The influence of intervertebral disc integrity on the surgical outcome of thoracolumbar burst fractures

English Keywords:Thoracolumbar burst fracture  Intervertebral disc  Injured vertebral pedicle instrumentation  Short-segment fixation  Fusion

English Abstract:

  【Abstract】 Objectives: To investigate the influence of the integrity of preoperative intervertebral disc and fusion or not on surgical outcome. Methods: 85 patients suffering from thoracolumbar burst fracture and receiving posterior short-segment fixation with instrumentation on injured vertebra from February 2009 to May 2012 were divided into 4 groups: integrity of intervertebral disc and nonfusion group(group A1); integrity of intervertebral disc and fusion group(group A2); damaged disc and nonfusion group(group B1); damaged disc and fusion group(group B2). These indexes before and after surgery were compared between each two groups, such as Cobb angle, anterior vertebral height, adjacent interverbral disc height, Oswetry disability index(ODI), visual analogue score(VAS) and Denis low back pain grade. Results: The mean follow-up of all patients was 62.9±12.4 months(43-82 months). There was no statistical significance in terms of the age, gender and damage segments among these groups(P>0.05). At the final follow-up, in group A1, the Cobb angle loss rate was (1.5±2.4)%, the anterior vertebral height loss rate was (4.9±3.8)%, the ODI score was 9.1±3.6, the VAS score was 0.87±0.50; in group A2, it was (2.1±2.2)%, (4.2±3.4)%, 8.4±3.3 and 0.56±0.76 respectively; in group B1, it was (3.6±2.3)%, (7.6±3.1)%, 15.0±4.2 and 1.64±1.10 respectively; in group B2, it was (2.8±1.8)%, (5.8±3.7)%, 10.0±3.5 and 1.16±0.48 respectively. There was no significant difference in Cobb angle loss rate, anterior vertebral height loss rate or ODI score between group A1 and A2(P>0.05). Cobb angle loss rate, anterior vertebral height loss rate and ODI score in group B1 were all higher than those in group B2(P<0.05). Cobb angle loss rate, anterior vertebral height loss rate and ODI score in group B1 were higher than those in group A1. Cobb angle loss rate in group B2 was higher than that in group A2(P<0.05), while there were no significant difference in other indexes between group A2 and B2(P>0.05). The intervertebral disc height showed no significant difference between every two groups(P>0.05). Conclusions: The integrity of intervertebral disc has a certain impact on the surgery clinical curative effect for the thoracolumbar burst fracture patients. For the patients who have intervertebral disc obvious tearing damage, removing the damaged intervertebral disc and proceeding intervertebral bone graft fusion is necessary.