Modified Posterior Short-Segment Pedicle Screw Instrumentation for Lumbar Burst Fractures with Incomplete Neurological Deficit

• Published in: World neurosurgery 2018-11, Vol.119, p.e977-e985
• Main Authors: Yang, Sheng, Shang, De-Peng, Lu, Jian-Min, Liu, Ji-Feng, Fu, Da-Peng, Zhou, Fei, Cong, Yang, LV, Zhong-Zhe
• Format: Article
• Language: English
• Subjects: Accidental Falls; Accidents, Traffic; Adult; Back Pain - etiology; Back Pain - surgery; Blood Loss, Surgical - statistics & numerical data; Burst fracture; Female; Fracture Fixation, Internal - instrumentation; Fracture Fixation, Internal - methods; Humans; Incomplete neurological deficit; Lumbar; Lumbar Vertebrae - diagnostic imaging; Lumbar Vertebrae - injuries; Lumbar Vertebrae - surgery; Male; Middle Aged; Nervous System Diseases - etiology; Nervous System Diseases - surgery; Operative Time; Pedicle Screws; Postoperative Care; Radiography; Retrospective Studies; Schanz pedicle screw; Short-segment fixation; Spinal Fractures - diagnostic imaging; Spinal Fractures - surgery; Time-to-Treatment - statistics & numerical data; Treatment Outcome; Young Adult
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.08.014

We have introduced a method of modified posterior short-segment pedicle screw fixation and evaluated its clinical effects in treating lumbar burst fractures with incomplete neurological deficits. The data from 22 patients with lumbar burst fracture and incomplete neurological deficits who had undergone modified posterior short-segment instrumentation with Schanz screw fixation from January 2012 to February 2018 in our clinic were evaluated in the present retrospective study. All Schanz screws were implanted in an oblique downward direction into the vertebrae above and below the injured vertebra (insertion depth, 90%–100%). The implants were removed ∼1 year after surgery. Neurological function, back pain, anterior and posterior body height ratio, kyphosis angle, percentage of canal compromise, fracture severity, and treatment-related complications were evaluated. Technical success was achieved in all 22 patients. No infection, instrument loosening or failure, or breakage was observed. Statistically significant improvements with regard to the anterior body height (P < 0.05) and posterior body height (P < 0.05) ratios, kyphosis angle, and percentage of canal compromise (P < 0.05) were observed at 1 week postoperatively or the final follow-up visit. No correction loss had occurred at the final follow-up examination. Postoperatively, all patients with neurological deficits had functional improvement equivalent to ≥1 grade on the American Spinal Injury Association impairment scale and fracture union. Back pain was greatly improved postoperatively. Short-segment Schanz screw fixation implanted in an oblique downward direction seems to be a promising method for lumbar burst fractures with incomplete neurological deficits because it provided good clinical and radiographic outcomes. •A novel method treating lumbar burst fractures with an incomplete neurological deficit was introduced.•Four Schanz screws were implanted in an oblique downward direction into the vertebrae above and below the injured vertebra.•This technique is a promising method for such fractures because it provided good clinical and radiographic outcomes.