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Vercoulen TF, Niemeyer MJ, Peuker F, Verlaan JJ, Oner FC, Sadiqi S. Surgical treatment of traumatic fractures of the thoracic and lumbar spine: A systematic review. BRAIN & SPINE 2024; 4:102745. [PMID: 38510618 PMCID: PMC10951763 DOI: 10.1016/j.bas.2024.102745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/27/2023] [Accepted: 01/03/2024] [Indexed: 03/22/2024]
Abstract
Introduction The treatment of traumatic thoracic and lumbar spine fractures remains controversial. To date no consensus exists on the correct choice of surgical approach and technique. Research question to provide a comprehensive up-to-date overview of the available different surgical methods and their quantified outcomes. Methods PubMed and EMBASE were searched between 2001 and 2020 using the term 'spinal fractures'. Inclusion criteria were: adults, ≥10 cases, ≥12 months follow-up, thoracic or lumbar fractures, and surgery <3 weeks of trauma. Studies were categorized per surgical technique: Posterior open (PO), posterior percutaneous (PP), stand-alone vertebral body augmentation (SA), anterior scopic (AS), anterior open (AO), posterior percutaneous and anterior open (PPAO), posterior percutaneous and anterior scopic (PPAS), posterior open and anterior open (POAO) and posterior open and anterior scopic (POAS). The PO group was used as a reference group. Results After duplicate removal 6042 articles were identified. A total of 102 articles were Included, in which 137 separate surgical technique cohorts were described: PO (n = 75), PP, (n = 39), SA (n = 12), AO (n = 5), PPAO (n = 1), PPAS (n = 1), POAO (n = 2) and POAS (n = 2). Discussion and conclusion For type A3/A4 burst fractures, without severe neurological deficit, posterior percutaneous (PP) technique seems the safest and most feasible option in the past two decades. If needed, PP can be combined with anterior augmentation to prevent secondary kyphosis. Furthermore, posterior open (PO) technique is feasible in almost all types of fractures. Also, this technique can provide for an additional posterior decompression or fusion. Overall, no neurologic deterioration was reported following surgical intervention.
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Affiliation(s)
- Timon F.G. Vercoulen
- Diakonessenhuis, Department of Orthopedic Surgery, Bosboomstraat 1, 3582, KE, Utrecht, the Netherlands
- University Medical Center Utrecht, Department of Orthopedic Surgery, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - Menco J.S. Niemeyer
- University Medical Center Utrecht, Department of Orthopedic Surgery, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - Felix Peuker
- University Medical Center Utrecht, Department of Orthopedic Surgery, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - Jorrit-Jan Verlaan
- University Medical Center Utrecht, Department of Orthopedic Surgery, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - F. Cumhur Oner
- University Medical Center Utrecht, Department of Orthopedic Surgery, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - Said Sadiqi
- University Medical Center Utrecht, Department of Orthopedic Surgery, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
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Perna A, Franchini A, Gorgoglione FL, Barletta F, Moretti B, Piazzolla A, Bocchi MB, Velluto C, Tamburrelli F, Proietti L. Short-segment percutaneous fusion versus open posterior fusion with screw in the fractured vertebra for thoracolumbar junction burst vertebral fracture treatment. J Neurosci Rural Pract 2024; 15:34-41. [PMID: 38476412 PMCID: PMC10927060 DOI: 10.25259/jnrp_370_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/11/2023] [Indexed: 03/14/2024] Open
Abstract
Objectives The treatment options for thoracolumbar junction burst fractures remain a topic of controversy. Short-segment percutaneous fixation (SSPF) and short-segment open fixation including the fractured level (SSOFIFL) are both viable procedures for managing these fractures. At present, there is a lack of evidence in the literature demonstrating the absolute superiority of one treatment over the other. This study aimed to compare these two surgical strategies with a focus on radiological and clinical outcomes. Materials and Methods This retrospective case-control multicenter analysis involved patients with A3 and A4 vertebral fractures at the thoracolumbar junction (T11-L2) who underwent surgical treatment with either SSPF or SSOFIFL in the participating centers. Clinical outcomes were measured using the Oswestry Disability Index and visual analogue scale (VAS) both pre- and postoperatively. Radiological outcomes included kyphotic deformity (KD), anterior vertebral body height (AVBH), segmental kyphosis, and sagittal alignment parameters. Results A total of 156 patients were enrolled in the study, with 81 patients in Group A (SSPF) and 75 patients in Group B (SSOFIFL). Group B demonstrated better correction of KD (Group B: 3.4 ± 2.7° vs. Group A: 8.3 ± 3.2°, P = 0.003), AVBH, and sagittal alignment. A minor loss of correction was observed in Group B with respect to Group A (0.9 ± 1.7° vs 4.3° ± 2.1°, P = 0.043). Blood losses were lower in Group A (78 ± 15 min vs. 118 ± 23 min, P = 0.021) as well as during surgery (121.3 ± 34 mL vs. 210.2 ± 52 mL, P = 0.031), but the post-operative hemoglobin levels were comparable between the two groups. Conclusion SSOFIFL appears to show a major amount of KD correction and prevent loss of correction. This technique should be the preferred choice whenever possible. However, SSPF can be considered a valid alternative for damage control in polytrauma patients and fractures with low KD.
