Intervertebral disc injury is the mainspring for the postoperative increase in Cobb Angle after thoracolumbar burst fracture

• Published in: Journal of orthopaedic surgery (Hong Kong) Vol. 30; no. 2; p. 10225536221088753
• Main Authors: Peng, Zhi, Cui, Zhongfeng, Kuang, Xiaolin, Yu, Chen, Ruan, Yushan, Li, Chuan, Li, Shaobo, Lu, Sheng
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.05.2022; Sage Publications Ltd; SAGE Publishing
• Subjects: Back surgery; Fracture Fixation, Internal - methods; Fractures, Comminuted; Humans; Intervertebral Disc - diagnostic imaging; Intervertebral Disc - surgery; Lumbar Vertebrae - injuries; Lumbar Vertebrae - surgery; Pedicle Screws; Postoperative period; Retrospective Studies; Spinal Fractures - diagnostic imaging; Spinal Fractures - surgery; Thoracic Vertebrae - injuries; Thoracic Vertebrae - surgery; Treatment Outcome; thoracolumbar segment; Burst fracture; intervertebral disc injury; intervertebral height index; Cobb angle
• ISSN: 1022-5536; 2309-4990
• DOI: 10.1177/10225536221088753

Study Design A single-institution retrospective study of a cohort of patients who underwent internal fixation spine surgery for thoracolumbar burst fracture (TLBF). Objective To observe the imaging manifestations of intervertebral disc changes in TLBF, to analyze the relationship between the degree of disc injury and the Cobb angle increase. Methods We retrospectively analyzed the data of patients who underwent short-segment pedicle screw instrumentation in the spinal surgery department of a single hospital between January 2014 and December 2017 (n = 90). According to the magnetic resonance imaging characteristics of the superior intervertebral disc tissue of the injured vertebrae before the operation, the intervertebral disc injury was divided into three types, which was used for group allocation: group A, uninjured intervertebral disc group; group B, mild intervertebral disc injury group; and group C, severe intervertebral disc injury group. The main imaging results of the three groups Cobb, IVA, IHI, AHIV, and VAS were compared among groups. Results Ninety patients were included in the study (n = 38, 32, and 20, in groups A, B, and C, respectively). There was no statistically significant difference in demographics among the three groups (p > .05). 1-year post-surgery, the Cobb angle in group C differed significantly from that in groups A and B (p < .01). There was a significant difference in Cobb angle between groups A and B after internal fixation was removed for 6 months. At 1-year post-surgery, the IHI group C differed significantly from groups A and B (p < .01), while groups A and B were similar (p = .102); however, at 6 months after the internal fixation was removed, the IHI differed significantly between these two groups, also the AHIV between groups A and B was statistically significant (p < .01). The VAS pain score was similar among the three groups. Pearson’s test showed that the increase in the Cobb angle was moderately correlated with IVA and IHI, and weakly correlated with AHIV. Conclusion For TLBF with an intervertebral disc injury, the presurgical degree of intervertebral disc injury is the main reason for the post-surgery increase in the Cobb angle. Thus, diagnosis and treatment of this kind of patient require attention to the risk of spinal deformity.