A Comparative Analysis of the Efficacy of Short-Segment Pedicle Screw Fixation with that of Long-Segment Pedicle Screw Fixation for Unstable Thoracolumbar Spinal Burst Fractures

Jin-Woo Hur; Jong-Joo Rhee; Jong-Won Lee; Hyun-Koo Lee

doi:doi:10.11648/j.cmr.20150401.11

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A Comparative Analysis of the Efficacy of Short-Segment Pedicle Screw Fixation with that of Long-Segment Pedicle Screw Fixation for Unstable Thoracolumbar Spinal Burst Fractures

Jin-Woo Hur, Jong-Joo Rhee, Jong-Won Lee, Hyun-Koo Lee

Published in Clinical Medicine Research (Volume 4, Issue 1)

Received: 22 December 2014 Accepted: 6 January 2015 Published: 14 January 2015

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Abstract

The indications for operative treatment and type of stabilization procedures for the treatment of thoracolumbar burst fracture remain controversial. As surgical reconstruction for the thoracolumbar burst fracture, both long-segment pedicle screw fixation and short-segment pedicle screw fixation including fractured vertebral body have been used widely. The present study evaluated the efficacy of short-segment fixation compared with that of long-segment fixation in terms of the radiological and clinical outcomes in unstable thoracolumbar burst fractures. From January 2007 to December 2012, 76 patients with thoracolumbar burst fracture underwent posterior pedicle screw fixation consecutively in our hospital. These patients were divided into two groups: the short-segment group, which included patients who underwent short-segment pedicle screw fixation including the fractured vertebral body, and the long-segment group, which included patients who underwent long-segment pedicle screw fixation (2 levels above and 1 level below the fractured vertebral body). There were 44 and 32 patients in the long-segment and short-segment group, respectively. Radiological assessment of the kyphotic angle was performed using the Cobb method immediately after the operation and at 3, 6, and 12 months postoperatively. The clinical outcomes were evaluated using the modified Mcnab criteria at the last follow-up. The sex ratio, mean age of patients, and composition of the fractured vertebral body were similar in both groups. In the long-segment and short-segment group, 37 (84.1%) and 26 (81.3%) cases showed excellent or good outcomes, respectively. The mean kyphotic angle at the immediate postoperative period was 7.3° ± 5.8° and 0.6° ± 11.9° in the long-segment and short-segment group, respectively. The average loss of kyphosis correction was 5.4° ± 4.4°, 8.6° ± 6.2°, and 10.5° ± 4.8° in the long-segment group and 4.1° ± 3.6°, 6.2° ± 5.2°, and 7.5° ± 4.4° in the short-segment group at 3, 6, and 12 months postoperatively, respectively. There was no statistically significant difference in the average loss of kyphosis correction between the two groups (p > 0.05). In conclusion, short-segment pedicle screw fixation including the fractured vertebral body might be as effective as long-segment pedicle screw fixation for the treatment of unstable thoracolumbar spinal burst fracture.

Published in	Clinical Medicine Research (Volume 4, Issue 1)
DOI	10.11648/j.cmr.20150401.11
Page(s)	1-5
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2015. Published by Science Publishing Group

Keywords

Loss of Kyphosis Correction, Long-Segment Pedicle Screw Fixation, Short-Segment Pedicle Screw Fixation, Thoracolumbar Burst Fracture

