Operative gradual reduction in thoracolumbar burst fracture using the pedicle screw-plate spinal system: Surgical technique and neurological outcomes

Abstract

Posterior distraction and stabilization using pedicle screws instrumentation for unstable thoracolumbar burst fracture is less extensive approach and offers comparable neurological outcome to anterior direct decompression. However, this method requires spinal column distraction which may result in late kyphotic deformity. Pedicle screws insert at the level of fracture (index screws) confers mechanical advantage for deformity correction and maintain spinal alignment. We suppose that the index screws manipulation with gradual reduction technique could facilitate reduction and restore vertebral height which promotes reduction of retropulsed bone fragments. Therefore, the aim of this study was to present our gradual reduction technique with index pedicle screws applied for treatment of thoracolumbar burst fracture and evaluate the results. There were 14 male and 17 female patients with thoracolumbar burst fracture recruited in this retrospective study. The mean age was 41 years (range, 16 to 79 y). The mean preoperative Cobb angle was 17.5±11.82 degrees. The kyphotic deformity was corrected to -0.23±7.04 degrees (P<0.0001) after operation. At the final follow-up, 1 year after the surgery, mean kyphotic angle was changed to 0.32±8.77 degrees. No statistically significant difference was demonstrated when compared with the immediately postoperative results (P=0.974). No neurological deterioration was found after the operation. The overall motor recovery was 70% with additional simple laminectomy. In conclusion, short-segment pedicle screws instrumentation with gradual reduction technique could achieve the strong implant construction for reduction and maintain kyphosis deformity correction. The neurological recovery could be expected with additional simple laminectomy. © 2014 by Lippincott Williams & Wilkins.