Skip to main content
Top
Published in: European Spine Journal 6/2013

01-11-2013 | Original Article

Pure percutaneous pedicle screw fixation without arthrodesis of 32 thoraco-lumbar fractures: clinical and radiological outcome with 36-month follow-up

Authors: Marco Cimatti, Stefano Forcato, Filippo Polli, Massimo Miscusi, Alessandro Frati, Antonino Raco

Published in: European Spine Journal | Special Issue 6/2013

Login to get access

Abstract

Purpose

To evaluate the outcome of pure percutaneous fixation of unstable single level fractures at the thoraco-lumbar junction (A1 to B2 Magerl/AO Spine).

Method

Neurological intact patients were included in a 2-year prospective study (follow-up 36 months). Two groups were considered: the group in which additional short bilateral screws in the fractured vertebra were placed was called lordorizing screw group (LSG), the other was called non lordorizing screw group (nLSG). Clinical outcome was evaluated using the SF-36, the Oswestry disability index and the recovery time needed to go back work. The following radiological parameters were also evaluated on the follow-up exams: the Mid-Sagittal Index, the Cobb’s angle and the Sagittal Index.

Results

In the LSG, the correction values of MSI, Cobb’s angle and SI were statistically significantly higher than in nLSG.

Conclusion

When feasible we recommend a pure percutaneous short segment pedicle screw fixation adding a lordorizing screw.
Literature
1.
2.
go back to reference Rampersaud YR, Annand N, Dekutoski MB (2006) Use of minimally invasive surgical techniques in the management of thoracolumbar trauma: current concepts. Spine (Phila Pa 1976) 31(11 Suppl):S96–S102 (discussion S104)CrossRef Rampersaud YR, Annand N, Dekutoski MB (2006) Use of minimally invasive surgical techniques in the management of thoracolumbar trauma: current concepts. Spine (Phila Pa 1976) 31(11 Suppl):S96–S102 (discussion S104)CrossRef
3.
go back to reference Siebenga J, Leferink VJ, Segers MJ, Elzinga MJ, Bakker FC, Haarman HJ, Rommens PM, ten Duis HJ, Patka P (2006) Treatment of traumatic thoracolumbar spine fractures: a multicenter prospective randomized study of operative versus nonsurgical treatment. Spine (Phila Pa 1976) 31:2881CrossRef Siebenga J, Leferink VJ, Segers MJ, Elzinga MJ, Bakker FC, Haarman HJ, Rommens PM, ten Duis HJ, Patka P (2006) Treatment of traumatic thoracolumbar spine fractures: a multicenter prospective randomized study of operative versus nonsurgical treatment. Spine (Phila Pa 1976) 31:2881CrossRef
4.
go back to reference Wild MH, Glees M, Plieschnegger C, Wenda K (2007) Five-year follow-up examination after purely minimally invasive posterior stabilization of thoracolumbar fractures: a comparison of minimally invasive percutaneously and conventionally open treated patients. Arch Orthop Trauma Surg 127(5):335–343PubMedCrossRef Wild MH, Glees M, Plieschnegger C, Wenda K (2007) Five-year follow-up examination after purely minimally invasive posterior stabilization of thoracolumbar fractures: a comparison of minimally invasive percutaneously and conventionally open treated patients. Arch Orthop Trauma Surg 127(5):335–343PubMedCrossRef
5.
go back to reference Assaker R (2004) Minimal access spinal technologies: state-of-the-art, indications, and techniques. Joint Bone Spine 71(6):459–469PubMedCrossRef Assaker R (2004) Minimal access spinal technologies: state-of-the-art, indications, and techniques. Joint Bone Spine 71(6):459–469PubMedCrossRef
6.
go back to reference Wang ST, Ma HL, Liu CL, Yu WK, Chang MC, Chen TH (2006) Is fusion necessary for surgically treated burst fractures of the thoracolumbar and lumbar spine?: a prospective, randomized study. Spine (Phila Pa 1976) 31(23):2646–2652 (discussion 2653)CrossRef Wang ST, Ma HL, Liu CL, Yu WK, Chang MC, Chen TH (2006) Is fusion necessary for surgically treated burst fractures of the thoracolumbar and lumbar spine?: a prospective, randomized study. Spine (Phila Pa 1976) 31(23):2646–2652 (discussion 2653)CrossRef
7.
