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Risk factors for a kyphosis recurrence after short-segment temporary posterior fixation for thoracolumbar burst fractures

      Highlights

      • We investigated rick factor for kyphosis after temporary fixation for burst fracture.
      • Fractured vertebrae were well reduced and maintained after surgery.
      • Kyphosis recurrence was observed at disc level mainly after implant removal.
      • Preoperative kyphotic deformity and canal compromise ratio were the risk factors.

      Abstract

      Short-segment temporary posterior spinal instrumentation has been widely used to treat thoracolumbar burst fractures. However, kyphosis recurrence without hardware failure has become a concern. Therefore, we investigated risk factors for kyphosis recurrence after short-segment temporary fixation for thoracolumbar burst fractures. Our prospective multicenter study involved 76 consecutive patients with thoracolumbar burst fractures who underwent short-segment temporary posterior fixation using ligamentotaxis with Schanz screws and without fusion. Patients were divided into two groups -kyphosis recurrence and no kyphosis recurrence- according to correction loss of the kyphotic angle. Clinical and radiographic data were examined to reveal the risk factors for postoperative kyphosis recurrence. After surgery, all patients experienced fracture union. Kyphotic deformity was reduced significantly, and maintenance of the reduced vertebra was successful. However, mean 9.1° loss of correction in kyphotic angle was observed. Statistical analysis revealed that a high ratio of canal compromise before surgery, as seen on computed tomography scanning, and a large preoperative kyphotic angle influenced kyphosis recurrence. In conclusion,short-segment temporary posterior fixation yields satisfactory results regarding reduction and maintenance of fractured vertebrae. However, correction loss after implant removal is associated with a high compromised canal ratio before surgery and a large preoperative kyphotic angle.

