Journal of Musculoskeletal Trauma

The Impact on Clinical Results by Sagittal Imbalance in Posterior Fixation for Thoraco-lumbar Burst Fractures: Seung Wook Baek, Kyu Dong Shim, Ye Soo Park; J Korean Fract Soc 2011;24(4):354-360. Published online October 31, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.4.354

Abstract PDF: PURPOSE
Evaluate the effects of sagittal imbalance on the clinical outcomes in thoracolumbar burst fractures.
MATERIALS AND METHODS
We evaluated 11 patients who had received posterior fixation for unstable burst fractures. Radiologic assessment including the compression ratio, focal kyphotic angle and sagittal balance were obtained. The clinical outcomes were assessed by ODI, VAS and SF-36. We subdivided the patients into sagittal balance and imbalance group, and compared with clinical outcomes. The relationship between radiologic and clinical outcomes was examined using correlation analysis.
RESULTS
The radiologic assessment were changed on preoperative and postoperative as follows: mean compression ratio: 15.2%, 4.9%, mean focal kyphotic angle: 43.2degrees, 20.9degrees. The mean sagittal balance was 11.5 cm. The mean score of VAS, ODI, Physical and Mental Component Summary of SF-36 were 3.7, 45.8, 43.3 and 39.8, respectively. The ODI was significantly higher in sagittal imbalance group, and SF-36 was significantly higher in sagittal balance group (p<0.05). The VAS was correlated with compression ratio and focal kyphotic angle. The ODI and Mental Component Summary of SF-36 were correlated with sagittal imbalance.
CONCLUSION
Sagittal balance effects on the functions of spine, surgical treatment should be carefully considered with unstable burst fractures.

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Relationship between Lamina Fractures and Dural Tear in Low Lumbar Burst Fractures: Ki Chan An, Dae Hyun Park, Yong Wook Kwon; J Korean Fract Soc 2011;24(3):256-261. Published online July 31, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.3.256

PURPOSE
To investigate the relationship between the greenstick laminar fractures and the dural tear in low lumbar burst fractures and their optimal treatment.
MATERIALS AND METHODS
We enrolled 51 patients (52 cases) who had been diagnosed with low lumbar burst fracture from June 2003 to May 2007. The average age was 39 years (range, 22 to 58), 30 male patients (58.8%), and 21 female patients (41.2%). Average follow-up periods was 19 months (range, 11 to 45). Lumbar CT scan were taken 1 mm slices in precision for all patients. We judged it incomplete fracture if lumbar CT scans show loss of cortical continuity over 3 slices if there is an aggrement of two among one radiologist and two orthopaedic surgeons reached a consensus. Dural tear and entrapment of nerve root were confirmed intraoperatively by the senior surgeon.
RESULTS
In 52 burst fractures, complete lamina fractures occurred in 21 cases and there were green stick laminar fractures in 14 cases. Neurologic defect has been found in 12 cases, 5 (63%) from complete laminar fractures and 3 (37%) from green stick laminar fractures. Dural tears has been detected in 9 cases (26%), 4 (19%) from complete laminar fractures and 5 (36%) from green stick laminar fractures.
CONCLUSION
Dural tear and nerve root entrapment can be accompanied in patients with green stick fracture. There is necessary to consider the possibility of dural tear and nerve root entrapment before operation and to indentify carefully to the presence of nerve root entrapment during operation.

