Treatment of Thoracolumbar Burst Fractures with Polymethyl Methacrylate Vertebroplasty and Short-segment Pedicle Screw Fixation

Der Yang Cho, Wuen Yen Lee, Pon Chun Sheu, Volker K H Sonntag, Patrick W. Hitchon, Paul R. Cooper, Michael Y. Wang, Mark N. Hadley

Research output: Contribution to journalArticle

142 Citations (Scopus)

Abstract

OBJECTIVES: We aimed to evaluate the efficacy of reinforcing short-segment pedicle screw fixation with polymethyl methacrylate (PMMA) vertebroplasty in patients with thoracolumbar burst fractures. METHODS: We enrolled 70 patients with thoracolumbar burst fractures for treatment with short-segment pedicle screw fixation. Fractures in Group A (n = 20) were reinforced with PMMA vertebroplasty during surgery. Group B patients (n = 50) were not treated with PMMA vertebroplasty. Kyphotic deformity, anterior vertebral height, instrument failure rates, and neurological function outcomes were compared between the two groups. RESULTS: Kyphosis correction was achieved in Group A (PMMA vertebroplasty) and Group B (Group A, 6.4 degrees; Group B, 5.4 degrees). At the end of the follow-up period, kyphosis correction was maintained in Group A but lost in Group B (Group A, 0.33-degree loss; Group B, 6.20-degree loss) (P = 0.0001). After surgery, greater anterior vertebral height was achieved in Group A than in Group B (Group A, 12.9%; Group B, 2.3%) (P < 0.001). During follow-up, anterior vertebral height was maintained only in Group A (Group A, 0.13 ± 4.06%; Group B, -6.17 ± 1.21%) (P < 0.001). Patients in both Groups A and B demonstrated good postoperative Denis Pain Scale grades (P1 and P2), but Group A had better results than Group B in terms of the control of severe and constant pain (P4 and P5) (P < 0.001). The Frankel Performance Scale scores increased by nearly 1 in both Groups A and B. Group B was subdivided into Group B1 and B2. Group B1 consisted of patients who experienced instrument failure, including screw pullout, breakage, disconnection, and dislodgement (n = 11). Group B2 comprised patients from Group B who did not experience instrument failure (n = 39). There were no instrument failures among patients in Group A. Preoperative kyphotic deformity was greater in Group B1 (23.5 ± 7.9 degrees) than in Group B2 (16.8 ± 8.40 degrees), P < 0.05. Severe and constant pain (P4 and P5) was noted in 36% of Group B1 patients (P < 0.001), and three of these patients required removal of their implants. CONCLUSION: Reinforcement of short-segment pedicle fixation with PMMA vertebroplasty for the treatment of patients with thoracolumbar burst fracture may achieve and maintain kyphosis correction, and it may also increase and maintain anterior vertebral height. Good Denis Pain Scale grades and improvement in Frankel Performance Scale scores were found in patients without instrument failure (Groups A and B2). Patients with greater preoperative kyphotic deformity had a higher risk of instrument failure if they did not undergo reinforcement with vertebroplasty. PMMA vertebroplasty offers immediate spinal stability in patients with thoracolumbar burst fractures, decreases the instrument failure rate, and provides better postoperative pain control than without vertebroplasty.

Original languageEnglish
Pages (from-to)1354-1361
Number of pages8
JournalNeurosurgery
Volume53
Issue number6
StatePublished - Dec 1 2003
Externally publishedYes

Fingerprint

Vertebroplasty
Polymethyl Methacrylate
Kyphosis
Therapeutics
Postoperative Pain
Pain
Pedicle Screws

Keywords

  • Anterior vertebral height
  • Instrument failure
  • Kyphotic deformity
  • Pedicle screw
  • Polymethyl methacrylate
  • Short segment
  • Thoracolumbar burst fracture
  • Vertebroplasty

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Cho, D. Y., Lee, W. Y., Sheu, P. C., Sonntag, V. K. H., Hitchon, P. W., Cooper, P. R., ... Hadley, M. N. (2003). Treatment of Thoracolumbar Burst Fractures with Polymethyl Methacrylate Vertebroplasty and Short-segment Pedicle Screw Fixation. Neurosurgery, 53(6), 1354-1361.

