Does the fracture fragment at the anterior column in thoracolumbar burst fractures get enough attention?

Abstract

Prospective cohort study. To evaluate whether failure of the fracture fragment at the anterior column reduction in thoracolumbar fracture has an influence on the final radiologic and clinical outcomes.Cervical teardrop fracture has caused wide concern in spinal surgery field. Although similar fracture fragment at the anterior column was also observed in thoracolumbar burst fractures, the conception of teardrop fracture in thoracolumbar fractures was rarely mentioned in the literature, let alone a study.Fifty patients who suffered from thoracolumbar burst fractures with a fracture fragment at the anterior column were prospectively analyzed. Twenty-seven patients in whom the fragments were reduced by posterior surgery, verified by postoperative X-ray or CT, were included in the reduced group, and 23 patients were included in the nonreduced group. Radiologic and clinical outcomes of both groups were compared after over 2 years follow-up.There was no significant difference regarding to Cobb angle, Oswestry Disability Index (ODI) score, and disc grade between the 2 groups preoperatively. At final follow-up, the mean angle of kyphosis was 13.91° ± 3.47° in the nonreduced group and 8.42° ± 2.07° in the reduced groups (P < 0.01). All fractures consolidated in the reduced group, but the nonreduced group revealed 3 cases with nonunion. Besides, the average Pfirrmann grade of degenerative disc adjacent to the fractured vertebral was 2.87 ± 1.18 in the nonreduced group, higher than 1.81 ± 0.62 in the reduced group (P < 0.01). The ODI score in the nonreduced group was 0.54 ± 0.13 and 0.36 ± 0.12 in the reduced group (P < 0.01).In the present study, failure reduction of the fracture fragment at the anterior column could result in poor radiologic and clinical outcomes of the thoracolumbar burst fractures treated with posterior surgery. Therefore, we recommend the surgeon should pay more attention to reducing the fracture fragment at the anterior column.

Figure 1

A 46-year-old man, with L2 burst fracture. Preoperative lateral radiograph (A) and CT (B) showed L2 vertebral fracture with a fragment in the vertebral anterior edge. Preoperative MRI (C) showed Pfirrmann grade 1 of L1-L2 disc and Pfirrmann grade 2 of L2-L3 disc. X radiograph immediately after surgery (D) revealed the teardrop fragment was not reduced completely. After follow-up for 2 years, X radiograph (E) showed no healing of L2 fracture. MRI (F) showed Pfirrmann grade 3 of L1-L2 disc and Pfirrmann grade 3 of L2-L3 disc. CT = computerized tomography, MRI = magnetic resonance imaging.

Figure 2

A 48-year-old woman who had a burst fracture at L2 vertebra. Preoperative lateral radiograph (A) and CT (B) showed a fracture fragment at the anterior column of L2 vertebra. Preoperative MRI (C) showed Pfirrmann grade 1 of L1-L2 disc and Pfirrmann grade 2 of L2-L3 disc. X radiograph and CT immediately after surgery (D, E) revealed the fracture fragment at the anterior column was reduced. After follow-up for 12 months, X radiograph (F) showed healing of T12 fracture and MRI (G) showed no progress to degeneration. CT = computerized tomography, MRI = magnetic resonance imaging.