Bipedicular Fixation of affected vertebrae in thoracolumbar brust fractures
|IJOCP | November 2015 | Volume 2015 | Issue 2015 | Page 119
Conference: 28th Annual Conference of Association of Spine Surgeons of India 2015, Pune. , India [Click for Full details]
Authors: Pravin Padalkar, Varun Joshi, Saurabh Tanver
Authors Affiliatoins: MGM Institute of Health Sciences.
Address of correspondence: Pravin P Padalkar Center for Orthopaedic Superspecialities & spine Surgery, 105, Neel Enclave, Sec 09, Khanda Colony, New Panvel, Navi Mumbai 410206
Background – Burst fractures are the most common type of fracture of the thoracolumbar spine, accounting for greater than 50% of all thoracolumbar trauma SSPF is the use of pedicle screw instrumentation one level cephalad to and one level caudal to the fractured vertebra. Failure of SSPF can be attributed to inadequate fixation points on the vertebrae and insufficient anterior column support In this study, we propose SSPF using longest possible screws in both pedicle of fractured vertebra. A long pedical screw in bilateral fractured vertebrae supports subcondral bone, superior endplate and allows more correction by cantilever forces created by distraction maneuver. This three point fixation also prevents collaps and loss of kyphosis achieved.
Material & Methods: A retrospective chart review was done involving 25 single burst fracture patients between September 2009 and April 2013 in a tertiary care trauma center.. Surgical indications included more than 50% loss of vertebral body height, kyphosis progressing 20% or more, or more than 50% of canal involvement, posterior ligametous complex injury. Patients were also graded preoperatively and postoperatively based on the Frankel Scale; Plain radiographs were evaluated preoperatively and postoperatively for anterior vertebral height (AVH), posterior vertebral height (PVH) and kyphotic angulations using the traditional Cobb method.
Posterior spinal approach was made one level above and below the fracture. Pedicle screws were placed at one level above and below the fracture site .Fracture level screws were inserted at the same time with the other screws prior to compression/distraction, and were included into the lordosing distracting maneuver. Both the fractured pedicels were inserted and care is taken to insert longest possible screws so that they can support subcondral bone and superior end plate of fractured vertebrae. Kyphosis correction achieved by cantilever forces created by distraction and compression maneuver
A mean of 15.2° of kyphosis correction was attained from pre-operation to post-operation (P < 0.0001). Although there was a 15° average improvement of kyphosis post-fixation, loss of correction over time was nearly 8°, resulting in a 7° mean correction of kyphosis
Burst fractures are the most common type of fracture of the thoracolumbar spine, accounting for greater than 50% of all thoracolumbar trauma1 Traditional pedicle screw instrumentation allows indirect reduction and kyphosis correction of thoracolumbar burst by distraction and ligamentotaxis, but because of frequent failure to support the anterior spinal column, loss of correction associated with high rate of failure is not rare A long pedical screw in bilateral fractured vertebrae supports subcondral bone, superior endplate and allows more correction by cantilever forces created by distraction maneuver. This three point fixation also prevents collaps and loss of kyphosis achieved.
|How to Cite this Abstract|
|Padalkar P, Joshi V, Tanver S. Bipedicular Fixation of affected Vertebare in thoracolumbar Brust Fractures. International Journal of Conference Proceedings November 2015;(2015):119|