Analysis Of The Clinical Effect Of Excessive Lordosis Reduction Technique And Screw Placement In The Treatment Of Thoracolumbar Fractures

Objective:To evaluate the effect of hyperlordotic reduction combined with short-segment pedicle screw fixation(SSPF)in the treatment of thoracolumbar fractures.Methods:From January 2012 to June 2014,a total of 44 patients suffered from thoracolumbar fractures treated with short segment fixation were included in this retrospective study.According to with or without hyperlordotic reduction,Patients were divided into two groups.The experimental group comprised 21 patients treated with hyperlordotic reduction and the control group comprised 23 patients treated without hyperlordotic reduction.All patients were followed up from 18 to 36 months.Indicators were recorded and compared between two groups before surgery,a week after surgery,and at final follow up.They included the relative height of anterior vertebra body,the sagittal Cobb angles,and loss of spinal correction.Visual analog scale(VAS)of back pain was also evaluated before surgery,a week after surgery,and at final follow up.Results:The two groups were similar in their ages,sex,follow-up periods,fracture levels,Load-Sharing classification score(LSC),and severity of the deformity of thoracolumbar fractures.All patients achieved significant improvement in kyphotic angle correction and restoration of anterior vertebral height after surgery(P<0.05).The sagittal Cobb angles of fractured vertebra in experimental group was much lower than in the control group at a week after surgery and the final follow up(P<0.05).They were-6.33±2.82° and 5.30±4.31°,respectively at a week after operation;And at the final follow up,they were-2.57±3.9° and 9.91±6.85°,respectively.However,no significant difference was found in anterior vertebral height between the two groups at any time points(P>0.05).Also,we did not find any statistically difference between the two groups in terms of correction loss(P>0.05).With respect to VAS scores for back pain,though there were no statistically differences between both groups at the time of before and a week after surgery(P>0.05),the difference was statistically at the last follow-up(P<0.05).The average VAS scores in the experimental group and control group were 1.38±0.86 and 2.22±1.38,respectively.There were no died cases and no failure of instrumentation happened in both groups.Conclusions:Short segment fixation combined with hyperlordotic reduction is a safe and effective surgical method in treating thoracolumbar fractures.It can reduce the incidence of delayed kyphosis after surgical treatment and provided better load transfer pattern of thoracolumbar spine.It is also associated with a decrease of back pain.Another advantage was that it may maintain lower implant failure rate theoretically.Objective:To compare the radiographic outcomes and clinical effects of posterior short fixation with or without screws at the level of fracture in treating thoracolumbar mono-segmental vertebral fractures.And to evaluate the safety and effectiveness of this innovative fixation method.Methods:From June 2012 and June 2015,48 patients with thoracolumbar fractures were managed with posterior short-segment pedicle fixation.There were 29 males and 19 females,aged from 18 to 59 years old with an average of 45.6±10.4 years.According to the methods of fixation at the level of fracture,they were divided into two groups.Experimental group included 22 patients treated by posterior fixation with bilateral fracture-level screws.Control group included 26 patients were treated by posterior fixation alone,without bilateral fracture-level screws.All patients were periodically follow-up at least 12 months.Radiological parameters and clinical outcomes were compared among both groups.Results:All patients were followed up postoperatively for 12-26 months with an average of 17.4±4.3 months.No complications such as incision infection,poor wound healing,internal fixation loosening and breakage were found in experimental group during the follow-up period.1 patient in the control group had failure of internal faxation.There were similar in their ages,sex,fracture levels,Load-Sharing classification score(LSC),and follow-up periods between both groups(P>0.05).There were no significance differences between the two groups with respect to the relative height of the fractured vertebra at any time points.The sagittal Cobb angles between the two groups were similar preoperatively,and a week after operation.At the time of the latest follow-up,the sagittal Cobb angles and the loss of Cobb angle in the experimental group were significantly smaller than the control group(P<0.05).The sagittal Cobb angles of both group were(2.5±3.9)° and(5.9±4.7)°,respectively.The loss of Cobb angle were(1.1 ±3.4)0and(4.3±2.8)°,respectively.With respect to back pain VAS scores,the two groups were similar at preoperatively,a week after operation and the latest follow-up(P>0.05).Conclusion:Compared to traditional posterior fixation alone,pedicle screw fixation at the level of fracture can significantly decrease the loss of correction in the middle-long term,and reduce the incidence of late kyphosis deformity.They give excellent radiological results and clinical outcomes with a safe surgical procedure.