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Risk factors for damage to the dura mater in thoracic and lumbar spine injury
A. G. Martikyan, A. A. Grin, A. E. Talypov, S. L. Arakelyan
Hirurgiâ pozvonočnika (Spine Surgery).2022; 19(1): 31. CrossRef
Clinical Efficacy of Large-Channel Percutaneous Lumbar Endoscopic Decompression in the Treatment of Lumbar Spinal Stenosis Secondary to Old Compression Fractures
Junlin Liu, Qingquan Kong, Walter Munesu Chirume, Pin Feng, Bin Zhang, Junsong Ma, Yuan Hu
World Neurosurgery.2022; 166: e118. CrossRef
Diagnostics, pathogenesis and treatment of damage to the dura mater in spinal injury
A. G. Martikyan, A. A. Grin
Russian journal of neurosurgery.2018; 20(2): 74. CrossRef

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Related Factors of Ligamentotaxis with Posterior Instrumentation for the Surgical Treatment of Thoracolumbar Bursting Fracture: Sang Bum Kim, Taek Soo Jeon, Seung Hwan Kim, Han Chang, Cheol Mog Hwang; J Korean Fract Soc 2010;23(2):213-219. Published online April 30, 2010; DOI: https://doi.org/10.12671/jkfs.2010.23.2.213

Abstract PDF: PURPOSE
To investigate factors influencing the amount of indirect reduction by ligamentotaxis according to timing of surgery, extent of surgery, and characteristics of fractures.
MATERIALS AND METHODS
We reviewed 22 cases of thoracolumbar fracture which had been performed posterior instrumentation and fusion using pedicle screw system. We divided patients into each group according to timing of surgery, number of fusion segment, insertion of screw on fractured vertebra, and rupture of posterior ligament complex, and Denis type. We measured changes of kyphotic angle, anterior vertebral height and wedge angle on plain radiographs, and we compared spinal canal area before and after operation using computed tomographic scans.
RESULTS
Kyphotic angle, anterior vertebral height, wedge angle, and area of spinal canal showed significant improvement postoperatively. The wedge angle improved significantly operated within 3 days after injury, however, kyphotic angle and anterior vertebral height had no correlation with variable factors except the rupture of posterior ligament complex. The amount of restoration of spinal canal also affected only by rupture of posterior ligament complex.
CONCLUSION
There is little relationship between timing of surgery and canal restoration, so we cannot conclude that prompt operation helps reduction of narrowed spinal canal. Otherwise narrowed spinal canal had much less restored by ligamentotaxis when there were rupture of posterior ligament complexes.

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Change of Kyphotic Angle in Posterior Pedicle Screw Fixation for Thoracic and Lumbar Burst Fractures: Comparison Study by the Screw Fixation Level: Jeong Gook Seo, Jong Ho Park, Jeong Seok Moon, Woo Chun Lee; J Korean Fract Soc 2009;22(1):39-44. Published online January 31, 2009; DOI: https://doi.org/10.12671/jkfs.2009.22.1.39

Abstract PDF: PURPOSE
To evaluate the relationship between the level of screw fixation and the stability of the segment of endplate fracture after posterior pedicle screw instrumentation for thoracic and lumbar burst fractures.
MATERIALS AND METHODS
The 41 patients of burst fractures who had been operated with pedicle screw instrumentation were retrospectively evaluated. The patients were divided into two groups by the levels of screw fixation. One group was treated with screws fixed by one-level to the direction of fractured endplate (One-level group, 16 cases). The other group was treated with screws fixed by two-level to the direction of endplate fracture (Two-level group, 25 cases). The two groups were compared by the radiographic changes of kyphotic angle between the day of surgery and 6 months after surgery.
RESULTS
At the 6 months, one-level group showed the change of kyphotic angle of 17.5+/-2.4 degrees, which was different from two-level group of 5.2+/-0.8 degrees (p=0.000).
CONCLUSION
In posterior pedicle screws fixation for thoracic and lumbar burst fractures, 2 vertebrae to the direction of the endplate fracture should be included to prevent the postoperative kyphotic change.