      Keywords

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      References

        • Denis F.
        The three column spine and its significance in the classification of acute thoracolumbar spinal injuries.
        Spine. 1983; 8: 817-831
        • Ebelke D.K.
        • Asher M.A.
        • Neff J.R.
        • Kraker D.P.
        Survivorship analysis of VSP spine instrumentation in the treatment of thoracolumbar and lumbar burst fractures.
        Spine. 1991; 16: S428-S432
        • McCormack T.
        • Karaikovic E.
        • Gaines R.W.
        The load sharing classification of spine fractures.
        Spine. 1994; 19: 1741-1744
        • McLain R.F.
        • Sparling E.
        • Benson D.R.
        Early failure of short-segment pedicle instrumentation for thoracolumbar fractures. A preliminary report.
        J. Bone Joint Surg. Am. Vol. 1993; 75: 162-167
        • Altay M.
        • Ozkurt B.
        • Aktekin C.N.
        • Ozturk A.M.
        • Dogan O.
        • Tabak A.Y.
        Treatment of unstable thoracolumbar junction burst fractures with short- or long-segment posterior fixation in magerl type a fractures.
        Eur. Spine J.: Off. Publ. Eur. Spine Soc., Eur. Spinal Deformity Soc. Eur. Sect. Cervical Spine Res. Soc. 2007; 16: 1145-1155
        • Tezeren G.
        • Kuru I.
        Posterior fixation of thoracolumbar burst fracture: short-segment pedicle fixation versus long-segment instrumentation.
        J. Spinal Disord. Tech. 2005; 18: 485-488
        • Korovessis P.
        • Baikousis A.
        • Zacharatos S.
        • Petsinis G.
        • Koureas G.
        • Iliopoulos P.
        Combined anterior plus posterior stabilization versus posterior short-segment instrumentation and fusion for mid-lumbar (L2–L4) burst fractures.
        Spine. 2006; 31: 859-868
        • McDonough P.W.
        • Davis R.
        Tribus C, Zdeblick TA. The management of acute thoracolumbar burst fractures with anterior corpectomy and Z-plate fixation.
        Spine. 2004; 1901–829 (discussion 9)
        • Marco R.A.
        • Meyer B.C.
        • Kushwaha V.P.
        Thoracolumbar burst fractures treated with posterior decompression and pedicle screw instrumentation supplemented with balloon-assisted vertebroplasty and calcium phosphate reconstruction. Surgical technique.
        J. Bone Joint Surg. Am. Vol. 2010; 92: 67-76
        • Toyone T.
        • Tanaka T.
        • Kato D.
        • Kaneyama R.
        • Otsuka M.
        The treatment of acute thoracolumbar burst fractures with transpedicular intracorporeal hydroxyapatite grafting following indirect reduction and pedicle screw fixation: a prospective study.
        Spine. 2006; 31: E208-E214
        • Verlaan J.J.
        • Dhert W.J.
        • Verbout A.J.
        • Oner F.C.
        Balloon vertebroplasty in combination with pedicle screw instrumentation: a novel technique to treat thoracic and lumbar burst fractures.
        Spine. 2005; 30: E73-E79
        • Aono H.
        • Tobimatsu H.
        • Ariga K.
        • Kuroda M.
        • Nagamoto Y.
        • Takenaka S.
        • et al.
        Surgical outcomes of temporary short-segment instrumentation without augmentation for thoracolumbar burst fractures.
        Injury. 2016; 47: 1337-1344
        • Aono Hiroyuki
        • Ishii Keisuke
        • Tobimatsu Hidekazu
        • Nagamoto Yukitaka
        • Takenaka Shota
        • Furuya Masayuki
        • Chiaki Horii
        • Iwasaki Motoki
        Temporary short-segment pedicle screw fixation for thoracolumbar burst fractures: comparative study with or without vertebroplasty.
        Spine J. 2017; 17: 1113-1119https://doi.org/10.1016/j.spinee.2017.03.022
        • Reinhold M.
        • Audige L.
        • Schnake K.J.
        • Bellabarba C.
        • Dai L.Y.
        • Oner F.C.
        AO spine injury classification system: a revision proposal for the thoracic and lumbar spine.
        Eur. Spine J.: Off. Publ. Eur. Spine Soc., Eur. Spinal Deformity Soc. Eur. Sect. Cervical Spine Res. Soc. 2013; 22: 2184-2201
        • Chen C.
        • Lv G.
        • Xu B.
        • Zhang X.
        • Ma X.
        Posterior short-segment instrumentation and limited segmental decompression supplemented with vertebroplasty with calcium sulphate and intermediate screws for thoracolumbar burst fractures.
        Eur. Spine J.: Off. Publ. Eur. Spine Soc., Eur. Spinal Deformity Soc. Eur. Sect. Cervical Spine Res. Soc. 2014; 23: 1548-1557
        • Fuentes S.
        • Blondel B.
        • Metellus P.
        • Gaudart J.
        • Adetchessi T.
        • Dufour H.
        Percutaneous kyphoplasty and pedicle screw fixation for the management of thoraco-lumbar burst fractures.
        Eur. Spine J.: Off. Publ. Eur. Spine Soc., Eur. Spinal Deformity Soc. Eur. Sect. Cervical Spine Res. Soc. 2010; 19: 1281-1287
        • Vu T.T.
        • Morishita Y.
        • Yugue I.
        • Hayashi T.
        • Maeda T.
        • Shiba K.
        Radiological outcome of short segment posterior instrumentation and fusion for thoracolumbar burst fractures.
        Asian Spine J. 2015; 9: 427-432
        • Wang X.Y.
        • Dai L.Y.
        • Xu H.Z.
        • Chi Y.L.
        Kyphosis recurrence after posterior short-segment fixation in thoracolumbar burst fractures.
        J. Neurosurg. Spine. 2008; 8: 246-254
        • Chou P.H.
        • Ma H.L.
        • Wang S.T.
        • Liu C.L.
        • Chang M.C.
        • Yu W.K.
        Fusion may not be a necessary procedure for surgically treated burst fractures of the thoracolumbar and lumbar spines: a follow-up of at least ten years.
        J. Bone Joint Surg. Am. Volume. 2014; 96: 1724-1731
        • Kim G.W.
        • Jang J.W.
        • Hur H.
        • Lee J.K.
        • Kim J.H.
        • Kim S.H.
        Predictive factors for a kyphosis recurrence following short-segment pedicle screw fixation including fractured vertebral body in unstable thoracolumbar burst fractures.
        J. Korean Neurosurg. Soc. 2014; 56: 230-236
        • Pellise F.
        • Barastegui D.
        • Hernandez-Fernandez A.
        • Barrera-Ochoa S.
        • Bago J.
        • Issa-Benitez D.
        • et al.
        Viability and long-term survival of short-segment posterior fixation in thoracolumbar burst fractures.
        Spine J.: Off. J. North Am. Spine Soc. 2015; 15: 1796-1803
        • Lakshmanan P.
        • Jones A.
        • Mehta J.
        • Ahuja S.
        • Davies P.R.
        • Howes J.P.
        Recurrence of kyphosis and its functional implications after surgical stabilization of dorsolumbar unstable burst fractures.
        Spine J.: Off. J. North Am. Spine Soc. 2009; 9: 1003-1009
        • Chen J.X.
        • Xu D.L.
        • Sheng S.R.
        • Goswami A.
        • Xuan J.
        • Jin H.M.
        • et al.
        Risk factors of kyphosis recurrence after implant removal in thoracolumbar burst fractures following posterior short-segment fixation.
        Int. Orthop. 2016; 40: 1253-1260