References

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[2]	Ferguson RL, Allen BL Jr. An algorithm for the treatment of unstable thoracolumbar fractures. Orthop. Clin. North. Am. 17: 105-112, 1986.
[3]	Meves R, Avanzi O. Correlation between neurological deficit and spinal canal compromise in 198 patients with thoracolumbar and lumbar fractures. Spine. (Phila Pa 1976) 30: 787-791, 2005.
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[7]	Baaj AA, Reyes PM, Yaqoobi AS et al. Biomechanical advantage of the index-level pedicle screw in unstable thoracolumbar junction fractures. J. Neurosurg. Spine. 14: 192-197, 2011.
[8]	Mahar A, Kim C, Wedemeyer M, et al. Short-segment fixation of lumbar burst fractures using pedicle fixation at the level of the fracture. Spine. (Phila Pa 1976) 32: 1503-1507, 2007.
[9]	Parker JW, Lane JR, Karaikovic EE, Gaines RW. Successful short-segment instrumentation and fusion for thoracolumbar spine fractures: a consecutive 41/2-year series. Spine. (Phila Pa 1976) 25: 1157-1170, 2000.
[10]	Sanderson PL, Fraser RD, Hall DJ et al. Short segment fixation of thoracolumbar burst fractures without fusion. Eur. Spine. J. 8: 495-500, 1999.
[11]	Tezeren G, Kuru I. Posterior fixation of thoracolumbar burst fracture: short-segment pedicle fixation versus long-segment instrumentation. J. Spinal. Disord. Tech. 18: 485-488, 2005.
[12]	Wang ST, Ma HL, Liu CL et al. Is fusion necessary for surgically treated burst fractures of the thoracolumbar and lumbar spine?: a prospective, randomized study. Spine. (Phila Pa 1976) 31: 2646-2652; discussion 2653, 2006.
[13]	Kim GW, Jang JW, Hur H, et al. Predictive factors for a kyphosis recurrence following short-segment pedicle screw fixation including fractured vertebral body in unstable thoracolumbar burst fractures. J. Korean. Neurosurg. Soc. 56: 230-236, 2014.
[14]	Kanna RM, Shetty AP, Rajasekaran S. Posterior fixation including the fractured vertebra for severe unstable thoracolumbar fractures. Spine. J. Sep 22, 2014
[15]	Gurwitz GS, Dawson JM, McNamara MJ, Federspiel CF, Spengler DM. Biomechanical analysis of three surgical approaches for lumbar burst fractures using short-segment instrumentation. Spine. (Phila Pa 1976) 18: 977-982, 1993.
[16]	McLain RF, Sparling E, Benson DR. Early failure of short-segment pedicle instrumentation for thoracolumbar fractures. A preliminary report. J. Bone. Joint. Surg. Am. 75: 162-167, 1993.
[17]	Sasso RC, Cotler HB. Posterior instrumentation and fusion for unstable fractures and fracture-dislocations of the thoracic and lumbar spine. A comparative study of three fixation devices in 70 patients. Spine. (Phila Pa 1976) 18: 450-460, 1993.
[18]	Cantor JB, Lebwohl NH, Garvey T, Eismont FJ. Nonoperative management of stable thoracolumbar burst fractures with early ambulation and bracing. Spine. (Phila Pa 1976) 18: 971-976, 1993.
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[20]	Weinstein JN, Collalto P, Lehmann TR. Thoracolumbar “burst” fractures treated conservatively: a long-term follow-up. Spine. (Phila Pa 1976) 13: 33-38, 1988.
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[22]	Toyone T, Ozawa T, Inada K et al. Short-segment fixation without fusion for thoracolumbar burst fractures with neurological deficit can preserve thoracolumbar motion without resulting in post-traumatic disc degeneration: a 10-year follow-up study. Spine. (Phila Pa 1976) 38: 1482-1490, 2013.

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Jin-Woo Hur, Jong-Joo Rhee, Jong-Won Lee, Hyun-Koo Lee. (2015). A Comparative Analysis of the Efficacy of Short-Segment Pedicle Screw Fixation with that of Long-Segment Pedicle Screw Fixation for Unstable Thoracolumbar Spinal Burst Fractures. Clinical Medicine Research, 4(1), 1-5. https://doi.org/10.11648/j.cmr.20150401.11

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ACS Style

Jin-Woo Hur; Jong-Joo Rhee; Jong-Won Lee; Hyun-Koo Lee. A Comparative Analysis of the Efficacy of Short-Segment Pedicle Screw Fixation with that of Long-Segment Pedicle Screw Fixation for Unstable Thoracolumbar Spinal Burst Fractures. Clin. Med. Res. 2015, 4(1), 1-5. doi: 10.11648/j.cmr.20150401.11

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AMA Style

Jin-Woo Hur, Jong-Joo Rhee, Jong-Won Lee, Hyun-Koo Lee. A Comparative Analysis of the Efficacy of Short-Segment Pedicle Screw Fixation with that of Long-Segment Pedicle Screw Fixation for Unstable Thoracolumbar Spinal Burst Fractures. Clin Med Res. 2015;4(1):1-5. doi: 10.11648/j.cmr.20150401.11