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Treatment of Osteoporotic Stable Burst Fracture with Percutaneous Vetebroplasty: Shin Kwon Choi, Kwang Yul Kim, Moon Sup Yim, Do Young Lee; J Korean Fract Soc 2006;19(2):247-253. Published online April 30, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.2.247

Abstract

PURPOSE
To evaluate the result of percutaneous vertebroplasty in the treatment of osteorporotic stable burst fracture that has not neurologic symptom.
MATERIALS AND METHODS
A retrospective review was conducted in 37 vertebrae of 33 patinets with osteoporotic stable burst fracrure treated by percutaneous vertebroplasty from February 2000 to May 2003. Stable burst fracture was classified by McAfee. The operation was performed in the patient without neurologic symptom, BMD T-score was below -2.5 and hot uptake was seen in (99m)Tc bone scan. The operation was held from post-traumatic 7 to 32 days, average 17 days. Follow up period was from 5 months to 38 months, average 11 months. The result of the treatment was assesed by clinical finding (pain scale and work status by Denis) and radiologic findings (percentage height restored and change of kyphotic angle).
RESULTS
In clinical assessment, 27 had a satisfactory pain scale below the P3, 25 had a satisfactory work status below the W3. In the radiologic findings, percentage height restore was increased from 0% to 62%, average 23.3%. The preop. kyphotic angle was from -20 degree to 42 degree, average 8.9 degree. The postop. kyphotic angle was from -20 to 42 degree, average 6.5 degree. The kyphotic angle was decreased average 2.4 degree after operation.
CONCLUSION
Treatment of osteoporotic stable burst fracture with percutaneous vertebroplasty is the minimal invasive treatment that has satisfactory pain relief and reduction of fracture.

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Outcome Comparison between Percutaneous Vertebroplasty and Conservative Treatment in Acute Painful Osteoporotic Vertebral Compression Fracture
Hwa-Yeop Na, Young-Sang Lee, Tae-Hoon Park, Tae-Hwan Kim, Kang-Won Seo
Journal of Korean Society of Spine Surgery.2014; 21(2): 70. CrossRef

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Relevancy of Posterior Column Injury and Dural Tear in Unstable Burst Fracture: Ye Soo Park, Kee Hun Son, Ki Chul Park, Il Hoon Sung, Jae Lim Cho; J Korean Fract Soc 2005;18(1):65-68. Published online January 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.1.65

Abstract PDF

PURPOSE
To analyze the pattern of posterior column injury in unstable burst fractures and to predict the possibility of dural injury.
MATERIALS AND METHODS
Retrospective review was carried out on 22 patients of unstable burst fracture from Nov. 1996 to Sep. 2003. The pattern posterior column injury was analyzed by simple x-ray, CT and MRI findings. In simple x-ray, authors analyzed laminar fracture, posterior facet injury, inter-spinous widening and inter-spinous malalignment, posterior bony injury by CT, posterior inter-spinous ligament injury and dural tear by MRI. The statistical analysis was performed using Mann-Whitney test and Chi-square test.
RESULTS
There were 13 men and 9 women, and mean age was 41 years-old (18~65). The level of injury showed 15 cases in T12-L2, 6 in L3, 3 L4. In simple x-ray, findings were showed 13 cases (59.1%) in laminar fracture, 7 (31.8%) in posterior facet injury, 16 (72.7%) in inter-spinous widening and 8 (36.4%) in inter-spinous malalignment. In CT, findings were showed 13 (59.1%) in laminar fracture, 10 (45.5%) in posterior facet injury, 9 (40.9%) in transverse process fracture. In MRI, findings were showed 18 (81.8%) in posterior inter-spinous ligament injury and were not showed dural tear. The combined cases of posterior bony and ligamentous injury was 6 (27%) and 5 of 6 showed dural tear and the analysis of dural tear and radiologic findings was showed positive correlation (p=0.004).
CONCLUSION
Posterior ligament injury was more frequent than bony injury in unstable burst fracture. Among the posterior bony injuries, dural tear was more frequent in facet injury. Authors confirmed all dural tear with operation. In cases of posterior bony injury combined with ligamentous injuries, the possibility of dural tear was significantly higher than that of single structural injury (p=0.004).

