Short-segment compression instrumentation for selected thoracic and lumbar spine fractures: the short-rod/two-claw...

The short-rod/two-claw (SRTC) technique of spine instrumentation was recently introduced for the treatment of thoracic and lumbar spine fractures. The use of this technique in 10 patients harboring wedge compression or burst fractures of the thoracic or lumbar spine is described. Of three patients treated with the construct placed in a distraction mode, the average follow-up loss of angle (the difference between the immediate postoperative and follow-up midsagittal angle as measured on x-ray films) was 18.3 degrees. Of the seven patients in whom the instrumentation was placed in a compression mode, the average observed loss of angle at follow-up examination was 1.6 degrees. Two patients had a preoperative scoliotic deformity at the fracture site, and both deformities were exaggerated by the placement of the SRTC technique in compression. Although no patient experienced an adverse outcome and all achieved a solid fusion, the application of the SRTC technique of universal spine instrumentation in distraction was associated with an exaggerated loss of angle. Loss of angle and deformity exaggeration are not desirable and are preventable by strict patient selection and by applying the construct in a compression mode. It is emphasized that few patients are candidates for this form of instrumentation. When applicable, however, the advantages of decreased pain and stiffness and the elimination of the need for instrumentation removal make the SRTC and related short-segment techniques desirable alternatives to traditional methods of spinal fixation.