- Email: [email protected]
Functional and radiological outcome of using long segment posterior pedicle screw constructs in unstable thoraco-lumbar fractures
j o u r n a l o f c l i n i c a l o r t h o p a e d i c s a n d t r a u m a 6 ( 2 0 1 5 ) 5 5 e5 7
BMI as one of the components for early recovery. It may significantly reduce the duration of hospital stay as well.
AC6. Assessment of posterior spinal fusion using mixture of autologous platelet rich plasma and hydroxyapatite granules P. Kumar, A. Kashyap, R. Kumar, A. Dagar Safdarjung Hospital, India Background: One of the most common complications of spinal fusion is non-union Recognizing and treating nonunion of the spine may be crucial in preventing progressive deformity in identifying instrumentation failure, and in relieving persistent pain. Methods: A prospective study of 30 Patients presenting with various diagnosis was done. Freshly prepared PRP and hydroxyapatite was mixed thoroughly and the resultant mixture was applied evenly to graft bed. Patients were followed up at intervals of 6 weeks, 12 weeks and 24 weeks with AP and lateral x rays. At 24 weeks CT scan of operative site was done to assess fusion. Result: In this study no fusion seen on x-ray after 6 weeks. After 12 weeks fusion mass seen in 2 cases (6.7%) on x-ray. After 24 weeks on x-ray, fusion mass seen in 17 cases(56.7%) and after 24 weeks fusion mass seen in 19 cases(63.3%) on CT-scan. Conclusion: Combined use of hydroxyapatite granules and platelet rich plasma makes near to ideal bone graft substitute as hydroxyapatite provides osteoconductive property and PRP provides osteogenic and osteoinductive property. Though this study shows beneficial effect of use of both PRP and hydroxyapatite, we recommend further randomised control to prove efficacy and study in large sample size and long duration of follow up.
AC7. Functional and radiological outcome of using long segment posterior pedicle screw constructs in unstable thoraco-lumbar fractures D. Batheja, M. Chadha, S.S. Arora University College of Medical Sciences, India
57
Background: The treatment of unstable thoracolumbar fracture remains controversial. Various options exist, but which approach to be used and the number of levels to be instrumented still remains a matter of debate. In this study we assess the outcome of these fractures with long segment posterior pedicle constructs alone. Methods: Study comprising of 18 patients with unstable thoraco-lumbar fractures, was conducted with inclusion criteria a) age 18- 50 yrs, b)injury e surgery duration <3 weeks and exclusion criteria a)open fractures, b)pathological fractures, c) fractures dislocations, and d) pregnant and lactating females. All patients underwent posterior decompression and stabilization with long segment posterior instrumentation using 8 pedicle screws (2 above and 2 below). The average follow-up was 18.5 months. The outcomes were analysed in terms of functional quality of life measured by ODI (Oswestry Disability Index), kyphotic angle, anterior vertebral height, duration of surgery and blood loss. Results: Mean age of patients was 32.8 yrs with majority being males (14/18) and L1 was most common vertebra involved (10/18). Mean duration of surgery was 160 minutes (range 130e195) and average blood loss was 447 ml (range 290-550). Mean preoperative ODI score was 91.88% which improved to 14.42% at final follow up. Mean kyphotic angle improved from 20.22 preoperatively to 2 in immediate post operative period and was 6.1 at final follow up. The mean pre-operative anterior vertebral height was 53.21% which improved to 90.18% after surgery and was 82.08% at final follow-up. Conclusion: The authors recommend long segment posterior pedicle instrumentation alone for unstable thoraco-lumbar fractures as it has advantage of achieving better correction with maintenance of correction and decreased failure rates as compared to short segment posterior instrumentation and substantially less morbidity and complications as compared to anterior approach or combined anterior and posterior approach.
BMI as one of the components for early recovery. It may significantly reduce the duration of hospital stay as well.
AC6. Assessment of posterior spinal fusion using mixture of autologous platelet rich plasma and hydroxyapatite granules P. Kumar, A. Kashyap, R. Kumar, A. Dagar Safdarjung Hospital, India Background: One of the most common complications of spinal fusion is non-union Recognizing and treating nonunion of the spine may be crucial in preventing progressive deformity in identifying instrumentation failure, and in relieving persistent pain. Methods: A prospective study of 30 Patients presenting with various diagnosis was done. Freshly prepared PRP and hydroxyapatite was mixed thoroughly and the resultant mixture was applied evenly to graft bed. Patients were followed up at intervals of 6 weeks, 12 weeks and 24 weeks with AP and lateral x rays. At 24 weeks CT scan of operative site was done to assess fusion. Result: In this study no fusion seen on x-ray after 6 weeks. After 12 weeks fusion mass seen in 2 cases (6.7%) on x-ray. After 24 weeks on x-ray, fusion mass seen in 17 cases(56.7%) and after 24 weeks fusion mass seen in 19 cases(63.3%) on CT-scan. Conclusion: Combined use of hydroxyapatite granules and platelet rich plasma makes near to ideal bone graft substitute as hydroxyapatite provides osteoconductive property and PRP provides osteogenic and osteoinductive property. Though this study shows beneficial effect of use of both PRP and hydroxyapatite, we recommend further randomised control to prove efficacy and study in large sample size and long duration of follow up.
AC7. Functional and radiological outcome of using long segment posterior pedicle screw constructs in unstable thoraco-lumbar fractures D. Batheja, M. Chadha, S.S. Arora University College of Medical Sciences, India
57
Background: The treatment of unstable thoracolumbar fracture remains controversial. Various options exist, but which approach to be used and the number of levels to be instrumented still remains a matter of debate. In this study we assess the outcome of these fractures with long segment posterior pedicle constructs alone. Methods: Study comprising of 18 patients with unstable thoraco-lumbar fractures, was conducted with inclusion criteria a) age 18- 50 yrs, b)injury e surgery duration <3 weeks and exclusion criteria a)open fractures, b)pathological fractures, c) fractures dislocations, and d) pregnant and lactating females. All patients underwent posterior decompression and stabilization with long segment posterior instrumentation using 8 pedicle screws (2 above and 2 below). The average follow-up was 18.5 months. The outcomes were analysed in terms of functional quality of life measured by ODI (Oswestry Disability Index), kyphotic angle, anterior vertebral height, duration of surgery and blood loss. Results: Mean age of patients was 32.8 yrs with majority being males (14/18) and L1 was most common vertebra involved (10/18). Mean duration of surgery was 160 minutes (range 130e195) and average blood loss was 447 ml (range 290-550). Mean preoperative ODI score was 91.88% which improved to 14.42% at final follow up. Mean kyphotic angle improved from 20.22 preoperatively to 2 in immediate post operative period and was 6.1 at final follow up. The mean pre-operative anterior vertebral height was 53.21% which improved to 90.18% after surgery and was 82.08% at final follow-up. Conclusion: The authors recommend long segment posterior pedicle instrumentation alone for unstable thoraco-lumbar fractures as it has advantage of achieving better correction with maintenance of correction and decreased failure rates as compared to short segment posterior instrumentation and substantially less morbidity and complications as compared to anterior approach or combined anterior and posterior approach.