Reason And Treatment For The Failure Of Posterior Pedicle Screw Internal Fixation On Thoracolumbar Fracture

Objectives To analyze the reason and strategy for failure of posterior pedicle screw internal fixation on serious thoracolumbar fractures. Methods A total of 18 patients failed posterior pedicle screw internal fixation on serious thoracolumbar fracture from Apr 2003 to Nov 2006, 11 male and 7 female with ages from 19 to 67 (average 38.8 yrs). There were 11 patients who were laminectomy additional, 12 patients were bone grafted. The duration from the first operation to complication occurrence was 5～49 months (average 14.3 months). Nonunion was 5 cases, nonunion following screw breakage was 2 cases, nonunion following kyphosis was 2 cases, screw breakage was 3 cases, staff breakage was 1 cases, the progressing kyphosis was 2 cases, the progressing neuro-dysfunction was 2 cases. Results The strategy of treatment including: anterior internal fixation remaining posterior fixation was 7 cases, anterior internal fixation after posterior fixation removal was 6 cases, kyhpoplasty after posterior fixation removal was 1 case, removing internal fixation was 4 cases, removing partial fixation was 1 cases. Thirteen patients were followed up. The time of follow-up was 7～51 months, the mean was 31.4 months. There were not complications of internal fixation, such as breakage and loosening. The kyphosis was rectified. The union was accomplished well according to X ray or CT scans. The average Oswestry score in 11 follow-up back pain cases decreased from (30.6±5.2) preoperatively to (13.5±5.6) at postoperative first day and (8.2±3.1) at last follow-up. The outcome of operation was satisfied. Conclusions The appropriate treatments for serious thoracolumbar fracture should be chosen according to the injury mechanism, grouping and neuo-dysfunction. Posterior pedicle screw short-segment internal fixation for the management of serious thoracolumbar fracture may result in the complications such as nonunion, internal fixation breakage and progressing kyphosis. Anterior reconstruction may be a good strategy for the failure of posterior operation.