Treatment of Thoracolumbar Burst Fractures with Polymethyl Methacrylate Vertebroplasty and Short-segment Pedicle Screw Fixation. / Cho, Der Yang; Lee, Wuen Yen; Sheu, Pon Chun; Sonntag, Volker K H; Hitchon, Patrick W.; Cooper, Paul R.; Wang, Michael Y.; Hadley, Mark N.

In: Neurosurgery, Vol. 53, No. 6, 01.12.2003, p. 1354-1361.

Research output: Contribution to journalArticle

Cho, DY, Lee, WY, Sheu, PC, Sonntag, VKH, Hitchon, PW, Cooper, PR, Wang, MY & Hadley, MN 2003, 'Treatment of Thoracolumbar Burst Fractures with Polymethyl Methacrylate Vertebroplasty and Short-segment Pedicle Screw Fixation', Neurosurgery, vol. 53, no. 6, pp. 1354-1361.
Cho DY, Lee WY, Sheu PC, Sonntag VKH, Hitchon PW, Cooper PR et al. Treatment of Thoracolumbar Burst Fractures with Polymethyl Methacrylate Vertebroplasty and Short-segment Pedicle Screw Fixation. Neurosurgery. 2003 Dec 1;53(6):1354-1361.
Cho, Der Yang ; Lee, Wuen Yen ; Sheu, Pon Chun ; Sonntag, Volker K H ; Hitchon, Patrick W. ; Cooper, Paul R. ; Wang, Michael Y. ; Hadley, Mark N. / Treatment of Thoracolumbar Burst Fractures with Polymethyl Methacrylate Vertebroplasty and Short-segment Pedicle Screw Fixation. In: Neurosurgery. 2003 ; Vol. 53, No. 6. pp. 1354-1361.
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abstract = "OBJECTIVES: We aimed to evaluate the efficacy of reinforcing short-segment pedicle screw fixation with polymethyl methacrylate (PMMA) vertebroplasty in patients with thoracolumbar burst fractures. METHODS: We enrolled 70 patients with thoracolumbar burst fractures for treatment with short-segment pedicle screw fixation. Fractures in Group A (n = 20) were reinforced with PMMA vertebroplasty during surgery. Group B patients (n = 50) were not treated with PMMA vertebroplasty. Kyphotic deformity, anterior vertebral height, instrument failure rates, and neurological function outcomes were compared between the two groups. RESULTS: Kyphosis correction was achieved in Group A (PMMA vertebroplasty) and Group B (Group A, 6.4 degrees; Group B, 5.4 degrees). At the end of the follow-up period, kyphosis correction was maintained in Group A but lost in Group B (Group A, 0.33-degree loss; Group B, 6.20-degree loss) (P = 0.0001). After surgery, greater anterior vertebral height was achieved in Group A than in Group B (Group A, 12.9{\%}; Group B, 2.3{\%}) (P < 0.001). During follow-up, anterior vertebral height was maintained only in Group A (Group A, 0.13 ± 4.06{\%}; Group B, -6.17 ± 1.21{\%}) (P < 0.001). Patients in both Groups A and B demonstrated good postoperative Denis Pain Scale grades (P1 and P2), but Group A had better results than Group B in terms of the control of severe and constant pain (P4 and P5) (P < 0.001). The Frankel Performance Scale scores increased by nearly 1 in both Groups A and B. Group B was subdivided into Group B1 and B2. Group B1 consisted of patients who experienced instrument failure, including screw pullout, breakage, disconnection, and dislodgement (n = 11). Group B2 comprised patients from Group B who did not experience instrument failure (n = 39). There were no instrument failures among patients in Group A. Preoperative kyphotic deformity was greater in Group B1 (23.5 ± 7.9 degrees) than in Group B2 (16.8 ± 8.40 degrees), P < 0.05. Severe and constant pain (P4 and P5) was noted in 36{\%} of Group B1 patients (P < 0.001), and three of these patients required removal of their implants. CONCLUSION: Reinforcement of short-segment pedicle fixation with PMMA vertebroplasty for the treatment of patients with thoracolumbar burst fracture may achieve and maintain kyphosis correction, and it may also increase and maintain anterior vertebral height. Good Denis Pain Scale grades and improvement in Frankel Performance Scale scores were found in patients without instrument failure (Groups A and B2). Patients with greater preoperative kyphotic deformity had a higher risk of instrument failure if they did not undergo reinforcement with vertebroplasty. PMMA vertebroplasty offers immediate spinal stability in patients with thoracolumbar burst fractures, decreases the instrument failure rate, and provides better postoperative pain control than without vertebroplasty.",
keywords = "Anterior vertebral height, Instrument failure, Kyphotic deformity, Pedicle screw, Polymethyl methacrylate, Short segment, Thoracolumbar burst fracture, Vertebroplasty",
author = "Cho, {Der Yang} and Lee, {Wuen Yen} and Sheu, {Pon Chun} and Sonntag, {Volker K H} and Hitchon, {Patrick W.} and Cooper, {Paul R.} and Wang, {Michael Y.} and Hadley, {Mark N.}",
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TY - JOUR

