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Orthopaedic Surgery Spine
Figure 4: Vertebral Kyphosis and Corrected Regional Angulation Table 1: Evolution of Vertebral Kyphosis (degrees)
Evolution at Different Stages of Treatment – Admission,
Post-operative, Device Removal and Follow-up
Admission Post-operative Removal Follow-up
Mean 18 1 2 2
Degrees
Maximum 30 7 6 18
20
Minimum 7 -3 0 0
Standard deviation 5 2 2 4
15
Table 2: Evolution of Corrected Regional Angulation (degrees)
10
Admission Post-operative Removal Follow-up
Mean 11 -4 3 6
5
Maximum 24 22 19 23
Minimum -3 -13 -7 -7
Standard deviation 7 6 8 9
0
Table 3: Evolution of Percentage of Vertebral Body
-5
Admission Post-operative Removal Follow-up Compression (%)
Mean VK Mean CRA
Admission Post-operative Removal Follow-up
VK = vertebral kyphosis; CRA = corrected regional angulation.
Mean anterior
compression 37 1 5 5
Mean medial
Figure 5: Evolution of the Percentage of Anterior, Medial and
compression 6 4 6
Posterior Vertebral Body Compression
Mean posterior
compression 5 1 1 1
Compression (%)
0.5
increase in kyphosis. As expected, a greater loss of regional angulation
was observed when the posterior arch ligaments were destroyed in the
0.4
five patients with type B1 fractures. We therefore retrospectively checked
0.3
the interspinous spaces for any missed type B fractures, but found none.
0.2
Oner et al. performed magnetic resonance imaging (MRI) on discs in
thoracolumbar fractures and correlated reduction loss in kyphosis to lack of
0.1
endplate reduction.
12
For these authors, disc changes were a consequence
of the destruction of the vertebral central plateau, not of primitive disc
-0.0 disruption. However, microvascular anastomosis of the bony endplate
could be destroyed at the time of trauma. Even if the macroscopic quality
-0.1
of endplate reduction seems to be good, the delicate interstitial nutritive
Admission Post-operative Removal Follow-up
flow of the disc may have been disrupted by injury, and some of the
Mean AC Mean MC Mean PC
post-trauma sclerosis could be due to such microvascular modifications.
AC = anterior compression; MC = medial compression; PC = posterior compression.
You may notice the large reduction in the anterior and medial parts, which is retained at follow-up.
Conclusion
Vertebral heights are also notably stable with our technique. Therefore, The addition of cement to thoracolumbar burst fractures marks a step
lesional screws seem to be a valuable tool for keeping the central plateau towards full reconstruction of the vertebra, and could be used for
pushed up until the bone cement crystallises. These screws could overcome percutaneous techniques of reduction, instrumentation and
one of the significant drawbacks of kyphoplasty that occurs after deflation reconstruction of unstable fractures.
13
Lesional screws could be used in
of the balloon: partial loss of the achieved reduction of the plateau, which conjunction with cement, securing the reduction while the cement
can allow the disc to drop back into the vertebral body. hardens in order to maintain the maximum possible reduction. Although
injury induces well-known corporeal lesions, it is also probable that
However, negative results were also observed for CRA, with a reduction microvascular lesions affect disc nutrition and could be involved in the
loss of up to -9º at follow-up. There were some changes in the discs and final angulation prognosis. Thus, posterolateral graft or anterior
in the soft tissues between the vertebrae – posterolateral grafting was intervertebral fusions remain the only methods of preventing regional
not performed in this series, and consequently the intervertebral spaces angulation reduction loss once the vertebral body reconstruction has
between the discs would narrow; as a result, regional angulation would been managed by ligamentotaxis, instrumentation and cement. ■
1. Parker JW, et al., Spine, 2000;25(9):1157–70. 6. Verlaan JJ, et al., Spine, 2002;1;27(5):543–8. lésions traumatiques récentes du rachis, Montpellier: Sauramps
2. de Peretti F, et al., Eur Spine J, 1996;5(2):112–20. 7. Magerl F, et al., Eur Spine, 1994;3:184–201. Médical Ed, 1997;229–64.
3. Dick W, et al., Paraplegia, 1985;23(4):225–32. 8. Stagnara P, et al., Spine, 1982;7(4):335–42. 11. Siebenga J, et al., Spine, 2006;31(25):2881–90.
4. Kuner EH, et al., J Bone Joint Surg Br, 1994;76(1):107–12. 9. Verlaan JJ, et al., Spine, 2005;30(3):E73–9. 12. Oner FC, et al., Spine, 2002;27(6):629–36.
5. Daniaux H, Unfallchirurg, 1986;89(5):197–213. 10. Ramaré S, et al. In: Saillant G, et al. (eds), Traitement des 13. Fuentes S, et al., Neurochirurgie, 2007;53(4):272–6.
82 EUROPEAN MUSCULOSKELETAL REVIEW 2007
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