Chinese Journal of Tissue Engineering Research ›› 2021, Vol. 25 ›› Issue (24): 3902-3907.doi: 10.12307/2021.100

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Short-segment fixation of thoracolumbar burst fractures: method modification and strategies to reduce failure

Wang Ziao, Song Wenhui, Liu Changwen    

  1. Department of Orthopedics, Second Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi Province, China
  • Received:2020-10-12 Revised:2020-10-14 Accepted:2020-11-26 Online:2021-08-28 Published:2021-03-17
  • Contact: Song Wenhui, MD, Chief physician, Department of Orthopedics, Second Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi Province, China
  • About author:Wang Ziao, Master candidate, Department of Orthopedics, Second Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi Province, China
  • Supported by:
    the Applied Basic Research Project of Shanxi Province, No. 201801D121324 (to SWH)

Abstract: BACKGROUND: Short-segment fixation has been increasingly used in the treatment of thoracolumbar burst fractures. The procedure has been proven to have good clinical, functional and radiologic results. However, Kyphosis may recur after short-segment fixation and has been paid more and more attention by surgeons.  
OBJECTIVE: To summarize the classification of thoracolumbar fractures, indication of short-segment fixation, failure of short-segment fixation and the improved method of operation, so as to provide help for clinical treatment. 
METHODS: By searching CNKI, Wanfang, PubMed, Web of Science and other Chinese and English databases for articles published from 1983 to 2020, the Chinese search terms were “thoracolumbar fractures, short segment fixation, kyphosis” and the English search terms were “thoracolumbar fractures, short segment fixation, kyphosis”. Through the inclusion and exclusion criteria, 63 articles were finally included for induction and summary. 
RESULTS AND CONCLUSION: (1) For almost all type A and type B fractures of the non-ankylosing ridge column, posterior short-segment fixation can achieve good clinical results. Short-segment fixation is associated with a risk of recurrent kyphosis due to collapse of adjacent discs, and the clinical significance of recurrent kyphosis is not clear. (2) The posterior short-segment distraction reduction can effectively reduce the fractured vertebral body and promote the absorption and recovery of the bone mass in the vertebral canal through indirect traction, but it is not effective for the “inverted bone mass”. (3) The use of posterolateral fusion in conjunction with short-segment instrumentation is questionable. It has nothing to do with improving the clinical outcome, nor does it prevent recurrence of kyphosis or failure of internal fixation. (4) The use of load-sharing classification to quantify vertebral comminution and predict posterior fixation failure remains controversial. (5) The strategies for short-term fixation failure mainly focus on strengthening or enhancing the biomechanical strength of the rear structure in front. Transpedicular fixation in the strategy of increasing biomechanical strength of the posterior structure improved the effectiveness of the short-segment instrumentation and significantly reduced the implant failure rate, which is the current mainstream surgery in treatment of thoracolumbar fractures. (6) The surgical results of posterior short-segment fixation combined with transpedicular bone grafting or vertebroplasty for the reduction of fractured vertebrae need more clinical validation. (7) Minimally invasive percutaneous short-segment pedicle screw internal fixation is gradually applied in the treatment of the fracture of the ridge column, which can make the fracture well reduced and fixed in the early postoperative period, and is helpful for the recovery of the patient, and is the direction of development of short-segment fixation.

Key words: spine injuries, thoracolumbar fractures, short-segment fixation, kyphosis, minimally invasive, review

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