Short-segment percutaneous osteosynthesis with long pedicle screw fixation of the injured vertebra for thoracolumbar and lumbar non neurological fractures: The Trident Fixation - 08/07/25
, David Giber a, b , Michel Dagher a, b , Charles Henri Flouzat Lachaniette a, b , Marc Khalifé c , Arnaud Dubory a, b, ⁎ Highlights |
• | Trident Fixation (TF) is a percutaneous short posterior instrumentation including an intermediate long pedicle screw into the injured vertebra. |
• | TF is only excluded for neurologic patients and presence of a pedicle fracture into the injured vertebra. |
• | TF has to be performed using monoaxial screws in order to establish the correction thanks to the lordotic shape of the rod so that avoiding the potential neurological risk spinal canal reduction related to compression of the injured vertebra. |
• | TF gives interesting results in regard to the injured vertebral kyphosis correction and its maintain at 2-years follow-up. |
• | Few patients needed instrumentation removal despite the initial absence of bone graft. |
Abstract |
Study design |
Prospective cohort study
Objective |
This study aimed to assess the interest of a short percutaneous monaxial pedicle screw (PS) osteosynthesis, named the Trident Fixation (TF): fixation of one vertebra above and below the vertebral fracture and including two long monoaxial PS into the injured vertebra to treat thoracolumbar (TL) and lumbar (L) fractures.
Methods |
Patients operated by this surgical method were prospectively included. Preoperative data and immediate, one-year follow-up, and two-year follow-up postoperative data were collected. The surgical correction was studied, evaluating the radiologic parameters as follows: vertebral body angle, regional traumatic kyphosis, regional traumatic angulation, Anterior/Middle Column Vertebral Body Compression Ratio (VBCR) and Anterior Vertebral Body Compression Percentage and the mid sagittal diameter of the spinal canal. PS placement, bone fusion and the occurrence of instrumentation failure were sought.
Results |
Sixty-six patients were included (mean follow-up of 1.9 years (95% CI [1.9–2.6]). Regarding the accurate position of the PS, 11 of them (16.7%) presented a cortical bone violation. At the last follow-up, 3 patients (4.5%) presented a screw loosening, but no one progressed to a screw pull-out. One patient (1.5%) suffered from a rod breakage. All the radiologic parameters improved postoperatively, except the VBCR, which remained unchanged, despite the surgery. Vertebral fracture was healed for 54 patients (82%). Twenty (30.3%) patients presented an intervertebral fusion, either posterior facet fusion (12 patients [18.2%]) or interbody fusion (11 patients [16.6%]).
Conclusion |
TF gives relevant postoperative radiological outcomes and is an alternative to the kyphoplasty, which remains an expensive method.
Le texte complet de cet article est disponible en PDF.Keywords : Vertebral fracture, Pedicle screw, Percutaneous osteosynthesis, Short fixation, Kyphosis
Plan
Vol 71 - N° 5
Article 101700- septembre 2025 Retour au numéro
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