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Chen HW, Wang ZQ, Jing PJ, Ma DH, Wang WB, Song E, Li PW, Cheng P. Arthroscopic-assisted uniportal spinal surgery for treatment of lumbar burst fractures complicated with neurological symptoms: a case report. J Int Med Res 2025; 53:3000605241312828. [PMID: 39883801 PMCID: PMC11783536 DOI: 10.1177/03000605241312828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Accepted: 12/20/2024] [Indexed: 02/01/2025] Open
Abstract
Lumbar burst fractures account for 21% to 58% of all thoracolumbar fractures. L5 lumbar burst fractures are rare, comprising 1.2% of spinal burst fractures. This report discusses the optimal treatment for an adolescent with an L5 lumbar burst fracture and neurological symptoms caused by a high-fall injury, which involved surgical decompression and spinal fixation. Complete decompression and fixation of the L5 lumbar burst fracture, complicated by neurological symptoms, were achieved using arthroscopic-assisted uniportal spinal surgery (AUSS) combined with percutaneous pedicle screw fixation (PPSF). The AUSS approach, used alongside PPSF, significantly improved the vertebral canal occupation rate, increased the anterior edge height ratio of the damaged vertebra, and alleviated the lower back pain and nerve root symptoms postoperatively. AUSS combined with PPSF is a minimally invasive technique for treating lumbar burst fractures, effectively relieving compression of the vertebral canal and nerves caused by fracture fragments.
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Affiliation(s)
- Hai-Wei Chen
- Department of Emergency Medicine, The Second Hospital of Lanzhou University, Lanzhou, Gansu, PR China
- Department of Orthopedics, The Second Hospital of Lanzhou University, Lanzhou, Gansu Province, PR China
| | - Zhi-Qiang Wang
- Department of Emergency Medicine, The Second Hospital of Lanzhou University, Lanzhou, Gansu, PR China
- Department of Orthopedics, The Second Hospital of Lanzhou University, Lanzhou, Gansu Province, PR China
| | - Peng-Ju Jing
- Department of Emergency Medicine, The Second Hospital of Lanzhou University, Lanzhou, Gansu, PR China
| | - Dong-Hong Ma
- Department of Emergency Medicine, The Second Hospital of Lanzhou University, Lanzhou, Gansu, PR China
| | - Wen-Bo Wang
- Department of Emergency Medicine, The Second Hospital of Lanzhou University, Lanzhou, Gansu, PR China
| | - En Song
- The First Affiliated Hospital of Kunming Medical University Sports Medicine Department, Kunming, China
| | - Pei-Wu Li
- Department of Emergency Medicine, The Second Hospital of Lanzhou University, Lanzhou, Gansu, PR China
- The Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu, PR China
| | - Peng Cheng
- Department of Emergency Medicine, The Second Hospital of Lanzhou University, Lanzhou, Gansu, PR China
- Department of Orthopedics, The Second Hospital of Lanzhou University, Lanzhou, Gansu Province, PR China
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Sun S, Chu H, Wu Z, Sun J, Guo Q, Man Q, Wang T, Tao J. Clinical application of a modified wiltse approach in middle and lower thoracic vertebrae: a case-control study of thoracic fracture patients. BMC Musculoskelet Disord 2024; 25:701. [PMID: 39227785 PMCID: PMC11370313 DOI: 10.1186/s12891-024-07763-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Accepted: 08/06/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND The Wiltse approach has been extensively employed in thoracolumbar surgeries due to its minimal muscle damage. However, in the middle and lower thoracic spine, the conventional Wiltse approach necessitates the severance of the latissimus dorsi and trapezius muscles, potentially leading to muscular injury. Consequently, we propose a modified Wiltse approach for the middle and lower thoracic vertebrae, which may further mitigate muscular damage. METHODS From May 2018 to April 2022, 60 patients with spinal fractures in the middle and lower thoracic vertebrae (T5-12) were enrolled in this study. Thirty patients underwent surgery using the modified Wiltse approach (Group A), while the remaining 30 patients received traditional posterior surgery (Group B). The observation indices included operation time, intraoperative blood loss, incision length, number of C-arm exposures, postoperative drainage, postoperative ambulation time, discharge time, as well as preoperative and postoperative Cobb's angle, percentage of anterior vertebral body height (PAVBH), visual analog scale (VAS) Score, and Oswestry disability index (ODI). RESULTS Compared to the traditional posterior approach, the modified Wiltse approach demonstrated significant advantages in operation time, intraoperative blood loss, length of incision, postoperative ambulation time, postoperative drainage, and discharge time, as well as postoperative VAS and ODI scores. No significant differences were observed between the two groups in terms of number of C-arm exposures, postoperative Cobb's angle, or postoperative PAVBH. CONCLUSION We propose a modification of the Wiltse approach for the middle and lower thoracic vertebral regions, which may further minimize muscular damage and facilitate the recovery of patients who have undergone surgery in the middle and lower thoracic vertebrae.
