Common pedicle screw placement under direct vision combined with dome shaped decompression via small incision for double segment thoracolumbar fracture with nerve injury_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SHEN Kai ,  TAN Zujian , YANG Fubin , ZHANG Shengli , CAO Daigui

Department of Spine Surgery, Chongqing General Hospital, Chongqing, 400013, P.R.China;

Corresponding author：

TAN Zujian, Email: 196448315@qq.com

Keywords：

Thoracolumbar fracture; spinal cord injury; dome shaped decompression

DOI：

10.7507/1002-1892.201701092

Video：

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Objective To determine the feasibility, safety, and efficacy of common pedicle screw placement under direct vision combined with dome shaped decompression via small incision for double segment thoracolumbar fracture with nerve injury. Methods A retrospective analysis was performed on the clinical data of 32 patients with double segment thoracolumbar fracture with nerve injury undergoing common pedicle screw placement under direct vision combined with dome shaped decompression via small incision between November 2011 and November 2015 (combined surgery group), and another 32 patients undergoing traditional open pedicle screw fixation surgery (traditional surgery group). There was no significant difference in gender, age, cause of injury, time of injury-to-surgery, injury segments and Frankel classification of neurological function between two groups (P>0.05). The length of soft tissue dissection, the operative time, the blood loss during surgery, the postoperative drainage, the visual analogue scale (VAS) of incision after surgery, and recovery of neurological function after surgery were evaluated. Results All cases were followed up 9 to 12 months (mean, 10.5 months) in combined surgery group, and 8 to 12 months (mean, 9.8 months) in traditional surgery group. The length of soft tissue dissection, the operative time, the blood loss during surgery, the postoperative drainage, and the postoperative VAS score in the combined surgery group were significantly better than those in the traditional surgery group (P<0.05). Dural rupture during surgery and pedicle screw pulling-out at 6 months after surgery occurred in 2 cases and 1 case of the combined surgery group; dural rupture during surgery occurred in 1 case of the traditional surgery group. The X-ray films showed good decompression, and fracture healing; A certain degree of neurological function recovery was achieved in two groups. Conclusion Common pedicle screw placement under direct vision combined with dome shaped decompression via small incision can significantly reduce iatrogenic trauma and provide good nerve decompression. Therefore, it is a safe, effective, and minimally invasive treatment method for double segment thoracolumbar fracture with neurological injury.

Citation： SHEN Kai, TAN Zujian, YANG Fubin, ZHANG Shengli, CAO Daigui. Common pedicle screw placement under direct vision combined with dome shaped decompression via small incision for double segment thoracolumbar fracture with nerve injury. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(6): 677-682. doi: 10.7507/1002-1892.201701092 Copy