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Lumbar Spine Fracture
Seung-Wook Back, Hyun-Joong Cho, Ye-Soo Park
Journal of the Korean Fracture Society.2011; 24(3): 277. CrossRef
Relationship between Lamina Fractures and Dural Tear in Low Lumbar Burst Fractures
Ki-Chan An, Dae Hyun Park, Yong-Wook Kwon
Journal of the Korean Fracture Society.2011; 24(3): 256. CrossRef

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MRI Findings of Posterior Ligament Complex Injury in Thorcolumbar Bursting Fractures: Young Do Koh, Yeo Heon Yun, Hoon Jeong; J Korean Soc Fract 2003;16(4):541-547. Published online October 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.4.541

Abstract PDF: PURPOSE
To investigate the MR findings of structures injured in the burst fractures of thoracolumbar spine.
MATERIALS AND METHODS
Twenty-one patients who had thoracolumbar burst fractures with posterior ligament complex injury on MRI were studied. For the evaluation of stability of fractures, we used the scheme described by Oner et al. We identified the state of posterior ligament complex on surgery.
RESULTS
The MRI findings of ALL were state 1 in four, state 2 in fourteen, and state 3 in three. Those of PLL were state 1 in twelve, state 2 in six, and state 3 in three. The findings of posterior ligament complex were state 2 in one, state 3 in three, and state 4 in seventeen. The endplate state 1 was in four, state 2 in six, state 3 in seven, and state 4 in four. The disc state 1 was in twelve, state 2 in six, state 3 in two, state 4 in one. The vertebral body involvement state was 1 in four, state 2 in nine, and state 3 in eight. The injuries of posterior ligament complex were confirmed intraoperatively in all twenty-one patients.
CONCLUSION
We recommend the use of MRI to evaluate stability of fractures and state of posterior ligament complex in thoracolumbar burst fractures.

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Relationship between Simple X-ray and CT Findings on the Degree of Canal Encroachment in Burst Fracture of Thoracolumbar Junction: Young Do Koh, Jong Oh Kim; J Korean Soc Fract 1999;12(2):388-394. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.388

Abstract PDF: In burst fracture of thoracolumbar junction, compressive injury of middle column is characteristic and neurologic symptom develops by retropulsion of bony fragment into spinal canal. Authors had treated 44 cases with burst fracture of thoracolumbar junction at Ewha Woman' University Mokdong Hospital from September, 1993 to December, 1997 and analyzed the relationships between simple radiologic findings and canal encroachment and between neurology and canal encroachment. The results were as follows; Canal encroachment by bony fragment was larger in lower vertebra than in upper one. Canal encroachment was larger in Denis type A than in type B. Both anterior vertebral height(AVH) and presence of neurology were not related with the amount of canal encroachment. The lesser loss of posterior vertebral height(PVH) and kyphotic angle were, the more canal encroachment was. In summary, factors that influenced the amount of canal encroachment were fracture level and type. There was no significant relationship between neurology and the amount of canal encroachment. AVH, PVH and kyphotic angle were not related with the amount of canal encroachment.

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The Change of Kyphotic Angle and Anterior Vertebral Height after Posterior or Posterolateral Fusion with Transpedicular Screws for Thoracolumbar Bursting Fractures: Jae Sung Ahn, June Kyu Lee, Deuk Soo Hwang, Young Mo Kim, Won Jung Kim, Kyu Hwan Byun; J Korean Soc Fract 1999;12(2):379-387. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.379

