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Journal of Peking University (Health Sciences) ›› 2021, Vol. 53 ›› Issue (1): 167-174. doi: 10.19723/j.issn.1671-167X.2021.01.025

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Risk factors of recurrent kyphosis in thoracolumbar burst fracture patients treated by short segmental pedicle screw fixation

HOU Guo-jin,ZHOU Fang(),TIAN Yun,JI Hong-quan,ZHANG Zhi-shan,GUO Yan,LV Yang,YANG Zhong-wei,ZHANG Ya-wen   

  1. Department of Orthopaedic Surgery, Peking University Third Hospital, Beijing 100191, China
  • Received:2020-03-31 Online:2021-02-18 Published:2021-02-07
  • Contact: Fang ZHOU E-mail:zhouf@bjmu.edu.cn
  • Supported by:
    Key Clinical Projects of Peking University Third Hospital(BYSY2017014)

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Abstract:

Objective: To analyze the risk factors of recurrent kyphosis after removal of short segmental pedicle screw fixation in patients with thoracolumbar burst fractures.Methods: Retrospective analysis was conducted of 144 cases of thoracolumbar burst fractures without neurological impairment treated in Peking University Third Hospital from January 2010 to December 2017. There were 74 males and 70 females, with an average age of (39.1±13.2) years. The distribution of the injured vertebrae was T12: 42, L1: 72 and L2: 30, with fracture types of A3: 90, B1: 25 and B2: 29. The patients were divided into two groups: Recurrent kyphosis group (n=92) and non-recurrent kyphosis group (n=52). SPSS 26.0 software was used for univariate analysis and Logistic regression analysis.Results: The average follow-up time was 28 (20-113) months. The imaging indexes of pre-operation, 3 days post-operation, 12 months post-operation and the last follow-up were measured and compared. Anterior vertebral body height, segmental kyphosis, vertebral wadge angle and Gardner deformity were significantly improved after operation (P<0.05), and there were some degrees of loss in the 1-year follow-up; anterior vertebral body height and vertebral wadge angle were no longer changed after the removal of the screws; however, segmental kyphosis and Gardner deformity were still aggravated after the removal of the screws (P<0.05). There were some degrees of collapse of the height of the upper and lower discs during the follow-up. Univariate analysis showed that there were statistically significant differences (P<0.05) between the two groups in gender, age (36.9 years vs. 43.0 years), upper disc injury, CT value (174 vs. 160), segmental kyphosis (16.6° vs. 13.3°), vertebral wadge angle (16.7° vs. 13.6°), Gardner deformity (19.1° vs. 15.2°) and ratio of anterior vertebral body height (0.65 vs. 0.71). Logistic regression analysis showed that male (OR: 2.88, 95%CI: 1.196-6.933), upper disc injury (OR: 2.962, 95%CI: 1.062-8.258) and injured vertebral wedge angle were risk factors of recurrent kyphosis after removal of internal fixation for thoracolumbar burst fracture (P<0.05).Conclusion: The patients with thoracolumbar burst fracture can obtain satisfactory effect immediately after posterior short segmental pedicle screw fixation, however, there may be some degree of loss during the follow-up. Male, upper disc injury and injured vertebral wedge angle are the risk factors of recurrent kyphosis after removal of internal fixation for thoracolumbar burst fracture.

Key words: Spinal fracture, Fracture fixation, internal, Pedicle screws, Kyphosis, Risk factors

CLC Number: 

  • R683.2

Figure 1

Measurement index of lateral X-ray A, measurement of the height of the anterior/posterior border of vertebral body; B, ∠α, segmental kyphosis; C, ∠γ, vertebral wedge angle; D, ∠β, Gardner deformity."

