The results after treatment of 52 lumbar and thoracolumbar fractures with Cotrel-Dubousset instrumentation were reviewed as part of an ongoing study. 19 patients (average duration of follow-up, 15 months) had been managed with short-segment pedicle-screw instrumentation. This preliminary report outlines the complications and pitfalls identified during the initial healing phase in this subgroup of patients. There were no neurological or vascular injuries due to placement of the pedicle screws, but 10 patients had some form of failure of the fixation during the early period of healing. Failure of the fixation was manifested in 3 ways: progressive kyphosis secondary to the bending of screws (6 patients), kyphosis secondary to osseous collapse or vertebral translation without bending of the hardware (3 patients), and segmental kyphosis after a caudad screw in the lumbar construct broke (one patient, who had had a combined instrumentation for multiple fractures). Untreated anterior instability, and pre-stressing of the screws when the rods were contoured in situ, resulted in a high rate of failure. The high rate of failure of the hardware associated with this fixation construct suggests that posterior screw fixation alone may not be adequate when Cotrel-Dubousset instrumentation is used for short-segment lumbar arthrodeses. Bent screws or measurable kyphosis did not always herald a clinical failure, but patients who had progressive kyphosis of more than 10 degrees had substantially more pain than did those who had little or no progression. The results reported here are preliminary, and speculation as to the importance of these findings and as to the long-term outcome in these patients would be premature.(ABSTRACT TRUNCATED AT 250 WORDS)
Copyright remains with the authors and publisher.
The results after treatment of 52 lumbar and thoracolumbar fractures with Cotrel-Dubousset instrumentation were reviewed as part of an ongoing study. 19 patients (average duration of follow-up, 15 months) had been managed with short-segment pedicle-screw instrumentation. This preliminary report outlines the complications and pitfalls identified during the initial healing phase in this subgroup of patients. There were no neurological or vascular injuries due to placement of the pedicle screws, but 10 patients had some form of failure of the fixation during the early period of healing. Failure of the fixation was manifested in 3 ways: progressive kyphosis secondary to the bending of screws (6 patients), kyphosis secondary to osseous collapse or vertebral translation without bending of the hardware (3 patients), and segmental kyphosis after a caudad screw in the lumbar construct broke (one patient, who had had a combined instrumentation for multiple fractures). Untreated anterior instability, and pre-stressing of the screws when the rods were contoured in situ, resulted in a high rate of failure. The high rate of failure of the hardware associated with this fixation construct suggests that posterior screw fixation alone may not be adequate when Cotrel-Dubousset instrumentation is used for short-segment lumbar arthrodeses. Bent screws or measurable kyphosis did not always herald a clinical failure, but patients who had progressive kyphosis of more than 10 degrees had substantially more pain than did those who had little or no progression. The results reported here are preliminary, and speculation as to the importance of these findings and as to the long-term outcome in these patients would be premature.(ABSTRACT TRUNCATED AT 250 WORDS)
Copyright remains with the authors and publisher.