Pedicle screw placement via paraspinal approach versus conventional approach for the treatment of thoracolumbar vertebral fracture

doi:10.3969/j.issn.2095-4344.2013.13.009

Abstract

Abstract:

BACKGROUND: Pedicle screw and rod fixation system is a common method for the treatment of thoracolumbar vertebral fracture. Conventional approach is the midline approach which needs to cut paraspinal muscle widely, and parts of patients suffer from back pain after surgery.
OBJECTIVE: To observe the clinical outcome and paraspinal muscle injury after the treatment of thoracolumbar fractures via paraspinal approach and conventional approach.
METHODS: A total of 45 patients with thoracolumbar fractures were selected from Department of Orthopedics, Affiliated Provincial Hospital of Anhui Medical University during June 2010 to June 2012. According to Denis fracture classification, there were 11 compression fractures and 34 burst fractures with intact posterior column, and the spinal canal occupied for less than 1/3. American Spinal Injury Association grade was E-class with no neurological symptoms. Randomly, 21 patients adopted paraspinal approach and the other 24 patients underwent the conventional approach. The perioperative parameters and intervertebral indicators were compared between two groups. The visual analogue scale score and Japanese Orthopaedic Association score were analyzed postoperatively, and the postoperative and 1, 3, and 5 days preoperative serum level of creatine kinase were compared, also multifidus muscle electromyography assessment was adopted during follow-up.
RESULTS AND CONCLUSION: There was no significant difference in the Cobb’s angle restoration between two groups, but the operation time, blood loss, volume of drainage, serum level of creatine kinase and postoperative visual analogue scale score in the paraspinal approach group were significantly lower than those in the conventional approach group (P < 0.05). The Japanese Orthopaedic Association score at 6 months postoperatively in the paraspinal approach group was lower than that in the conventional approach group, but the difference was not statistically significant (P > 0.05). The multifidus muscle electromyography assessment after 6 months showed that the fibrillation potentials in the paraspinal approach group were less than that in the conventional approach group, and the difference was statistically significant (P < 0.05). Paraspinal approach has satisfactory curative effect with the advantages of less trauma and bleeding as well as shorter operation time.

Key words: bone and joint implants, spinal implants, spinal internal fixation, thoracic vertebrae fracture, lumbar vertebrae fracture, paraspinal approach, muhifidus muscle, fracture fixation, creatine kinase, electromyography, back pain, photographs-containing paper of bone and joint implants

CLC Number:

R318

Dai Hu-ming, Fang Shi-yuan, Xia Rui, Wang Xu-jin, Sun Jian-wan, Xu Lei. Pedicle screw placement via paraspinal approach versus conventional approach for the treatment of thoracolumbar vertebral fracture[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(13): 2339-2345.

Figures/Tables 7

References

[1] Wiltse LL, Bateman JG, Hutchinson RH, et al.The paraspinal sacrospinalis-splitting approach to the lumbar spine. J Bone Joint Surg Am. 1968;50(5):919-926.

[2] Vialle R, Wicart P, Drain O,et al. The Wiltse paraspinal approach to the lumbar spine revisited: an anatomic study. Clin Orthop Relat Res. 2006;445:175-180.

[3] Mao ZG,Zhu JM,Fan SW. Zhejiang Linchuang Yixue. 2008; 10(4):502. 毛兆光,祝介明,范顺武.椎旁肌间隙入路在腰椎骨折内固定术中的应用[J].浙江临床医学,2008,10(4):502-503.

[4] Li QC,Hu HL,Liu BG,et al. Zhongguo Jizhu Jisui Zazhi. 2011; 21(4):303-307. 黎庆初,胡辉林,刘宝戈,等.多裂肌间隙入路微创手术治疗腰椎滑脱症[J].中国脊柱脊髓杂志,2011,21(4):303-307.

[5] Huskisson EC. Measurement of pain. Lancet. 1974;2(7889): 1127-1131.

[6] Fukui M, Chiba K, Kawakami M,et al. Japanese Orthopaedic Association Back Pain Evaluation Questionnaire. Part 2. Verification of its reliability : The Subcommittee on Low Back Pain and Cervical Myelopathy Evaluation of the Clinical Outcome Committee of the Japanese Orthopaedic Association. J Orthop Sci. 2007;12(6):526-532.

[7] Stein J, Baker E, Pine ZM. Medial paraspinal muscle electromyography: techniques of examination. Arch Phys Med Rehabil. 1993;74(5):497-500.

[8] Fang XQ,Hu ZJ,Fan SW,et al. Zhonghua Guke Zazhi. 2009; 29(4):315-319. 方向前,胡志军,范顺武,等.胸腰段骨折经肌间隙入路与传统入路内固定的比较研究[J].中华骨科杂志,2009,29(4):315-319.

[9] Kang CH, Shin MJ, Kim SM, et al. MRI of paraspinal muscles in lumbar degenerative kyphosis patients and control patients with chronic low back pain. Clin Radiol. 2007;62(5):479-486.

[10] Kim K, Isu T, Sugawara A, et al. Comparison of the effect of 3 different approaches to the lumbar spinal canal on postoperative paraspinal muscle damage. Surg Neurol. 2008; 69(2):109-113.

[11] Zheng J,Li KN,Liu L,et al. Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu. 2010;14(39):7307-7310. 郑江,李开南,刘莉,等. 腰椎后路经皮微创与传统开放手术影响竖脊肌形态学改变的比较[J].中国组织工程研究与临床康复, 2010,14(39):7307-7310.

[12] Watkins MB.Posterolateral bonegrafting for fusion of the lumbar and lumbosacral spine. J Bone Joint Surg Am. 1959; 41-A(3):388-396.

[13] Zhao HY,Wang YF. Zhongguo Dangdai Yiyao. 2010;17(5): 13-16. 赵海燕,王蕴峰.血清肌酸激酶活性测定和临床应用[J].中国当代医药,2010,17(5):13-16.

[14] Kotil K, Tunckale T, Tatar Z, et al. Serum creatine phosphokinase activity and histological changes in the multifidus muscle: a prospective randomized controlled comparative study of discectomy with or without retraction. J Neurosurg Spine. 2007;6(2):121-125.

[15] Thesleff S, Ward MR. Studies on the mechanism of fibrillation potentials in denervated muscle. J Physiol. 1975;244(2): 313-323.

[16] Kramer M, Katzmaier P, Eisele R, et al. Surface electromyography-verified muscular damage associated with the open dorsal approach to the lumbar spine. Eur Spine J. 2001;10(5):414-420.

[17] Leinonen V, Määttä S, Taimela S, et al. Paraspinal muscle denervation, paradoxically good lumbar endurance, and an abnormal flexion-extension cycle in lumbar spinal stenosis. Spine (Phila Pa 1976). 2003;28(4):324-331.

[18] Warren A, Prasad V, Thomas M. Pre-operative planning when using the Wiltse approach to the lumbar spine. Ann R Coll Surg Engl. 2010;92(1):74-75.

[19] Zhang Y,Yin QS,Xu GZ,et al. Zhongguo Jiaoxing Waike Zazhi. 2001;8(4):334-336. 张余,尹庆水,徐国洲,等.胸腰椎椎弓根钉内固定术并发症的分析[J].中国矫形外科杂志,2001,8(4):334-336．

[20] Crossman K, Mahon M, Watson PJ, et al. Chronic low back pain-associated paraspinal muscle dysfunction is not the result of a constitutionally determined "adverse" fiber-type composition.Spine (Phila Pa 1976). 2004;29(6):628-634.