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Objectives: To retrospectively investigate the outcome of transpedicular intracorporeal grafting and posterolateral grafting in treatment of thoracolumbar burst fractures., Methods: Forty-six patients treated with transpedicular intracorporeal grafting from January 1999 to December 2009 and followed up for 19-119 months (average 67 ± 13 months) were reviewed retrospectively, and were compared with 18 patients who had underwent posterolateral fusion during the same period through radiographic analysis. Radiographic measurements included Cobb angle, vertebral wedge angle (VWA), ratio between anterior and posterior vertebral height (APHR), upper inter-vertebral angle, lower inter-vertebral angle on X-ray, CT and MRI., Results: In transpedicular intracorporeal grafting group, the VWA was corrected from 27.2° ± 6.5° to 7.0° ± 3.0° and the APHR from (53.3 ± 11.8)% to (92.3 ± 2.4)%. In posterolateral fusion group, the VWA was corrected from 23.9° ± 4.4° to 8.8° ± 2.1° and the APHR from (60.7 ± 10.0)% to (88.5 ± 3.3)%. Transpedicular intracorporeal grafting group showed better postoperative correction results than posterolateral fusion group (P < 0.05), and had less loss of correction of Cobb angle, VWA and APHR at final follow-up (P < 0.05)., Conclusions: The transpedicular intracorporeal grafting can improve injured vertebral body morphology recovery better than posterolateral bone grafting, but can not prevent the late loss of correction after implant removal.

Objectives: To investigate the spatial structure of pedicle rib units in normal thoracic human spines and to compare the dimensions of the pedicle rib unit with corresponding dimensions., Methods: Thoracic spine specimens in four fresh adult cadaveric were used. Computerized tomographic (CT) images (including two-dimensional, three-dimensional reconstruction) of the thoracic spines were obtained. Measurement parameters include:the width, the height, the chord length and the sagittal angles of the pedicle rib unit compared with pedicle, especially for the pedicle-rib overlapping height., Results: The pedicle rib unit was not a simple two-dimensional structure but a three-dimensional structure. The shortest height of pedicle rib unit was (12.6 ± 0.8) mm (T(1)), while the longest was (16.9 ± 1.1) mm (T(11)). The shortest height of pedicle-rib overlap was (7.2 ± 0.3) mm (T(1)), while the longest was (11.8 ± 1.0) mm (T(10)). The height of pedicle rib unit and the height of pedicle were significantly larger than that of the pedicle-rib overlap (P < 0.05), while there was no significantly difference between the height of pedicle rib unit and the height of pedicle (P > 0.05)., Conclusions: The pedicle rib unit is a complicated spatial structure, and the longitudinal height of pedicle-rib overlap should be taken as the real height of the unit.

Objective: To study the influence of different age and short or long segments of pedicle screw fixation to the clinical efficacy of early single thoracolumbar fracture., Methods: From June 2005 to June 2008, 27 patients of early single thoracolumbar fracture were treated using short or long segments pedicle screw instrumentation, fracture vertebral (AO classification: type A1 or A2) was between T11 or L2. All patients were divided into A or B group according to age. A group: 12 cases mean age (32.6+/-10.7) years old (range, 16-55 years old). B group: 15 cases mean age (66.8+/-9.2) years old (range, 56-78 years old). All patients were treated with bony autograft by transpedicular of fracture vertebral and internal fixation by pedicle instrumentation. Pedicle screws were inserted in the pedicles of above and lower adjacent vertebral body of fracture vertebral, and others were inserted in the pedicles of above and lower two vertebral bodies of injured vertebral. Recorded operation time, blood loss and occurrence of complications. All patients took X radiograph plane examination (anterior-posterior position and lateral position) before operation and during 1 week of post operation and more than 1 year of follow up. Measured percentage of anterior compression vertebral high and kyphosis angle of the fracture vertebral by the same one group doctors., Results: Mean follow up time was (29.6+/-9.1) months (range, 10 - 34 months). The patients using short segments pedicle screw fixation in A and B group, mean operation time were (102+/-16) min and (118+/-24) min (P=0.072), mean volume of loss blood were (315+/-87) ml and (331+/-87) ml (P=0.064) respectively. The patients using long segments pedicle screw fixation in A and B group, Mean operation time were (138+/-22) min and (159+/-31) min (P=0.052), Mean volume of loss blood were (446+/-102) ml and (482+/-148) ml (P=0.055) respectively. There was no statistic different significantly between A and B group. The patients using short segments fixation, preoperative, during one week of post operation, one year of follow up, in A group the percentage of anterior compression vertebral high were 41.3+/-14.0, 5.4+/-1.0, 13.6+/-1.1, and 38.5+/-11.2, 8.3+/-2.1, 21.4+/-5.2 in B group. The patients using long segments fixation, at some time of preoperative, during one week of post operation and one year of follow up the percentage of anterior compression vertebral high were 40.8+/-11.5, 4.6+/-1.2, 8.3+/-1.0 in group A, and 44.3+/-10.2, 9.7+/-2.1, 11.2+/-3.0 in group B. In group A and B the kyphosis angle of fracture segment was 17.5 degrees+/-1.0 degrees and 16.3 degrees+/-3.1 degrees before operation, 4.2 degrees+/-1.0 degrees and 6.0 degrees+/-1.1 degrees in one week of postoperation and 11.5 degrees+/-1.0 degrees, 13.4 degrees+/-3.0 degrees in one year later postoperation. All the compression vertebral high was recovered and kyphosis was corrected significantly during one week and one year after operation (P<0.05), but there was some loss of kyphosis correction rate in follow up., Conclusion: There is better clinical efficacy of short segments pedicle instrumentation for treating early thoracolumbar fracture in the young group, but long segments fixation of pedicle instrumentation is more suitable for the older group.

