1
|
Furukawa M, Fujiyoshi K, Kajikawa K, Kobayashi Y, Konomi T, Yato Y. Surgical outcomes of anterior column reconstruction for spinal fractures caused by minor trauma-preoperative examination of the number of intervertebral bone bridges is key to obtaining good bone fusion. BMC Musculoskelet Disord 2024; 25:216. [PMID: 38481188 PMCID: PMC10938728 DOI: 10.1186/s12891-024-07326-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 03/01/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND To achieve good bone fusion in anterior column reconstruction for vertebral fractures, not only bone mineral density (BMD) and bone metabolism markers but also lever arms due to bone bridging between vertebral bodies should be evaluated. However, until now, no lever arm index has been devised. Therefore, we believe that the maximum number of vertebral bodies that are bony and cross-linked with the contiguous adjacent vertebrae (maxVB) can be used as a measure for lever arms. The purpose of this study is to investigate the surgical outcomes of anterior column reconstruction for spinal fractures and to determine the effect of bone bridging between vertebral bodies on the rate of bone fusion using the maxVB as an indicator of the length of the lever arm. METHODS The clinical data of 81 patients who underwent anterior column reconstruction for spinal fracture between 2014 and 2022 were evaluated. The bone fusion rate, back pain score, between the maxVB = 0 and the maxVB ≥ 2 patients were adjusted for confounding factors (age, smoking history, diabetes mellitus history, BMD, osteoporosis drugs, surgical technique, number of fixed vertebrae, materials used for the anterior props, etc.) and analysed with multivariate or multiple regression analyses. The bone healing rate and incidence of postoperative back pain were compared among the three groups (maxVB = 0, 2≦maxVB≦8, maxVB ≧ 9) and divided by the maxVB after adjusting for confounding factors. RESULTS Patients with a maxVB ≥ 2 had a significantly higher bone fusion rate (p < 0.01) and postoperative back pain score (p < 0.01) than those with a maxVB = 0. Among the three groups, the bone fusion rate and back pain score were significantly higher in the 2≦maxVB≦8 group (p = 0.01, p < 0.01). CONCLUSIONS Examination of the maxVB as an indicator of the use of a lever arm is beneficial for anterior column reconstruction for vertebral fractures. Patients with no intervertebral bone bridging or a high number of bone bridges are in more need of measures to promote bone fusion than patients with a moderate number of bone bridges are.
Collapse
Affiliation(s)
- Mitsuru Furukawa
- Department of Orthopedic Surgery, NHO Murayama Medical Center, Tokyo, Japan.
- Institute of Murayama Medical Center, 2-37-11 Gakuen, Musashimurayamashi, Tokyo, 208-0011, Japan.
| | - Kanehiro Fujiyoshi
- Department of Orthopedic Surgery, NHO Murayama Medical Center, Tokyo, Japan
| | - Keita Kajikawa
- Department of Orthopedic Surgery, NHO Murayama Medical Center, Tokyo, Japan
| | - Yoshiomi Kobayashi
- Department of Orthopedic Surgery, NHO Murayama Medical Center, Tokyo, Japan
| | - Tsunehiko Konomi
- Department of Orthopedic Surgery, NHO Murayama Medical Center, Tokyo, Japan
| | - Yoshiyuki Yato
- Department of Orthopedic Surgery, NHO Murayama Medical Center, Tokyo, Japan
| |
Collapse
|
2
|
Li J, Xu L, Liu Y, Sun Z, Wang Y, Yu M, Li W, Zeng Y. Open Surgical Treatments of Osteoporotic Vertebral Compression Fractures. Orthop Surg 2023; 15:2743-2748. [PMID: 37587622 PMCID: PMC10622270 DOI: 10.1111/os.13822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/24/2023] [Accepted: 05/27/2023] [Indexed: 08/18/2023] Open
Abstract
With an aging population, the osteoporotic vertebral compression fracture (OVCF) has become a constant concern for its physical and neurological complications, such as spinal kyphosis and refractory pains. Compared with traditional conservative treatments, the open surgery is more superior in some ways because of its direct decompression and correction. Various operation methods applying to different indications have been developed to deal with different fracture situations, including anterior, posterior, and combined surgery. In this review, we have concluded the latest developments of the surgery treating OVCF and the internal fixation as references for spinal surgeons of the choice of suitable treatments.
Collapse
Affiliation(s)
- Junyu Li
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Lizhi Xu
- School of Basic Medical SciencesPeking University Health Science CenterBeijingChina
| | - Yinhao Liu
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Zhuoran Sun
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Yongqiang Wang
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Miao Yu
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Weishi Li
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Yan Zeng
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| |
Collapse
|
3
|
Zeng Z, Zhang D, Zeng FL, Ao J. Posterior unilateral small fenestration of lamina combined with a custom-made Y-shaped fracture reduction device for the treatment of severe thoracolumbar burst fracture: a prospective comparative study. J Orthop Surg Res 2023; 18:529. [PMID: 37491312 PMCID: PMC10369761 DOI: 10.1186/s13018-023-03971-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/03/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND The purpose was to evaluate the clinical effect of a custom-made Y-shaped fracture fragment reduction device and to assist in posterior unilateral small fenestration of lamina to reduce the fracture fragments. METHODS In this study, 40 patients were assigned to one of two groups: the traditional reduction device group (TRG) or the Y-shaped reduction device group (YRG). All patients underwent posterior unilateral small fenestration of the lamina and direct decompression through the spinal canal. And the operation time (OT), intraoperative bleeding (IB), preoperative, postoperative, and final follow-up data on the spinal stenosis rate (SSR), Cobb angle, the anterior compression ratio of injured vertebrae (ACRIV), and ASIA neurological function grade were compared between the two groups. RESULT There were no complications, including vascular and nerve injury, serious postoperative infection, internal fixation fracture, or loosening, for any of the patients. And the average follow-up time of the two groups was 14.2 months, the average operation time of the TRG was 236.6 min, and the average intraoperative blood loss was 357.20 ml. Moreover, the average operation time of the YRG was 190.6 min, and the average intraoperative blood loss was 241.5 ml. There were significant differences between the two groups in terms of operation duration and intraoperative blood loss. The YRG's was lower than that of the TRG. Besides, there was no difference in SSR, Cobb angle, ACRIV, or neurological recovery between the two groups before or immediately after the operation or at the last follow-up. CONCLUSION The Y-shaped fracture reduction device can reduce the fracture fragments and the OT and IB stably; it also has satisfactory postoperative curative effects and clinical utility.
