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  • Percutaneous Pedicle Screw Fixation after Direct Spinal Canal Decompression in Magerl Type A3 Thoracolumbar Burst Fractures with Neurological Injury: An Alternative Option

    Final Number:
    153

    Authors:
    Jung-Kil Lee MD; Bong Ju Moon; Ki-Young Choi

    Study Design:
    Clinical Trial

    Subject Category:
    Spine

    Meeting: Section on Disorders of the Spine and Peripheral Nerves Spine Summit- 2017

    Introduction: Utilization of a posterior approach to the spine for placement of pedicle screws for fixation has become a popular treatment of TLBFs. PPSF systems have increasingly been used, but not explored in combination with decompression for TLBFs with neurological injury. To investigate the surgical results of percutaneous pedicle screw fixation (PPSF) after spinal canal decompression via a small laminotomy for the treatment of thoracolumbar burst fractures (TLBFs) with neurological deficits

    Methods: Seventeen patients who had neurological injury after a thoracolumbar burst fracture and underwent decompression followed by immediate percutaneous pedicle screw fixation were retrospectively reviewed for operative time, length of hospital stay, Cobb angle, vertebral wedge angle, and vertebral body index. A sample of 17 patients sustaining neurological injury due to a single-level thoracolumbar burst fracture. Operative time, length of hospital stay, neurological assessment as determined using the Frankel grading system, Cobb angle, vertebral wedge angle, and vertebral body index were measured. Seventeen patients underwent PPSF after spinal canal decompression via small laminectomies between April 2009 and April 2015. Inclusion criteria consisted of a single-level TLBF and neurological deficits. Patients with multiple or pathological fractures, or polytrauma were excluded. Decompression was performed via a small laminectomy, followed by PPSF, including at the level of the fractured vertebra

    Results: The average follow-up period was 20 months (range 6 to 62 months). The average Cobb angle was 15.77° ± 6.64°, and significantly decreased to 6.54° ± 6.22° postoperatively (p < 0.001). The average vertebral wedge angle was 20.58° ± 6.26°, and decreased significantly to 12.21° ± 6.22° postoperatively (p <0.001). The vertebral body index significantly decreased from 0.58 ± 0.11 to a postoperative value of 0.78 ± 0.10 (p <0.001). No patient deteriorated subsequent to surgery

    Conclusions: Percutaneous pedicle screw fixation after spinal canal decompression via small laminotomy provides significant kyphotic correction and improved neurological outcome while offering decreased surgical morbidity. This may be applied as an effective primary surgery in select patients with TLBFs with neurologic deficits

    Patient Care: Yes, You can decrease surgical time. So patient get more satisfaction.

    Learning Objectives: By the conclusion of this session, participants shoulde be able to: 1) not be afraid to manage for thoracolubmar burst fracture 2) get the another surgical option for thoracolumbar burst fracture

    References:

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