Age- and gender-specific clinical characteristics of acute adult spine fractures in China

A Novel Intravertebral Fixation Technique of Lumbar Osteoporotic Vertebral Bipedicular Dissociation Fractures

OBJECTIVE

A significant portion of traumatic spinal fractures involves the thoracolumbar spine. Fracture stabilization using pedicle screws initially demanded fixation of two levels above and below the fractured vertebra to achieve a stable construct. Over the years, a short-segment pedicle screw fixation was found to be adequate. Balloon kyphoplasty (BKP) is commonly used as a minimally invasive treatment for vertebral compression fractures. At times, lumbar burst fractures can extend to the posterior elements. These recently acknowledged subtypes of fracture do not cause posterior column instability other than coronal bipedicular dissociation. BKP alone is inadequate in these cases; a combination of BKP addressing anterior column reduction and support with a middle column stabilization by transpedicular fixation has the potential to treat all fracture elements without losing motion segments through a minimally invasive technique. This study aims to describe this novel concept and technique.

METHODS

Five patients were treated with the intravertebral fixation (IVF) technique for coronal bipedicular dissociation fractures. We describe the surgical technique and review the pertinent literature.

RESULTS

The IVF technique is clinically safe in stabilizing the specified fractures, with good clinical and functional outcomes.

CONCLUSION

IVF is a promising surgical technique and an exciting treatment concept for unique fracture types involving bipedicular coronal dissociation with or without burst fracture. Further studies are required to assess long-term results and possible complications.

STUDY DESIGN

Case series for a new surgical technique.

Advances in the clinical diagnosis and treatment of multiple-level noncontiguous spinal fractures

Multiple-level noncontiguous spinal fractures (MNSF) are spinal fractures that involve at least 2 sites and are characterized by the presence of one intact vertebra or intact functional spinal unit between the fractured vertebrae. MNSF account for 2.5-19% of all spinal fractures. MNSF are easily missed or have a delayed diagnosis in clinical practice and their treatment is more complex than that for single-segment spine fractures. In this article, the authors briefly summarize the advances in the etiology and mechanisms of MNSF, the identification of their involved sites and their classification, diagnosis, treatment, and prognosis.

Traumatic spine fractures and concomitant venous thromboembolism: A systematic review

Objective

Venous thromboembolism (VTE) associated with bony fractures have been documented in the literature. However, the literature is not very exhaustive when it comes to VTE associated with traumatic spine fractures. Thus the purpose of this systematic review analyzing the incidence of VTE associated with spinal trauma.

Methods

An electronic search strategy was elaborated in Pubmed, Cochrane Library and Google Scholar (page 1-20) since inception till November 2023.

Results

Twelve studies were included with three prospective clinical studies, seven retrospective studies, one observational cohort study, and one propensity-matched analysis. These involved 256,107 subjects with 6039 concomitant VTE (2.4 %). Potential risk factors included age, D-dimer levels, length of hospital stay, associated spinal cord injury, location of the vertebral trauma and other baseline patient-dependent characteristics.

Conclusion

This review found that the rate VTE in spinal trauma patients was 2.4 % (6039/256107). To optimize care, clinical decision making should be tailored to each patient using a combined approach of imaging, laboratory findings, and serial physical examinations.

Epidemiological characteristics of traumatic spinal fractures among the elderly in China