Collapse
Affiliation(s)
- Zheng Zeng
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China
| | - Dan Zhang
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China
| | - Fen-Lian Zeng
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China
| | - Jun Ao
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China.
| |
Collapse
|
4
|
Pan B, Yu W, Lou C, Gao J, Huang W, He D. Comparison of mini-open, anteroinferior psoas approach and mini-open, direct lateral transpsoas approach for lumbar burst fractures: A retrospective cohort study. Front Surg 2022; 9:995410. [PMID: 36311940 PMCID: PMC9614075 DOI: 10.3389/fsurg.2022.995410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/26/2022] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE We evaluated the effect of a novel modified OLIF technique (anteroinferior psoas approach, AIPA) for anterior decompression reconstruction in lumbar burst fractures, and compared the clinical, radiological outcomes and approach-related complications with the mini-open, lateral transpsoas approach (LTPA). METHODS From March 2016 to November 2019, 68 patients with lumbar burst fractures underwent one-stage monosegmental posterior/anterior surgery from L1-L4 segments. 35 patients included in AIPA and 33 patients in LTPA group underwent anterior decompression reconstruction. The clinical, radiological and functional evaluation outcomes were recorded during the 16-60 months follow-up period. RESULTS At the latest follow up, neurological state of one or more ASIA grades were achieved in AIPA (90.9%) and LTPA group (94.9%). No significant differences were noted between the two groups regarding preoperative and postoperative Cobbs angle. The surgery time (192.29 vs. 230.47 min, P = 0.02) in AIPA group was better compared with LTPA. The AIPA showed better improvement on Oswestry Disability Index (43.4% vs. 60.8%, P < 0.05) and Mental Component Score (49.0% vs. 43.7%, P < 0.05) one month after surgery, but no difference at the latest follow-up. 10 patients (9 in LTPA and 1 in AIPA) experienced temporary motor deficits in hip flexor and groin or thigh numbness, which disappeared six months after surgery. CONCLUSIONS Compared with lateral transpsoas approach, anterior decompression reconstruction via mini-open, anteroinferior psoas approach was a safe and less invasive approach, with fewer approach-related complications in the treatment for unstable lumbar burst fractures.
Collapse
|
5
|
Optimization of Spinal Reconstructions for Thoracolumbar Burst Fractures to Prevent Proximal Junctional Complications: A Finite Element Study. Bioengineering (Basel) 2022; 9:bioengineering9100491. [DOI: 10.3390/bioengineering9100491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/17/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022] Open
Abstract
The management strategies of thoracolumbar (TL) burst fractures include posterior, anterior, and combined approaches. However, the rigid constructs pose a risk of proximal junctional failure. In this study, we aim to systemically evaluate the biomechanical performance of different TL reconstruction constructs using finite element analysis. Furthermore, we investigate the motion and the stress on the proximal junctional level adjacent to the constructs. We used a T10-L3 finite element model and simulated L1 burst fracture. Reconstruction with posterior instrumentation (PI) alone (U2L2 and U1L1+(intermediate screw) and three-column spinal reconstruction (TCSR) constructs (U1L1+PMMA and U1L1+Cage) were compared. Long-segment PI resulted in greater global motion reduction compared to constructs with short-segment PI. TCSR constructs provided better stabilization in L1 compared to PI alone. Decreased intradiscal and intravertebral pressure in the proximal level were observed in U1L1+IS, U1L1+PMMA, and U1L1+Cage compared to U2L2. The stress and strain energy of the pedicle screws decreased when anterior reconstruction was performed in addition to PI. We showed that TCSR with anterior reconstruction and SSPI provided sufficient immobilization while offering additional advantages in the preservation of physiological motion, the decreased burden on the proximal junctional level, and lower risk of implant failure.
Collapse
|
6
|
Does local vancomycin powder impregnated with autogenous bone graft and bone substitute decrease the risk of deep surgical site infection in degenerative lumbar spine fusion surgery?—An ambispective study. BMC Musculoskelet Disord 2022; 23:853. [PMID: 36088338 PMCID: PMC9463828 DOI: 10.1186/s12891-022-05802-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 06/15/2022] [Indexed: 11/25/2022] Open
Abstract
Background Deep surgical site infection (DSSI) is one of the most challenging complications in lumbar fusion surgery. Few investigations examined the effect of vancomycin powder mixed with autogenic bone graft (ABG) and bone substitutes on preventing DSSI in degenerative lumbar fusion surgeries as well as any interference with bony fusion. The aim of the study was to investigate the effects of ABG along with bone substitutes as a local vancomycin delivery system on preventing DSSI in lumbar instrumented fusion and compared with those who did not use vancomycin powder. Methods From January, 2015 through December, 2015, a one-year prospective study using vancomycin powder mixed with ABG and bone substitute for degenerative lumbar fusion surgeries as vancomycin (V) group, 1 gm vancomycin for 2 and 3-level, and 2 gm for more than 3-level instrumentation. From December, 2013 through December 2014, patients received degenerative lumbar fusion surgeries without using vancomycin before the vancomycin protocol were retrospectively enrolled as non-vancomycin (NV) group. Vancomycin concentration was checked at post-operative days 1 and 3 for both the serum and drainage. Patients’ demographic data, microbiology reports, fusion status and functional outcomes were evaluated. Results One hundred and ten patients were enrolled prospectively in the V group, and 86 for the NV group. After an average 41 months follow-up (range, 36–54), 3 patients (3.48%) developed postoperative DSSIs in the NV group, thereby requiring revision surgeries and parenteral antibiotics treatment versus no DSSIs (0%, 0/100) in the V group. (p = 0.048). The postoperative serum vancomycin levels were undetectable and no vancomycin related side effects was encountered. The mean vancomycin concentration of drainage at postoperative days 1 and 3 were 517.96 ± 174.4 and 220.14 ± 102.3 μg/mL, respectively. At final follow-up, there was no statistical difference observed in terms of clinical and radiologic outcomes. Conclusions Our vancomycin protocol may reduce the incidence of DSSI in degenerative lumbar fusion surgery without affecting bony fusion. Level of Evidence Level III ambispective comparative study.