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@article{10.11648/j.cmr.20150401.11,
  author = {Jin-Woo Hur and Jong-Joo Rhee and Jong-Won Lee and Hyun-Koo Lee},
  title = {A Comparative Analysis of the Efficacy of Short-Segment Pedicle Screw Fixation with that of Long-Segment Pedicle Screw Fixation for Unstable Thoracolumbar Spinal Burst Fractures},
  journal = {Clinical Medicine Research},
  volume = {4},
  number = {1},
  pages = {1-5},
  doi = {10.11648/j.cmr.20150401.11},
  url = {https://doi.org/10.11648/j.cmr.20150401.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cmr.20150401.11},
  abstract = {The indications for operative treatment and type of stabilization procedures for the treatment of thoracolumbar burst fracture remain controversial. As surgical reconstruction for the thoracolumbar burst fracture, both long-segment pedicle screw fixation and short-segment pedicle screw fixation including fractured vertebral body have been used widely. The present study evaluated the efficacy of short-segment fixation compared with that of long-segment fixation in terms of the radiological and clinical outcomes in unstable thoracolumbar burst fractures. From January 2007 to December 2012, 76 patients with thoracolumbar burst fracture underwent posterior pedicle screw fixation consecutively in our hospital. These patients were divided into two groups: the short-segment group, which included patients who underwent short-segment pedicle screw fixation including the fractured vertebral body, and the long-segment group, which included patients who underwent long-segment pedicle screw fixation (2 levels above and 1 level below the fractured vertebral body). There were 44 and 32 patients in the long-segment and short-segment group, respectively. Radiological assessment of the kyphotic angle was performed using the Cobb method immediately after the operation and at 3, 6, and 12 months postoperatively. The clinical outcomes were evaluated using the modified Mcnab criteria at the last follow-up. The sex ratio, mean age of patients, and composition of the fractured vertebral body were similar in both groups. In the long-segment and short-segment group, 37 (84.1%) and 26 (81.3%) cases showed excellent or good outcomes, respectively. The mean kyphotic angle at the immediate postoperative period was 7.3° ± 5.8° and 0.6° ± 11.9° in the long-segment and short-segment group, respectively. The average loss of kyphosis correction was 5.4° ± 4.4°, 8.6° ± 6.2°, and 10.5° ± 4.8° in the long-segment group and 4.1° ± 3.6°, 6.2° ± 5.2°, and 7.5° ± 4.4° in the short-segment group at 3, 6, and 12 months postoperatively, respectively. There was no statistically significant difference in the average loss of kyphosis correction between the two groups (p > 0.05). In conclusion, short-segment pedicle screw fixation including the fractured vertebral body might be as effective as long-segment pedicle screw fixation for the treatment of unstable thoracolumbar spinal burst fracture.},
 year = {2015}
}

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TY  - JOUR
T1  - A Comparative Analysis of the Efficacy of Short-Segment Pedicle Screw Fixation with that of Long-Segment Pedicle Screw Fixation for Unstable Thoracolumbar Spinal Burst Fractures
AU  - Jin-Woo Hur
AU  - Jong-Joo Rhee
AU  - Jong-Won Lee
AU  - Hyun-Koo Lee
Y1  - 2015/01/14
PY  - 2015
N1  - https://doi.org/10.11648/j.cmr.20150401.11
DO  - 10.11648/j.cmr.20150401.11
T2  - Clinical Medicine Research
JF  - Clinical Medicine Research
JO  - Clinical Medicine Research
SP  - 1
EP  - 5
PB  - Science Publishing Group
SN  - 2326-9057
UR  - https://doi.org/10.11648/j.cmr.20150401.11
AB  - The indications for operative treatment and type of stabilization procedures for the treatment of thoracolumbar burst fracture remain controversial. As surgical reconstruction for the thoracolumbar burst fracture, both long-segment pedicle screw fixation and short-segment pedicle screw fixation including fractured vertebral body have been used widely. The present study evaluated the efficacy of short-segment fixation compared with that of long-segment fixation in terms of the radiological and clinical outcomes in unstable thoracolumbar burst fractures. From January 2007 to December 2012, 76 patients with thoracolumbar burst fracture underwent posterior pedicle screw fixation consecutively in our hospital. These patients were divided into two groups: the short-segment group, which included patients who underwent short-segment pedicle screw fixation including the fractured vertebral body, and the long-segment group, which included patients who underwent long-segment pedicle screw fixation (2 levels above and 1 level below the fractured vertebral body). There were 44 and 32 patients in the long-segment and short-segment group, respectively. Radiological assessment of the kyphotic angle was performed using the Cobb method immediately after the operation and at 3, 6, and 12 months postoperatively. The clinical outcomes were evaluated using the modified Mcnab criteria at the last follow-up. The sex ratio, mean age of patients, and composition of the fractured vertebral body were similar in both groups. In the long-segment and short-segment group, 37 (84.1%) and 26 (81.3%) cases showed excellent or good outcomes, respectively. The mean kyphotic angle at the immediate postoperative period was 7.3° ± 5.8° and 0.6° ± 11.9° in the long-segment and short-segment group, respectively. The average loss of kyphosis correction was 5.4° ± 4.4°, 8.6° ± 6.2°, and 10.5° ± 4.8° in the long-segment group and 4.1° ± 3.6°, 6.2° ± 5.2°, and 7.5° ± 4.4° in the short-segment group at 3, 6, and 12 months postoperatively, respectively. There was no statistically significant difference in the average loss of kyphosis correction between the two groups (p > 0.05). In conclusion, short-segment pedicle screw fixation including the fractured vertebral body might be as effective as long-segment pedicle screw fixation for the treatment of unstable thoracolumbar spinal burst fracture.
VL  - 4
IS  - 1
ER  -