The exploration of traumatic spinal fractures (TSFs) within the senior demographic has not been thoroughly scrutinized, particularly with respect to variations across genders, age groups, seasonal periods, and causative factors. This retrospective analysis aimed to dissect differences in the prevalence and characteristics of TSFs among the elderly, factoring in gender, age, seasonal timing, and causation. A retrospective analysis was conducted on the medical and imaging records of 1,415 patients, all aged 60 years or older, who were diagnosed with TSFs from 2013 to 2019. This study categorized the data by gender, age groups (60-70, 70-80, and 80 years or older), seasons, and the cause of injuries, including road traffic crashes (RTCs), falls from low heights (LHF), falls from high heights (HHF), and injuries incurred during everyday activities and agricultural labor (DFI). Male patients exhibited notably higher incidences of RTCs, high-height falls (HHFs), outdoor incidents, comas post-injury, fractures of the lower limbs (LLFs), pelvic fractures (PFs), rib fractures (RFs), intra-thoracic injuries (ITIs), intra-abdominal injuries (IAIs), cervical fractures, and spinal cord injuries (SCIs). With advancing age, there was a marked decline in occurrences of RTCs, HHFs, outdoor incidents, RFs, craniocerebral injuries (CCIs), ITIs, cervical fractures, and SCIs, while the incidences of DFIs, indoor incidents, and thoracic and lumbar (T + L) fractures notably increased. During autumn, LLF occurrences were significantly reduced, whereas the winter season saw an increase in thoracic fractures. Spring time was associated with a higher frequency of lumbar fractures and noncontiguous spinal fractures (NSFs). Significant distinctions were observed in the age distribution, injury circumstances, associated injuries, and SCIs between high-energy impacts (RTCs and HHFs) and low-energy traumas (LHFs and DFIs). In the elderly demographic, TSFs exhibited discernible distinctions based on gender, age, seasonal variations, and etiological factors, impacting the nature and circumstances of injuries, associated traumas, complications, fracture sites, and the occurrence of SCIs.

Percutaneous monoplanar screws versus hybrid fixed axial and polyaxial screws in intermediate screw fixation for traumatic thoracolumbar burst fractures: a case-control study

BACKGROUND

To compare the clinical and radiological outcomes of monoplanar screws (MSs) versus hybrid fixed axial and polyaxial screws (HSs) in percutaneous short-segment intermediate screw fixation (PSISF) for traumatic thoracolumbar burst fractures (TTBFs) in patients without neurologic impairment.

METHODS

A consecutive series of 100 patients with single-segment TTBFs and no neurologic impairment who underwent PSISF with 6 monoplanar screws (MS group) or correct were retrospectively enrolled. The demographic data, radiologic evaluation indicators, perioperative indicators and clinical assessment indicators were analysed between the MS group and HS group.

RESULTS

The demographic data and perioperative indicators were not significantly different in the two groups (P > 0.05). The postoperative anterior vertebral height ratio (AVHR), kyphosis Cobb angle (KCA), vertebral wedge angle (VWA) and spinal canal encroachment rate (SCER) were significantly improved in both groups (*P < 0.05). The MS group obtained better correction than the HS group in terms of improvement in the AVHR, KCA and VWA after surgery (*P < 0.05). At the last follow-up, the MS group had less correction loss of AVHR, KCA and VWA (*P < 0.05). The MS group presented greater improvement in the SCER at the last follow-up (*P < 0.05). The visual analogue scale (VAS) score and Oswestry Disability Index (ODI) score of all patients were significantly better postoperatively than those preoperatively (*P < 0.05), and the scores collected at each follow-up visit did not differ significantly between the two groups (P > 0.05). In the MS group, no internal fixation failure was observed during the follow-up period, but, in the HS group, two cases of internal fixation failure were observed at the last follow-up (one case of rod loosening and one case of screw breakage).

CONCLUSIONS

Both MSs and HSs fixation are effective treatments for TTBFs and have comparable clinical outcomes. In contrast, MSs fixation can improve the correction effect, better improve the SCER, and further reduce correction loss as well as reduce the incidence of instrumentation failure. Therefore, MSs fixation might be a better option for treating TTBFs in patients without neurological deficits.

Perioperative morbidity and mortality in octogenarians sustaining traumatic osteoporotic type 4 and 5 thoracolumbar and lumbar fractures: a retrospective study with 3 years follow-up

PURPOSE

This study aimed to guide the more efficient management of type 4 and 5 thoracolumbar or lumbar osteoporotic fractures (OF) in patients aged 80 years and older with an acute onset of neurological decline. This aim was achieved by assessing the clinical course and morbidity and mortality rates and identifying potential risk factors for patient mortality METHODS: Electronic medical records were retrieved from a single institution pertaining to the period between September 2005 and December 2020. Data on patient demographics, neurological conditions, surgical characteristics, complications, hospital course, and 90-day mortality were also collected.

