Effectiveness of sagittal top compression reduction technique in treatment of thoracolumbar vertebral fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

JI Piyao , JIANG Huanyu ^△ ,  ZHOU Yan , MING Jianghua , CHEN Qing , DENG Ming , LI Yaming , MA Yonggang , LIU Shiqing

Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan Hubei, 430060, P. R. China;

Corresponding author：

ZHOU Yan, Email: yanzhou0827@163.com

Keywords：

Thoracolumbar vertebral fracture; injured vertebra; top compression reduction technique

DOI：

10.7507/1002-1892.202306020

Video：

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Objective To investigate the effectiveness of sagittal top compression reduction technique in the treatment of thoracolumbar vertebral fractures. Methods A retrospective analysis was conducted on the clinical data of 59 patients with thoracolumbar vertebral fractures who met the selection criteria and were admitted between November 2018 and January 2022. Among them, 34 patients were treated with sagittal top compression reduction technique (top pressure group), and 25 patients were treated with traditional reduction technique (traditional group). There was no significant difference in baseline data between the two groups (P>0.05), including gender, age, fracture segment, cause of injury, AO classification of thoracolumbar vertebral fractures, thoracolumbar injury classification and severity (TLICS) score, American Spinal Injury Association (ASIA) grading, surgical approach, preoperative vertebral body index, height ratio of the anterior margin of injured vertebra, injured vertebra angle, segmental kyphosis angle, visual analogue scale (VAS) score, and Oswestry disability index (ODI). The operation time, intraoperative blood loss, and incidence of complications between the two groups were recorded and compared. After operation, VAS score and ODI were used to evaluate effectiveness, and X-ray and CT examinations were performed to measure imaging indicators such as vertebral body index, height ratio of the anterior margin of injured vertebra, injured vertebra angle, and segmental kyphosis angle. Results There was no significant difference in operation time and intraoperative blood loss between the two groups (P>0.05). No complication such as dural sac, nerve root, or vascular injury was found during operation, and all incisions healed by first intention. Patients in both groups were followed up 6-48 months, with an average of 20.6 months. No loosening, breakage, or failure of internal fixation occurred during follow-up. The imaging indicators, VAS score, and ODI of the two groups significantly improved at 1 week and last follow-up when compared to preoperative ones (P<0.05). At last follow-up, the VAS score and ODI further significantly improved when compared to 1 week after operation (P<0.05). At 1 week after operation and last follow-up, the vertebral body index, segmental kyphosis angle, injured vertebra angle, and ODI in the top pressure group were significantly better than those in the traditional group (P<0.05). There was no significant difference in VAS score and height ratio of the anterior margin of injured vertebra between the two groups at 1 week after operation (P>0.05), but the two indicators in the top pressure group were significantly better than those in the traditional group at last follow-up (P<0.05). Conclusion The treatment of thoracolumbar vertebral fractures with sagittal top compression reduction technique can significantly improve the quality of vertebral reduction, and is superior to traditional reduction techniques in relieving pain and improving spinal function.

Citation： JI Piyao, JIANG Huanyu, ZHOU Yan, MING Jianghua, CHEN Qing, DENG Ming, LI Yaming, MA Yonggang, LIU Shiqing. Effectiveness of sagittal top compression reduction technique in treatment of thoracolumbar vertebral fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(10): 1246-1252. doi: 10.7507/1002-1892.202306020 Copy