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Affiliation(s)
- Shuangxi Sun
- Department of Orthopedics, Weihai Central Hospital, Qingdao University, No. 3 West of Mishan Road, Wendeng District, Shandong, 264499, China
| | - Hongxia Chu
- Department of Orthopedics, Weihai Central Hospital, Qingdao University, No. 3 West of Mishan Road, Wendeng District, Shandong, 264499, China
| | - Zhipeng Wu
- Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Naval Medical University, No. 415 Fengyang Road, Shanghai, 200003, China
| | - Jian Sun
- Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Naval Medical University, No. 415 Fengyang Road, Shanghai, 200003, China
| | - Qi Guo
- Department of Orthopedics, Weihai Central Hospital, Qingdao University, No. 3 West of Mishan Road, Wendeng District, Shandong, 264499, China
| | - Qianfeng Man
- Department of Orthopedics, Weihai Central Hospital, Qingdao University, No. 3 West of Mishan Road, Wendeng District, Shandong, 264499, China
| | - Ting Wang
- Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Naval Medical University, No. 415 Fengyang Road, Shanghai, 200003, China.
| | - Jun Tao
- Department of Orthopedics, Weihai Central Hospital, Qingdao University, No. 3 West of Mishan Road, Wendeng District, Shandong, 264499, China.
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Zhu Z, Chen G, Ma T, Wang S, Tang X, Liu C. A Novel Leverage Technique Using Monoaxial Pedicle Screw for Reduction of Thoracolumbar Compression Fractures: Surgical Technique and Analysis of Radiological Parameters. Orthop Surg 2024; 16:1538-1547. [PMID: 38784977 PMCID: PMC11216827 DOI: 10.1111/os.14065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 03/21/2024] [Accepted: 03/28/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVE Thoracolumbar compression fractures resulting from high-energy injuries are a common type of spinal fracture. Satisfying reduction of compressive vertebra body is essential for the clinical outcome. However, traditional distraction technique may lead to complications including pedicle screw loosening, pedicle screw breakage, and postoperative back pain because of excessive distraction. In this study, we reported a novel technique for reduction. Additionally, the effect and postoperative radiological parameters of this technique were compared with those of traditional distraction technique. METHODS The clinical data of 80 patients who had been treated with posterior pedicle screw fixation from January 2019 to December 2020 was retrospectively analyzed. Thirty-six patients were performed with the leverage technique, while 22 patients were treated with the traditional distraction technique. When pedicle screw fixation was performed with either the leverage technique or the traditional distraction technique, fracture reduction was completed with monoaxial pedicle screws using either the leverage maneuver or distraction of adjacent vertebrae. Clinical evaluation, including operation time, hospital stay, blood loss volume, and postoperative complications were collected. The American Spinal Injury Association (ASIA) score for neurological condition and the visual analog scale (VAS) score for pain were used to evaluate the patients' functional outcome. The radiographic analysis included local kyphotic angle (LKA), regional kyphotic angle (RKA), anterior vertebral height (AVH), posterior vertebral height (PVH), and sagittal compression (SC). The student t-test and the χ2-test (or the Fisher exact test) were used to compare the outcome measures between the two groups. RESULTS The leverage group comprised 36 patients, while 44 patients were included in the distraction group. No statistically significant differences were found in the demographic data. The VAS score in the leverage group (3.0 ± 0.8) was significantly lower than that in the distraction group (4.2 ± 0.6) on postoperative day 1. Total correction of the LKA in the leverage group (11.5 ± 2.5°) was significantly higher than that in the distraction group (7.1 ± 1.3°) (p = 0.0004). Total correction of the RKA was higher in the leverage group (12.1 ± 4.3°) than in the distraction group (6.1 ± 0.9°) (p = 0.005). The ratio of rear pillar /front pillar correction was 0.35 ± 0.13 and 0.89 ± 0.18 in the leverage and distraction groups, respectively (p = 0.014). Total correction of the upper and lower foraminal height in the leverage group was significantly less than that in the distraction group. The leverage group had significantly higher correction of the upper and lower intervertebral space height than the distraction group. CONCLUSIONS Our novel leverage technique provided better kyphotic reduction and restoration than compared to conventional distraction technique in the surgical treatment of thoracolumbar compression fractures.
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Affiliation(s)
- Ziqing Zhu
- Department of Orthopedics, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Guangzi Chen
- Department of Orthopedics, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Tian Ma
- Department of Orthopedics, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Shanxi Wang
- Department of Orthopedics, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Xiangyu Tang
- Department of Radiology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Chaoxu Liu
- Department of Orthopedics, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
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Han Y, Ma J, Zhang G, Huang L, Kang H. Percutaneous monoplanar screws versus hybrid fixed axial and polyaxial screws in intermediate screw fixation for traumatic thoracolumbar burst fractures: a case-control study. J Orthop Surg Res 2024; 19:85. [PMID: 38254136 PMCID: PMC10801944 DOI: 10.1186/s13018-024-04547-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
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.
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Affiliation(s)
- Yaozheng Han
- Medical College, Wuhan University of Science and Technology, Wuhan, 430065, Hubei, China
| | - Jun Ma
- Department of Orthopaedic, General Hospital of Central Theater Command, Wuhan, 430070, Hubei, China
| | - Guoquan Zhang
- Medical College, Hubei University of Medicine, Shiyan, 442000, Hubei, China
| | - Liangliang Huang
- Department of Orthopaedic, General Hospital of Central Theater Command, Wuhan, 430070, Hubei, China.
| | - Hui Kang
- Department of Orthopaedic, General Hospital of Central Theater Command, Wuhan, 430070, Hubei, China.
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