Treatment Of Thoracolumbar Burst Fractures Using Combined Pedicle Screw-Laminar Hook Fixation

Abstract

Objective: The aim of this study was to evaluate the mid-term outcome of pedicle screw-laminar hook (PS-LH) fixation in the surgical treatment of thoracolumbar burst fractures. Methods: Nineteen patients (12 male, 7 female; mean age: 34.4 years, range: 19 to 57 years) with thoracolumbar burst fractures treated using PS-LH between 1996 and 2006 were evaluated. The 17 patients (11 Male, 6 female) who had a minimum of 2 years follow-up were included in the study. Radiographic outcome was evaluated by measuring the local kyphosis angle (LKA) and anterior vertebral height (AVH). Mean follow-up was 81 (range: 38 to 122) months and 15 patients completed more than 5 years of follow-up. Results: Preoperative vertebral height loss and LKA of 41.2% (range: 29% to 64%) and 16.8 degrees (range: 5 degrees to 36 degrees), respectively, were corrected to 16.3% (range: 0% to 44%) and -1.2 degrees (range: -17 degrees to 10 degrees), respectively, after the operation. Mean losses of correction for vertebral height and local kyphosis were 1.8 +/- 7.9% and 4.3 +/- 7.1 degrees, respectively, at the 2-year follow-up and -1.8 +/- 4.5% and 0.5 +/- 1.5 degrees, respectively, between 2 years and 5 years. Loss of correction was significant for the LKA (p=0.023) but not for vertebral height (p=0.360). Five patients had losses of correction of more than 5 degrees. Changes between 2 and 5 years were not significant for vertebral height loss and local kyphosis (p=0.147 and p=0.205, respectively) and remained improved when compared with the preoperative values (p < 0.001). Average SF-36 scores of the 15 patients evaluated at the final follow-up were comparable with the general Turkish population. Conclusion: The PS-LH construct provided a significant correction of the local kyphotic deformity. Augmentation of the upper and lower pedicle screw by the sublaminar hook did not completely prevent correction loss but was found to stabilize at the 5th year of follow-up without any clinical problems.