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Author Information

Jin-Woo Hur

Department of Neurosurgery, Cheongju Saint Mary’s Hospital, Cheongju, Korea
Jong-Joo Rhee

Department of Neurosurgery, Cheongju Saint Mary’s Hospital, Cheongju, Korea
Jong-Won Lee

Department of Neurosurgery, Cheongju Saint Mary’s Hospital, Cheongju, Korea
Hyun-Koo Lee

Department of Neurosurgery, Cheongju Saint Mary’s Hospital, Cheongju, Korea

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APA Style

Jin-Woo Hur, Jong-Joo Rhee, Jong-Won Lee, Hyun-Koo Lee. (2015). A Comparative Analysis of the Efficacy of Short-Segment Pedicle Screw Fixation with that of Long-Segment Pedicle Screw Fixation for Unstable Thoracolumbar Spinal Burst Fractures. Clinical Medicine Research, 4(1), 1-5. https://doi.org/10.11648/j.cmr.20150401.11

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ACS Style

Jin-Woo Hur; Jong-Joo Rhee; Jong-Won Lee; Hyun-Koo Lee. A Comparative Analysis of the Efficacy of Short-Segment Pedicle Screw Fixation with that of Long-Segment Pedicle Screw Fixation for Unstable Thoracolumbar Spinal Burst Fractures. Clin. Med. Res. 2015, 4(1), 1-5. doi: 10.11648/j.cmr.20150401.11

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AMA Style

Jin-Woo Hur, Jong-Joo Rhee, Jong-Won Lee, Hyun-Koo Lee. A Comparative Analysis of the Efficacy of Short-Segment Pedicle Screw Fixation with that of Long-Segment Pedicle Screw Fixation for Unstable Thoracolumbar Spinal Burst Fractures. Clin Med Res. 2015;4(1):1-5. doi: 10.11648/j.cmr.20150401.11

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@article{10.11648/j.cmr.20150401.11,
  author = {Jin-Woo Hur and Jong-Joo Rhee and Jong-Won Lee and Hyun-Koo Lee},
  title = {A Comparative Analysis of the Efficacy of Short-Segment Pedicle Screw Fixation with that of Long-Segment Pedicle Screw Fixation for Unstable Thoracolumbar Spinal Burst Fractures},
  journal = {Clinical Medicine Research},
  volume = {4},
  number = {1},
  pages = {1-5},
  doi = {10.11648/j.cmr.20150401.11},
  url = {https://doi.org/10.11648/j.cmr.20150401.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cmr.20150401.11},
  abstract = {The indications for operative treatment and type of stabilization procedures for the treatment of thoracolumbar burst fracture remain controversial. As surgical reconstruction for the thoracolumbar burst fracture, both long-segment pedicle screw fixation and short-segment pedicle screw fixation including fractured vertebral body have been used widely. The present study evaluated the efficacy of short-segment fixation compared with that of long-segment fixation in terms of the radiological and clinical outcomes in unstable thoracolumbar burst fractures. From January 2007 to December 2012, 76 patients with thoracolumbar burst fracture underwent posterior pedicle screw fixation consecutively in our hospital. These patients were divided into two groups: the short-segment group, which included patients who underwent short-segment pedicle screw fixation including the fractured vertebral body, and the long-segment group, which included patients who underwent long-segment pedicle screw fixation (2 levels above and 1 level below the fractured vertebral body). There were 44 and 32 patients in the long-segment and short-segment group, respectively. Radiological assessment of the kyphotic angle was performed using the Cobb method immediately after the operation and at 3, 6, and 12 months postoperatively. The clinical outcomes were evaluated using the modified Mcnab criteria at the last follow-up. The sex ratio, mean age of patients, and composition of the fractured vertebral body were similar in both groups. In the long-segment and short-segment group, 37 (84.1%) and 26 (81.3%) cases showed excellent or good outcomes, respectively. The mean kyphotic angle at the immediate postoperative period was 7.3° ± 5.8° and 0.6° ± 11.9° in the long-segment and short-segment group, respectively. The average loss of kyphosis correction was 5.4° ± 4.4°, 8.6° ± 6.2°, and 10.5° ± 4.8° in the long-segment group and 4.1° ± 3.6°, 6.2° ± 5.2°, and 7.5° ± 4.4° in the short-segment group at 3, 6, and 12 months postoperatively, respectively. There was no statistically significant difference in the average loss of kyphosis correction between the two groups (p > 0.05). In conclusion, short-segment pedicle screw fixation including the fractured vertebral body might be as effective as long-segment pedicle screw fixation for the treatment of unstable thoracolumbar spinal burst fracture.},
 year = {2015}
}