go back to reference Sanderson PL, Fraser RD, Hall DJ, Cain CM, Osti OL, Potter GR (1999) Short segment fixation of thoracolumbar burst fractures without fusion. Eur Spine J 8(6):495–500PubMedCrossRef Sanderson PL, Fraser RD, Hall DJ, Cain CM, Osti OL, Potter GR (1999) Short segment fixation of thoracolumbar burst fractures without fusion. Eur Spine J 8(6):495–500PubMedCrossRef
8.
go back to reference Mumford J, Weinstein JN, Spratt KF, Goel VK (1993) Thoracolumbar burst fractures. The clinical efficacy and outcome of nonoperative management. Spine (Phila Pa 1976) 18(8):955–970CrossRef Mumford J, Weinstein JN, Spratt KF, Goel VK (1993) Thoracolumbar burst fractures. The clinical efficacy and outcome of nonoperative management. Spine (Phila Pa 1976) 18(8):955–970CrossRef
9.
go back to reference Aglietti P, Di Muria GV, Taylor TK, Ruff SJ, Marcucci M, Novembri A, Innocenti M, Mizzau M, Mariani D, Sartori E et al (1983) Conservative treatment of thoracic and lumbar vertebral fractures. Ital J Orthop Traumatol 9(Suppl):83–105PubMed Aglietti P, Di Muria GV, Taylor TK, Ruff SJ, Marcucci M, Novembri A, Innocenti M, Mizzau M, Mariani D, Sartori E et al (1983) Conservative treatment of thoracic and lumbar vertebral fractures. Ital J Orthop Traumatol 9(Suppl):83–105PubMed
10.
go back to reference Farcy JP, Weidenbaum M, Glassman SD (1990) Sagittal index in management of thoracolumbar burst fractures. Spine (Phila Pa 1976) 15(9):958–965CrossRef Farcy JP, Weidenbaum M, Glassman SD (1990) Sagittal index in management of thoracolumbar burst fractures. Spine (Phila Pa 1976) 15(9):958–965CrossRef
11.
go back to reference Gertzbein SD, Macmichael D, Tile M (1982) Harrington instrumentation as a method of fixation in fractures of the spine. J Bone Joint Surg Br 64(5):526–529PubMed Gertzbein SD, Macmichael D, Tile M (1982) Harrington instrumentation as a method of fixation in fractures of the spine. J Bone Joint Surg Br 64(5):526–529PubMed
12.
go back to reference Hu R, Mustard CA, Burns C (1996) Epidemiology of incident spinal fracture in a complete population. Spine (Phila Pa 1976) 21(4):492–499CrossRef Hu R, Mustard CA, Burns C (1996) Epidemiology of incident spinal fracture in a complete population. Spine (Phila Pa 1976) 21(4):492–499CrossRef
13.
go back to reference Krompinger WJ, Fredrickson BE, Mino DE, Yuan HA (1986) Conservative treatment of fractures of the thoracic and lumbar spine. Orthop Clin North Am 17(1):161–170PubMed Krompinger WJ, Fredrickson BE, Mino DE, Yuan HA (1986) Conservative treatment of fractures of the thoracic and lumbar spine. Orthop Clin North Am 17(1):161–170PubMed
14.
go back to reference McAfee PC, Yuan HA, Fredrickson BE, Lubicky JP (1983) The value of computed tomography in thoracolumbar fractures. An analysis of one hundred consecutive cases and a new classification. J Bone Joint Surg Am 65(4):461–473PubMed McAfee PC, Yuan HA, Fredrickson BE, Lubicky JP (1983) The value of computed tomography in thoracolumbar fractures. An analysis of one hundred consecutive cases and a new classification. J Bone Joint Surg Am 65(4):461–473PubMed
15.
go back to reference McEvoy RD, Bradford DS (1985) The management of burst fractures of the thoracic and lumbar spine. Experience in 53 patients. Spine (Phila Pa 1976) 10(7):631–637CrossRef McEvoy RD, Bradford DS (1985) The management of burst fractures of the thoracic and lumbar spine. Experience in 53 patients. Spine (Phila Pa 1976) 10(7):631–637CrossRef
16.
go back to reference Moon MS, Choi WT, Sun DH, Chae JW, Ryu JS, Chang H, Lin JF (2007) Instrumented ligamentotaxis and stabilization of compression and burst fractures of dorsolumbar and mid-lumbar spines. Indian J Orthop 41(4):346–353. doi:10.4103/0019-5413.36999 PubMedCrossRef Moon MS, Choi WT, Sun DH, Chae JW, Ryu JS, Chang H, Lin JF (2007) Instrumented ligamentotaxis and stabilization of compression and burst fractures of dorsolumbar and mid-lumbar spines. Indian J Orthop 41(4):346–353. doi:10.​4103/​0019-5413.​36999 PubMedCrossRef
17.