T1 - Treatment of Thoracolumbar Burst Fractures with Polymethyl Methacrylate Vertebroplasty and Short-segment Pedicle Screw Fixation

AU - Cho, Der Yang

AU - Lee, Wuen Yen

AU - Sheu, Pon Chun

AU - Sonntag, Volker K H

AU - Hitchon, Patrick W.

AU - Cooper, Paul R.

AU - Wang, Michael Y.

AU - Hadley, Mark N.

PY - 2003/12/1

Y1 - 2003/12/1

N2 - OBJECTIVES: We aimed to evaluate the efficacy of reinforcing short-segment pedicle screw fixation with polymethyl methacrylate (PMMA) vertebroplasty in patients with thoracolumbar burst fractures. METHODS: We enrolled 70 patients with thoracolumbar burst fractures for treatment with short-segment pedicle screw fixation. Fractures in Group A (n = 20) were reinforced with PMMA vertebroplasty during surgery. Group B patients (n = 50) were not treated with PMMA vertebroplasty. Kyphotic deformity, anterior vertebral height, instrument failure rates, and neurological function outcomes were compared between the two groups. RESULTS: Kyphosis correction was achieved in Group A (PMMA vertebroplasty) and Group B (Group A, 6.4 degrees; Group B, 5.4 degrees). At the end of the follow-up period, kyphosis correction was maintained in Group A but lost in Group B (Group A, 0.33-degree loss; Group B, 6.20-degree loss) (P = 0.0001). After surgery, greater anterior vertebral height was achieved in Group A than in Group B (Group A, 12.9%; Group B, 2.3%) (P < 0.001). During follow-up, anterior vertebral height was maintained only in Group A (Group A, 0.13 ± 4.06%; Group B, -6.17 ± 1.21%) (P < 0.001). Patients in both Groups A and B demonstrated good postoperative Denis Pain Scale grades (P1 and P2), but Group A had better results than Group B in terms of the control of severe and constant pain (P4 and P5) (P < 0.001). The Frankel Performance Scale scores increased by nearly 1 in both Groups A and B. Group B was subdivided into Group B1 and B2. Group B1 consisted of patients who experienced instrument failure, including screw pullout, breakage, disconnection, and dislodgement (n = 11). Group B2 comprised patients from Group B who did not experience instrument failure (n = 39). There were no instrument failures among patients in Group A. Preoperative kyphotic deformity was greater in Group B1 (23.5 ± 7.9 degrees) than in Group B2 (16.8 ± 8.40 degrees), P < 0.05. Severe and constant pain (P4 and P5) was noted in 36% of Group B1 patients (P < 0.001), and three of these patients required removal of their implants. CONCLUSION: Reinforcement of short-segment pedicle fixation with PMMA vertebroplasty for the treatment of patients with thoracolumbar burst fracture may achieve and maintain kyphosis correction, and it may also increase and maintain anterior vertebral height. Good Denis Pain Scale grades and improvement in Frankel Performance Scale scores were found in patients without instrument failure (Groups A and B2). Patients with greater preoperative kyphotic deformity had a higher risk of instrument failure if they did not undergo reinforcement with vertebroplasty. PMMA vertebroplasty offers immediate spinal stability in patients with thoracolumbar burst fractures, decreases the instrument failure rate, and provides better postoperative pain control than without vertebroplasty.