Collapse
|
7
|
Takeda K, Aoki Y, Nakajima T, Sato Y, Sato M, Yoh S, Takahashi H, Nakajima A, Eguchi Y, Orita S, Inage K, Shiga Y, Nakagawa K, Ohtori S. Postoperative loss of correction after combined posterior and anterior spinal fusion surgeries in a lumbar burst fracture patient with Class II obesity. Surg Neurol Int 2022; 13:210. [PMID: 35673667 PMCID: PMC9168345 DOI: 10.25259/sni_138_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/28/2022] [Indexed: 11/06/2022] Open
Abstract
Background: When treating thoracolumbar fractures with severe cranial endplate injury but no or slight caudal endplate injury, it is debatable whether anterior fusion should be performed only for the injured cranial level, or for both cranial and caudal levels. We report an unexpected postoperative correction loss after combined multilevel posterior and single-level anterior fusion surgery in a patient with obesity. Case Description: A 28-year-old male with Class II obesity was brought to the emergency room with an L1 burst fracture with spinal canal involvement. Cranial endplate injury was severe, whereas caudal endplate injury was mild. The first surgery with 1-above 1-below posterior fixation failed to achieve sufficient stability; thus, additional surgeries (3-above 3-below posterior fixation and single-level T12-L1 anterior fusion) were performed. Postoperatively, the local kyphosis angle (LKA) between T12 and L2 was 22° in the lateral lying position and 29° in the standing position. Twenty-one-month post surgery, bony fusion between T12 and L1 was observed, and the LKA was 28° in both the lateral lying and standing positions. After posterior implants were removed 24 months after the surgery, significant correction loss both at the T12-L1 segment (6°) and L1-L2 segment (6°) occurred, and LKA was 40° at the final follow-up. Conclusion: In this patient, an intense axial load due to excessive body weight was at least one of the causes of postoperative correction loss. Postural differences in LKA may be useful to evaluate the stability of thoracolumbar fractures after fusion surgery and to predict postoperative correction loss.
Collapse
Affiliation(s)
- Kosuke Takeda
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan
| | - Takayuki Nakajima
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan
| | - Yusuke Sato
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan
| | - Masashi Sato
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan
| | - Satoshi Yoh
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan
| | - Hiroshi Takahashi
- Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Arata Nakajima
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Japan
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Chiba University, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Chiba University, Chiba, Japan
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Chiba University, Chiba, Japan
| | - Yasuhiro Shiga
- Department of Orthopaedic Surgery, Chiba University, Chiba, Japan
| | - Koichi Nakagawa
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Chiba University, Chiba, Japan
| |
Collapse
|
8
|
Nakashima H, Kanemura T, Satake K, Ito K, Tanaka S, Segi N, Ouchida J, Ando K, Kobayashi K, Imagama S. Transdiaphragmatic Approach as a Novel Less Invasive Retroperitoneal Approach at Thoracolumbar Junction: Comparison with Conventional Diaphragmatic Incision. Spine Surg Relat Res 2021; 5:405-411. [PMID: 34966867 PMCID: PMC8668210 DOI: 10.22603/ssrr.2020-0191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/21/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Lateral corpectomy has been considered a minimally invasive surgery, allowing a “transdiaphragmatic approach” at the thoracolumbar junction. This approach allows for a small diaphragmatic incision directly in the retroperitoneal space and the affected vertebra. However, its effectiveness in comparison to a conventional approach remains unclear. Thus, in this present study, we compared the surgical outcomes between conventional diaphragmatic detachment and the transdiaphragmatic approach in patients with vertebral fracture at the thoracolumbar junction. Methods In total, 31 patients with a vertebral fracture at the thoracolumbar junction (T12-L2) were included in this study: 17 underwent a conventional approach, whereas 14 underwent a transdiaphragmatic approach, with a minimum 2-year follow-up. The effectiveness of surgery was evaluated in each category of the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ). Results Operative time and estimated blood loss were determined to be significantly shorter in the transdiaphragmatic than in the conventional approach. Perioperative complications were observed in the conventional approach (one atelectasis and one pleural effusion), while no complication was noted in the transdiaphragmatic approach. There were no significant differences in postoperative quality of life as assessed by JOABPEQ in terms of pain-related disorders, lumbar spine dysfunction, gait disturbance, social life dysfunction, or psychological disorders between the conventional and transdiaphragmatic approaches. Conclusions A “transdiaphragmatic approach” using lateral access surgery has been found to be associated with a shorter operative time and less blood loss with fewer complications than the conventional approach. Given that equivalent clinical outcomes were achieved in both conventional and transdiaphragmatic approaches, this “transdiaphragmatic approach” could be useful because of its minimal invasiveness.
