Sextant percutaneous pedicle screw fixation for correcting single-segment thoracolumbar fractures

doi:10.3969/j.issn.2095-4344.2014.35.014

Abstract

Abstract:

BACKGROUND: Though the effects of conservative or traditional open reduction and internal fixation in the treatment of thoracolumbar fractures are reliable and satisfactory for most cases, two methods also have shortages. Minimal-invasive percutaneous pedicle screw system provides a new available method.
OBJECTIVE: To investigate the clinical effect of Sextant percutaneous pedicle screw system in the treatment of thoracolumbar fractures.
METHODS: A total of 55 patients, who had undergone percutaneous pedicle screw fixation using Sextant system (25 patients) or traditional open internal fixation (30 patients) for single-level vertebral body compression fractures in Department of Orthopedics of Renmin Hospital of Wuhan University from February 2011 to January 2013, were enrolled in this study.
RESULTS AND CONCLUSION: Except two patients in traditional open internal fixation group were lost after discharge, all other patients were followed up for 8-14 months. Operative time, intraoperative blood loss, postoperative drainage amount and hospital day were better in percutaneous pedicle screw fixation group than in the traditional open internal fixation group (P < 0.05). Compared with preoperation, the sagittal Cobb angle, visual analogue scale and Oswestry disability index after operation were significantly lower (P < 0.05), while anterior vertebral body height ratio was significantly higher in each group (P < 0.05). No significant difference was found in terms of correction loss and Oswestry disability index between two groups at 8 months after operation (P > 0.05). The results show that percutaneous pedicle screw fixation using Sextant system has a satisfactory outcome in the treatment of thoracolumbar fractures. However, obeying indication strictly is very important for clinical application.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: internal fixators, lumbar vertebrae, thoracic vertebrae, fractures, compression

CLC Number:

R318

Ming Jiang-hua, Zheng Hui-feng, Zhao Qi, Chen Qing, Wang Gang. Sextant percutaneous pedicle screw fixation for correcting single-segment thoracolumbar fractures[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(35): 5654-5659.

Figures/Tables 1

Analysis of the number of participants in the two groups All patients in percutaneous pedicle screw fixation group were followed up successfully; in traditional open internal fixation group, besides two patients who were lost, the remaining patients were followed up. The total time of follow-up ranged from 8 to14 months (average, 12.8±1.8 months). There was no statistical difference in age, sex ratio and body mass between two groups (P > 0.05; Table 1). Comparison of outcomes of participants in the two groups The operative time, intraoperative blood loss, postoperative drainage amount and hospital day in the percutaneous pedicle screw fixation group were all less than those in the traditional open internal fixation group, and the differences were statistically significant (P < 0.01; Table 2). There were no significant differences between two groups in terms of sagittal Cobb angle and anterior vertebral body height ratio before and after operation (P > 0.05). No significant difference was found between two groups in correction loss at 8 months after operation (P > 0.05). At 1 week after operation, the sagittal Cobb angle was significantly lower while anterior vertebral body height ratio was significantly higher than those before operation in each group (P < 0.01; Tables 3, 4). Bone healing was obtained in all patients at the last follow-up, without loosening of internal fixators. There were no significant differences between two groups in terms of visual analogue scale and Oswestry disability index before operation and at 8 months after operation (P > 0.05). At 1 week after operation, the visual analogue scale in percutaneous pedicle screw fixation group was significantly less than that in traditional open internal fixation group (P < 0.01). The postoperative visual analogue scale and Oswestry disability index were significantly less than those before operation in each group (P < 0.01). Visual analogue scale at 1 week after operation was significantly higher than that at 8 months after operation in traditional open internal fixation group. More details are shown in Tables 5, 6. Adverse events Delayed healing occurred in two patients due to wound hematocele in traditional open internal fixation group, and I phase healing was obtained in other patients. Typical case A 46-year-old man with L1 vertebra body compression fractures caused by high falling injury, without neurological symptoms and signs, was treated by percutaneous pedicle screw fixation using Sextant system. A 10-month follow-up was obtained, and the vertebral body height retained well during the period of follow-up, without related complications (Figure 1)."

