Objective To evaluate the effectiveness and the value of balloon kyphoplasty in treating aged osteoporosis thoracolumbar vertebrae burst fracture. Methods Between January 2003 and January 2008, 36 thoracolumbar vertebrae burst fracture patients were treated. There were 15 males and 21 females with an average age of 65.4 years (range, 59-72 years). Fourteen cases had no obvious history of trauma, 19 had a history of sl ight trauma, and 3 had a history of severe trauma. Forty vertebral bodies were involved, including 1 T7, 3 T9, 8 T10, 10 T12, 9 L1, 7 L2, and 2 L4. All patients displayed local pain and osteoporosis by bone density measurement with no neurological symptom of both lower limbs. Balloon kyphoplasty through unilateral (31 cases) or bilateral (5 cases) vertebral pedicles with polymethylmethacrylate was performed at the injection volume of (3.46 ± 0.86) mL per vertebral body. Before and after operation, the anterior height and posterior height of fractured vertebral body and the sagittal displacement were measured. Results Two cases had intraoperative cerebrospinal fluid leakage; 1 case had no remission of waist-back pain and pain was released after symptomatic treatment. All 36 patients were followed up 2.3 years on average (range, 1.5-4.0 years). No cement leakage was found with good diffusion of cement on X-ray film. The restoration of the height of vertebral bodies was satisfactory without nerve compression symptoms and other compl ications. The Visual Analogue Score at last follow-up (2.34 ± 1.03) was significantly lower than that of preoperation (6.78 ± 1.21), (P lt; 0.05). The compressive percentage of anterior height (19.80% ± 1.03%) of fractured vertebral body after operation was significantly lower than that before operation(25.30% ± 2.50%), (P lt; 0.05). There was no significant difference in posterior compressive percentage and sagittal displacement between pre- and post- operation (P gt; 0.05). Conclusion Based on roentgenographic scores, balloon kyphoplasty is selectively used to treat aged osteoporosis thoracolumbar vertebrae burst fracture, and the radiographic and cl inical results were satisfactory.
Objective To evaluate the cl inical outcomes of anterior decompression, bone graft and internal fixation in treating fourth lumbar burst fractures with il iac fenestration. Methods From February 2001 to May 2006, 8 cases of fourth lumbar burst fractures were treated by anterior decompression, correction, reduction, il iac autograft, Z-plate internal fixation with il iac fenestration. Of them, there were 7 males and 1 female, aging 24-46 years with an average of 29.3 years, including 3 cases of Denis type A and 5 cases of Denis type B. The decompression, intervertebral height were compared betweenpreoperation and postoperation by CT scanning. According to Frankel assessment for neurological status, 2 cases were at grade C, 5 at grade D and 1 at grade E before operation. Four cases had different degrees of disturbance of sphincter. Time from injury to operation was 8 hours to 11 days. The preoperative height of the anterior border of the L4 vertebral body was (13.8 ± 2.3) mm, the Cobb angel of fractured vertebral body was (13.2 ± 2.5)°, the vertebral canal sagittal diameter of L4 was (10.6 ± 3.5) mm. The bone graft volume was (7.5 ± 1.3) cm3 during operation. Results Operations were performed successfully. The mean operative time was (142 ± 25) minutes and the mean amount of blood loss was (436 ± 39) mL. The incisions obtained heal ing by first intention after operation. Two cases suffered donor site pain and recevied no treatment. The follow-up time of 8 cases was from 21 months to 52 months (mean 24.5 months). At one week after operation, the height of the anterior border of the L4 vertebral body was (32.5 ± 2.6) mm, the Cobb angel of fractured vertebral body was (6.8 ± 3.7)°, and the vertebral canal sagittal diameter of L4 was (19.8 ± 5.1) mm, showing significant difference when compared with those of preoperation (P lt; 0.01). At the final follow-up, the results showed that the pressure was reduced sufficiently, all autograft fused well, the neurological status improved at Frankel grade from C to D in 1 patient, from D to E in 3 patients, but the others had no improvement. In 4 patients who had disturbance of sphincter, 3 restored to normal and 1 was better off. Conclusion Cl inical outcomes of anterior surgery for fourth lumbar burst fractures with il iac fenestration are satisfactory. It can facil icate operation, reduce the pressure sufficiently, maintenance intervertebral height and recover the neurological function.
Objective To explore an improved surgical approach to the superior posterior partial resection of the fractured vertebral body followed by the single segmental fusion to treat lumbar burst fracture and to evaluate its preliminary clinical application. Methods From June to October 2006, 4 patients (2 males, 2 females; age, 17-39 years) with Denis B type lumbar burst fracture underwent the superior posterior partial resection of the fractured vertebral body followed by the single segmental fusion. The fracture occurred in 2 patients at L1 and 2 at L2. According to the Frankel scales assessment, before operation, 2patients were at Grade B and the other 2 at Grade C, and the visual analogue scale (VAS) was 7.00±0.82. Radiological evaluation was performed, which revealed the kyphosis Cobb angel of 22.94±11.21°, the adjacent superior and the inferiorintervertebal disc heights of 12.78±1.52 mm and 11.68±1.04 mm, espectively, and the vertebral canal sagittal diameter of 9.56±2.27 mm on the computer tomography (CT) scan. The neurological and the radiological evaluations were also made immediately and 3 months after operation. Results The anterior single segmental decompression and fusion operations were performed successfully in all the patients. The average operating time was 166±29 min and the average amount of blood loss was 395± 54 ml. The Frankel scales assessment showed that at the time immediately after operation, one of the 2 Grade B patients had an improvement to Grade C, but the other patient had no improvement. One of the 2 Grade C patientshad an improvement to Grade D, but the other patient had no improvement. Three months after operation, the 2 Grade B patients had an improvement to Grade C. The 2 grade C patients had an improvement to Grade D or E. The VAS score was significantly decreased to 3.50±1.29 after operation and to 1.25±0.50 3 months later （P＜0.05）. The vertebral canal sagittal diameter was significantly increased to 19.76±3.82 mm (Plt;0.01), but it was maintained to 19.27±3.41 mm3 months later, with no significant difference（Pgt;0.05）. The patients’ kyphosis Cobb angle was significantly improved to 8.71±5.41° (P＜0.05) , but it was maintained to 9.52±5.66° 3 months later, with no significant difference（Pgt;0.05）. The heights of the adjacent discs remained unchanged. No complication was observedduring and after operation, and the radiological and the CT scanning evaluations 3 months later showed no failure of the internal fixation. Conclusion The superior and posterior partial resection of the fractured vertebral body followedby the single segmental fusion can effectively decompress the vertebral canal and maintain the spine stability in treatment of the Denis B type fracture thoughthe longterm effectiveness requires a further follow-up.