Collapse
Affiliation(s)
- Hiroaki Nakashima
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan.,Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tokumi Kanemura
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Kotaro Satake
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Kenyu Ito
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Satoshi Tanaka
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Naoki Segi
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan.,Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Jun Ouchida
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan.,Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
9
|
Jordan MC, Jansen H, Meffert RH, Heintel TM. Comparing porous tantalum fusion implants and iliac crest bone grafts for spondylodesis of thoracolumbar burst fractures: Prospectice Cohort study. Sci Rep 2021; 11:17409. [PMID: 34465811 PMCID: PMC8408264 DOI: 10.1038/s41598-021-96400-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/10/2021] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to compare two different techniques of performing one-level spondylodesis for thoracolumbar burst fractures using either an autologous iliac crest bone graft (ICBG) or a porous tantalum fusion implant (PTFI). In a prospective nonrandomized study, 44 patients (20 women, 24 men; average age 43.1 ± 13.2 years) suffering from severe thoracolumbar burst fractures were treated with combined anterior–posterior stabilization. An ICBG was used in 21 cases, and a PTFI was used in the other 23 cases. A two-year clinical and radiographic follow-up was carried out. There were no statistically significant differences in age, sex, localization/classification of the fracture, or visual analog scale (VAS) before injury between the two groups. All 44 patients were followed up for an average period of 533 days (range 173–1567). The sagittal spinal profile was restored by an average of 11.1° (ICBG) vs. 14.3° (PTFI) (monosegmental Cobb angle). Loss of correction until the last follow-up tended to be higher in the patients treated with ICBG than in those treated with PTFI (mean: 2.8° vs. 1.6°). Furthermore, significantly better restoration of the sagittal profile was obtained with the PTFI than with the iliac bone graft at the long-term follow-up (mean: ICBG 7.8°, PTFI 12.3°; p < 0.005). Short-segment posterior instrumentation combined with anterior one-level spondylodesis using either an ICBG or a PTFI resulted in sufficient correction of posttraumatic segmental kyphosis. PTFI might be a good alternative for autologous bone grafting and prevent donor site morbidities.
Collapse
Affiliation(s)
- Martin C Jordan
- Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Julius-Maximilians-University, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
| | - Hendrik Jansen
- Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Julius-Maximilians-University, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Rainer H Meffert
- Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Julius-Maximilians-University, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Timo M Heintel
- Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Julius-Maximilians-University, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| |
Collapse
|
10
|
Wong CE, Hu HT, Tsai CH, Li JL, Hsieh CC, Huang KY. Comparison of Posterior Fixation Strategies for Thoracolumbar Burst Fracture: A Finite Element Study. J Biomech Eng 2021; 143:1104431. [PMID: 33729440 DOI: 10.1115/1.4050537] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Indexed: 11/08/2022]
Abstract
The management of thoracolumbar (TL) burst fractures remained challenging. Due to the complex nature of the fractured vertebrae and the lack of clinical and biomechanical evidence, currently, there was still no guideline to select the optimal posterior fixation strategy for TL burst fracture. We utilized a T10-L3 TL finite element model to simulate L1 burst fracture and four surgical constructs with one- or two-level suprajacent and infrajacent instrumentation (U1L1, U1L2, U2L1, and U2L2). This study was aimed to compare the biomechanical properties and find an optimal fixation strategy for TL burst fracture in order to minimize motion in the fractured level without exerting significant burden in the construct. Our result showed that two-level infrajacent fixation (U1L2 and U2L2) resulted in greater global motion reduction ranging from 66.0 to 87.3% compared to 32.0 to 47.3% in one-level infrajacent fixation (U1L1 and U2L1). Flexion produced the largest pathological motion in the fractured level but the differences between the constructs were small, all within 0.26 deg. Comparisons in implant stress showed that U2L1 and U2L2 had an average 25.3 and 24.8% less von Mises stress in the pedicle screws compared to U1L1 and U1L2, respectively. The construct of U2L1 had better preservation of the physiological spinal motion while providing sufficient range of motion reduction at the fractured level. We suggested that U2L1 is a good alternative to the standard long-segment fixation with better preservation of physiological motion and without an increased risk of implant failure.
Collapse
Affiliation(s)
- Chia-En Wong
- Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Hsuan-Teh Hu
- Department of Civil Engineering, National Cheng Kung University, Tainan 701, Taiwan; Department of Civil and Disaster Prevention Engineering, National United University, Miaoli 360, Taiwan
| | - Cho-Hsuan Tsai
- Department of Civil Engineering, National Cheng Kung University, Tainan 701, Taiwan
| | - Jun-Liang Li
- Department of Otolaryngology, Tungs' Taichung MetroHarbor Hospital, Taichung 433, Taiwan
| | - Chin-Chiang Hsieh
- Department of Radiology, Tainan Hospital, Ministry of Health and Welfare, Tainan 700, Taiwan
| | - Kuo-Yuan Huang
- Department of Orthopedics,National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
| |
Collapse
|
11
|
Yao Y, Yan J, Jiang F, Zhang S, Qiu J. Comparison of Anterior and Posterior Decompressions in Treatment of Traumatic Thoracolumbar Spinal Fractures Complicated with Spinal Cord Injury. Med Sci Monit 2020; 26:e927284. [PMID: 33211674 PMCID: PMC7684844 DOI: 10.12659/msm.927284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background For patients with thoracolumbar spinal fractures complicated with spinal cord injury, timely surgery is the first choice. We compared the effects of anterior and posterior decompressions in treatment of these patients. Material/Methods A total of 80 male patients with traumatic thoracolumbar spinal fractures and spinal cord injury were prospectively selected and divided into 2 groups. The control group underwent posterior decompression and internal fixation and the observation group underwent real-time anterior decompression. Results The observation group had longer operative time and length of postoperative hospital stay, larger intraoperative blood loss, remarkably greater immediate postoperative anterior height and middle column height of the fractured vertebrae, and a notably smaller Cobb’s angle than in the control group. The total ASIA score was significantly higher in the observation group than in the control group immediately after surgery and at 6 months and 1 year after surgery. The maximal urine flow, maximal detrusor pressure, and bladder compliance were also evidently higher in the observation group than in the control group during 1 year of follow-up. Compared with the control group, the International Index of Erectile Function-5 (IIEF-5) score in the observation group was significantly higher at 3 months, 6 months, and 1 year after surgery. Conclusions Compared with the posterior approach, anterior decompression in patients with thoracolumbar spinal fractures complicated with spinal cord injury can effectually enhance the surgical efficiency, and restore the physiological anatomy of the fractured vertebrae, thereby improving patient quality of life.
