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Spontaneous Spinal Canal Remodeling after Postural Pillow Reduction and Lordotic Posterior Column Compressive Percutaneous Transpedicular Screw fixation in neurologically intact Thoracolumbar Burst Fractures
Hyeun Sung Kim1, Byapak Paudel1 , Ki Joon Kim1, Jee -Soo Jang1, Jeong-Hoon Choi1, Sung Kyun Chung1, Jeong Hoon Kim1, Il-Tae Jang1, Seong-Hoon Oh2, Jae Eun Park1, Sol Lee1
1Department of Neurosurgery, Nanoori Suwon Hospital, Suwon, Korea, Suwon-si, Gyeonggi-do, , Korea
2Nanoori Incheon Hospital, Incheon, Korea, Incheon, Korea
Correspondence :  Byapak Paudel ,Tel: +82-31-1688-9797, Fax: + 82-31-8065-9701, Email: drbyapak@gmail.com
Received: April 3, 2017  Revised: May 2, 2017   Accepted: May 8, 2017
The optimal treatment methods for thoracolumbar burst fracture with intact neurology are not established yet. Spinal canal integrity, sagittal balance and anterior column intactness are very important for successful outcome in this type of injury. There is no study analyzing restoration of these parameters by low pressure restoration using postural pillow reduction and lordotic posterior column compressive percutaneous transpedicular screw fixation and this study analyzes canal remodeling, spinal balance and anterior column intactness after this procedure.
The surgical procedure included three different elements: 1) preoperative postural pillow reduction for 1-2 days, 2) augmentation of fractured vertebra by polymethylmethacrylate (PMMA) in osteoporotic bone or by non-PMMA materials in non-osteoporotic bone), and 3) lordotic, posterior column compressive, percutaneous transpedicular screw fixation. We measured anterior vertebral height, canal size and lordotic angle preoperatively, immediate postoperatively and after 6 months in 34 patients treated with this technique and were analyzed.
Of 34 patients 17 were male. The mean age was 52.03  12.51 years. They were followed for 30.68  11.67 months on average. At 6 months, preoperative canal stenosis of 44 % remodeled to 12 %, preoperative anterior vertebral height of 44 % increased to 77 % and preoperative average kyphosis of 14 degrees corrected to 3.4 degrees No neurological deterioration noted. Functionally all patients returned to their previous status.
The postural pillow reduction and lordotic posterior column compressive percutaneous screw fixation in patients with neurologically intact thoracolumbar burst fracture is effective and safe. Key Words: Thoracolumbar Burst Fracture, Canal Remodeling, Postural Reduction, Percutaneous fixation, Pedicle Screw
KeyWords: Thoracolumbar Burst Fracture; Canal Remodeling; Postural Reduction; Percutaneous fixation; Pedicle Screw
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