Analysis of Factors Affecting Postoperative Loss of Reduction in Unstable Thoracolumbar Fractures (흉-요추부 불안정성 골절 수술 후 정복 소실에 영향을 미치는 요인 분석)

SOH JAE WAN (소재완); Changhwa Hong (홍창화); 방청원; Jae Chul Lee (이재철); Byungjoon Shin (신병준)

Analysis of Factors Affecting Postoperative Loss of Reduction in Unstable Thoracolumbar Fractures

Journal of Korean Society of Spine Surgery
Abbr : J Kor Spine Sur
2017, 24(3), pp.190-197
Publisher : Korean Society Of Spine Surgery
Research Area : Medicine and Pharmacy > Orthopedic Surgery

SOH JAE WAN ¹, Changhwa Hong ¹, 방청원 ², Jae Chul Lee ¹, Byungjoon Shin ¹

¹순천향대학교
²순천향대학교 의과대학 천안병원 정형외과학교실

Accredited

ABSTRACT

Study Design: Retrospective analysis Objectives: Loss of fracture reduction after posterior surgery to treat unstable thoracolumbar fractures can cause several complications. We analyzed the factors influencing postoperative loss of reduction. Summary of Literature Review: Controversy exists about the factors causing postoperative loss of reduction in thoracolumbar fractures during the follow-up period. Materials and Methods: We analyzed the records of 59 patients who underwent posterior surgery for thoracolumbar unstable fractures and had completed a minimum follow-up of 1 year. Postoperative loss of reduction was defined as 30% or more loss of vertebral body height or 15° or more progression of the kyphotic angle at the 1-year follow-up compared to immediately after surgery. The associations between the patients’ gender, age, level of fracture, injury of the posterior column, initial loss of fractured vertebral body height, loadsharing score, Thoraco-Lumbar Injury Classification and Severity score, number of fixed segments, type of pedicle screws, degree of postoperative reduction, degree of postoperative corrected kyphotic angle, changes in the insertion angle of the most proximal and the most distal pedicle screws, decreases in the upper and lower disc height of the fractured vertebral body, and postoperative loss of reduction were analyzed. Results: Thirteen patients (22.0%) had postoperative loss of reduction. Age at the time of the operation (p=0.034), initial loss of fractured vertebral body height (p=0.042), and changes in the insertion angles of the most distal pedicle screws (p=0.021) were significantly associated with postoperative loss of reduction. However, the other factors did not show a significant relationship. Conclusions: In patients who underwent posterior surgery for unstable thoracolumbar fractures, the frequency of loss of reduction was high in patients more than 45 years old at the time of the operation, with a 50% or more loss of the initial fractured vertebral body height, and with changes of 5° or more in the insertion angles of the most distal pedicle screws.

KEYWORDS

Key words: Thoracolumbar, Unstable fractures, Posterior surgery, Loss of fracture reduction

Citation status

* References for papers published after 2023 are currently being built.

[journal] Denis F / 1983 / Three column spine and its significanca in the classification of acute thoracolumbar spinal injuries / Spine (Phila Pa 1976) 8 : 817~831

[journal] McCormack T / 1994 / The load sharing classification of spine fractures / Spine (Phila Pa 1976) 19 : 1741~1744

[journal] Vaccaro AR / 2005 / The thoracolumbar injury severity score : a proposed treatment algorithm / J Spinal Disord Tech 18 : 209~215

[journal] Mahar A / 2007 / Short-segment fixation of lumbar burst fractures using pedicle fixation at the level of the fracture / Spine (Phila Pa 1976) 32 : 1503~1507

[journal] Sjostrom L / 1993 / CT analysis of pedicles and screw tracts after implant removal in thoracolumbar fractures / J Spinal Disord 6 : 225~231

[journal] Yue JJ / 2002 / The treatment of unstable thoracic spine fractures with transpedicular screw instrumentation : a 3-year consecutive series / Spine (Phila Pa 1976) 27 : 2782~2787

[journal] Carl AL / 1992 / Pedicle screw instrumentation for thoracolumbar burst fractures and fracture-dislocations / Spine (Phila Pa 1976) 17(Suppl) : 317~324

[journal] Dickson JH / 1978 / Results of reduction and stabilization of the severely fractured thoracic and lumbar spine / J Bone Joint Surg Am 60 : 799~805

[journal] Stambough JL / 1994 / Cotrel-Dubousset instrumentation and thoracolumbar spine trauma : a review of 55 cases / J Spinal Disorders 7 : 461~469

[journal] Stambough JL / 1997 / Posterior instrumentation for thoracolumbar trauma / Clin Orthop Relat Res 335 : 73~88

[journal] 김정환 / 2005 / Treatment of Thoraco-Lumbar Bursting Fractures According to Load-Sharing Classification / 대한골절학회지 / 대한골절학회 18(1) : 69~75

[journal] Chen JX / 2016 / Risk factors of kyphosis recurrence after implant removal in thoracolumbar burst fractures following posterior short-segment fixation / Int Orthop 40 : 1253~1260

[journal] Gun-Woo Kim / 2014 / Predictive Factors for a Kyphosis Recurrence Following Short-Segment Pedicle Screw Fixation Including Fractured Vertebral Body in Unstable Thoracolumbar Burst Fractures / 대한신경외과학회지 / 대한신경외과학회 56(3) : 230~236

[journal] Denis F / 1984 / Acute thoracolumbar burst fractures in the absence of neurologic deficit. A comparison between operative and nonoperative treatment / Clin Orthop Relat Res 189 : 142~149

[journal] Holdsworth F / 1970 / Fractures, dislocations, and fracture-dislocations of the spine / J Bone Joint Surg Am 52 : 1534~1551

[journal] Nagel DA / 1981 / Stability of the upper lumbar spine following progressive disruptions and the application of individual internal and external fixation devices / J Bone Joint Surg Am 63 : 62~70

[journal] James KS / 1994 / Biomechanical evaluation of the stability of thoracolumbar burst fractures / Spine (Phila Pa 1976) 19 : 1731~1740

[journal] Gurr KR / 1988 / Biomechanical analysis of anterior and posterior instrumentation systems after corpectomy. A calf-spine model / J Bone Joint Surg Am 70 : 1182~1191

[journal] Lee KY / 2001 / Posterior short-segment instrumentation of thoracic and lumbar bursting fractures -Retrospective study / J Korean Soc Spine Surg 8 : 497~503

[journal] Gurr KR / 1988 / Cotrel-Dubousset instrumentation in adults. A preliminary report / Spine (Phila Pa 1976) 13 : 510~520

[journal] Alvine GF / 2004 / Treatment of thoracolumbar burst fractures with variable screw placement or Isola instrumentation and arthrodesis : case series and literature review / J Spinal Disord Tech 17 : 251~264

[journal] Wagar M / 2017 / Short versus long-segment posterior fixation in the treatment of thoracolumbar junction fractures : a comparison of outcomes / Br J Neurosurg 31 : 54~57

[journal] Wang H / 2012 / Biomechanical efficacy of monoaxial or polyaxial pedicle screw and additional screw insertion at the level of fracture, in lumbar burst fracture : An experimental study / Indian J Orthop 46 : 395~401

[journal] 신병준 / 2009 / More Than 5 Year Follow-Up of Thoracolumbar Fractures Treated By Pedicle Screw Fixation / 대한척추외과학회지 / 대한척추외과학회 16(4) : 251~258

[journal] Mclain RF / 1993 / Early failure of short-segment pedicle instrumentation for thoracolumbar fractures. A preliminary report / J Bone Joint Surg Am 75 : 162~167

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