RESULTS

Over a 16-year period, 35 patients aged ≥80 years diagnosed with thoracolumbar and lumbar OF were enrolled in the study. The mean Charlson comorbidity index (CCI) was >6, indicating a poor baseline reserve (9.4 ± 1.9), while cardiovascular diseases were the most prevalent among comorbidities. The mean surgical duration was 231.6 ± 89.3 min, with a mean blood loss of 694.4± 200.3 mL. The in-hospital was 8.6% and 90-day mortality rates at 11.4%. Two patients underwent revision surgery for deep wound infection. Intraoperative and postoperative radiography and computed tomography (CT) imaging revealed correct screw placement. Proper alignment of the thoracolumbar spine was achieved in all the patients. Unique risk factors for mortality included the presence of comorbidities and the occurrence of postoperative complications.

CONCLUSIONS

Emergent instrumentation in patients with acute onset of neurological decline and potentially unstable spines due to thoracolumbar and lumbar OF improved functional outcomes at discharge. Age should not be a determinant of whether to perform surgery.

Automated detection and classification of acute vertebral body fractures using a convolutional neural network on computed tomography

BACKGROUND

Acute vertebral fracture is usually caused by low-energy injury with osteoporosis and high-energy trauma. The AOSpine thoracolumbar spine injury classification system (AO classification) plays an important role in the diagnosis and treatment of the disease. The diagnosis and description of vertebral fractures according to the classification scheme requires a great deal of time and energy for radiologists.

PURPOSE

To design and validate a multistage deep learning system (multistage AO system) for the automatic detection, localization and classification of acute thoracolumbar vertebral body fractures according to AO classification on computed tomography.

MATERIALS AND METHODS

The CT images of 1,217 patients who came to our hospital from January 2015 to December 2019 were collected retrospectively. The fractures were marked and classified by 2 junior radiology residents according to the type A standard in the AO classification. Marked fracture sites included the upper endplate, lower endplate and posterior wall. When there were inconsistent opinions on classification labels, the final result was determined by a director radiologist. We integrated different networks into different stages of the overall framework. U-net and a graph convolutional neural network (U-GCN) are used to realize the location and classification of the thoracolumbar spine. Next, a classification network is used to detect whether the thoracolumbar spine has a fracture. In the third stage, we detect fractures in different parts of the thoracolumbar spine by using a multibranch output network and finally obtain the AO types.

RESULTS

The mean age of the patients was 61.87 years with a standard deviation of 17.04 years, consisting of 760 female patients and 457 male patients. On vertebrae level, sensitivity for fracture detection was 95.23% in test dataset, with an accuracy of 97.93% and a specificity of 98.35%. For the classification of vertebral body fractures, the balanced accuracy was 79.56%, with an AUC of 0.904 for type A1, 0.945 for type A2, 0.878 for type A3 and 0.942 for type A4.

CONCLUSION

The multistage AO system can automatically detect and classify acute vertebral body fractures in the thoracolumbar spine on CT images according to AO classification with high accuracy.

Long- versus short-segment fixation with an index vertebral screw for management of thoracolumbar fractures

The choice of the best stabilization technique for thoracolumbar fractures remains controversial. While LSF includes too many motion segments, SSF is associated with a high rate of fixation failure and subsequent loss of kyphotic correction. Our objective is to compare the surgical, clinical, and radiological outcomes of thoracolumbar spine fixation using long-segment fixation (LSF) versus short-segment fixation (SSF) with a screw in the fractured vertebra. We retrospectively evaluated 63 patients with single- level thoracolumbar fracture types A and B treated during the period between 2010 and 2017 in our institution. Group A (30 patients) was treated by SSF with an intermediate screw in the fractured vertebra, while group B (33 patients) was treated by LSF. Both groups were compared in terms of surgical, clinical, and radiological outcomes. The mean operative blood loss was significantly lower in group A than in group B (451.3 ± 79.9 and 690 ± 92.1 ml, respectively). The mean operative time in Group A was significantly shorter than in group B (58.4 ± 14.8 and 81.5 ± 12.3 minutes, respectively). Both groups achieved a similar Visual Analogue Scale (VAS) for pain and Oswestry Disability Index (ODI) score. No significant difference was found as regards the kyphotic angle correction and the correction loss at final follow-up. In conclusion, SSF with a screw in the fractured vertebra achieved comparable functional and radiological outcomes to LSS with less blood loss and operative time.

Epidemiologic analysis of 8000 acute vertebral fractures: evolution of treatment and complications at 10-year follow-up

Study design

This is a retrospective cohort study.