AB - OBJECTIVES: We aimed to evaluate the efficacy of reinforcing short-segment pedicle screw fixation with polymethyl methacrylate (PMMA) vertebroplasty in patients with thoracolumbar burst fractures. METHODS: We enrolled 70 patients with thoracolumbar burst fractures for treatment with short-segment pedicle screw fixation. Fractures in Group A (n = 20) were reinforced with PMMA vertebroplasty during surgery. Group B patients (n = 50) were not treated with PMMA vertebroplasty. Kyphotic deformity, anterior vertebral height, instrument failure rates, and neurological function outcomes were compared between the two groups. RESULTS: Kyphosis correction was achieved in Group A (PMMA vertebroplasty) and Group B (Group A, 6.4 degrees; Group B, 5.4 degrees). At the end of the follow-up period, kyphosis correction was maintained in Group A but lost in Group B (Group A, 0.33-degree loss; Group B, 6.20-degree loss) (P = 0.0001). After surgery, greater anterior vertebral height was achieved in Group A than in Group B (Group A, 12.9%; Group B, 2.3%) (P < 0.001). During follow-up, anterior vertebral height was maintained only in Group A (Group A, 0.13 ± 4.06%; Group B, -6.17 ± 1.21%) (P < 0.001). Patients in both Groups A and B demonstrated good postoperative Denis Pain Scale grades (P1 and P2), but Group A had better results than Group B in terms of the control of severe and constant pain (P4 and P5) (P < 0.001). The Frankel Performance Scale scores increased by nearly 1 in both Groups A and B. Group B was subdivided into Group B1 and B2. Group B1 consisted of patients who experienced instrument failure, including screw pullout, breakage, disconnection, and dislodgement (n = 11). Group B2 comprised patients from Group B who did not experience instrument failure (n = 39). There were no instrument failures among patients in Group A. Preoperative kyphotic deformity was greater in Group B1 (23.5 ± 7.9 degrees) than in Group B2 (16.8 ± 8.40 degrees), P < 0.05. Severe and constant pain (P4 and P5) was noted in 36% of Group B1 patients (P < 0.001), and three of these patients required removal of their implants. CONCLUSION: Reinforcement of short-segment pedicle fixation with PMMA vertebroplasty for the treatment of patients with thoracolumbar burst fracture may achieve and maintain kyphosis correction, and it may also increase and maintain anterior vertebral height. Good Denis Pain Scale grades and improvement in Frankel Performance Scale scores were found in patients without instrument failure (Groups A and B2). Patients with greater preoperative kyphotic deformity had a higher risk of instrument failure if they did not undergo reinforcement with vertebroplasty. PMMA vertebroplasty offers immediate spinal stability in patients with thoracolumbar burst fractures, decreases the instrument failure rate, and provides better postoperative pain control than without vertebroplasty.

KW - Anterior vertebral height

KW - Instrument failure

KW - Kyphotic deformity

KW - Pedicle screw

KW - Polymethyl methacrylate

KW - Short segment

KW - Thoracolumbar burst fracture

KW - Vertebroplasty

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