Collapse
Affiliation(s)
- Yilun Yao
- Department of Orthopedic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Junwei Yan
- Department of Orthopedic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Fan Jiang
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Sheng Zhang
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Junjun Qiu
- Department of Orthopedic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| |
Collapse
|
12
|
Piccone L, Cipolloni V, Nasto LA, Pripp C, Tamburrelli FC, Maccauro G, Pola E. Reprint of: Thoracolumbar burst fractures associated with incomplete neurological deficit in patients under the age of 40: Is the posterior approach enough? Surgical treatment and results in a case series of 10 patients with a minimum follow-up of 2 years. Injury 2020; 51 Suppl 3:S45-S49. [PMID: 32800314 DOI: 10.1016/j.injury.2020.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/16/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Surgical management of thoracolumbar burst fractures is controversial. While the goals of surgical treatment are well accepted (i.e., fracture reduction and stabilization, neural elements decompression, and segmental angular deformity correction), the choice of the best surgical approach (i.e., posterior vs. anterior vs. combined approach) remains controversial. Several studies have debated the advantages of each surgical approach but there is no definitive evidence available to date, particularly in young adult patients. The aim of this study was to assess whether posterior approach alone can be a valid surgical treatment for patient under the age of 40 affected by thoracolumbar burst fractures and incomplete neurological deficits. MATERIAL AND METHODS A total of 10 consecutive patients affected by thoracolumbar burst fractures associated with incomplete neurological deficits treated at our institution from January 2015 to February 2017 were included in our study. All patients were under the age of 40 at the time of injury and underwent decompression and stabilization using the posterior surgical approach alone. Demographics, clinical, and radiographic parameters were recorded preoperatively, postoperatively and at the latest available follow-up. The minimum follow-up was set at 2 years post-operatively. RESULTS The mean operative time was 303.6 min (range, 138-486). Average blood loss was 756 mL (range, 440-2100). Nine out of ten patients returned to a normal neurological status after surgery while 1 patient showed some improvement but did not recover completely. Segmental kyphotic deformity improved from a mean of 21.8° before surgery to 14.8° at the time of the last follow-up. The anterior and posterior wall height of the fractured vertebra was restored with an average of 4 mm. The Visual Analogue Scale score reported an improvement from the mean preoperative value of 7.92 to 1.24 at the last follow-up; 8 out of 10 patients resumed physical activity while all of them returned to work. CONCLUSIONS A single posterior surgical approach is an acceptable option in terms of clinical, radiological and functional outcomes at 2 years follow-up in patients under the age of 40 presenting with a thoracolumbar burst fracture and neurological deficit.
Collapse
Affiliation(s)
- L Piccone
- Division of Spine Surgery, Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - V Cipolloni
- Division of Spine Surgery, Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - L A Nasto
- Department of Pediatric Orthopaedics, IRCCS Istituto "G Gaslini", Genova, Italy
| | - C Pripp
- Division of Spine Surgery, Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - F C Tamburrelli
- Division of Spine Surgery, Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - G Maccauro
- Division of Spine Surgery, Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - E Pola
- Division of Spine Surgery, Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy.
| |
Collapse
|
13
|
Piccone L, Cipolloni V, Nasto LA, Pripp C, Tamburrelli FC, Maccauro G, Pola E. Thoracolumbar burst fractures associated with incomplete neurological deficit in patients under the age of 40: Is the posterior approach enough? Surgical treatment and results in a case series of 10 patients with a minimum follow-up of 2 years. Injury 2020; 51:312-316. [PMID: 31917009 DOI: 10.1016/j.injury.2019.12.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 12/16/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Surgical management of thoracolumbar burst fractures is controversial. While the goals of surgical treatment are well accepted (i.e., fracture reduction and stabilization, neural elements decompression, and segmental angular deformity correction), the choice of the best surgical approach (i.e., posterior vs. anterior vs. combined approach) remains controversial. Several studies have debated the advantages of each surgical approach but there is no definitive evidence available to date, particularly in young adult patients. The aim of this study was to assess whether posterior approach alone can be a valid surgical treatment for patient under the age of 40 affected by thoracolumbar burst fractures and incomplete neurological deficits. MATERIAL AND METHODS A total of 10 consecutive patients affected by thoracolumbar burst fractures associated with incomplete neurological deficits treated at our institution from January 2015 to February 2017 were included in our study. All patients were under the age of 40 at the time of injury and underwent decompression and stabilization using the posterior surgical approach alone. Demographics, clinical, and radiographic parameters were recorded preoperatively, postoperatively and at the latest available follow-up. The minimum follow-up was set at 2 years post-operatively. RESULTS The mean operative time was 303.6 min (range, 138-486). Average blood loss was 756 mL (range, 440-2100). Nine out of ten patients returned to a normal neurological status after surgery while 1 patient showed some improvement but did not recover completely. Segmental kyphotic deformity improved from a mean of 21.8° before surgery to 14.8° at the time of the last follow-up. The anterior and posterior wall height of the fractured vertebra was restored with an average of 4 mm. The Visual Analogue Scale score reported an improvement from the mean preoperative value of 7.92 to 1.24 at the last follow-up; 8 out of 10 patients resumed physical activity while all of them returned to work. CONCLUSIONS A single posterior surgical approach is an acceptable option in terms of clinical, radiological and functional outcomes at 2 years follow-up in patients under the age of 40 presenting with a thoracolumbar burst fracture and neurological deficit.
