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Usefulness of Percutaneous Pedicle Screw Fixation for Treatment of Lower Lumbar Burst (A3-A4) Fractures: Comparative Study with Thoracolumbar Junction Fractures – Lumbar Fusion

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This article discusses the effectiveness of percutaneous pedicle screw fixation (PPSF) without fusion in treating lower lumbar burst fractures. Previous studies have recommended PPSF for thoracolumbar fractures to minimize adverse effects and restore range of motion, but there is limited research on lower lumbar fractures. The study retrospectively analyzed 50 patients with AO type A3 and A4 thoracolumbar fractures who underwent PPSF. The patients were divided into a thoracolumbar junction (TLJ) group and a lower lumbar (LL) group. Various parameters were measured and compared between the two groups, including vertebral height, consolidation, retropulsed fragment, sagittal curve, and fixation failure. The results showed that PPSF without fusion effectively managed lower lumbar fractures, and the procedure restored the movement of the lower lumbar spine. However, there was a significant difference in cobb angle loss between the two groups. Overall, the findings suggest that PPSF without fusion can be a viable treatment option for lower lumbar fractures

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article

CONCLUSION: Patients with lower lumbar fracture can be effectively managed with PPSF without fusion. PPSF following the implant removal can restore the movement of the lower lumbar spine, which is essential for daily life.

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Indian J Orthop. 2023 Jun 12;57(9):1415-1422. doi: 10.1007/s43465-023-00911-9. eCollection 2023 Sep.ABSTRACTBACKGROUND: Percutaneous pedicle screw fixation (PPSF) without fusion has been recently recommended in the treatment of thoracolumbar fracture to reduce the adverse effects associated with the conventional open approaches and to restore range of motion. However, those studies report on the thoracolumbar junction, and there,

Indian J Orthop. 2023 Jun 12;57(9):1415-1422. doi: 10.1007/s43465-023-00911-9. eCollection 2023 Sep.

ABSTRACT

BACKGROUND: Percutaneous pedicle screw fixation (PPSF) without fusion has been recently recommended in the treatment of thoracolumbar fracture to reduce the adverse effects associated with the conventional open approaches and to restore range of motion. However, those studies report on the thoracolumbar junction, and there is no report on lower lumbar fracture.

PURPOSE: To assess effectiveness of PPSF without fusion for treating lower lumbar burst (A3 and A4) fractures.

METHODS: A retrospective analysis was made to evaluate consecutive 50 patients with AO type A3 and A4 thoracolumbar fracture underwent PPSF. Patients were divided into a thoracolumbar junction (TLJ) group (T11-L2) and lower lumbar (LL) group (L3-5). The following items were measured and compared between the two groups. Vertebral height and consolidation, retropulsed fragment, sagittal curve and fixation failure were assessed with certain interval regularly.

RESULTS: The average height at pre- and post-reduction were 56.2% (36.2-74.3), 95.3% (84.2-98.3) in TLJ group and 65.7% (45.7-86.2), 91% (73.1-100) in LL group. The average canal area occupancy rate at pre- and post-reduction were 46.1% (37.4%-67.5%), 38.1% (31.3%-40.8%) in TLJ group and 40.4% (15.0-65.7), 19.3% (9.4-26.6) in LL group. Consolidation was completed within 12 months after surgery in both groups. There was no significant difference between two groups in clinical and radiographic parameters except cobb angle loss.

CONCLUSION: Patients with lower lumbar fracture can be effectively managed with PPSF without fusion. PPSF following the implant removal can restore the movement of the lower lumbar spine, which is essential for daily life.

PMID:37609026 | PMC:PMC10441996 | DOI:10.1007/s43465-023-00911-9

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Usefulness of Percutaneous Pedicle Screw Fixation for Treatment of Lower Lumbar Burst (A3-A4) Fractures: Comparative Study with Thoracolumbar Junction Fractures

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Indian J Orthop. 2023 Jun 12;57(9):1415-1422. doi: 10.1007/s43465-023-00911-9. eCollection 2023 Sep.ABSTRACTBACKGROUND: Percutaneous pedicle screw fixation (PPSF) without fusion has been recently recommended in the treatment of thoracolumbar fracture to reduce the adverse effects associated with the conventional open approaches and to restore range of motion. However, those studies report on the thoracolumbar junction, and there
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