The Impact of Endplate Fracture on the Clinical Efficacy of Minimally Invasive Percutaneous Pedicle Screw Fixation for Treatment of Thoracolumbar Vertebra Burst Fractures

Presented at SMISS Annual Forum 2018
By Yongxin Ren MD, PHD
With Hui Che Master,

Disclosures: Yongxin Ren MD, PHD None Hui Che Master None,

Introduction:

Thoracolumbar fractures account for about 50 percent of spine fractures. Among the patients with thoracolumbar burst fractures, failure of internal fixation and loss of correction occurred in the long term.

Aims/Objectives:

This retrospective study investigated the impact of the fracture degree of endplate on the clinical efficacy of minimally invasive percutaneous pedicle screw fixation for treatment of thoraco-lumbar vertebra burst fractures.

Methods:

From September 2012 to June 2016, 35 patients with thoraco-lumbar vertebra burst fractures in our hospital underwent minimally invasive percutaneous pedicle screw fixation. Patients were divided into two groups: Minor group with minor endplate fracture degree, and Severe group with severe endplate fracture degree. Visual analogue scale (VAS), Oswestry disability index (ODI) scores, the Mos 36-item Short Form Health Survey (SF-36), vertebral compression rate and restoring rate, kyphosis Cobb angle and correction rate of vertebral kyphosis of each patient were recorded before surgery, before discharge, as well as, 6 months, and the time of the last follow-up.

Results:

Each group compared to itself between pre-operation and post-operation, the VAS, ODI and SF-36 scores decreased significantly, vertebral compression rate and kyphosis Cobb angle increased significantly, the differences were statistically significant (P =0.000) which indicate a better curative effect in surgery. The VAS, ODI and SF-36 scores in Severe group did not increase significantly (P <0.01) compared to the Minor one until the time of the last follow-up, in addition to this, vertebral compression rate increased and restoring rate decreased in the Severe group much significantly (P <0.01) compared to the Minor group the time of the last follow-up. No statistically significant differences were observed in kyphosis Cobb angle between the two groups (P >0.05) during the follow-up.

Conclusions:

The degree of endplate fracture is not significant for the recovery of vertebral height in the early-to-mid stage of the treatment of thoraco-lumbar vertebra burst fractures with minimally invasive percutaneous pedicle screw fixation. However, the higher fracture degree of endplate is, the higher the high forward loss rate of the vertebral body, and the greater the influence on the long-term life of the patients. As a result, in addition to the reconstruction of spine stability, the rebuilt of the endplate integrity should be considered for patients with severe endplate fracture, so as to achieve good long-term effect.