Posterior Unilateral Small Fenestration of Lamina Combined with a Custom-made Y-shaped Fracture Reduction Device for the Treatment of Severe Thoracolumbar Burst Fracture: a Prospective Comparative Study

Overview

Journal J Orthop Surg Res

Publisher Biomed Central

Specialty Orthopedics

Date 2023 Jul 25

PMID 37491312

Authors

Zheng Zeng

Dan Zhang

Fen-Lian Zeng

Jun Ao

Affiliations

Soon will be listed here.

Abstract

Background: The purpose was to evaluate the clinical effect of a custom-made Y-shaped fracture fragment reduction device and to assist in posterior unilateral small fenestration of lamina to reduce the fracture fragments.

Methods: In this study, 40 patients were assigned to one of two groups: the traditional reduction device group (TRG) or the Y-shaped reduction device group (YRG). All patients underwent posterior unilateral small fenestration of the lamina and direct decompression through the spinal canal. And the operation time (OT), intraoperative bleeding (IB), preoperative, postoperative, and final follow-up data on the spinal stenosis rate (SSR), Cobb angle, the anterior compression ratio of injured vertebrae (ACRIV), and ASIA neurological function grade were compared between the two groups.

Result: There were no complications, including vascular and nerve injury, serious postoperative infection, internal fixation fracture, or loosening, for any of the patients. And the average follow-up time of the two groups was 14.2 months, the average operation time of the TRG was 236.6 min, and the average intraoperative blood loss was 357.20 ml. Moreover, the average operation time of the YRG was 190.6 min, and the average intraoperative blood loss was 241.5 ml. There were significant differences between the two groups in terms of operation duration and intraoperative blood loss. The YRG's was lower than that of the TRG. Besides, there was no difference in SSR, Cobb angle, ACRIV, or neurological recovery between the two groups before or immediately after the operation or at the last follow-up.

Conclusion: The Y-shaped fracture reduction device can reduce the fracture fragments and the OT and IB stably; it also has satisfactory postoperative curative effects and clinical utility.

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References

Chen L, Liu H, Hong Y, Yang Y, Hu L . Minimally Invasive Decompression and Intracorporeal Bone Grafting Combined with Temporary Percutaneous Short-Segment Pedicle Screw Fixation for Treatment of Thoracolumbar Burst Fracture with Neurological Deficits. World Neurosurg. 2019; 135:e209-e220. DOI: 10.1016/j.wneu.2019.11.123. View

Deng Z, Zou H, Cai L, Ping A, Wang Y, Ai Q . The retrospective analysis of posterior short-segment pedicle instrumentation without fusion for thoracolumbar burst fracture with neurological deficit. ScientificWorldJournal. 2014; 2014:457634. PMC: 3958728. DOI: 10.1155/2014/457634. View

Arlet V, Orndorff D, Jagannathan J, Dumont A . Reverse and pseudoreverse cortical sign in thoracolumbar burst fracture: radiologic description and distinction--a propos of three cases. Eur Spine J. 2008; 18(2):282-7. PMC: 2899345. DOI: 10.1007/s00586-008-0848-x. View

Qiu T, Tan K, Lee V, Teo E . Investigation of thoracolumbar T12-L1 burst fracture mechanism using finite element method. Med Eng Phys. 2005; 28(7):656-64. DOI: 10.1016/j.medengphy.2005.10.011. View

Oro J, Watts C, Gaines R . Vertebral body impactor for posterior lateral decompression of thoracic and lumbar fractures. Technical note. J Neurosurg. 1989; 70(2):285-6. DOI: 10.3171/jns.1989.70.2.0285. View

Mohanty S, Bhat N, Abraham R, Ishwara Keerthi C . Neurological deficit and canal compromise in thoracolumbar and lumbar burst fractures. J Orthop Surg (Hong Kong). 2008; 16(1):20-3. DOI: 10.1177/230949900801600105. View