1.	Hu C, Zhong W, Chen Z, et al. Comparison of the outcomes between AO type B2 thoracolumbar fracture with and without disc injury after posterior surgery. Orthop Surg, 2022, 14(9): 2119-2131.
2.	Waddell WH, Gupta R, Stephens BF. Thoracolumbar spine trauma. Orthop Clin North Am, 2021, 52(4): 481-489.
3.	Yin N, Du L, Pan M, et al. Minimally invasive technique of monoaxial percutaneous screws and instrumentational maneuvers in thoracolumbar and lumbar fractures. Injury, 2022, 53(12): 4028-4032.
4.	丰峰, 周炎, 瞿新丛, 等. 腰椎骨折AF系统内固定术后椎弓根钉断裂原因分析. 中国骨与关节损伤杂志, 2012, 27(5): 442-443.
5.	吴相阳, 杨卫保, 易谭勇, 等. 后路经椎弓根固定治疗胸腰椎骨折165例分析. 生物骨科材料与临床研究, 2014, 11(4): 62-64.
6.	郝正新, 张元智, 包金全, 等. 跨伤椎与经伤椎固定治疗胸腰椎爆裂性骨折的有限元分析. 生物骨科材料与临床研究, 2021, 18(6): 54-60.
7.	朱亮, 沈强, 丁浩, 等. 跨伤椎和经伤椎置钉固定治疗胸腰椎爆裂骨折的疗效比较. 临床骨科杂志, 2022, 25(3): 328-333.
8.	Trungu S, Ricciardi L, Forcato S, et al. Percutaneous pedicle screw fixation without arthrodesis of 368 thoracolumbar fractures: long-term clinical and radiological outcomes in a single institution. Eur Spine J, 2023, 32(1): 75-83.
9.	Vanek P, Bradac O, Konopkova R, et al. Treatment of thoracolumbar trauma by short-segment percutaneous transpedicular screw instrumentation: prospective comparative study with a minimum 2-year follow-up. J Neurosurg Spine, 2014, 20(2): 150-156.
10.	王彪, 陈建, 张海平, 等. 经皮自撑开复位螺钉系统治疗椎体高度严重丢失的胸腰椎骨折. 中华骨科杂志, 2019, 39(24): 1514-1522.
11.	阎崇楠, 王欢, 崔少千, 等. 后路前凸弯棒预加压复位固定技术治疗胸腰段不稳定性爆裂骨折. 中华骨科杂志, 2020, 40(15): 988-995.
12.	Vu C, Gendelberg D. Classifications in brief: AO thoracolumbar classification system. Clin Orthop Relat Res, 2020, 478(2): 434-440.
13.	Dauleac C, Mottolese C, Beuriat PA, et al. Superiority of thoracolumbar injury classification and severity score (TLICS) over AOSpine thoracolumbar spine injury classification for the surgical management decision of traumatic spine injury in the pediatric population. Eur Spine J, 2021, 30(10): 3036-3042.
14.	Kanna RM, Raja DC, Shetty AP, et al. Thoracolumbar fracture dislocations without spinal cord injury: Classification and principles of management. Global Spine J, 2021, 11(1): 63-70.
15.	Li Y, Feng X, Pan J, et al. Percutaneous vertebroplasty versus kyphoplasty for thoracolumbar osteoporotic vertebral compression fractures in patients with distant lumbosacral pain. Pain Physician, 2021, 24(3): E349-E356.
16.	Passias PG, Horn SR, Segreto FA, et al. ODI cannot account for all variation in PROMIS scores in patients with thoracolumbar disorders. Global Spine J, 2020, 10(4): 399-405.
17.	Costachescu B, Popescu CE, Iliescu BF. Analysis of the classification systems for thoracolumbar fractures in adults and their evolution and impact on clinical management. J Clin Med, 2022, 11(9): 2498.
18.	Su Q, Li C, Li Y, et al. Analysis and improvement of the three-column spinal theory. BMC Musculoskelet Disord, 2020, 21(1): 537.
19.	Xue X, Zhao S. Posterior monoaxial screw fixation combined with distraction-compression technology assisted endplate reduction for thoracolumbar burst fractures: a retrospective study. BMC Musculoskelet Disord, 2020, 21(1): 17.
20.	张刚刚, 李朋飞, 祁朝阳, 等. 伤椎植钉与撑开复位的先后次序对轻中度胸腰椎爆裂骨折手术疗效的影响. 中国修复重建外科杂志, 2022, 36(5): 600-608.
21.	Park B, Noh SH, Park JY. Reduction and monosegmental fusion for lumbar spondylolisthesis with a long tab percutaneous pedicle screw system: “swing” technique. Neurosurg Focus, 2019, 46(5): E11.
22.	Wu J, Liu YY, Jin HJ, et al. Fate of the intervertebral disc and analysis of its risk factors following high-energy traumatic thoracic and lumbar fractures: MRI results of minimum five years after injury. Eur Spine J, 2022, 31(6): 1468-1478.
23.	申科律, 计李超, 成茂华, 等. 胸腰椎骨折椎弓根螺钉内固定术后椎体高度再丢失的相关影响因素分析. 中华创伤杂志, 2021, 37(11): 990-996.
24.	贺宝荣, 郝定均. 胸腰段椎体骨折分型对手术入路选择的指导价值. 中华创伤杂志, 2017, 33(1): 10-12.
25.	Tanasansomboon T, Kittipibul T, Limthongkul W, et al. Thoracolumbar burst fracture without neurological deficit: Review of controversies and current evidence of treatment. World Neurosurg, 2022, 162: 29-35.
26.	Su Y, Ren D, Chen Y, et al. Effect of endplate reduction on endplate healing morphology and intervertebral disc degeneration in patients with thoracolumbar vertebral fracture. Eur Spine J, 2023, 32(1): 55-67.