Objective: To discuss the prevention and management of the neurological complications during treatment for severe scoliosis., Methods: Seventy-one patients with the coronal Cobb angle more than 80 degrees underwent operation. The average coronal Cobb angle was 96.6 degrees (80 degrees - 135 degrees ), and 31 patients combined with kyphotic deformity with average sagittal Cobb angle 83.0 degrees (52 degrees - 145 degrees ). Fourteen patients were treated with posterior pedicle screw fixation alone, 21 combined with posterior wedge resection, 34 with staged operation, and 2 with combined anterior and posterior approach. Intraoperative somatosensory evoked potentials (SEP) monitoring and wake up test were used in 61 cases, and wake up test was used alone in 10 cases., Results: The average coronal curve correction was 59.2% (average 39.6 degrees ) and sagittal curve correction was 61.6% (average 31.9 degrees ). Thirty-nine patients were followed up with average 51 months (5 - 81 months). Among them, 33 patients achieved solid spinal fusion and the rate of correction loss was 2.1%. Two patients underwent reoperation because of the breakages of the internal fixation. Among 8 patients with neurological dysfunction pre-operatively, 3 patients obtained complete recovery, 1 patient incomplete recovery, and the rest had not recovered because of post-poliomyelitis syndrome. Four of 5 patients developed neurological dysfunction post-operatively obtained complete recovery and 1 partial recovery., Conclusions: Halo-pelvic distraction and apical vertebra osteotomy are useful for increasing the correction rate and decreasing the neurological dysfunction. Intraoperative SEP monitoring combined with wake up test can call attention to early nerve injury. Early using of glucocorticoids and dehydration therapy promptly post-operatively is benefit to prevent neurological complications.

Objective: To introduce a new kind of grade system for thoracic pedicle screws placement by performing postoperative computerized tomography (CT) scanning and discussion the clinical purpose., Methods: Four hundred and fifty thoracic pedicle screws were implanted in 64 patients with the assistance of fluoroscopy. Postoperative CT scanning was conducted to determine a grade for each screw: Part A, screw entirely contained within pedicle; Part B(1), violate lateral or upper pedicle but screw tip entirely contained within the vertebral body (VB); Part B(2), violate medial or inferior of pedicle; Part B(3), tip penetrated anterior or lateral VB; Part C, violate pedicle or VB and endangers spinal cord, nerve roots, or great vessels. Based on anatomical morphometry, thoracic vertebral were subdivided into upper (T(1 - 2)), middle (T(3 - 6)), and lower (T(7 - 12)) regions. The mean follow-up period was 25.8 months., Results: The postoperative CT scanning-documented grade were determined: Part A, 367 screws (81.6%); Part B, 78 (17.3%), B(1) 40 (8.1%); Part B(2), 23 (5.1%); Part B(3), 15 (3.4%); Part C, 5 (1.1%). There were not significant difference between upper and lower thoracic that the placement of pedicle screws in part B or C. In part C, 5 pedicle screws were all in the middle thoracic., Conclusion: Postoperative CT scanning should be considered as a routine examination for evaluating thoracic pedicle screw placement.