye, Conglin
AU  - Ye C
AD  - aDepartment of Orthopedics, The First Affiliated Hospital of Nanchang University,
      Artificial Joints Engineering and Technology Research Center of Jiangxi Province,
      Nanchang, Jiangxi bDepartment of Orthopaedics, Shenzhen Hospital, Southern
      Medical University, Bao'an District, Shenzhen City, China.
FAU - Luo, Zhiping
AU  - Luo Z
FAU - Yu, Xiaolong
AU  - Yu X
FAU - Liu, Hucheng
AU  - Liu H
FAU - Zhang, Bin
AU  - Zhang B
FAU - Dai, Min
AU  - Dai M
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
EDAT- 2017/08/24 06:00
MHDA- 2017/08/24 06:00
CRDT- 2017/08/24 06:00
AID - 10.1097/MD.0000000000007893 [doi]
AID - 00005792-201708250-00043 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Aug;96(34):e7893. doi: 10.1097/MD.0000000000007893.