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Affiliation(s)
- Andrea Perna
- Department of Orthopedics and Traumatology, Fondazione Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy
| | - Andrea Franchini
- Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari “Aldo Moro,”Bari, Italy
| | - Franco Lucio Gorgoglione
- Department of Orthopedics and Traumatology, Fondazione Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy
| | - Felice Barletta
- Department of Orthopedics and Traumatology, Fondazione Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy
| | - Biagio Moretti
- Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari “Aldo Moro,”Bari, Italy
| | - Andrea Piazzolla
- Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari “Aldo Moro,”Bari, Italy
| | - Maria Beatrice Bocchi
- Department of Orthopedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli, IRCCS - Università Cattolica del Sacro Cuore, Roma, Italy
| | - Calogero Velluto
- Department of Orthopedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli, IRCCS - Università Cattolica del Sacro Cuore, Roma, Italy
| | - Francesco Tamburrelli
- Department of Orthopedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli, IRCCS - Università Cattolica del Sacro Cuore, Roma, Italy
| | - Luca Proietti
- Department of Orthopedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli, IRCCS - Università Cattolica del Sacro Cuore, Roma, Italy
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Rui L, Li F, Chen C, E Y, Wang Y, Yuan Y, Li Y, Lu J, Huang S. Efficacy of a novel percutaneous pedicle screw fixation and vertebral reconstruction versus the traditional open pedicle screw fixation in the treatment of single-level thoracolumbar fracture without neurologic deficit. Front Surg 2023; 9:1039054. [PMID: 36684284 PMCID: PMC9852511 DOI: 10.3389/fsurg.2022.1039054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/07/2022] [Indexed: 01/08/2023] Open
Abstract
Objective The aim of this study was to compare the efficacy and safety of a novel percutaneous pedicle screw fixation and vertebral reconstruction (PPSR) vs. that of open pedicle screw fixation (OPSF) in the treatment of thoracolumbar fractures. Methods This retrospective study enrolled 153 patients who underwent PPSR and 176 patients who received OPSF. Periprocedural characteristics, radiographic parameters, and clinical outcomes were compared between the two groups. Results The operation duration was 93.843 ± 20.611 in PPSR group and 109.432 ± 11.903 in OPSF group; blood loss was 131.118 ± 23.673 in PPSR group and 442.163 ± 149.701 in OPSF group, incision length was 7.280 ± 1.289 in PPSR group and 14.527 ± 2.893 in OPSF group, postoperative stay was 8.732 ± 1.864 in PPSR group and 15.102 ± 2.117 in OPSF group, and total hospitalization costs were 59027.196 ± 8687.447 in PPSR group and 73144.432 ± 11747.567 in OPSF group. These results indicated that these parameters were significantly lower in PPSR compared with those in OPSF group. No significant difference was observed in the incidence of complications between the two groups. The radiographic parameters including height of the anterior vertebra, Cobb angle, and vertebral wedge angle were better in PPSR group than in OPSF group. Recovery rate of AVH was 0.449 ± 0.079 in PPSR group and 0.279 ± 0.088 in OPSF group. Analysis of clinical results revealed that during postoperative period, the VAS and ODI scores in PPSR group were lower than those in OPSF group. Conclusions Collectively, these results indicated that PPSR more effectively restored the height of anterior vertebra and alleviated local kyphosis compared with OPSF. Moreover, the VAS and ODI scores in PPSR group were better than those of OPSF group.