Objectives

This study aims to determine the proportional incidence, clinical characteristics, treatment patterns with complications and changes in treatment of vertebral fractures over 10 years at a Swiss university hospital.

Methods

A retrospective cohort study was performed. All patients with an acute vertebral fracture were included in this study. The extracted anonymized data from the medical records were manually assessed. Demographic data, exact location, etiology, type of treatment and complications related to the treatment were obtained.

Results

Of 330,225 treated patients, 4772 presented with at least one vertebral fracture. In total 8307 vertebral fractures were identified, leading to a proportional incidence of 25 vertebral fractures in 1000 patients. Fractures were equally distributed between genders. Male patients were significantly younger and more likely to sustain a traumatic fracture, while female patients more commonly presented with osteoporotic fractures. The thoracolumbar junction (Th11-L2) was the most frequent fracture site in all etiologies. More than two-thirds of vertebral fractures were treated surgically (68.6%). Out of 4622 performed surgeries, we found 290 complications (6.3%). The odds for surgical treatment in osteoporotic fractures were two times higher before 2010 compared to 2010 and after (odds ratio: 2.1, 95% CI 1.5–2.9, p < 0.001).

Conclusion

Twenty-five out of 1000 patients presented with a vertebral fracture. More than 4000 patients with over 8307 vertebral body fractures were treated in 10 years. Over two-thirds of all fractures were treated surgically with 6.3% complications. There was a substantial decrease in surgeries for osteoporotic fractures after 2009.

Collecting data on fractures: a review of epidemiological studies on orthopaedic traumatology and the Chinese experience in large volume databases

PURPOSE

This study aimed to review the epidemiological studies on orthopedic traumatology and the Chinese experience in large volume databases of fractures.

METHODS

Review of international and Chinese literature.

RESULTS

Traumatic fractures are associated with high risks of death and disability worldwide, thus increasing financial burden on affected families and society. In the current study, epidemiological surveys on fractures around the world were reviewed to explore distribution and types of fractures in different populations. Different populations exhibit heterogeneity in the type, incidence of traumatic fractures, and the underlying causes and severity of fractures. Fracture epidemiology has strengthened clinical practice and increased understanding of the causes and patterns of fracture occurrence. Fracture and trauma epidemiological studies provide findings for use in public health education and data that can be used to develop targeted prevention intervention strategies by health departments.

CONCLUSION

The current study summarized the worldwide epidemiological studies on orthopedic traumatology. The findings of this study will provide a basis for designing effective methods for fracture prevention and management.

A comparison of monoaxial pedicle screw versus polyaxial pedicle screw in short-segment posterior fixation for the treatment of thoracolumbar fractured vertebra

Background

Posterior pedicle screw fixation had been applied to maintain spinal stability and avoid further nerve damage in thoracolumbar fracture. This study aimed to evaluate the efficacy of short-segment posterior fixation with monoaxial pedicle screws versus polyaxial pedicle screws in treating thoracolumbar fracture.

Methods

A total of 75 patients with thoracolumbar fracture who underwent short-segment posterior fixation with monoaxial pedicle screw (group A) or polyaxial pedicle screw (group B) were retrospectively enrolled. The patient demographic and radiological data were analyzed between the two groups.

Results

A total of 63 patients with an average age of 44.7±11.5 years were finally recruited in this study. There were no significant differences in age, gender, fracture level, thoracolumbar injury classification and severity scale (TLISS) score, American Spinal Injury Association (ASIA) score, Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification, and hospital stay between the two groups (P>0.05). At the last follow-up, the prevertebral height ratio and normal-to-injured vertebral height ratio were significantly decreased in group A compared to group B (P=0.027 and P=0.007, respectively).

Conclusions

Short-segment posterior fixation with monoaxial or polyaxial pedicle screw for fractured thoracolumbar vertebra can restore injured vertebral height. Compared with polyaxial pedicle screw, monoaxial pedicle screw endows stronger leverage which is more beneficial for restoring injured vertebral height and recovery of the damaged endplate in thoracolumbar short-segment posterior fixation.

A comparative epidemiologic study of fractures among people in rural and urban areas

PURPOSE

This study aimed to comparatively analyse the epidemiologic characteristics of fractures among inpatients from rural and urban areas.