Copy | Download

TY  - JOUR
T1  - A Comparative Analysis of the Efficacy of Short-Segment Pedicle Screw Fixation with that of Long-Segment Pedicle Screw Fixation for Unstable Thoracolumbar Spinal Burst Fractures
AU  - Jin-Woo Hur
AU  - Jong-Joo Rhee
AU  - Jong-Won Lee
AU  - Hyun-Koo Lee
Y1  - 2015/01/14
PY  - 2015
N1  - https://doi.org/10.11648/j.cmr.20150401.11
DO  - 10.11648/j.cmr.20150401.11
T2  - Clinical Medicine Research
JF  - Clinical Medicine Research
JO  - Clinical Medicine Research
SP  - 1
EP  - 5
PB  - Science Publishing Group
SN  - 2326-9057
UR  - https://doi.org/10.11648/j.cmr.20150401.11
AB  - The indications for operative treatment and type of stabilization procedures for the treatment of thoracolumbar burst fracture remain controversial. As surgical reconstruction for the thoracolumbar burst fracture, both long-segment pedicle screw fixation and short-segment pedicle screw fixation including fractured vertebral body have been used widely. The present study evaluated the efficacy of short-segment fixation compared with that of long-segment fixation in terms of the radiological and clinical outcomes in unstable thoracolumbar burst fractures. From January 2007 to December 2012, 76 patients with thoracolumbar burst fracture underwent posterior pedicle screw fixation consecutively in our hospital. These patients were divided into two groups: the short-segment group, which included patients who underwent short-segment pedicle screw fixation including the fractured vertebral body, and the long-segment group, which included patients who underwent long-segment pedicle screw fixation (2 levels above and 1 level below the fractured vertebral body). There were 44 and 32 patients in the long-segment and short-segment group, respectively. Radiological assessment of the kyphotic angle was performed using the Cobb method immediately after the operation and at 3, 6, and 12 months postoperatively. The clinical outcomes were evaluated using the modified Mcnab criteria at the last follow-up. The sex ratio, mean age of patients, and composition of the fractured vertebral body were similar in both groups. In the long-segment and short-segment group, 37 (84.1%) and 26 (81.3%) cases showed excellent or good outcomes, respectively. The mean kyphotic angle at the immediate postoperative period was 7.3° ± 5.8° and 0.6° ± 11.9° in the long-segment and short-segment group, respectively. The average loss of kyphosis correction was 5.4° ± 4.4°, 8.6° ± 6.2°, and 10.5° ± 4.8° in the long-segment group and 4.1° ± 3.6°, 6.2° ± 5.2°, and 7.5° ± 4.4° in the short-segment group at 3, 6, and 12 months postoperatively, respectively. There was no statistically significant difference in the average loss of kyphosis correction between the two groups (p > 0.05). In conclusion, short-segment pedicle screw fixation including the fractured vertebral body might be as effective as long-segment pedicle screw fixation for the treatment of unstable thoracolumbar spinal burst fracture.
VL  - 4
IS  - 1
ER  -

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