Pedicle screw fixation with translaminar facet joint screws for the treatment of thoracolumbar fracture

摘要

Objective: To evaluate the efficacy of Cotrel-Dubeusset ( CD ) instrumentation combined with translaminar facet joint screw (TLS) in the treatment of thoracolumbar fracture. Methods: A total of six L_2-L_4 spines were used to establish unstable fracture model with three-dimensional range of motion ( ROM) of the spines measured. Fixation with CD and fixation with CD combined with translaminar facet joint screw were achieved to compare their stability. Thirty cases of thoracolumbar fracture, in whom the anterior edge of vertebral body was compressed to 59 % and the posterior edge compressed to 88 %, were treated by pedicle screw fixation combined with TLS. Among them, 19 received posterolateral or anterior-posterior bone grafting Results: There was significant difference in ROM between the two techniques except that in extension. In Group CD + TLS, ROM was 5.38% lower, lateral bending 4.91% lower and axial rotation 11.85% lower than those in Group CD respectively. In the clinical group, the average anterior edge restored to 97% and posterior edge to 98%. The duration of follow-up was 5-24 months ( mean, 10 months). The rate of correction loss on the anterior edge was 4.5%. Among the 19 cases of bone grafting, all of them achieved bony fusion (mean fusion time, 4.3 month) with a correction loss rate of 3.4%. Conclusions: In the treatment of thoracolumbar fracture, pedicle screw fixation combined with TLS can strengthen the stability of pedicle screws, especially anti-rotation stability and enhance fusion rate and reduce correction loss.