Radiological And Clinical Results Of Minimal-laminectomy And Short-segment Pedicle Screw Fixation For Thoracolumbar Burst Fracture

Objective: To evaluate the treatment of minimal-laminectomy and short-segment pedicle screw fixation in thoracolumbar burst fracture by analyzing the anatomy and the bony structure reconstruction.Methods: The subject study was performed using protocols approved by institutional review board.We retrospectively analyzed 38 patients with single-level thoracolumbar burst fracture from January 2012 to September 2015.The radiographic data comprising percentage of the canal(?),anterior vertebra height(H),Beck's index(BI),Cobb angle(CA),vertebral wedge angle(VWA),load-sharing classification(LSC)score and the clinical data including,thoracolumbar injury classification,AISA classification were acquired,and we also used the MIMICS to measure the 3-dimensional reconstruction of the bone defect in the vertebra.Results: No patient was lost to follow-up evaluation.The LSC was(7.06±0.87)point.The preoperative,post-operative,3-months follow-up,final follow-up radiographic date were H(55.96±13.78)%,(99.52±4.92)%,(98.69±2.60)%,(96.68±4.70)%,BI(57.20±14.02)%,(91.67±5.95)%,(90.97±5.36)%,(89.48±6.73)%,C A(15.34±7.30)°,(2.10±6.38)°,(3.26±7.52)°,(6.02± 6.64),VWA(12.17±5.82)°,(2.61±1.69)°,(2.97±2.24)°,(3.59±2.74)°,Analysis of the data revealed: 1)significant difference in H,BI,CA,and VWA between pre-operation and post-operation or later follow-up(p<0.05),significant difference in H,BI and C A between post-operation and final follow-up(p<0.05),and significant difference in C A between 3-months follow-up and final follow-up.2)No significant difference in H,BI,CA,VWA between post-operation and 3-months follow-up(p>0.05).3-dimensional reconstruction of the bone defect in the vertebra based MIMICS:1 post-operative patient,8 patients in the final follow-up;The CT value of ROI was different from the normal region.According to the ASIA grading system,patients with incompletely neurological injury were improved by at least one grade.Conclusion: This study confirms that short-segment pedicle-screw-based fixation with the minimal-laminectomy approach achieves satisfactory curative effect in the treatment of thoracolumbar fracture with neurological deficits and justifies the use of MIMICS evaluating the bone defect in the thoracolumbar fractures.It can help the surgeon select short-segment pedicle-screw-based fixation using the minimal-laminectomy approach for those more comminuted thoracolumbar fractures with high LSC scores.