[Treatment of thoracolumbar fractures with transpedicular intervertebral bone graft and pedicle screws fixation in injured vertebrae].

OBJECTIVE: To study the effectiveness of transpedicular intervertebral bone graft and pedicle screws fixation in injured vertebrae for the treatment of thoracolumbar fractures.

METHODS: Between February 2007 and January 2009, 25 patients with thoracolumbar fractures were treated by posterior short-segment fixation combined with transpedicular intervertebral bone graft and pedicle screw fixation in injured vertebrae. There were 18 males and 7 females with a mean age of 46 years (range, 28-63 years). The injured vertebrae were located at T10 in 1 case, T11 in 2 cases, T12 in 8 cases, L1 in 6 cases, L2 in 6 cases, L3 in 1 case, and L4 in 1 case. According to Denis classification, there were 14 cases of burst fractures and 11 cases of compression fractures. Based on Frankel classifications, 2 cases were rated as grade A, 4 cases as grade B, 8 cases as grade C, 7 cases as grade D, and 4 cases as grade E. The time between injury and operation was 6 hours to 7 days (mean, 4.6 days). The X-ray film was taken to measure the relative height of fractured vertebrae and Cobb angle, and Frankel classification was conducted to evaluate the function recovery of the spinal cord.

RESULTS: The operations were performed successfully, and incisions healed primarily. All the patients were followed up 12-25 months (mean, 16 months). CT and X-ray films showed good bone graft healing and no loosening or breakage of screws and rods. The relative height of fractured vertebrae were 56.8% +/- 15.6% at preoperation, 91.2% +/- 10.7% immediately after operation, and 89.6% +/- 10.3% at 1 year after operation, showing significant differences between preoperation and postoperation (P < 0.01), while no significant difference between immediately after operation and 1 year after operation. The Cobb angles were (18.2 +/- 2.6), (7.5 +/- 1.4), and (8.7 +/- 1.1) degrees, respectively, showing significant differences between preoperation and postoperation (P < 0.01), while no significant difference between immediately and 1 year after operation. At 1 year after operation, the neural function in 16 cases was improved 1-3 grades.

CONCLUSION: Treatment of thoracolumbar fractures with transpedicular intervertebral bone graft and pedicle screw fixation in injured vertebrae has satisfactory effectiveness, which can reconstruct vertebral body height, increase the stability of anterior and middle column of the injured vertebrae, and prevent height loss of the injured vertebrae and loosening of instrumentation.