1.	Wang HW, Zhang Y, Xiang Q, et al. Epidemiology of traumatic spinal fractures: experience from medical university-affiliated hospitals in Chongqing, China, 2001-2010. J Neurosurg Spine, 2012, 17(5): 459-468.
2.	杨宗酉, 刘磊, 孙家元, 等. 2003 年至 2012 年河北医科大学第三医院成人胸腰椎骨折的流行病学分析. 中华创伤骨科杂志, 2015, 17(3): 243-247.
3.	Ruiz Santiago F, Tomás Muñoz P, Moya Sánchez E, et al. Classifying thoracolumbar fractures: role of quantitative imaging. Quant Imaging Med Surg, 2016, 6(6): 772-784.
4.	Waqar M, Van-Popta D, Barone DG, et al. Short versus long-segment posterior fixation in the treatment of thoracolumbar junction fractures: a comparison of outcomes. Br J Neurosurg, 2017, 31(1): 54-57.
5.	Elsawaf AM. Outcome of percutaneous versus open posterior spinal fixation in thoracolumbar factures. Neurosurgery, 2016, 63 Suppl 1: 196.
6.	Wang H, Zhou Y, Li C, et al. Comparison of Open Versus Percutaneous Pedicle Screw Fixation Using the Sextant System in the Treatment of Traumatic Thoracolumbar Fractures. Clin Spine Surg, 2017, 30(3): E239-E246.
7.	Mathews HH, Long BH. Endoscopy assisted percutaneous anterior interbody fusion with subcutaneous suprafascial internal fixation: evolution of technique and surgical considerations. Orthop Int, 1995, 3: 456-500.
8.	Foley KT, Gupta SK, Justis JR, et al. Pereutaneous pedicle screw-rod fixation of the lumbar spine. Neurosurg Focus, 2001, 10(4): E10.
9.	薛文, 管晓鹂, 刘姝娆, 等. 微创经皮与传统开放椎弓根螺钉固定治疗胸腰椎骨折的 Meta 分析. 中华临床医师杂志(电子版), 2015, 9(23): 115-121.
10.	Magerl FP. Stabilization of the lower thoracic and lumbar spine with external skeletal fixation. Clin Orthop Relat Res, 1984, (189): 125-141.
11.	杨敬, 常鑫, 王强, 等. 腰椎" 人”字嵴顶点定位的三维 CT 影像研究. 中国临床解剖学杂志, 2013, 31(1): 60-63.
12.	陈威烨, 王宽, 元唯安, 等. 腰骶部多裂肌与腰椎间盘突出症关系的研究进展. 中国骨伤, 2016, 29(6): 581-584.
13.	Lai PL, Chen LH, Niu CC, et al. Relation between laminectomy and development of adjacent segment instability after lumbar fusion with pedicle fixation. Spine (Phila Pa 1976), 2004, 29(22): 2527-2532.
14.	Vaccaro AR, Lim MR, Hurlbert RJ, et al. Surgical Decision Making for Unstable Thoracolumbar Spine Injuries: Results of a Consensus Panel Review by the Spine Trauma Study Group. Spinal Disord Tech, 2006, 19(1): 1-10.
15.	章旭, 李庆伟, 孟纯阳. 腰背筋膜联合棘上、棘间韧带缝合对 PLIF 治疗腰椎间盘突出症术后疗效的影响. 中国骨与关节损伤杂志, 2017, 32(1): 72-73.
16.	Hung CW, Wu MF, Hong RT, et al. Comparison of multifidus muscle atrophy after posterior lumbar interbody fusion with conventional and cortical bone trajectory. Clin Neurol Neurosurg, 2016, 145: 41-45.
17.	陈林, 覃建朴, 伍富俊, 等. 微创通道下开窗减压椎体内植骨经皮椎弓根螺钉内固定治疗 Denis B 型胸腰椎爆裂骨折. 中国修复重建外科杂志, 2016, 30(8): 985-991.
18.	孟祥玉, 曾凯斌, 吐尔洪江·阿布都热西提, 等. Wiltse 入路结合非融合技术治疗胸腰椎骨折疗效分析. 中国修复重建外科杂志, 2014, 28(9): 1106-1109.
19.	李景峰, 徐振华, 陈廖斌, 等. 椎旁肌入路联合后正中入路手术治疗胸腰椎骨折合并脊髓损伤. 中国骨与关节损伤杂志, 2015, 30(3): 263-265.
20.	Wu H, Zhao DX, Jiang R, et al. Surgical treatment of Denis type B thoracolumbar burst fracture with neurological deficiency by paraspinal approach. Braz J Med Biol Res, 2016, 49(11): e5599.
21.	Lim TH, Eck JC, An HS, et al. Biomechanics of transfixation in pedical screw instrumentation. Spine (Phila Pa 1976), 1996, 21(19): 2224-2229.
22.	Hart R, Hettwer W, Liu Q, et al. Mechanical stiffness of segmental versus nonsegmental pedical screw constructs: the effects of cross-links. Spine (Phila Pa 1976), 2006, 31(2): E35-E38.
23.	Wahba GM, Bhatia N, Bui CN, et al. Biomechanical evaluation of short-segment posterior instrumentation with and without crosslinks in a human cadaveric unstable thoracolumbar burst fracture model. Spine (Phila Pa 1976), 2010, 35(3): 278-285.
24.	Garg S, Niswander C, Pan Z, et al. Cross-Links Do Not Improve Clinical or Radiographic Outcomes of Posterior Spinal Fusion with Pedicle Screws in Adolescent Idiopathic Scoliosis: A Multicenter Cohort Study. Spine Deform, 2015, 3(4): 338-344.
25.	Rahmathulla G, Deen HG. Spine fusion cross-link causing delayed dural erosion and CSF leak: case report. J Neurosurg Spine, 2015, 22(4): 439-443.

