J Korean Neurosurg Soc.  2012 Apr;51(4):203-207. 10.3340/jkns.2012.51.4.203.

Short Segment Screw Fixation without Fusion for Unstable Thoracolumbar and Lumbar Burst Fracture : A Prospective Study on Selective Consecutive Patients

• Kim HY
• Kim HS
• Kim SW
• Ju CI
• Lee SM
• Park HJ

• KMID: 2066911
• DOI: http://doi.org/10.3340/jkns.2012.51.4.203

Abstract

OBJECTIVE
The purpose of this prospective study was to evaluate the efficacy and safety of screw fixation without bone fusion for unstable thoracolumbar and lumbar burst fracture.
METHODS
Nine patients younger than 40 years underwent screw fixation without bone fusion, following postural reduction using a soft roll at the involved vertebra, in cases of burst fracture. Their motor power was intact in spite of severe canal compromise. The surgical procedure included postural reduction for 3 days and screw fixations at one level above, one level below and at the fractured level itself. The patients underwent removal of implants 12 months after the initial operation, due to possibility of implant failure. Imaging and clinical findings, including canal encroachment, vertebral height, clinical outcome, and complications were analyzed.
RESULTS
Prior to surgery, the mean pain score (visual analogue scale) was 8.2, which decreased to 2.2 at 12 months after screw fixation. None of the patients complained of worsening of pain during 6 months after implant removal. All patients were graded as having excellent or good outcomes at 6 months after implant removal. The proportion of canal compromise at the fractured level improved from 55% to 35% at 12 months after surgery. The mean preoperative vertebral height loss was 45.3%, which improved to 20.6% at 6 months after implant removal. There were no neurological deficits related to neural injury. The improved vertebral height and canal compromise were maintained at 6 months after implant removal.
CONCLUSION
Short segment pedicle screw fixation, including fractured level itself, without bone fusion following postural reduction can be an effective and safe operative technique in the management of selected young patients suffering from unstable burst fracture.

Keyword

Screw fixation; Burst fracture; Bone fusion

MeSH Terms

Humans
Prospective Studies
Spine
Stress, Psychological

Figure

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  Fig. 1 Fraction of canal compromise. *p=0.008 for preoperative versus 12 months after screw fixation. **p=0.008 for preoperative versus 6 months implant removal.

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  Fig. 2 Restoration of vertebral height. *p=0.001 for preoperative versus 12 months after screw fixation. **p=0.005 for preoperative versus 6 months implant removal.

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  Fig. 3 Improvement of pain score. *p=0.001 for preoperative versus 12 months after screw fixation. **p=0.002 for preoperative versus 6 months implant removal.

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  Fig. 4 A neurologically intact 16-year-old male patient fell down and sustained L4 bursting fracture. A and B : Preoperative computed tomography scans show severe canal compromise (about 80%) and spinous process fracture. C and D : Computed tomographic scans at 12 months follow-up, just before implant removal demonstrate bone healing and canal remodeling with improved canal compromise. E and F : Computed tomographic scans at 6 months after implant removal reveal well-maintained improved canal compromise.

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  Fig. 5 A neurologically intact 19-year-old female patient fell down and sustained L2 bursting fracture. A and B : Preoperative computed tomography scans show severe canal compromise (about 60%) and spinous process fracture. C and D : Computed tomographic scans at 12 months follow-up, just before implant removal demonstrate bone healing and canal remodeling with improved canal compromise. E and F : Computed tomographic scans at 6 months after implant removal reveal well-maintained improved canal compromise.

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