Collapse
Affiliation(s)
- L Piccone
- Division of Spine Surgery, Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - V Cipolloni
- Division of Spine Surgery, Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - L A Nasto
- Department of Pediatric Orthopaedics, IRCCS Istituto "G Gaslini", Genova, Italy
| | - C Pripp
- Division of Spine Surgery, Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - F C Tamburrelli
- Division of Spine Surgery, Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - G Maccauro
- Division of Spine Surgery, Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - E Pola
- Division of Spine Surgery, Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| |
Collapse
|
14
|
Machino M, Ando K, Kobayashi K, Ota K, Morozumi M, Tanaka S, Ito K, Kato F, Ishiguro N, Imagama S. A comparative study of two reconstruction procedures for osteoporotic vertebral fracture with lumbar spinal stenosis: Posterior lumbar interbody fusion versus posterior and anterior and combined surgery. J Orthop Sci 2020; 25:52-57. [PMID: 30853275 DOI: 10.1016/j.jos.2019.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/23/2018] [Accepted: 02/14/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Optimal treatment of lumbar spinal stenosis (LSS) with neurological deficit due to osteoporotic vertebral fractures (OVFs) has been controversial. We assessed the usefulness, safety, and efficacy of posterior lumbar interbody fusion (PLIF) for LSS with neurological deficit due to OVFs and compared this procedure to posterior/anterior combined surgery (PACS). METHODS Of 36 consecutive patients with LSS with neurological deficit due to OVFs, 15 underwent PLIF (6 males, 9 females; mean age, 74 years), and 21 underwent PACS (4 males, 17 females; mean age, 70 years). Surgical complications, clinical outcomes (operative time, blood loss, American Spinal Injury Association Impairment Scale [AIS], activities of daily living [ADLs]), and sagittal alignment were investigated. Bony fusion was assessed using plain and functional X-rays and computed tomography scans. RESULTS There were no significant differences in age, sex, or disease or follow-up duration between the groups. Operative time was significantly shorter and intraoperative blood loss significantly less in the PLIF than in the PACS groups. AIS and ADL improved significantly postoperatively in both groups. No significant difference was observed in neurological improvement, correction angle, loss of correction, and surgical complications. No pseudarthrosis occurred, and no patient required additional surgery in the PLIF group. CONCLUSIONS PLIF for LSS with neurological deficit due to OVFs achieves posterior rigid fixation with instrumentation, anterior column reconstruction by interbody fusion, and adequate decompression using a single posterior approach. This less invasive procedure is a useful reconstructive surgery option.
Collapse
Affiliation(s)
- Masaaki Machino
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kyotaro Ota
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masayoshi Morozumi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Tanaka
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keigo Ito
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Organization of Occupational Health and Safety, Nagoya, Japan
| | - Fumihiko Kato
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Organization of Occupational Health and Safety, Nagoya, Japan
| | - Naoki Ishiguro
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| |
Collapse
|
15
|
Venier A, Roccatagliata L, Isalberti M, Scarone P, Kuhlen DE, Reinert M, Bonaldi G, Hirsch JA, Cianfoni A. Armed Kyphoplasty: An Indirect Central Canal Decompression Technique in Burst Fractures. AJNR Am J Neuroradiol 2019; 40:1965-1972. [PMID: 31649154 DOI: 10.3174/ajnr.a6285] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 08/28/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Burst fractures are characterized by middle column disruption and may feature posterior wall retropulsion. Indications for treatment remain controversial. Recently introduced vertebral augmentation techniques using intravertebral distraction devices, such as vertebral body stents and SpineJack, could be effective in fracture reduction and fixation and might obtain central canal clearance through ligamentotaxis. This study assesses the results of armed kyphoplasty using vertebral body stents or SpineJack in traumatic, osteoporotic, and neoplastic burst fractures with respect to vertebral body height restoration and correction of posterior wall retropulsion. MATERIALS AND METHODS This was a retrospective assessment of 53 burst fractures with posterior wall retropulsion and no neurologic deficit in 51 consecutive patients treated with armed kyphoplasty. Posterior wall retropulsion and vertebral body height were measured on pre- and postprocedural CT. Clinical and radiologic follow-up charts were reviewed. RESULTS Armed kyphoplasty was performed as a stand-alone treatment in 43 patients, combined with posterior instrumentation in 8 and laminectomy in 4. Pre-armed kyphoplasty and post-armed kyphoplasty mean posterior wall retropulsion was 5.8 and 4.5 mm, respectively (P < .001), and mean vertebral body height was 10.8 and 16.7 mm, respectively (P < .001). No significant clinical complications occurred. Clinical and radiologic follow-up (1-36 months; mean, 8 months) was available in 39 patients. Three treated levels showed a new fracture during follow-up without neurologic deterioration, and no retreatment was deemed necessary. CONCLUSIONS In the treatment of burst fractures with posterior wall retropulsion and no neurologic deficit, armed kyphoplasty yields fracture reduction, internal fixation, and indirect central canal decompression. In selected cases, it might represent a suitable minimally invasive treatment option, stand-alone or in combination with posterior stabilization.