1. Hu C, Zhong W, Chen Z, et al. Comparison of the outcomes between AO type B2 thoracolumbar fracture with and without disc injury after posterior surgery. Orthop Surg, 2022, 14(9): 2119-2131.
2. Waddell WH, Gupta R, Stephens BF. Thoracolumbar spine trauma. Orthop Clin North Am, 2021, 52(4): 481-489.
3. Yin N, Du L, Pan M, et al. Minimally invasive technique of monoaxial percutaneous screws and instrumentational maneuvers in thoracolumbar and lumbar fractures. Injury, 2022, 53(12): 4028-4032.
4. 丰峰, 周炎, 瞿新丛, 等. 腰椎骨折AF系统内固定术后椎弓根钉断裂原因分析. 中国骨与关节损伤杂志, 2012, 27(5): 442-443.
5. 吴相阳, 杨卫保, 易谭勇, 等. 后路经椎弓根固定治疗胸腰椎骨折165例分析. 生物骨科材料与临床研究, 2014, 11(4): 62-64.
6. 郝正新, 张元智, 包金全, 等. 跨伤椎与经伤椎固定治疗胸腰椎爆裂性骨折的有限元分析. 生物骨科材料与临床研究, 2021, 18(6): 54-60.
7. 朱亮, 沈强, 丁浩, 等. 跨伤椎和经伤椎置钉固定治疗胸腰椎爆裂骨折的疗效比较. 临床骨科杂志, 2022, 25(3): 328-333.
8. Trungu S, Ricciardi L, Forcato S, et al. Percutaneous pedicle screw fixation without arthrodesis of 368 thoracolumbar fractures: long-term clinical and radiological outcomes in a single institution. Eur Spine J, 2023, 32(1): 75-83.
9. Vanek P, Bradac O, Konopkova R, et al. Treatment of thoracolumbar trauma by short-segment percutaneous transpedicular screw instrumentation: prospective comparative study with a minimum 2-year follow-up. J Neurosurg Spine, 2014, 20(2): 150-156.
10. 王彪, 陈建, 张海平, 等. 经皮自撑开复位螺钉系统治疗椎体高度严重丢失的胸腰椎骨折. 中华骨科杂志, 2019, 39(24): 1514-1522.
11. 阎崇楠, 王欢, 崔少千, 等. 后路前凸弯棒预加压复位固定技术治疗胸腰段不稳定性爆裂骨折. 中华骨科杂志, 2020, 40(15): 988-995.
12. Vu C, Gendelberg D. Classifications in brief: AO thoracolumbar classification system. Clin Orthop Relat Res, 2020, 478(2): 434-440.
13. Dauleac C, Mottolese C, Beuriat PA, et al. Superiority of thoracolumbar injury classification and severity score (TLICS) over AOSpine thoracolumbar spine injury classification for the surgical management decision of traumatic spine injury in the pediatric population. Eur Spine J, 2021, 30(10): 3036-3042.
14. Kanna RM, Raja DC, Shetty AP, et al. Thoracolumbar fracture dislocations without spinal cord injury: Classification and principles of management. Global Spine J, 2021, 11(1): 63-70.
15. Li Y, Feng X, Pan J, et al. Percutaneous vertebroplasty versus kyphoplasty for thoracolumbar osteoporotic vertebral compression fractures in patients with distant lumbosacral pain. Pain Physician, 2021, 24(3): E349-E356.
16. Passias PG, Horn SR, Segreto FA, et al. ODI cannot account for all variation in PROMIS scores in patients with thoracolumbar disorders. Global Spine J, 2020, 10(4): 399-405.
17. Costachescu B, Popescu CE, Iliescu BF. Analysis of the classification systems for thoracolumbar fractures in adults and their evolution and impact on clinical management. J Clin Med, 2022, 11(9): 2498.
18. Su Q, Li C, Li Y, et al. Analysis and improvement of the three-column spinal theory. BMC Musculoskelet Disord, 2020, 21(1): 537.
19. Xue X, Zhao S. Posterior monoaxial screw fixation combined with distraction-compression technology assisted endplate reduction for thoracolumbar burst fractures: a retrospective study. BMC Musculoskelet Disord, 2020, 21(1): 17.
20. 张刚刚, 李朋飞, 祁朝阳, 等. 伤椎植钉与撑开复位的先后次序对轻中度胸腰椎爆裂骨折手术疗效的影响. 中国修复重建外科杂志, 2022, 36(5): 600-608.
21. Park B, Noh SH, Park JY. Reduction and monosegmental fusion for lumbar spondylolisthesis with a long tab percutaneous pedicle screw system: “swing” technique. Neurosurg Focus, 2019, 46(5): E11.
22. Wu J, Liu YY, Jin HJ, et al. Fate of the intervertebral disc and analysis of its risk factors following high-energy traumatic thoracic and lumbar fractures: MRI results of minimum five years after injury. Eur Spine J, 2022, 31(6): 1468-1478.
23. 申科律, 计李超, 成茂华, 等. 胸腰椎骨折椎弓根螺钉内固定术后椎体高度再丢失的相关影响因素分析. 中华创伤杂志, 2021, 37(11): 990-996.
24. 贺宝荣, 郝定均. 胸腰段椎体骨折分型对手术入路选择的指导价值. 中华创伤杂志, 2017, 33(1): 10-12.
25. Tanasansomboon T, Kittipibul T, Limthongkul W, et al. Thoracolumbar burst fracture without neurological deficit: Review of controversies and current evidence of treatment. World Neurosurg, 2022, 162: 29-35.
26. Su Y, Ren D, Chen Y, et al. Effect of endplate reduction on endplate healing morphology and intervertebral disc degeneration in patients with thoracolumbar vertebral fracture. Eur Spine J, 2023, 32(1): 55-67.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of sagittal top compression reduction technique in treatment of thoracolumbar vertebral fractures

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