Radcliff K, Kepler C, Delasotta L, Rihn J, Harrop J, Hilibrand A . Current management review of thoracolumbar cord syndromes. Spine J. 2011; 11(9):884-92. DOI: 10.1016/j.spinee.2011.07.022. View

Gnanenthiran S, Adie S, Harris I . Nonoperative versus operative treatment for thoracolumbar burst fractures without neurologic deficit: a meta-analysis. Clin Orthop Relat Res. 2011; 470(2):567-77. PMC: 3254755. DOI: 10.1007/s11999-011-2157-7. View

Park S, Kim S, Moon B, Lee S, Lee J . Short segment percutaneous pedicle screw fixation after direct spinal canal decompression in thoracolumbar burst fractures: An alternative option. J Clin Neurosci. 2018; 53:48-54. DOI: 10.1016/j.jocn.2018.04.039. View

10.

Tezeren G, Kuru I . Posterior fixation of thoracolumbar burst fracture: short-segment pedicle fixation versus long-segment instrumentation. J Spinal Disord Tech. 2005; 18(6):485-8. DOI: 10.1097/01.bsd.0000149874.61397.38. View

11.

Machino M, Yukawa Y, Ito K, Nakashima H, Kato F . Posterior/anterior combined surgery for thoracolumbar burst fractures--posterior instrumentation with pedicle screws and laminar hooks, anterior decompression and strut grafting. Spinal Cord. 2010; 49(4):573-9. DOI: 10.1038/sc.2010.159. View

12.

Alpantaki K, Bano A, Pasku D, Mavrogenis A, Papagelopoulos P, Sapkas G . Thoracolumbar burst fractures: a systematic review of management. Orthopedics. 2010; 33(6):422-9. DOI: 10.3928/01477447-20100429-24. View

13.

Lenehan B, Street J, Kwon B, Noonan V, Zhang H, Fisher C . The epidemiology of traumatic spinal cord injury in British Columbia, Canada. Spine (Phila Pa 1976). 2012; 37(4):321-9. DOI: 10.1097/BRS.0b013e31822e5ff8. View

14.

Wood K, Li W, Lebl D, Lebl D, Ploumis A . Management of thoracolumbar spine fractures. Spine J. 2013; 14(1):145-64. DOI: 10.1016/j.spinee.2012.10.041. View

15.

Miyashita T, Ataka H, Tanno T . Clinical results of posterior stabilization without decompression for thoracolumbar burst fractures: is decompression necessary?. Neurosurg Rev. 2011; 35(3):447-54. DOI: 10.1007/s10143-011-0363-0. View

16.

Crutcher Jr J, Anderson P, King H, Montesano P . Indirect spinal canal decompression in patients with thoracolumbar burst fractures treated by posterior distraction rods. J Spinal Disord. 1991; 4(1):39-48. View

17.

Guerra Jr J, Garfin S, Resnick D . Vertebral burst fractures: CT analysis of the retropulsed fragment. Radiology. 1984; 153(3):769-72. DOI: 10.1148/radiology.153.3.6494475. View

18.

Jiang X, Tian W, Liu B, Li Q, Zhang G, Hu L . Comparison of a paraspinal approach with a percutaneous approach in the treatment of thoracolumbar burst fractures with posterior ligamentous complex injury: a prospective randomized controlled trial. J Int Med Res. 2012; 40(4):1343-56. DOI: 10.1177/147323001204000413. View

19.

Peng Y, Zhang L, Shi T, Lv H, Zhang L, Tang P . Relationship between fracture-relevant parameters of thoracolumbar burst fractures and the reduction of intra-canal fracture fragment. J Orthop Surg Res. 2015; 10:131. PMC: 4549871. DOI: 10.1186/s13018-015-0260-2. View

20.

Steudel W, Nabhan A, Shariat K . Intraoperative CT in spine surgery. Acta Neurochir Suppl. 2010; 109:169-74. DOI: 10.1007/978-3-211-99651-5_26. View