METHODS

This study retrospectively analysed patients with traumatic fractures of the limbs, pelvis and spine treated in our hospital from January 2017 to December 2017. Patients from rural and urban areas were classified into Group A and Group B, respectively. Data on age, sex, distribution of fracture locations, injury mechanism, season, date and time when the fracture occurred, length of hospital stay, chronic comorbidities and in-hospital mortality were collected, and compared between both groups.

RESULTS

A total of 10,046 patients (Group A: 4,440; 3,062 males and 1,378 females and Group B: 5,606; 3,374 males and 2,232 females) with traumatic fractures were included. The male-to-female ratio was significantly different between both groups (P<0.001). In Groups A and B, the patients aged 41.9 ± 21.6 and 45.0 ± 23.5 years old, respectively, showing significant difference (P<0.05). As for injury mechanism, the most common one was low-energy injury (Group A: 2110, accounting for 47.5%; Group B: 3422, accounting for 61.0%) in both Groups, followed by traffic accidents (Group A: 921, accounting for 20.7%; Group B: 973, accounting for 17.4%). In patients with multiple injuries, the most common mechanism of injury is traffic accidents (354, 46.1%). There were 178 patients in Group A (4.0%) and 141 patients in Group B (2.5%) combined with head injury. As for season, both groups had most of the fractures in autumn (Group A: 1449, accounting for 32.6%; Group B: 1518, accounting for 27.3%).

CONCLUSION

The epidemiological features of patients with traumatic fractures in rural and urban areas are somewhat different in terms of age distribution, injury mechanism, injured body site and season. Patients with high risk of fractures in rural areas were younger than those in urban areas. Fractures more frequently occurred in the wrist and hips in rural and urban areas, respectively. Prevention of low-energy-induced osteoporotic fractures has become very critical for both rural and urban populations. Reducing the risk of traffic accident remains critical to prevent multiple injuries.

Effect of the short-segment internal fixation with intermediate inclined-angle polyaxial screw at the fractured vertebra on the treatment of Denis type B thoracolumbar fracture

BACKGROUND

Short-segment internal fixation with intermediate straight-forward monoaxial screws (SSIF-SFM) and long-segment internal fixation (LSIF) are the two major surgical options for thoracolumbar (TL) fracture. However, SSIF-SFM might not provide adequate support to the spine, and LSIF is unnecessarily extensive. SSIF with intermediate inclined-angle polyxial screw (SSIF-IAP) might offer an alternative solution for the treatment of TL fracture.

METHODS

A retrospective study was conducted. Sixty-nine patients (47 males and 22 females; average 34.5 years) with Denis type B TL fracture who met the criteria for inclusion were enrolled. Sagittal Cobb's angle (SCA), anterior vertebral body height (AVBH), vertebral body index (VBI), and spinal canal encroachment (SCE) were measured and assessed. Visual analogue scale (VAS) and Oswestry disability index (ODI) were also evaluated.

RESULTS

The average values of incision length, blood loss, duration of operation, and hospital stay in the SSIF-IAP group and SSIF-SFM group were significantly decreased compared with those in the LSIF group. The AVBH and VBI in the SSIF-IAP group and LSIF group were significantly improved than those in the SSIF-SFM group at 6-month and the latest follow-ups (P < 0.05). The correction losses of AVBH and VBI (calculated by the reduction of AVBH and VBI) in the SSIF-IAP group and LSIF group were also significantly decreased compared with those in the SSIF-SFM group at 6-month and the latest follow-ups (P < 0.05). There was no significant difference of SCE among the three groups postoperatively. The VAS and ODI in the SSIF-IAP group and SSIF-SFM group were significantly decreased compared with those in the LSIF group at 6-month and the latest follow-ups (P < 0.05).

CONCLUSION

Both SSIF-IAP and LSIF can improve the biomechanical stability as compared with SSIF-SFM. Moreover, SSIF-IAP was less extensive compared to LSIF. SSIF-IAP was an effective and reliable operative technique for patients with Denis type B TL fracture.

Factors Impacting Mortality in Geriatric Patients with Acute Spine Fractures: A 12-Year Study of 613 Patients in Singapore

Study Design

Retrospective database analysis.

Purpose

To identify risk factors that predict mortality following acute spine fractures in geriatric patients of Singapore.

