DOI: 10.1097/BRS.0b013e31816068cf

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Issn Print: 0362-2436

Publication Date: 2008/01/15


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Letters

Choll Kim; Andrew Mahar; Steven Garfin

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Excerpt

The authors appreciate the thoughtful comments about our manuscript. It is true that short nonsegmental constructs with insufficient anterior column support have a high failure rate.1,2 However, there are no such studies of a segmental construct employing an intervening screw at the fractured level. Our study found that axial torsion stiffness was increased in short constructs with pedicle screws in the fractured vertebrae. These findings are supported by similar results in a recent study using a pig model.3 Other short-segment treatment options have been studied, including the use of supplemental hooks,4 and the use of vertebroplasty at the fractured level.5 These techniques however, have not gained wide clinical acceptance.
In our study model, the lower half of the L2 vertebral body was resected to allow measurement of disc pressures at the cephalad disc, which cannot be measured if the disc is disrupted. Although it is true that the distal end of the screw may be within the fractured vertebrae, the pedicles themselves are intact in many burst fractures. Thus, the proximal portion of the pedicle screw will find bony purchase even in A3 fractures. Finally, once fracture healing and fusion occur, implants are no longer necessary and may be removed.6
The purpose of the clinical series was to show feasibility and safety, along with kyphosis correction. No conclusions related to long-term results can be drawn without a well-powered randomized control trial.

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