249 - Operative Treatment of Thoracolumbar Burst Fracture with or without Co...

#249 Operative Treatment of Thoracolumbar Burst Fracture with or without Computer-assisted Pedicle Screw(s) at the Fracture Level

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Poster Presented by: S. Chen

Author(s):

S.-H. Chen (1)

(1) Kaohsiung Chang Gung Memorial Hospital, Orthopaedics, Kaohsiung, Taiwan, Republic of China

Abstract

Introduction: The purpose of this study is to compare the clinical results of operative treatment of thoracolumbar burst fractures with or without computer-assisted pedicle screw(s) at the fracture level. The surgical treatment of thoracolumbar burst fractures with short pedicle screw instrumentation has good results in clinical situations but failure to maintain the sagittal plane correction has been reported by several authors. Several methods have been mentioned to reduce the high fixation failure rate in the treatment of thoracolumbar burst fractures with short pedicle screw instrumentation. Computer-assisted pedicle screw insertion in the fracture side is one of the methods and the success rates may be improved by inserting an additional screw at the facture level.

Methods: Thirty-six patients (23 males and 13 females; mean age, 37.2 years; age range, 26-65 years) were treated with short posterior pedicle instrumentation with computer-assisted screw insertion at the fracture level in 17 cases (Group I) and without screw insertion in 19 cases (Group II). Segmental kyphosis and vertebral height were assessed by lateral view X-ray. Patients were thoroughly reexamined and the neurologic status, functional outcome and complications of both groups were assessed.

Results: The average kyphotic angle before and after surgery and at latest follow-up were 16º, 2º, and 4º, respectively, in Group I and 17º, 3º, and 11º, respectively, in Group II. Mean anterior vertebral body height before and after surgery and at latest follow-up were 56%, 78%, and 75% of normal, respectively, in Group I and 54%, 75% and 63%, respectively, in Group II. Loss of kyphotic correction or vertebral height was more severe (p< 0.05) and there was substantially more pain in Group II. No patients had an increase in neurologic deficit. Patients with neurologic deficit experienced improvement irrespective of treatment choice. Complications were relatively rare.

Conclusions: There are high fixation failure rates associated with thoracolumbar burst fractures treated with short pedicle instrumentation. Computer-assisted pedicle screw insertion at the fracture level effectively reduces the fixation failure of thoracolumbar burst fractures treated with short pedicle instrumentation.