Anterior column reconstruction with mono-segmental fusion and lag screw fixation of sagittal split for burst-split fracture of the thoracolumbar spine.
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| Title: | Anterior column reconstruction with mono-segmental fusion and lag screw fixation of sagittal split for burst-split fracture of the thoracolumbar spine. |
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| Authors: | Benneker LM; Orthopädie Sonnenhof, Bern, Switzerland., Despotidis V; Department of Orthopaedic Surgery and Traumatology, Bern University Hospital, University of Bern, Bern, Switzerland., Wangler S; Department of Orthopaedic Surgery and Traumatology, Bern University Hospital, University of Bern, Bern, Switzerland., Keel MJB; Trauma Center Hirslanden, Clinic Hirslanden Zürich, Medical School University of Zürich, Zürich, Switzerland., Deml MC; Department of Orthopaedic Surgery and Traumatology, Bern University Hospital, University of Bern, Bern, Switzerland., Gewiess J; Department of Orthopaedic Surgery and Traumatology, Bern University Hospital, University of Bern, Bern, Switzerland. jan.gewiess@insel.ch., Albers CE; Department of Orthopaedic Surgery and Traumatology, Bern University Hospital, University of Bern, Bern, Switzerland. |
| Source: | European journal of trauma and emergency surgery : official publication of the European Trauma Society [Eur J Trauma Emerg Surg] 2025 Nov 25; Vol. 51 (1), pp. 349. Date of Electronic Publication: 2025 Nov 25. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Springer Heidelberg Country of Publication: Germany NLM ID: 101313350 Publication Model: Electronic Cited Medium: Internet ISSN: 1863-9941 (Electronic) Linking ISSN: 18639933 NLM ISO Abbreviation: Eur J Trauma Emerg Surg Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2011- : Heidelberg : Springer Heidelberg Original Publication: Munich : Urban & Vogel, 2007- |
| MeSH Terms: | Thoracic Vertebrae*/injuries , Thoracic Vertebrae*/surgery , Thoracic Vertebrae*/diagnostic imaging , Spinal Fractures*/surgery , Spinal Fractures*/diagnostic imaging , Lumbar Vertebrae*/injuries , Lumbar Vertebrae*/surgery , Lumbar Vertebrae*/diagnostic imaging , Spinal Fusion*/methods , Spinal Fusion*/instrumentation , Bone Screws* , Fracture Fixation, Internal*/methods , Fracture Fixation, Internal*/instrumentation, Humans ; Male ; Female ; Adult ; Treatment Outcome ; Young Adult ; Middle Aged ; Retrospective Studies ; Adolescent |
| Abstract: | Competing Interests: Declarations. Ethical approval: This study was conducted in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Ethical approval for this research was obtained from the local ethics committee, reference number 2020-02976. Clinical trial number: Not applicable. Competing interests: The authors declare no competing interests. Objectives: To present and evaluate the safety and efficacy of our new procedure for treating thoracolumbar burst-split fractures without neurological injury. Methods: Our new surgical technique for the treatment of thoracolumbar burst-split fractures (AO type A4, Magerl classification A3.2.1) involving (1) posterior reduction and bisegmental instrumention, (2) anterior screw fixation of the caudal sagittal split, (3) anterior one-level fusion of the cranial segment, and (4) interval posterior implant removal was presented. In an initial cohort of patients, demographic information, surgical specifics and imaging data were evaluated. Results: Twenty-one patients (mean age 29.5 ± 11.8 years, 38% male, mean follow-up 36 ± 14 months) were included. Anterior column reconstruction involving sagittal split lag screw and monosegmental fusion was performed at a mean of 2.9 ± 2 days after posterior instrumentation. All fractures healed. There were no occurrences of implant failures or migrations. None of the patients required revision surgery. The removal of the temporary posterior instrumentation was performed at a mean of 8.4 ± 1.8 months after the initial surgery. Bisegmental, superior monosegmental, and inferior monosegmental kyphosis angle did not significantly change from six months to 12 months postoperatively after removal of the posterior instrumentation (p > 0.9). No listhesis or change in bisegmental scoliosis angle were observed. The inferior