References

[1] Boelderl A, Daniaux H, Kathrein A, et al. Danger of damaging the medial branches of the posterior rami of spinal nerves during a dorsomedian approach to the spine. Clin Anat. 2002;15(2):77-81.
[2] Agrawal A, Mizuno J, Kato Y, et al. Minimally invasive pedicle screw placement in a case of L4 fracture: case report with review of literature. Asian J Neurosurg. 2010;5(2):64-69.
[3] Foley KT, Gupta SK, Justis JR, et al. Percutaneous pedicle screw fixation of the lumbar spine. Neurosurg Focus. 2001; 10(4):E10.
[4] Lowery GL, Kulkarni SS. Posterior percutaneous spine instrumentation. Eur Spine J. 2000;9 Suppl 1:S126-130.
[5] Magerl FP. Stabilization of the lower thoracic and lumbar spine with external skeletal fixation. Clin Orthop Relat Res. 1984;(189):125-141.
[6] Foley KT, Gupta SK. Percutaneous pedicle screw fixation of the lumbar spine: preliminary clinical results. J Neurosurg. 2002;97(1 Suppl):7-12.
[7] Wang HW, Li CQ, Zhou Y, et al. The comparision of minimally invasive and traditional open treatment for thoracolumbar fractures using Sextant system. Zhongguo Jizhu Jisui Zazhi. 2010;20(2):112-116.
[8] Xiao LY, Guan HG, Cao ZL, et al. Sextant system in the treatment of thoracolumbar fracture. Shiyong Yixue Zazhi. 2012;28(9):1500-1501.
[9] Oh HS, Kim JS, Lee SH, et al. Comparison between the accuracy of percutaneous and open pedicle screw fixations in lumbosacral fusion. Spine J. 2013;13(12):1751-1757.
[10] Prokop A, Lohlein F, Chmielnicki M, et al. Minimally invasive percutaneous instrumentation for spine fractures. Unfallchirurg. 2009;112(7):621-624, 626-628.
[11] Schmidt OI, Strasser S, Kaufmann V, et al. Role of early minimal-invasive spine fixation in acute thoracic and lumbar spine trauma. Indian J Orthop. 2007;41(4):374-380.
[12] Wang HW, Li CQ, Zhou Y, et al. Percutaneous pedicle screw fixation through the pedicle of fractured vertebra in the treatment of type A thoracolumbar fractures using Sextant system: an analysis of 38 cases. Chin J Traumatol. 2010;13(3):137-145.
[13] Kruger A, Rammler K, Ziring E, et al. Percutaneous minimally invasive instrumentation for traumatic thoracic and lumbar fractures: a prospective analysis. Acta Orthop Belg. 2012;78(3):376-381.
[14] Wang HW, Zhou Y, Li CQ, et al. The biomechanicaI and clinical study of the percutaneous pedicle screw fixation in the treatment of thoracolumbar fractures. Zhonghua Guke Zazhi. 2011;31(9):932-937.
[15] Kang H, Cai XH, Xu F, et al. Clinical research of minimally invasive surgical management for lumbar spondylolisthesis via quadrant system assisted Sextant-R system. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2013;27(4):399-403.
[16] Sairyo K, Sakai T, Yasui N. Minimally invasive technique for direct repair of pars interarticularis defects in adults using a percutaneous pedicle screw and hook-rod system. J Neurosurg Spine. 2009;10(5):492-495.
[17] Maciejczak A, Barnas P, Dudziak P, et al. Posterior keyhole corpectomy with percutaneous pedicle screw stabilization in the surgical management of lumbar burst fractures. Neurosurgery. 2007;60(4 Suppl 2):232-241; discussion 241-242.
[18] Liu T, Li CQ, Zhou Y, et al. The designs and feasibility of clinical applications about a novel percutaneous pedicle screw system. Zhonghua Guke Zazhi. 2010;30(6):594-599.