Collapse
Affiliation(s)
- A Venier
- From the Departments of Neurosurgery (A.V., P.S., D.E.K., M.R.)
| | - L Roccatagliata
- Neuroradiology (L.R., M.I., A.C.), Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - M Isalberti
- Neuroradiology (L.R., M.I., A.C.), Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - P Scarone
- From the Departments of Neurosurgery (A.V., P.S., D.E.K., M.R.)
| | - D E Kuhlen
- From the Departments of Neurosurgery (A.V., P.S., D.E.K., M.R.)
| | - M Reinert
- From the Departments of Neurosurgery (A.V., P.S., D.E.K., M.R.)
| | - G Bonaldi
- Department of Neuroradiology (G.B.), Papa Giovanni XXIII Hospital, Bergamo, Italy
- Department of Neurosurgery (G.B.), Clinica Igea, Milan, Italy
| | - J A Hirsch
- Department of Neuroradiology (J.A.H.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - A Cianfoni
- Neuroradiology (L.R., M.I., A.C.), Neurocenter of Southern Switzerland, Lugano, Switzerland
- Department of Neuroradiology (A.C.), Inselspital, University Hospital of Bern, Bern, Switzerland
| |
Collapse
|
16
|
Mei L, Sang W, Chen Z, Lou C, Zheng L, Jin K, Huang W, He D. Titanium mesh bone grafting combined with pedicle screw internal fixation for treatment of Ku[Combining Diaeresis]mmell disease with cord compression: A case report and literature review. Medicine (Baltimore) 2018; 97:e12183. [PMID: 30200123 PMCID: PMC6133570 DOI: 10.1097/md.0000000000012183] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
RATIONALE In 1891, Dr. Hermann Kümmell, a German surgeon, described a clinical entity characterized by the development of progressive painful kyphosis following an asymptomatic period of months or years after a minor spinal trauma, leading to a gradual collapse of the vertebra and dynamic instability, ultimately progressing to kyphosis with prolonged back pain and/or paraparesis. To date, the main pathologic eliciting event remains unclear, and no standard treatment or single effective treatment are available for Kümmell disease. PATIENT CONCERNS A 74-year-old woman presented with severe back pain and numbness of both legs for approximately 2 months. DIAGNOSES According to the clinical symptoms and imaging examinations, the patient was diagnosed with stage III Kümmell disease. INTERVENTIONS The patient underwent titanium mesh bone grafting combined with pedicle screw internal fixation. OUTCOMES Postoperative kyphosis was corrected, and the vertebra was reconstructed. LESSONS Kümmell disease is not a rare complication of osteoporotic vertebral compression fractures, and treatment of each patient must be individualized. The application of titanium mesh bone grafting combined with pedicle screw internal fixation is an effective treatment option for stage III Kümmell disease.
Collapse
Affiliation(s)
- Liangwei Mei
- Department of Orthopaedic Surgery, The Fourth People's Hospital of Shanxi, Xi’an, Shanxi
| | - Wenhua Sang
- School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou
| | - Zhenzhong Chen
- Department of Orthopaedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, Zhejiang, China
| | - Chao Lou
- Department of Orthopaedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, Zhejiang, China
| | - Lin Zheng
- Department of Orthopaedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, Zhejiang, China
| | - Kangtao Jin
- Department of Orthopaedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, Zhejiang, China
| | - Wenjun Huang
- Department of Orthopaedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, Zhejiang, China
| | - Dengwei He
- Department of Orthopaedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, Zhejiang, China
| |
Collapse
|
17
|
Verheyden AP, Spiegl UJ, Ekkerlein H, Gercek E, Hauck S, Josten C, Kandziora F, Katscher S, Kobbe P, Knop C, Lehmann W, Meffert RH, Müller CW, Partenheimer A, Schinkel C, Schleicher P, Scholz M, Ulrich C, Hoelzl A. Treatment of Fractures of the Thoracolumbar Spine: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU). Global Spine J 2018; 8:34S-45S. [PMID: 30210959 PMCID: PMC6130107 DOI: 10.1177/2192568218771668] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
STUDY DESIGN consensus paper with systematic literature review. OBJECTIVE The aim of this study was to establish recommendations for treatment of thoracolumbar spine fractures based on systematic review of current literature and consensus of several spine surgery experts. METHODS The project was initiated in September 2008 and published in Germany in 2011. It was redone in 2017 based on systematic literature review, including new AOSpine classification. Members of the expert group were recruited from all over Germany working in hospitals of all levels of care. In total, the consensus process included 9 meetings and 20 hours of video conferences. RESULTS As regards existing studies with highest level of evidence, a clear recommendation regarding treatment (operative vs conservative) or regarding type of surgery (posterior vs anterior vs combined anterior-posterior) cannot be given. Treatment has to be indicated individually based on clinical presentation, general condition of the patient, and radiological parameters. The following specific parameters have to be regarded and are proposed as morphological modifiers in addition to AOSpine classification: sagittal and coronal alignment of spine, degree of vertebral body destruction, stenosis of spinal canal, and intervertebral disc lesion. Meanwhile, the recommendations are used as standard algorithm in many German spine clinics and trauma centers. CONCLUSION Clinical presentation and general condition of the patient are basic requirements for decision making. Additionally, treatment recommendations offer the physician a standardized, reproducible, and in Germany commonly accepted algorithm based on AOSpine classification and 4 morphological modifiers.
