Short-term Percutaneous Pedicle Screw Stabilization With out Fusion of Adolescent Thoracolumbar Backbone Fractures.
J Pediatr Orthop. 2016 Oct-Nov;36(7):701-Eight
Authors: Cui S, Busel GA, Puryear AS
BACKGROUND: Pediatric backbone trauma typically outcomes from high-energy mechanisms. Regardless of variations in therapeutic potential, comorbidities, and size of remaining life, therapy is ceaselessly primarily based on grownup standards; ligamentous accidents are fused and bony accidents are handled accordingly. On this research, we current short-term outcomes of a choose group of adolescent sufferers handled utilizing percutaneous pedicle screw instrumentation with out fusion.
METHODS: An IRB-approved retrospective evaluation was carried out at a degree 1 pediatric trauma heart for thoracolumbar backbone fractures handled by percutaneous pedicle screw instrumentation. Sufferers had been excluded if arthrodesis was carried out or if instrumentation was not eliminated. Demographics, damage mechanism, related accidents, fracture classification, surgical knowledge, radiographic measures, and issues had been collected. Radiographs had been analyzed for sagittal and coronal wedge angles and vertebral physique top ratio and statistical comparisons carried out on preoperative and postoperative values.
RESULTS: Between 2005 and 2013, 46 sufferers had been handled surgically. Fourteen sufferers (5 male, 9 feminine) met inclusion standards. Harm mechanisms included Eight motorized vehicle collisions, four falls, and a pair of all-terrain car/motorbike collisions. There have been Eight Magerl kind A accidents, four kind B accidents, and a pair of kind C accidents. There was 1 incomplete spinal wire damage. Implants had been eliminated between 5 and 12 months in 12 sufferers and after 12 months in 2 sufferers. Statistical evaluation revealed vital postoperative enchancment in all radiographic measures (P<zero.05). There have been no neurological issues, 1 superficial wound dehiscence, and a pair of instrumentation failures (handled with normal removing). Eventually follow-up, 11 sufferers returned to unrestricted actions together with sports activities. Common follow-up was 9 months after implant removing and 19.Three months after index process.
CONCLUSIONS: Adolescent thoracolumbar fractures current distinctive challenges and therapy alternatives completely different from the grownup affected person. We current a nonconsecutive collection of 14 sufferers quickly stabilized with percutaneous pedicle screw fixation for accidents together with Three-column fracture dislocations and purely ligamentous accidents. Short-term fusionless instrumentation can present profitable administration of choose thoracolumbar backbone accidents in pediatric trauma sufferers.
LEVEL OF EVIDENCE: Stage IV-Retrospective case collection.
PMID: 27603096 [PubMed – indexed for MEDLINE]