Results of the vertebral body regeneration during surgical treatment of burst fractures of the thoracic and lumbar spine
Background. Burst fracture of the vertebral body is a traumatic injury, in which the vertebral body explodes or explodes with displacement under the influence of high-energy axial compression, and is characterized by centrifugal extrusion of fragments with the penetration of bone fragments into prevertebral tissues or in the vertebral canal. It is accompanied by a rupture of the intervertebral disc, fragments of which fall into the vertebral body and impair the healing. Decompression of the nerve structures is achieved at the expense of laminectomy or corpectomy. In non-complicated injuries, spondylosyndesis is predominantly performed with transpedicular structures of varying lengths. The purpose was to perform an analysis of vertebral body regeneration, the quality of the anterior and posterior spondylosyndesis after surgical treatment of burst fractures of the thoracic and lumbar spine. Materials and methods. Seventy seven patients with burst fractures of the thoracic and lumbar spine were observed. Group A consisted of 55 patients, who underwent posterior spondylosyndesis with eight-screw transpedicular fixation. On the X-ray of the spine, the angle of kyphotic deformation according to Cobb and the degree of the vertebral body compression were measured. Group B consisted of 22 patients, who underwent anterior-posterior spondylosyndesis on 360°. Bone joints, presence of defects of the vertebral body, periosteal regenerate, filling of the intervertebral support with bone regenerate, formation of posterior spondylosyndesis were evaluated on computer tomograms. Results. In the group A (patients without neurological symptoms), the value of the vertebral height restoration was 20 %, in patients with neurological symptoms — 21.1 %. Kyphotic deformation was 17.8°. Patients, who had regeneration of the vertebral body due to periosteal regeneration, had the compression rate of 50.5 %. The degree of compression after surgery was 29.2 %. Twenty nine patients had subligamentous hemorrhage with the spread to one or two adjacent intervertebral discs. In 19 patients, who had periosteal regenerate, there was subligamentous hemorrhage. At kyphotic deformation more than 30°, patients had bone or ligamentous posterior injuries. At deformation from 12 to 20°, 64 % of patients had damages to the posterior support complex. 39 % of patients with deformation to 12° had damages to the posterior support bone or ligamentous complex. In group B, the kyphotic deformation was 19.7°. The majority of patients had remode-ling in the intervertebral support. 63 % of patients had rege-
neration of the removed vertebral body. An intervertebral implant filled with bone had a bone structure over a long period of time. Conclusions. During the treatment of burst fractures using eight-screw fixation, the regeneration occurs at 48 % of patients due to a combination of periosteal and endosteal regeneration of the vertebral body. The presence of subligamentous hemorrhage can be a factor that affects periosteal regeneration of the vertebral body. Periosteal regeneration of the vertebral body complements the endosteal one, and it is an important factor that influences the preservation of the achieved deformation correction. Restoration of the height of the vertebral body is 20 %. The use of combined anterior-posterior spondylosyndesis in 63 % of patients leads to remodeling of the intervertebral support on the bone tissue. Both methods prevent the progression of kyphotic deformation due to endosteal and periosteal regeneration of the vertebral body, remodeling of the intervertebral support to the bone tissue and the formation of posterior bone spondylosyndesis.
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