Overview of Literature

Acute geriatric spinal fractures contribute significantly to local healthcare costs and hospital admissions. However, geriatric mortality following acute spine fractures is scarcely assessed in the Asian population.

Methods

Electronic records of 3,010 patients who presented to our hospital’s emergency department and who were subsequently admitted during 2004–2015 with alleged history of traumatic spine fractures were retrospectively reviewed, and 613 patients (mean age, 85.7±4.5 years; range, 80–101 years; men, 108; women, 505) were shortlisted. Mortality rates were reviewed up to 1 year after admission and multivariate analyses were performed to identify independent risk factors correlating with mortality.

Results

Women were more susceptible to spine fractures (82.4%), with falls (77.8%) being the most common mechanism of injury. Mortality rates were 6.0%, 8.2%, and 10.4% at 3, 6, and 12 months, respectively. The most common causes of death at all 3 time points were pneumonia and ischemic heart disease. Based on the multivariate analysis at 1-year follow-up, elderly women had a lower mortality rate compared to men (p<0.001); mortality rates increased by 6.3% (p=0.024) for every 1-year increase in the patient’s age; and patients with an American Spinal Injury Association (ASIA) score of A–C had a much higher mortality rate compared to those with an ASIA score of D–E (p<0.001).

Conclusions

An older age at presentation, male sex, and an ASIA score of A–C were identified as independent factors predicting increased mortality among geriatric patients who sustained acute spine fractures. The study findings highlight at-risk groups for acute spine fractures, thereby providing an opportunity to develop strategies to increase the life expectancy of these patients.

Combined pedicle screw fixation at the fracture vertebrae versus conventional method for thoracolumbar fractures: A meta-analysis

BACKGROUND

Thoracolumbar fractures is a frequent injury occurring in spinal trauma. Outcomes and complications between combined pedicle screw fixation at the fracture vertebrae (AFV) and conventional method cross the fracture vertebrae (CFV) are still controversial. Thus, this study aimed to evaluate differences in outcome variables between these two operative methods.

MATERIALS AND METHODS

PubMed, Web of Science, Cochrane Library, EMBASE and CNKI were searched with the terms "thoracolumbar fractures", "posterior", "pedicle screw fixation", and "clinical trial" from Jan 1980 to July 2017. Two reviewers independently screened the studies for eligibility, evaluated the quality and extracted data from eligible studies, with confirmation by cross-checking. The major results and conclusions were concluded, and the different complication rates and functional outcomes were compared. Meta-analysis was performed using RevMan 5.3 software.

RESULTS

Eighteen randomized controlled trials involving 1280 patients were eligible. The pooled data revealed that AFV group might be associated with more intraoperative blood loss (MD = 9.84, 95%CI 7.45 to 12.22) and longer operation time (MD = 1.97, 95%CI 0.17 to 3.77) when compared with CFV group. However, AFV group significantly improved visual analogue scale (VAS) (MD = -1.27, 95%CI -1.70 to -0.83), anterior vertebral height (AVH) (MD = 7.58, 95%CI 3.99 to 11.17), short-term Cobb angle (MD = -1.29, 95%CI -2.39 to -0.19), long-term Cobb angle (MD = -4.47, 95%CI -7.30 to -1.63) and loss of long-term correction efficacy (MD = -6.56, 95%CI -7.49 to -5.62) after surgery. Moreover, compared with the CFV group, the AFV group had lower rate of implant failure (MD = 0.16, 95%CI 0.07 to 0.36). Both techniques had similar hospital stay (MD = 0.25, 95%CI -0.52 to 1.03) and postoperative infection (MD = 0.53, 95%CI 0.13 to 2.23).

CONCLUSIONS

Though with a more operation time and intraoperative hemorrhage, combined pedicle screw fixation at the fracture veterbrae may be better than traditional fixation cross the fracture level alone for thoracolumbar fractures.

History of orthopaedics in China: a brief review

BACKGROUND AND PURPOSE

Chinese orthopaedic surgeons have made a substantial contribution to the development of orthopaedics worldwide, and traditional Chinese medicine (TCM) in orthopaedics has a very long history in China. We make a brief review of the development of orthopaedics in China, intending to pave the way for further understanding of Chinese orthopaedics for scholars all over the world.

