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Comparison of pedicle fixation by the Wiltse approach and the conventional transmuscular approach for thoracolumbar fractures,using MRI,histological and electrophysiological analyses of the multifidus muscle

Comparison of pedicle fixation by the Wiltse approach and th...

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2016年浙江省骨科学学术年会

作者： Liu Junhui Zhao Fengdong Department of Othopaedics Sir Run Run Shaw HospitalSchool of MedicineZhejiang University

Purpose:To use imaging,histology,and electrophysiological assessment to compare the Wiltse approach to pedicle fixation with the conventional transmuscular approach for thoracolumbar ***:We analyzed clinical and radiographic records of consecutive patients with thoracolumbar fractures(without neurological deficits)who had undergone short-segment pedicle fixation using either the Wiltse approach or the conventional transmuscular ***-five patients were enrolled between June 2010 and August 2014(Wiltse approach:35 cases;conventional transmuscular approach:40 cases).The two groups were compared for:perioperative parameters,Visual Analogue Scale(VAS) pain scores,radiologic parameters,MRI appearance,and histological and electrophysiological changes in the multifidus ***:No significant differences were found between the groups regarding gender,age,fracture type,spinal level,or *** vertebral fractures had healed by the last follow-up,and no loosening or breaking of internal fixation was *** to the ’transmuscular’group,the ’Wiltse’ group was significantly better in terms of operation time,blood loss,hospital stay,and postoperative VAS scores,but the length of incision,R value and Cobb’s angle were the same for both *** Wiltse group showed a lower incidence of multifidus atrophy and less fatty infiltration on *** transmuscular group had significantly reduced fiber diameter and cross-sectional areas of the multifidus,and also an increased muscle fiber gap with more fat deposition and ***(EMG) demonstrated that the transmuscular group had significantly lower median frequency and average EMG amplitude in the multifidus ***:The Wiltse approach for pedicle fixation of thoracolumbar fractures is an effective and minimally-invasive treatment which has significant advantages over the conventional transmuscular approach.

关键词： multifidus muscle Wiltse approach thoracolumbar fractures conventional transmuscular approach

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Percutaneous Fixation as an Option for Traumatic Neurologically Intact thoracolumbar Vertebral fractures

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Open Journal of Modern Neurosurgery 2024年第4期14卷 246-255页

作者： Ahmed Hosameldin Ashraf Osman Mahmoud Gomaa Mahmoud Ramadan Department of Neurosurgery Fayoum University Faiyum Egypt Department of Neurosurgery Beni-Suef University Beni Suef Egypt

Background: The most frequent spinal fracture is the thoracolumbar fracture. Minimally invasive percutaneous fixation of cases having thoracolumbar vertebral fractures without neurological impairments has remained controversial. The advantages of minimally invasive percutaneous fixation are decreasing muscle and soft tissue injury, decreasing blood loss and infection rate, in addition to shortening hospital stay and recovery times. In comparison to the open technique, percutaneous fixation is adequate for treating thoracolumbar (TL) fractures without causing neurological impairments & with satisfactory outcomes in terms of kyphosis decline. Elevated radiation exposure to the surgeon &the patient, lack of decompression and fusion via bone graft, & a steep learning curve are all disadvantages of percutaneous fixation of vertebral fractures. Methods: This study was retrospectively conducted on forty-eight patients, age ranging from 16 to 65 years old, with a thoracolumbar (TL) fracture without causing neurological impairments who were meeting the eligibility criteria for fixation in the period from July 2019 to January 2024. Results: We included the forty-eight patients who met the inclusion criteria (34 males and 14 females) their ages ranged from 16 to 65 years. The most common pathology was L1 fracture in 38 patients. No major complications were experienced, only wound infection in five patients which was treated efficiently with repeated dressings and broad-spectrum antibiotics. Four patients experienced misdirected screws, only in one patient the screw encroach into the spinal canal with no deficit experienced, while the other three showed minimally laterally deviated screws. Conclusion: The advantages of percutaneous pedicle screw fixation in thoracolumbar fractures through preservation of posterior musculature, are less blood loss, shorter operative time, lower infection risk, less post-operative pain, shorter rehabilitation time as well as a shorter hospital st

关键词： thoracolumbar fractures Fracture Stability Percutaneous Fixation

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Assessment of load-sharing thoracolumbar injury: A modified scoring system

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World Journal of Clinical Cases 2020年第21期8卷 5128-5138页

作者： Qi-Hang Su Yong-Chao Li Yan Zhang Jun Tan Biao Cheng Department of Orthopedics Shanghai Tenth People's HospitalTongji University School of MedicineShanghai 200072China Department of Orthopedics Shanghai East HospitalTongji University School of MedicineShanghai 200120China

BACKGROUND Many classification systems of thoracolumbar spinal fractures have been proposed to enhance treatment protocols,but none have achieved universal *** To develop a new patient scoring system for cases with thoracolumbar injury classification and severity score(TLICS)=4,namely the load-sharing thoracolumbar injury score(LSTLIS).METHODS Based on thoracolumbar injury classification and severity score,this study proposes the use of the established load-sharing classification(LSC)to develop an improved classification system(LSTLIS).To prove the reliability and reproducibility of LSTLIS,a retrospective analysis for patients with thoracolumbar vertebral fractures has been *** A total of 102 cases were enrolled in the *** scoring trend of LSTLIS is roughly similar as the LSC scoring,however,the average deviation based on the former method is relatively smaller than that of the ***,the robustness of the LSTLIS scoring method is better than that of *** can further classify patients with TLICS=4,so as to assess more accurately this particular circumstance,and the majority of LSTLIS recommendations are consistent with actual clinical *** is a scoring system that combines LSC and TLICS to compensate for the lack of appropriate inclusion of anterior and middle column compression fractures with *** preliminary clinical verification,LSTLIS has greater feasibility and reliability value,is more practical in comprehensively assessing certain clinical circumstances,and has better accuracy with clinically significant guidelines.

关键词： Retrospective analysis thoracolumbar fractures Load-sharing classification thoracolumbar injury classification and severity score Scoring system Clinical protocols

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