1. Wang HW, Zhang Y, Xiang Q, et al. Epidemiology of traumatic spinal fractures: experience from medical university-affiliated hospitals in Chongqing, China, 2001-2010. J Neurosurg Spine, 2012, 17(5): 459-468.
2. 杨宗酉, 刘磊, 孙家元, 等. 2003 年至 2012 年河北医科大学第三医院成人胸腰椎骨折的流行病学分析. 中华创伤骨科杂志, 2015, 17(3): 243-247.
3. Ruiz Santiago F, Tomás Muñoz P, Moya Sánchez E, et al. Classifying thoracolumbar fractures: role of quantitative imaging. Quant Imaging Med Surg, 2016, 6(6): 772-784.
4. Waqar M, Van-Popta D, Barone DG, et al. Short versus long-segment posterior fixation in the treatment of thoracolumbar junction fractures: a comparison of outcomes. Br J Neurosurg, 2017, 31(1): 54-57.
5. Elsawaf AM. Outcome of percutaneous versus open posterior spinal fixation in thoracolumbar factures. Neurosurgery, 2016, 63 Suppl 1: 196.
6. Wang H, Zhou Y, Li C, et al. Comparison of Open Versus Percutaneous Pedicle Screw Fixation Using the Sextant System in the Treatment of Traumatic Thoracolumbar Fractures. Clin Spine Surg, 2017, 30(3): E239-E246.
7. Mathews HH, Long BH. Endoscopy assisted percutaneous anterior interbody fusion with subcutaneous suprafascial internal fixation: evolution of technique and surgical considerations. Orthop Int, 1995, 3: 456-500.
8. Foley KT, Gupta SK, Justis JR, et al. Pereutaneous pedicle screw-rod fixation of the lumbar spine. Neurosurg Focus, 2001, 10(4): E10.
9. 薛文, 管晓鹂, 刘姝娆, 等. 微创经皮与传统开放椎弓根螺钉固定治疗胸腰椎骨折的 Meta 分析. 中华临床医师杂志(电子版), 2015, 9(23): 115-121.
10. Magerl FP. Stabilization of the lower thoracic and lumbar spine with external skeletal fixation. Clin Orthop Relat Res, 1984, (189): 125-141.
11. 杨敬, 常鑫, 王强, 等. 腰椎" 人”字嵴顶点定位的三维 CT 影像研究. 中国临床解剖学杂志, 2013, 31(1): 60-63.
12. 陈威烨, 王宽, 元唯安, 等. 腰骶部多裂肌与腰椎间盘突出症关系的研究进展. 中国骨伤, 2016, 29(6): 581-584.
13. Lai PL, Chen LH, Niu CC, et al. Relation between laminectomy and development of adjacent segment instability after lumbar fusion with pedicle fixation. Spine (Phila Pa 1976), 2004, 29(22): 2527-2532.
14. Vaccaro AR, Lim MR, Hurlbert RJ, et al. Surgical Decision Making for Unstable Thoracolumbar Spine Injuries: Results of a Consensus Panel Review by the Spine Trauma Study Group. Spinal Disord Tech, 2006, 19(1): 1-10.
15. 章旭, 李庆伟, 孟纯阳. 腰背筋膜联合棘上、棘间韧带缝合对 PLIF 治疗腰椎间盘突出症术后疗效的影响. 中国骨与关节损伤杂志, 2017, 32(1): 72-73.
16. Hung CW, Wu MF, Hong RT, et al. Comparison of multifidus muscle atrophy after posterior lumbar interbody fusion with conventional and cortical bone trajectory. Clin Neurol Neurosurg, 2016, 145: 41-45.
17. 陈林, 覃建朴, 伍富俊, 等. 微创通道下开窗减压椎体内植骨经皮椎弓根螺钉内固定治疗 Denis B 型胸腰椎爆裂骨折. 中国修复重建外科杂志, 2016, 30(8): 985-991.
18. 孟祥玉, 曾凯斌, 吐尔洪江·阿布都热西提, 等. Wiltse 入路结合非融合技术治疗胸腰椎骨折疗效分析. 中国修复重建外科杂志, 2014, 28(9): 1106-1109.
19. 李景峰, 徐振华, 陈廖斌, 等. 椎旁肌入路联合后正中入路手术治疗胸腰椎骨折合并脊髓损伤. 中国骨与关节损伤杂志, 2015, 30(3): 263-265.
20. Wu H, Zhao DX, Jiang R, et al. Surgical treatment of Denis type B thoracolumbar burst fracture with neurological deficiency by paraspinal approach. Braz J Med Biol Res, 2016, 49(11): e5599.
21. Lim TH, Eck JC, An HS, et al. Biomechanics of transfixation in pedical screw instrumentation. Spine (Phila Pa 1976), 1996, 21(19): 2224-2229.
22. Hart R, Hettwer W, Liu Q, et al. Mechanical stiffness of segmental versus nonsegmental pedical screw constructs: the effects of cross-links. Spine (Phila Pa 1976), 2006, 31(2): E35-E38.
23. Wahba GM, Bhatia N, Bui CN, et al. Biomechanical evaluation of short-segment posterior instrumentation with and without crosslinks in a human cadaveric unstable thoracolumbar burst fracture model. Spine (Phila Pa 1976), 2010, 35(3): 278-285.
24. Garg S, Niswander C, Pan Z, et al. Cross-Links Do Not Improve Clinical or Radiographic Outcomes of Posterior Spinal Fusion with Pedicle Screws in Adolescent Idiopathic Scoliosis: A Multicenter Cohort Study. Spine Deform, 2015, 3(4): 338-344.
25. Rahmathulla G, Deen HG. Spine fusion cross-link causing delayed dural erosion and CSF leak: case report. J Neurosurg Spine, 2015, 22(4): 439-443.

Chinese Journal of Reparative and Reconstructive Surgery

Common pedicle screw placement under direct vision combined with dome shaped decompression via small incision for double segment thoracolumbar fracture with nerve injury

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