Abstract PDF

The purposes of this study are to make an operative treatment option of thoracolumbar burst fractures by the degree of initial kyphotic deformity or by the degree of initial loss of anterior vertebral height. We analyzed sixty-three cases of one segmental thoracolumbar bursting fractures treated surgically by posterior or posterolateral fusion with short segmental transpedicular screws fixation method using Diapason or CD from January, 1992 to October, 1996. Indications of operative treatment were that the degree of initial kyphotic deformity was above 15degreesor initial loss of anterior vertebral height was above 30%. Minimum follow-up period was 12 months and the results were as follows : 1. Entirely, mean kyphotic angle was 21.6degreesinitially, 11.3degreespostoperatively and 14.2degrees at the end of follow-up. Mean anterior vertebral height was 59.6% initially, 83.8% postoperatively and 80.8% at the end of follow-up. So 10.3degrees , 24.2% was corrected postoperatively and loss of correction was 2.9degrees , 3% at the end of follow-up. 2. In the respect of the degree of initial kyphotic deformity, when compared above 30degrees with below 30degrees , loss of correction was 7.3degrees , 1.4degrees at the end of follow-up respectively and this result had significant difference between these two groups statistically. 3. In the respect of initial loss of anterior vertebral height, when compared above 55% with below 55%, loss of correction was 7.7%, 2.2% at the end of follow-up respectively and this result had significant difference between these two groups statistically. 4. In the respect of time interval from injury to operation, when compared within 2 weeks with after 2 weeks, respectively loss of correction was 1.7-2.2degrees , 3-3.9% and 4.1degrees , 6.7% at the end of follow-up and this results had significant difference between these two groups statistically. These data suggested if initial kyphotic angle is below 30degrees or initial loss of anterior vertebral height less than 55%, short segmental transpedicular screw fixation provide sufficient stability but if initial kyphotic angle is above 30degrees or initial loss of anterior vertebral height is above 55%,additional anterior interbody fusion may be considered.

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Comparison of Percutaneous versus Open Pedicle Screw Fixation for Treating Unstable Thoracolumbar Fractures
Jin Young Han, Ki Youn Kwon
Journal of the Korean Fracture Society.2020; 33(1): 1. CrossRef
Nonfusion Method in Thoracolumbar and Lumbar Spinal Fractures
Yong-Min Kim, Dong-Soo Kim, Eui-Sung Choi, Hyun-Chul Shon, Kyoung-Jin Park, Byung-Ki Cho, Jae-Jung Jeong, Young-Chan Cha, Ji-Kang Park
Spine.2011; 36(2): 170. CrossRef
Efficiency of Implant Removal for Treatment of the Thoraco-lumbar Unstable Fractures - Multi Segments Fixation · Single Segment Fusion -
Heui-Jeon Park, Young-Jun Shim, Wan-Ki Kim, Tae-Yeon Cho, Sung-Min Kwon
Journal of Korean Society of Spine Surgery.2011; 18(3): 103. CrossRef
Change of Kyphotic Angle in Posterior Pedicle Screw Fixation for Thoracic and Lumbar Burst Fractures: Comparison Study by the Screw Fixation Level
Jeong-Gook Seo, Jong-Ho Park, Jeong-Seok Moon, Woo-Chun Lee
Journal of the Korean Fracture Society.2009; 22(1): 39. CrossRef
Clinical Efficacy of Implant Removal after Posterior Spinal Arthrodesis with Pedicle Screw Fixation for the Thoracolumbar Burst Fractures
Kyung-Jin Song, Kyu-Hyung Kim, Su-Kyung Lee, Jung-Ryul Kim
The Journal of the Korean Orthopaedic Association.2007; 42(6): 808. CrossRef
Results of Non-fusion Method in Thoracolumbar and Lumbar Spinal Fractures
Yong-Min Kim, Dong-Soo Kim, Eui-Seong Choi, Hyun-Chul Shon, Kyoung-Jin Park, Kyeong-Il Jeong, Young-Chan Cha, Hu-Shan Cui
Journal of Korean Society of Spine Surgery.2005; 12(2): 132. CrossRef
Relationships between Posterior Ligament Complex Injury and Plain Radiograph in Thoracolumbar Spinal Fracture
Heui-Jeon Park, Phil-Eun Lee, Byung-Ho Lee, Myung-Soon Kim
Journal of Korean Society of Spine Surgery.2005; 12(2): 140. CrossRef

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Change of Canal Compromise After Ligamentotaxis in Thoracolumbar Burst Fracture: Kyu Jung Cho, Min Suk Yang; J Korean Soc Fract 1996;9(3):759-766. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.759

