Modified one-stage posterior/anterior combined surgery with posterior pedicle instrumentation and anterior monosegmental reconstruction for unstable Denis type B thoracolumbar burst fracture
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This study aimed to evaluate the clinical and radiological results in patients with unstable Denis type B thoracolumbar burst fractures treated by modified one-stage posterior/anterior combined surgery.
Thirty-one patients with unstable Denis type B thoracolumbar burst fractures were enrolled in this study. The patients underwent one-stage posterior/anterior combined surgery with posterior instrumentation using pedicle screws and anterior monosegmental reconstruction utilizing titanium mesh cages. The mean follow-up period was 38.3 months. Clinical outcomes, radiological parameters, and treatment-related complications were assessed.
The mean age of the patients was 36.4 years. The mean operative time and blood loss were 230 min and 645 ml, respectively. The VAS pain score was significantly improved after surgery, and the improvement was maintained until the final follow-up. In 23 patients with neurologic dysfunction, 20 (87 %) patients had improvement after surgery. By the final follow-up, 27 patients had returned to work; 18 of the 27 patients returned to a similar job. The mean sagittal kyphosis was corrected from 21.2° preoperatively to 2.5° postoperatively, which increased slightly to 4.3° at the final follow-up. Minimal subsidence and tilt of the titanium mesh cage were observed during the follow-up period. Solid bony fusion was achieved in all patients. One patient developed a posterior surgical site infection, which was resolved by antibiotic treatment and surgical debridement.
Modified one-stage posterior/anterior combined surgery for Denis type B unstable thoracolumbar burst fractures can produce good clinical and radiological outcomes.
KeywordsThoracolumbar burst fracture Posterior/anterior combined surgery Posterior instrumentation Anterior monosegmental reconstruction
Compliance with ethical standards
Conflict of interest
Ethical approval was obtained from the institutional review board of the Ningbo No. 6 hospital prior to perform this study.
Informed consent was obtained from all individual participants included in the study.
- 6.Denis F (1984) Spinal instability as defined by the three-column spine concept in acute spinal trauma. Clin Orthop Relat Res 189:65–76Google Scholar
- 12.Mattei TA, Hanovnikian J, Dinh HD (2014) Progressive kyphotic deformity in comminuted burst fractures treated non-operatively: the Achilles tendon of the Thoracolumbar Injury Classification and Severity Score (TLICS). Eur Spine J 23(11):2255–2262. doi: 10.1007/s00586-014-3312-0 CrossRefPubMedGoogle Scholar
- 17.Viljoen SV, DeVries Watson NA, Grosland NM, Torner J, Dalm B, Hitchon PW (2014) Biomechanical analysis of anterior versus posterior instrumentation following a thoracolumbar corpectomy: laboratory investigation. J Neurosurg Spine 21(4):577–581. doi: 10.3171/2014.6.SPINE13751 CrossRefPubMedGoogle Scholar
- 18.Chen C, Lv G, Xu B, Zhang X, Ma X (2014) Posterior short-segment instrumentation and limited segmental decompression supplemented with vertebroplasty with calcium sulphate and intermediate screws for thoracolumbar burst fractures. Eur Spine J 23(7):1548–1557. doi: 10.1007/s00586-014-3374-z CrossRefPubMedGoogle Scholar
- 19.Shawky A, Al-Sabrout AM, El-Meshtawy M, Hasan KM, Boehm H (2013) Thoracoscopically assisted corpectomy and percutaneous transpedicular instrumentation in management of burst thoracic and thoracolumbar fractures. Eur Spine J 22(10):2211–2218. doi: 10.1007/s00586-013-2835-0 CrossRefPubMedPubMedCentralGoogle Scholar
- 22.Machino M, Yukawa Y, Ito K, Nakashima H, Kato F (2011) Posterior/anterior combined surgery for thoracolumbar burst fractures–posterior instrumentation with pedicle screws and laminar hooks, anterior decompression and strut grafting. Spinal Cord 49(4):573–579. doi: 10.1038/sc.2010.159 CrossRefPubMedGoogle Scholar