J Korean Soc Spine Surg.  2001 Jun;8(2):113-120. 10.4184/jkss.2001.8.2.113.

Survival Analysis of Posterior Short Fusion in Thoracolumbar Fracture: Significance of Load-Sharing Score and Bone Mineral Density-Changseop

Affiliations
  • 1Department of Orthopedics, Paik Hospital, Inje University, Pusan, Korea. osman64@unitel.co.kr

Abstract

STUDY DESIGN: A retrospective study.
OBJECTIVES
To evaluate the fixation survival rate and the radiologic prognostic factors of posterior short fusion in thoracolumbar fracture. SUMMARY OF BACKGROUND DATA: Posterior short fusion has the advantage of saving motion segments in spite of high fixation failure rate. The high load-sharing score is well known as a cause of fixation failure, but the effect of osteopenia is not evaluated.
MATERIALS AND METHODS
Authors evaluated 27 patients treated surgically with posterior short fusion using pedicle screws as thoracolumbar fractures from 1995 to 1999. The median follow-up was 20.5 months (6-54). The survivorship using Kaplan-Meier method and the radiologic prognostic factors were evaluated.
RESULTS
The sagittal index was preoperatively 16.7 dgree (+/-7.9 SD), immediate postoperatively 6.9 dgree (+/-4.6), and at last follow-up 10.6 dgree (+/-6.9). The fixation failures were detected in 4 patients, and the failure time was ranged from 6 months to 11(median 7.5). The overall survival rate was 82.3% at the last follow-up. The significant prognostic variables were load-sharing score, Jikei grade, compression percent and age in uni-variate analysis, but the load-sharing score and Jikei grade were significant prog-nostic factors in multivariate analysis.
CONCLUSIONS
In decision to perform posterior short fusion, the load-sharing score and evidence of osteopenia should be consid-ered as a prognostic factors to avoid fixation failure in thoracolumbar fracture.

Keyword

Thoracolumbar fracture; Posterior short fusion; Survival rate; Prognostic factors

MeSH Terms

Bone Diseases, Metabolic
Follow-Up Studies
Humans
Multivariate Analysis
Retrospective Studies
Survival Analysis*
Survival Rate

Figure

  • Fig. 1-A. Preoperative radiographs of 61 years-old male showed L2 stable burstfracture with more than 40% compression, load-sharing score 8 point and Jikei grade 1. Fig. 1-B. Immediate postoperative, 7 and 33 months followup lateral radiographs showed acceptable correction and fixation failure, but radiologic bone union.

  • Fig. 2. The fixation survival rates according to load-sharing scores. The survival rate of less than 7 score was higher than 7 or more score (p<0.05).

  • Fig. 3. The fixation survival rates according to Jikei grades. Jikei grade 0.5 or more showed significantly lower survival rate (p<0.05).


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