RESULTS

The description of fractures firstly appeared in 3600 years ago in China, and the theories, experience, and treatment strategies of TCM still play important roles in clinical diagnosis and treatment of orthopaedic disorders in our country. Western orthopaedics was first introduced into China in the early twentieth century. After decades of development, Chinese scholars have made some gratifying achievements in orthopaedics.

CONCLUSIONS

Orthopaedics is constantly evolving, and we need to strengthen the ability of independent innovation to achieve orthopaedic surgeons' Chinese dream, and better serve our patients.

Pedicle screw fixation combined with intermediate screw at the fracture level for treatment of thoracolumbar fractures: A meta-analysis

BACKGROUND

Use of a pedicle screw at the level of fracture, also known as an intermediate screw, has been shown to improve clinical results in managing thoracolumbar(TL) fractures, but there is a paucity of powerful evidence to support the claim. The aim of this study was to compare outcomes between pedicle screw fixation combined with intermediate screw at the fracture level and conventional pedicle screw fixation (one level above and one level below the fracture level) for thoracolumbar (TL) fractures.

METHODS

A meta-analysis of cohort studies was conducted between pedicle screw fixation combined with intermediate screw at the fracture level (combined screw group) and conventional pedicle screw fixation (conventional group) for the treatment of TL fractures from their inception to December 2015. An extensive search of studies was performed in PubMed, Medline, Embase, and the Cochrane library. The following outcome measures were extracted: visual analogue scale (VAS), operation time and intraoperative blood loss, Cobb angle and anterior vertebral height (AVH), and complications. Data analysis was conducted with RevMan 5.3.5.

RESULTS

From 10 relevant studies identified, 283 patients undergoing pedicle screw fixation combined with intermediate screw at the fracture level were compared with 285 conventional pedicle screw procedures. The pooled analysis showed that there was statistically significant difference in terms of postoperative Cobb angle (95% confidence interval (CI), -3.00, -0.75; P = 0.001) and AVH (95% CI, 0.04, 12.23; P = 0.05), correction loss (Cobb angle: P < 0.0001; AVH: P < 0.0001) and implant failure rate (95% CI, 0.06, 0.62; P = 0.006), and blood loss (W 95% CI, 2.22, 23.60; P = 0.02) between 2 groups. But in terms of other complications, there were no differences between 2 groups (95% CI, 0.23, 2.04; P = 0.50). No difference was found in operation time (95% CI, -5.36, 14.67; P = 0.36) and VAS scores (95% CI, -0.44, 0.01; P = 0.06).

CONCLUSIONS

The combined screw fixation technique was associated with better reduction of the fractured vertebrae, less correction loss in the follow-up, and lower implant failure rate. Given the lack of robust clinical evidence, these findings warrant verification in large prospective registries and randomized trials with long-term follow-up.

Effect of the percutaneous pedicle screw fixation at the fractured vertebra on the treatment of thoracolumbar fractures

PURPOSE

The purpose of this study was to evaluate the efficacy and safety of percutaneous pedicle screw fixation at the fractured vertebra in the treatment of thoracolumbar fractures.

METHODS

Thirty-two consecutive patients were enrolled in the study. All patients received percutaneous pedicle screw fixation, and they were randomly divided into two groups to undergo either the placement of pedicle screws into the fractured vertebra (fractured group) or not (control group). The operation time and intra-operative blood loss were recorded. Oswestry disability index (ODI) questionnaire and visual analogue scale (VAS) as clinical assessments were quantified. Radiographic follow-up was defined by the vertebral body index (VBI), anterior vertebral body height (AVBH), and Cobb angle (CA).

RESULTS

No significant difference was observed in the operation time and intra-operative blood loss between the two groups. Clinical results (VAS and ODI scores) showed no significant difference during all the follow-up periods. In the fractured group, there were better correction and less loss of AVBH and VBI compared with the control group. However, post-operative correction of the CA immediately after surgery and the correction loss at the final follow-up showed no significant difference between the two groups.

CONCLUSION

Percutaneous screw fixation combined with intermediate screws at the fractured vertebra could more effectively restore and maintain fractured vertebral height, and is an acceptable, minimally invasive surgical choice for patients with type A thoracolumbar fractures.