monosegmental angle was significantly greater in flexion (1.2° ± 5.8°) compared to extension (-3.3° ± 6°) at 12 months postoperatively indicating motion in the inferior, non-fused segment after removal of the posterior instrumentation (p = 0.0001). The intervertebral disc height at the temporarily fused segment decreased significantly from six (9.2 ± 2.2) to 12 months postoperatively (8.3 ± 2.2; p < 0.0101). Conclusion: Thoracolumbar burst-split fractures can be safely and successfully treated through a treatment protocol that includes (1) posterior reduction and bisegmental instrumention, (2) anterior screw fixation of the caudal sagittal split, (3) anterior one-level fusion of the cranial segment, and (4) interval posterior implant removal. This new surgical technique promotes reliable fracture healing, kyphosis correction and preserves the physiological motion at the caudal segment. (© 2025. The Author(s).) |
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| Contributed Indexing: | Keywords: Burst fracture; Lag screw; Spine; Surgical technique; Thoracolumbar |
| Entry Date(s): | Date Created: 20251125 Date Completed: 20251125 Latest Revision: 20251128 |
| Update Code: | 20251128 |
| PubMed Central ID: | PMC12647322 |
| DOI: | 10.1007/s00068-025-03018-y |
| PMID: | 41288731 |
| Database: | MEDLINE |
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Nájsť tento článok vo Web of Science | Abstract: | Competing Interests: Declarations. Ethical approval: This study was conducted in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Ethical approval for this research was obtained from the local ethics committee, reference number 2020-02976. Clinical trial number: Not applicable. Competing interests: The authors declare no competing interests.<br />Objectives: To present and evaluate the safety and efficacy of our new procedure for treating thoracolumbar burst-split fractures without neurological injury.<br />Methods: Our new surgical technique for the treatment of thoracolumbar burst-split fractures (AO type A4, Magerl classification A3.2.1) involving (1) posterior reduction and bisegmental instrumention, (2) anterior screw fixation of the caudal sagittal split, (3) anterior one-level fusion of the cranial segment, and (4) interval posterior implant removal was presented. In an initial cohort of patients, demographic information, surgical specifics and imaging data were evaluated.<br />Results: Twenty-one patients (mean age 29.5 ± 11.8 years, 38% male, mean follow-up 36 ± 14 months) were included. Anterior column reconstruction involving sagittal split lag screw and monosegmental fusion was performed at a mean of 2.9 ± 2 days after posterior instrumentation. All fractures healed. There were no occurrences of implant failures or migrations. None of the patients required revision surgery. The removal of the temporary posterior instrumentation was performed at a mean of 8.4 ± 1.8 months after the initial surgery. Bisegmental, superior monosegmental, and inferior monosegmental kyphosis angle did not significantly change from six months to 12 months postoperatively after removal of the posterior instrumentation (p > 0.9). No listhesis or change in bisegmental scoliosis angle were observed. The inferior monosegmental angle was significantly greater in flexion (1.2° ± 5.8°) compared to extension (-3.3° ± 6°) at 12 months postoperatively indicating motion in the inferior, non-fused segment after removal of the posterior instrumentation (p = 0.0001). The intervertebral disc height at the temporarily fused segment decreased significantly from six (9.2 ± 2.2) to 12 months postoperatively (8.3 ± 2.2; p < 0.0101).<br />Conclusion: Thoracolumbar burst-split fractures can be safely and successfully treated through a treatment protocol that includes (1) posterior reduction and bisegmental instrumention, (2) anterior screw fixation of the caudal sagittal split, (3) anterior one-level fusion of the cranial segment, and (4) interval posterior implant removal. This new surgical technique promotes reliable fracture healing, kyphosis correction and preserves the physiological motion at the caudal segment.<br /> (© 2025. The Author(s).) |
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| ISSN: | 1863-9941 |
| DOI: | 10.1007/s00068-025-03018-y |