Details

Autor(en) / Beteiligte

• Modi, Hitesh N.
• Chung, Kook Jin
• Yoon, Hoi Soo
• Hwang, Ji Hyo
• Kim, Hong Kyun
• Noh, Kyu Cheol
• Park, Yong Wook
• Yoo, Jung Han

Titel

Effectiveness of pedicle screw-based ligamentotaxis in reducing preoperative kyphosis in thoracolumbar spinal fractures: a retrospective analytical study based on injury surgery interval

Ist Teil von

• European journal of orthopaedic surgery & traumatology, 2010-04, Vol.20 (3), p.199-204

Ort / Verlag

Paris: Springer-Verlag

Erscheinungsjahr

2010

Link zum Volltext

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• Objectives Although there is an agreement of using long-level construct than short-level construct to correct the kyphosis, no literature mentioned the success of this treatment based on timing of surgery after the injury. Objective of this paper was to study the effect of ligamentotaxis on preventing the development of postoperative kyphosis in unstable thoracolumbar burst fractures based on injury surgery interval (ISI). Study design This is a retrospective analysis in 67 patients with unstable thoracolumbar burst fractures operated with posterior-only pedicle screw fixation. Methods A retrospective analytical study was conducted in 67 patients who had unstable thoracolumbar fracture and operated with posterior-only pedicle screw construct two levels above and one level below the fractured vertebra. Results were analyzed based on ISI: group 1 (34 patients) was operated within 7 days; group 2 (19 patients) operated between 7 and 14 days; and group 3(14 patients) operated after 14 days of injury. Immediate postoperative and final follow-up kyphotic angles were analyzed among all three groups using Kruskal–Wallis test. Complications regarding implant failure were also noted at final follow-up. Results Average follow-up was 37 ± 8.1 months. Average preoperative kyphosis at thoracolumbar junction was 26.3° ± 3.9°, 26.3° ± 2.9° and 26.3° ± 2.8° in groups 1, 2 and 3, respectively, which did not show any difference ( P  = 0.98). Immediate postoperatively kyphotic angle was improved to 4.3° ± 1.9°, 5.4° ± 1.7° and 10.1° ± 3.0° in groups 1, 2 and 3, respectively, which exhibited statistically significant difference ( P  < 0.001); and at final follow-up kyphotic angles were 5.4° ± 1.9°, 7.2° ± 1.7° and 15.0° ± 1.6° in groups 1, 2 and 3, respectively showing 1.1°, 1.7° and 4.9° loss in correction at final follow-up. Comparison of kyphotic angles and loss of kyphotic angles amongst the three groups showed statistically significant difference ( P  < 0.001). Two patients from group 3 had implant failure that required implant extraction. Conclusion Posterior-only pedicle screw fixation in unstable thoracolumbar fractures would correct and maintain the postoperative correction in kyphosis, at least at 3-year follow-up, without increasing implant failure if ISI is less than 2 weeks. While patients operated after 2 weeks of injury would require additional anterior procedure.