Table 1

Load-sharing classification of thoracolumbar fracture"

Items Load-sharing classification
1 2 3
Comminution (by CT) <30% 30%-60% >60%
Apposition of fragments (by CT) <1 mm ≥2 mm, displacement of
<50% cross section of body		 >2 mm, displacement of
>50% cross section of body
Reducibility of sagittal deformation (by X-ray) <4° 4°-9° >9°

Table 2

Measurement of each index in different periods (x-±s)"

Variables Pre-operation 3 d after operation 12 months after operation Last follow-up
Ratio of anterior height 0.67±0.11 0.93±0.09 0.90±0.09 0.89±0.08
Ratio of posterior height 0.89±0.08 0.97±0.04 0.96±0.05 0.94±0.12
Ratio of discs height 0.89±0.13 0.90±0.13 0.86±0.10 0.82±0.15
Segmental kyphosis/(°) 15.4±7.3 6.7±6.9 9.5±7.7 13.4±8.6
Vertebral wage angle/(°) 15.6±4.7 7.2±3.5 8.4±3.7 8.7±3.5
Gardner deformity/(°) 17.7±6.2 8.7±4.7 11.5±5.7 13.8±5.6
Upper intervertebral angle/(°) -2.5±2.9 -4.2±2.9 -2.5±2.9 0.1±3.1
Lower intervertebral angle/(°) -5.9±2.4 -5.5±2.6 -5.0±2.0 -3.9±2.4

Table 3

General data comparison of recurrent kyphosis and non-recurrent kyphosis groups"

Variables Non-recurrent kyphosis (n=52) Recurrent kyphosis (n=92) Statistics P value
Gender (Male/Female) 18/34 56/36 χ2=9.167 0.002
Age/years 43.0±13.1 36.9±12.7 t=2.764 0.006
Body mass index 24.1±3.4 23.9±3.5 t=0.397 0.692
Location (T12/L1/L2) 12/30/10 30/42/20 χ2=2.098 0.350
Type of fracture (A3/B1/B2) 36/8/8 54/17/21 χ2=1.687 0.430
Disc injury (No/Uncertain/Yes) 16/16/20 16/10/66 χ2=16.122 <0.001
PLC injury (No/Yes) 36/16 54/38 χ2=1.573 0.210
Load-sharing classification 5.5(4.0-7.0) 6.0(4.0-8.0) Z=1.699 0.089
CT value 160.7±40.6 174.4±35.2 t=-2.031 0.045
SK pre-operation/(°) 13.3±7.6 16.6±6.9 t=-2.611 0.010
VWA pre-operation/(°) 13.6±4.7 16.7±4.4 t=-4.080 <0.001
Gardner deformity pre-operation/(°) 15.2±5.8 19.1±6.0 t=-3.800 <0.001
UIVA pre-operation/(°) -2.8±2.3 -2.4±3.3 t=-0.789 0.431
LIVA pre-operation/(°) -5.9±2.4 -5.9±2.5 t=-0.021 0.983
A% pre-operation 0.71±0.13 0.65±0.09 t=2.520 0.014
P% pre-operation 0.91±0.08 0.89±0.08 t=1.529 0.128
Ratio of upper/lower discs height 0.91±0.13 0.89±0.13 t=0.702 0.484
Vertebral height restoration/% 0.24±0.14 0.27±0.10 t=-1.402 0.163

Table 4

Logistic regression analysis of risk factors for recurrent kyphosis"

Variables Regression coefficient SE Wald χ2 P OR 95%CI
Gender (Male/Female) 1.058 0.448 5.565 0.018 2.880 1.196-6.933
Upper disc injury (No/Uncertain/Yes) 24.789 <0.001
Uncertain vs. No -2.437 0.767 10.100 0.001 0.087 0.019-0.393
Yes vs. No 1.086 0.523 4.309 0.038 2.962 1.062-8.258
VWA pre-operation 0.283 0.063 19.874 <0.001 1.327 1.172-1.503
Constant -4.321 0.984 19.281 <0.001 0.013

Figure 2

Typical case 1 (Male, 54 years old, T12 burst fracture) A, lateral X-ray before surgery; B, MRI before surgery showed upper intervertebral disc injury; C, lateral X-ray 3 days after surgery; D, lose of correction angle 12 months after surgery (X-ray); E, disc collapse and recurrent kyphosis 24 months after surgery (X-ray)."

Figure 3

Typical case 2 (Female, 53 years old, T12 burst fracture) A, lateral X-ray before surgery; B, MRI before surgery showed PLC injury; C, lateral X-ray 3 days after surgery; D, no lose of correction angle 12 months after surgery (X-ray); E, no recurrent kyphosis 24 months after surgery X-ray."

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