go back to reference Palmisani M, Gasbarrini A, Barbanti Brodano G, De Iure F, Cappuccio M, Boriani L, Amendola L, Boriani S (2009) Minimally invasive percutaneous fixation in the treatment of thoracic and lumbar spine fractures. Eur Spine J 18(1 Supplement):71–74PubMedCrossRef Palmisani M, Gasbarrini A, Barbanti Brodano G, De Iure F, Cappuccio M, Boriani L, Amendola L, Boriani S (2009) Minimally invasive percutaneous fixation in the treatment of thoracic and lumbar spine fractures. Eur Spine J 18(1 Supplement):71–74PubMedCrossRef
18.
go back to reference Panjabi MM, Oxland TR, Kifune M, Arand M, Wen L, Chen A (1995) Validity of the three-column theory of thoracolumbar fractures. A biomechanic investigation. Spine (Phila Pa 1976) 20(10):1122–1127CrossRef Panjabi MM, Oxland TR, Kifune M, Arand M, Wen L, Chen A (1995) Validity of the three-column theory of thoracolumbar fractures. A biomechanic investigation. Spine (Phila Pa 1976) 20(10):1122–1127CrossRef
19.
go back to reference Spivak JM, Vaccaro AR, Cotler JM (1995) Thoracolumbar Spine Trauma: II. Principles of Management. J Am Acad Orthop Surg 3(6):353–360PubMed Spivak JM, Vaccaro AR, Cotler JM (1995) Thoracolumbar Spine Trauma: II. Principles of Management. J Am Acad Orthop Surg 3(6):353–360PubMed
20.
go back to reference Stadhouder A, Buskens E, de Klerk LW, Verhaar JA, Dhert WA, Verbout AJ, Vaccaro AR, Oner FC (2008) Traumatic thoracic and lumbar spinal fractures: operative or nonoperative treatment: comparison of two treatment strategies by means of surgeon equipoise. Spine (Phila Pa 1976) 33(9):1006–1017. doi:10.1097/BRS.0b013e31816c8b32 CrossRef Stadhouder A, Buskens E, de Klerk LW, Verhaar JA, Dhert WA, Verbout AJ, Vaccaro AR, Oner FC (2008) Traumatic thoracic and lumbar spinal fractures: operative or nonoperative treatment: comparison of two treatment strategies by means of surgeon equipoise. Spine (Phila Pa 1976) 33(9):1006–1017. doi:10.​1097/​BRS.​0b013e31816c8b32​ CrossRef
21.
go back to reference Weinstein JN, Collalto P, Lehmann TR (1988) Thoracolumbar “burst” fractures treated conservatively: a long-term follow-up. Spine (Phila Pa 1976) 13(1):33–38CrossRef Weinstein JN, Collalto P, Lehmann TR (1988) Thoracolumbar “burst” fractures treated conservatively: a long-term follow-up. Spine (Phila Pa 1976) 13(1):33–38CrossRef
22.
go back to reference Frymoyer JW, Howe J, Kuhlmann D (1978) The long-term effects of spinal fusion on the sacroiliac joints and ilium. Clin Orthop Relat Res 134:196–201PubMed Frymoyer JW, Howe J, Kuhlmann D (1978) The long-term effects of spinal fusion on the sacroiliac joints and ilium. Clin Orthop Relat Res 134:196–201PubMed
23.
go back to reference Merom L, Raz N, Hamud C, Weisz I, Hanani A (2009) Minimally invasive burst fracture fixation in the thoracolumbar region. Orthopedics 32(4):273–275 Merom L, Raz N, Hamud C, Weisz I, Hanani A (2009) Minimally invasive burst fracture fixation in the thoracolumbar region. Orthopedics 32(4):273–275
24.
go back to reference Jaikumar S, Kim DH, Kam AC (2002) History of minimally invasive spine surgery. Neurosurgery 51(5 Suppl):S1–S14PubMed Jaikumar S, Kim DH, Kam AC (2002) History of minimally invasive spine surgery. Neurosurgery 51(5 Suppl):S1–S14PubMed
25.
go back to reference Isaacs RE, Podichetty VK, Santiago P, Sandhu FA, Spears J, Kelly K, Rice L, Fessler RG (2005) Minimally invasive microendoscopy-assisted transforaminal lumbar interbody fusion with instrumentation. J Neurosurg Spine 3(2):98–105PubMedCrossRef Isaacs RE, Podichetty VK, Santiago P, Sandhu FA, Spears J, Kelly K, Rice L, Fessler RG (2005) Minimally invasive microendoscopy-assisted transforaminal lumbar interbody fusion with instrumentation. J Neurosurg Spine 3(2):98–105PubMedCrossRef
Metadata
Title
Pure percutaneous pedicle screw fixation without arthrodesis of 32 thoraco-lumbar fractures: clinical and radiological outcome with 36-month follow-up
Authors
Marco Cimatti
Stefano Forcato
Filippo Polli
Massimo Miscusi
Alessandro Frati
Antonino Raco
Publication date
01-11-2013
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue Special Issue 6/2013
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-013-3016-x

Other articles of this Special Issue 6/2013

European Spine Journal 6/2013 Go to the issue