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Affiliation(s)
- Lining Rui
- Department of Spinal Surgery, WujinHospital of Traditional Chinese Medicine, Changzhou, China
| | - Fudong Li
- Department of Orthopaedic Surgery, Spine Center, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Cao Chen
- Department of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Yuan E
- Department of Spinal Surgery, WujinHospital of Traditional Chinese Medicine, Changzhou, China
| | - Yuchen Wang
- Department of Sports Medicine, Wujin Hospital of Traditional Chinese Medicine, Changzhou, China
| | - Yanhong Yuan
- Department of Spinal Surgery, WujinHospital of Traditional Chinese Medicine, Changzhou, China
| | - Yunfeng Li
- Department of Spinal Surgery, WujinHospital of Traditional Chinese Medicine, Changzhou, China
| | - Jian Lu
- Department of Spinal Surgery, WujinHospital of Traditional Chinese Medicine, Changzhou, China
| | - Shengchang Huang
- Department of Spinal Surgery, WujinHospital of Traditional Chinese Medicine, Changzhou, China,Correspondence: Shengchang Huang
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Fei G, Yan H. Clinical Effect of Minimally Invasive Percutaneous Pedicle Screw Internal Fixation Combined with Injured Vertebrae Bone Grafting in the Treatment of Thoracolumbar Fractures in Orthopedic Surgery. Emerg Med Int 2022; 2022:3081380. [PMID: 35875250 PMCID: PMC9300293 DOI: 10.1155/2022/3081380] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/11/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To observe the clinical effect of minimally invasive percutaneous pedicle screw internal fixation combined with injured vertebrae bone grafting in the treatment of thoracolumbar fractures in orthopedic surgery. Methods A total of 132 patients with thoracolumbar fractures admitted to the hospital were enrolled between January 2020 and April 2021. Both groups underwent minimally invasive percutaneous pedicle screw internal fixation. According to the presence or absence of intraoperative injured vertebrae bone grafting, they were divided into the grafting group (73 cases) and the injured vertebrae ungrafted group (59 cases). The perioperative indexes, pain at 2 weeks after surgery, surgical stress, recovery of an injured vertebra, self-care ability, quality of life, and postoperative complications were compared between the two groups. Result There was no significant difference in intraoperative blood loss, operation time, or hospitalization time between the grafting group and the nongrafting group (P > 0.05).2 weeks after surgery, scores of the Visual Analogue Scale (VAS) in the grafting group were lower than those in the nongrafting group (P < 0.05).At 3d after surgery, levels of serum cortisol (COR), epinephrine (E), and norepinephrine (NE) in both groups were higher than those before surgery, which were lower in the grafting group than in the nongrafting group (P < 0.05).At 3 months after surgery, the anterior edge height of the injured vertebra in both groups was increased, which was higher in the grafting group than in the nongrafting group (P < 0.05). At 3 months after surgery, the Cobb angle of sagittal kyphosis in both groups was decreased, which was lower in the grafting group than that in the nongrafting group (P < 0.05). At 3 months after surgery, the scores of activity of daily living (ADL) and the MOS item-short form health survey (SF-36) in both groups were higher than those before surgery, which were higher in the grafting group than in the nongrafting group (P < 0.05). The difference in the incidence rate of injured vertebrae collapse, internal fixation breakage, or kyphosis between the grafting group and the nongrafting group was not statistically significant (1.37% vs 6.78%) (P > 0.05). Conclusion Minimally invasive percutaneous pedicle screw internal fixation combined with injured vertebrae bone grafting in orthopedic surgery can improve postoperative pain and surgical stress in patients with thoracolumbar fractures, which is conducive to the recovery of injured vertebrae and improvement in the quality of life.
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Affiliation(s)
- Guoce Fei
- Orthopedics Ward 3, No. 215 Hospital of Shaanxi Nuclear Industry, Xianyang, Shanxi 712000, China
| | - Huaru Yan
- Department of Orthopedics, Xi'an Daxing Hospital, Xi'an, Shanxi 710016, China
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Dong S, Li Z, Tang ZR, Zheng Y, Yang H, Zeng Q. Predictors of adverse events after percutaneous pedicle screws fixation in patients with single-segment thoracolumbar burst fractures. BMC Musculoskelet Disord 2022; 23:168. [PMID: 35193550 PMCID: PMC8864915 DOI: 10.1186/s12891-022-05122-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Percutaneous pedicle screw fixation (PPSF) is the primary approach for single-segment thoracolumbar burst fractures (TLBF). The healing angle at the thoracolumbar junction is one of the most significant criteria for evaluating the efficacy of PPSF. Therefore, the purpose of this study was to analyze the predictors associated with the poor postoperative alignment of the thoracolumbar region from routine variables using a support vector machine (SVM) model. METHODS We retrospectively analyzed patients with TLBF operated at our academic institute between March 1, 2014 and December 31, 2019. Stepwise logistic regression analysis was performed to assess potential statistical differences between all clinical and radiological variables