Abstract PDF: Twenty-one patients with burst fracture of the thoracolumbar spine were treated by posterior pedicle screw instrumentation and fusion. We assessed canal compromise using CT fcan preoperatively and its restoration shortly after instrunientation lot confirmation of effect of lisamentotafis. The amount of neurologic recovery in each patient was compared to the final area of the spinal canal. The mean initial canal compromise was 42.6% and this was reduced to 16.2% postoperatively. The mean sagittal diameter was 10.2mm preoperatively & 12.9mm postoperatively. We achieved a mean reduction of canal compromise of 62%. A significant correlation between preoperative canal compromise and amount of restoration, or severity of neurologic deficit could not be established. Ligamentotaxis by pedicle screw instrumentation could effectively decompress the canal in thoracolumbar burst fracture.

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Comparative Study of Radiologic Changes after Conservative Treatment in Compression fracture and Stable Bursting Fracture of Thoracolumbar Spine: Ho Young Sun, Jung Woung Lee, Sang Don Jung, Jae Young Cho, Deok Young Yoon; J Korean Soc Fract 1995;8(3):667-674. Published online July 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.3.667

Abstract PDF: The diagnosis and management of thoracolumbar spine fracture have been progressrd greatly, because CT and MRI increase the apprehension to thoracolumbar fracture. Middle dolumn was known to be important factor in determining fracture stability, according to "Three column concept by Denis and McAfee." From Jan. 1990 to Jan. 1994 we have managed 63 cases of thoracolumbar compressive fracture and stable burst type thoracolumbar wpine fracture nonoperatively Clinical and radiologic results(kyphotic angle, wedging angle) were evaluated according to fracture pattern. We obtained the following results; 1. The change of kyphotic angle in stable burst fracture is more severe than compressive fracture. 2. The change of wedging angle in stable burst fracture is more severe than compressive fracture. 3. Clinical results of stable bursting fracture was worse than compressive fracture. We concBuded that stable bursting thoracolumbar fracture need more aggressive management.

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Treatment of Unstable Fracture of the Thoracolumbar Spine Using Kaneda Instrumentation: Ik Soo Choi, Woo Il Kim, Sung Lim, Seung Ho Lee; J Korean Soc Fract 1994;7(1):192-200. Published online May 31, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.1.192

Abstract PDF

In cases of unstable thoracolumbar burst fractures, recently the operative treatments such as posterior stabilization and fusion, anterior decompression and fusion, and combined method have been used and choice of procedures is determined by neurologic deficit, instability, and interval between injury and operation. Kaneda instrumentation is rigid anterior spinal device that provides sufficient stability for anterior decompression through partial or total corpectomy and adequate correction of kyphosis as one stage operation by instrumentation. We have experienced 12 cases of Kaneda instrumentation via anterior approach for thoracolumbar fracture, from Aug. 1989 to Jun. 1991 Among them, 7 cases have been followed for more than 12 months and reviewed. The results were as followed: 1. There was no relationship between canal compromise and Frankel grade. Incomplete neurologlc deficit improved by 1.4 Frankel grade but complete neurologic deficit did not improve. 2. The mean preoperative kyphotIc angulation was 26.1, postoperative angulation 12.7, correction angle 13.4, and sorrection rate was 51.4%. 3. Anterior spinal approach for the unstable thoracolumbar fractures using Kaneda instrumentation provided 1) sufficient anterior spinal decompression and fusion 2) adequate correction of kyphotic deformity and 3) stability to enable early ambulation.

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Biomechanical Efficacy of Various Anterior Spinal Fixation in Treatment of Thoraco-lumbar Spine Fracture
Ye-Soo Park, Hyoung-Jin Kim, Choong-Hyeok Choi, Won-Man Park, Yoon-Hyuk Kim
Journal of the Korean Fracture Society.2007; 20(1): 70. CrossRef

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