Open Access, Peer-reviewed
pISSN 2093-4378
eISSN 2093-4386
    J Korean Soc Spine Surg. 2002 Dec;9(4):364-373. Korean.
    Published online Dec 31, 2002.
    https://doi.org/10.4184/jkss.2002.9.4.364
    Copyright © 2002 Korean Society of Spine Surgery
    Original Article

    Preliminary Report of Temporary Posterior Instrumentation in Stable Thoracolumbar Burst Fractures

    Ho-Guen Chang, M.D., Young-Woo Kim, M.D., Jong-Churel Jung, M.D., Hyeong-Su Kim, M.D.,* and Kee-Byoung Lee, M.D.
      • Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea.
      • *Department of Preventive Medicine, Kon-kuk University,Chungju, Korea.
    • Address reprint requests to Ho-Guen Chang, M.D. Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, #896 Dongan-gu, Anyang city, Kyounggi-do 431-070, Korea. Tel: 82-31-380-1814, Fax: 82-31-382-1814, Email: hgc2000@dreamwiz.com

    Abstract

    Study Design

    A prospective study of posterior instrumentation without fusion for the stable thoracolumbar fracture.

    Objectives

    To confirm vertebral body collapse by roentgenography and computerized tomography after removing posterior instrumentation at 6 months postoperatively in stable thoracolumbar burst fractures.

    Summary of literature review

    Many authors have reported that vertebral body collapse occurs after instrumentation removal.

    Materials & Method

    Sixty patients admitted between March 1999 and March 2001 with thoracolumbar junction fractures were included. Patients were divided into 3 groups: Group I - the Conservative management group (20 patients), Group II - Reduction and posterior fixation with fusion group (20 patients), Group III - Reduction and temporary posterior fixation group (20 patients). The patients were aged between 21 and 49 years (mean 38), and the follow-up period exceeded 1 year (mean 13.3 months). We studied vertebral height, kyphotic angle, disc height and facet hypertrophy by roentgenography, and the continuity of the anterior cortical connection, cavity formation, sclerotic bone formation and new bone formation by CT.

    Results

    The loss of vertebral height was 7.9% (from 21.5 to 29.4%) in Group I, 3.7% in Group II (preop 35%, postop 12.7%, postop 1Yr. 16.4%), and 3.5% in Group III (preop. 35.2%, postop 5.6%, postop 1Yr. 9.1%). Loss of angulation was 4.2° (from 9.6° to 13.8°) in Group I, 3.0° in Group II (preop 15.3° , postop 7.2°, postop. 1Yr. 10.2°), and 3.0° in Group III (preop 14.6°, postop. 5.9°, postop 1Yr. 8.9°). Loss of disc height was not statistically different for the 3 groups. Degenerative changes of the posterior facet were seen 3 patients of Group I, 11 patients of Group II, and in 5 patients of group III. On CT scan of Group III, all cases showed cavity formation and sclerosis ,and continuity of the anterior cortical connection and of new bone formation into the cavity were seen in 18 cases.

    Conclusions

    Vertebral body collapse were not observed by roentgenography by computerized tomography after removing the posterior instrumentation at 6 months postoperatively in stable thoracolumbar burst fractures.

    Keywords
    Thoracolumbar spine; Burst fracture; Posterior fixation; Temporary

    Figures

    Fig. 1
    A. Case1: Simple radiograph of a 31 years old female. From the left, at injury, at Postop., at POD 6M., at POD 1Yr. degrees of comperssion was 45.5%, 2%,3%,5% respectively. The angle of kyphosis was 22°, 5°, 7°, 8° respectively. At POD 1Yr,the loss of reduction was 2%, and the loss of kyphosis was 3 degrees.

    B. CT findings at injury (above) & POD 1Yr. (below).Removal of instrumentation at 7 months. With Preop. CT, burst fracture was seen.At POD 1Yr., cavity formation, sclerosis around the cavity ,new bone formation in the cavity, and boney connection of anterior vertebral body are seen.

    Fig. 2
    A. Case2: Simple radiograph of a 41 years old female with 48.7% comperession & 20° kyphosis. From the left, at injury, at Postop., at POD 6M., at POD 1Yr. degrees of comperssion was 48.7%, 3%, 4%, 6% respectively. The angle of kyphosis was 20°, 6°, 8°, 11° respectively. At POD 1Yr,, the loss of reduction was 3%, and the loss of kyphosis was 5 degrees.

    B. CT findings at injury (above) & POD 1Yr. (below).Removal of instrumentation was done at postop.6 months. Collapse of vertebral body is prevented.

    Tables

    Table 1
    Height of vertebral body : degrees of compression (%):P-value >0.05

    Table 2
    Angles of kyphosis (degrees):P-value >0.05

    Table 3
    CT findings after removal of temporary posterior instrumentaion (person)

    Table 4
    Hight of intervertebral disc (%):P-value >0.05

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    MeSH Terms
    Follow-Up Studies
    Humans
    Hypertrophy
    Osteogenesis
    Prospective Studies
    Radiography
    Sclerosis
    Tomography, X-Ray Computed
    Metrics
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