and the adverse events. Based on multivariate logistic results, a series of independent risk factors were fed into the SVM model. Meanwhile, the feature importance of radiologic outcome for each parameter was explored. The predictive performance of the SVM classifier was evaluated using the area under the receiver operating characteristic curve (AUC), accuracy (ACC) and confusion matrices with 10-fold cross-validation, respectively. RESULTS In the recruited 150 TLBFs, unfavorable radiological outcomes were observed in 53 patients (35.33%). The relationship between osteoporosis (p = 0.036), preoperative Cobb angle (p = 0.001), immediate postoperative Cobb angle (p = 0.029), surgically corrected Cobb angle (p = 0.001), intervertebral disc injury (Score 2 p = 0.001, Score 3 p = 0.001), interpedicular distance (IPD) (p = 0.001), vertebral body compression rate (VBCR) (p = 0.010) and adverse events was confirmed by univariate regression. Thereafter, independent risk factors including preoperative Cobb angle, the disc status and IPD and independent protective factors surgical correction angle were identified by multivariable logistic regression. The established SVM classifier demonstrated favorable predictive performance with the best AUC = 0.93, average AUC = 0.88, and average ACC = 0.87. The variables associated with radiological outcomes, in order of correlation strength, were intervertebral disc injury (42%), surgically corrected Cobb angle (25%), preoperative Cobb angle (18%), and IPD (15%). The confusion matrix reveals the classification results of the discriminant analysis. CONCLUSIONS Critical radiographic indicators and surgical purposes were confirmed to be associated with an unfavorable radiographic outcome of TLBF. This SVM model demonstrated good predictive ability for endpoints in terms of adverse events in patients after PPSF surgery.
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Affiliation(s)
- Shengtao Dong
- Department of Spine Surgery, the Second Affiliated Hospital of Dalian Medical University, Dalian, 116023, China
| | - Zongyuan Li
- Department of Orthopedics, Mianyang Central Hospital, Mianyang, 621000, China
| | - Zhi-Ri Tang
- School of Physics and Technology, Wuhan University, Wuhan, 430072, China
| | - Yuanyuan Zheng
- Department of Oncology, the Second Affiliated Hospital of Dalian Medical University, Dalian, 116023, China
| | - Hua Yang
- Department of Otolaryngology, the Second Affiliated Hospital of Dalian Medical University, Dalian, 116023, China
| | - Qiuming Zeng
- Department of Orthopedics, University-Town Hospital of Chongqing Medical University, Chongqing, 401331, China.
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Perna A, Santagada DA, Bocchi MB, Zirio G, Proietti L, Tamburrelli FC, Genitiempo M. Early loss of angular kyphosis correction in patients with thoracolumbar vertebral burst (A3-A4) fractures who underwent percutaneous pedicle screws fixation. J Orthop 2021; 24:77-81. [PMID: 33679031 DOI: 10.1016/j.jor.2021.02.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/28/2020] [Accepted: 02/14/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose Percutaneous trans-pedicle screws represent a surgical option frequently performed in patients affected by thoracolumbar vertebral burst fractures (A3-A4). The aim of the study was to evaluate the early loss of kyphosis correction and its clinical correlations in a cohort of patients affected by burst spinal fracture treated with percutaneous trans-pedicle screws fixation. Methods The present investigation consists in a retrospective one center analysis. The primary outcome was the evaluation of the early loss of correction. Secondary outcomes were the bi-segmental kyphosis change, the clinical outcome and the correlation between clinical outcome and the loss of correction. Results Among 435 patients 97 were included in the study. A mean 3.3° of early loss of correction was observed between postoperative and 1 month follow-up evaluations. The mean anterior vertebral body height change was 3.8 mm. No statistical differences were found in clinical and functional outcomes between patients with >2° or <2° of kyphosis loss of correction. Conclusion No statistical differences were found between 1 e 6 months postoperative kyphosis loss of correction. The amount of loss of correction seems not to influence clinical outcomes after percutaneous trans-pedicle screw fixation in patients with vertebral burst fractures.
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Affiliation(s)
- Andrea Perna
- Istituto di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli, Catholic University, Rome, Italy
| | | | - Maria Beatrice Bocchi
- Istituto di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli, Catholic University, Rome, Italy
| | - Gianfranco Zirio
- Istituto di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli, Catholic University, Rome, Italy
| | - Luca Proietti
- Istituto di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli, Catholic University, Rome, Italy.,Istituto di Clinica Ortopedica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Ciro Tamburrelli
- Istituto di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli, Catholic University, Rome, Italy.,Istituto di Clinica Ortopedica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maurizio Genitiempo
- Istituto di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli, Catholic University, Rome, Italy
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