Collapse
Affiliation(s)
- Akhil P. Verheyden
- Clinic for Trauma, Orthopaedic and Spine Surgery, Lahr, Germany,These authors contributed equally to this article.,Akhil P. Verheyden, Clinic for Trauma, Orthopaedic and Spine Surgery, Lahr, 77933, Germany.
| | - Ulrich J. Spiegl
- Klinik für Orthopädie, Unfallchirurgie und plastische Chirurgie, Leipzig, Germany,These authors contributed equally to this article
| | | | - Erol Gercek
- Zentrum für Unfallchirurgie und Orthopädie, Koblenz, Germany
| | - Stefan Hauck
- Clinic for Trauma, Orthopaedic and Spine Surgery, Lahr, Germany
| | - Christoph Josten
- Klinik für Orthopädie, Unfallchirurgie und plastische Chirurgie, Leipzig, Germany
| | - Frank Kandziora
- Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, Frankfurt am Main, Germany
| | - Sebastian Katscher
- Leitender Arzt Orthopädie / Unfallchirurgie, Sana Klinikum Borna, Borna, Germany
| | - Philipp Kobbe
- Sektion Becken- und Wirbelsäulenchirurgie, Uniklinik RWTH Aachen, Aachen, Germany
| | - Christian Knop
- Klinik für Unfallchirurgie und Orthopädie, Klinikum Stuttgart, Katharinenhospital, Stuttgart, Germany
| | - Wolfgang Lehmann
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Goettingen, Göttingen, Germany
| | - Rainer H. Meffert
- Klinik und Poliklinik für Unfall-, Hand-, Plastische- und Wiederherstellungschirurgie, Universitätsklinik Würzburg, Würzburg, Germany
| | - Christian W. Müller
- Unfallchirurgische Klinik, Medizinische Hochschule Hannover, Hannover, Germany
| | | | - Christian Schinkel
- Klinik für Unfallchirurgie, Handchirurgie und Orthopädie, Klinikum Memmingen, Memmingen, Germany
| | - Philipp Schleicher
- Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, Frankfurt am Main, Germany
| | - Matti Scholz
- Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, Frankfurt am Main, Germany
| | | | | |
Collapse
|
18
|
Piazza M, Sinha S, Agarwal P, Mallela A, Nayak N, Schuster J, Stein S. Post-operative bracing after pedicle screw fixation for thoracolumbar burst fractures: A cost-effectiveness study. J Clin Neurosci 2017; 45:33-39. [PMID: 28800928 DOI: 10.1016/j.jocn.2017.07.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 07/21/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE While frequently prescribed to patients following fixation for spine trauma, the utility of spinal orthoses during the post-operative period is poorly described in the literature. In this study, we calculated rates of reoperation and performed a decision analysis to determine the utility of bracing following pedicle screw fixation for thoracic and lumbar burst fractures. METHODS Pubmed was searched for articles published between 2005 and 2015 for terms related to pedicle screw fixation of thoracolumbar fractures. Additionally, a database of neurosurgical patients operated on within the authors institution was also used in the analysis. Incidences of significant adverse events (wound revision for either dehiscence or infection or re-operation for non-union or instability due to hardware failure) were determined. Pooled means and variances of reported parameters were obtained using a random-effects, inverse variance meta-analytic model for observational data. Utilities for surgical outcome and complications were assigned using previously published values. RESULTS Of the 225 abstracts reviewed, 48 articles were included in the study, yielding a total of 1957 patients. After including patients from the institutional registry, together a total of 2081 patients were included in the final analysis, 1328 of whom were braced. Non-braced patients were older then braced patients, although this only approached significance (p=0.051). Braced patients had significantly lower rates of re-operation for non-union or clinically significant hardware failure (1.3% vs. 1.8%, p<0.001) although the groups had comparable rates of operative wound dehiscence and infection (p=1.000). These two approaches yielded comparable utility scores (p=0.120). Costs between braced and non-braced patients were comparable excluding the cost of the brace (p=0.256); hence, the added cost of the brace suggests that bracing post-operatively is not a cost effective measure. CONCLUSIONS Bracing following operative stabilization of thoracolumbar fracture does not significantly improve stability, nor does it increase wound complications. Moreover, our data suggests that post-operative bracing may not be a cost-effective measure.
Collapse
Affiliation(s)
- Matthew Piazza
- Hospital of the University of Pennsylvania, Department of Neurosurgery, 3400 Spruce Street, 3 Silverstein Pavilion, Philadelphia, PA 19104, United States.
| | - Saurabh Sinha
- Hospital of the University of Pennsylvania, Department of Neurosurgery, 3400 Spruce Street, 3 Silverstein Pavilion, Philadelphia, PA 19104, United States
| | - Prateek Agarwal
- Hospital of the University of Pennsylvania, Department of Neurosurgery, 3400 Spruce Street, 3 Silverstein Pavilion, Philadelphia, PA 19104, United States
| | - Arka Mallela
- Hospital of the University of Pennsylvania, Department of Neurosurgery, 3400 Spruce Street, 3 Silverstein Pavilion, Philadelphia, PA 19104, United States
| | - Nikhil Nayak
- Hospital of the University of Pennsylvania, Department of Neurosurgery, 3400 Spruce Street, 3 Silverstein Pavilion, Philadelphia, PA 19104, United States
| | - James Schuster
- Hospital of the University of Pennsylvania, Department of Neurosurgery, 3400 Spruce Street, 3 Silverstein Pavilion, Philadelphia, PA 19104, United States
| | - Sherman Stein
- Hospital of the University of Pennsylvania, Department of Neurosurgery, 3400 Spruce Street, 3 Silverstein Pavilion, Philadelphia, PA 19104, United States
| |
Collapse
|
19
|
Modified one-stage posterior/anterior combined surgery with posterior pedicle instrumentation and anterior monosegmental reconstruction for unstable Denis type B thoracolumbar burst fracture. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:1499-1505. [DOI: 10.1007/s00586-016-4800-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 09/17/2016] [Accepted: 09/29/2016] [Indexed: 11/24/2022]
|
20
|
Comparative study of 2 surgical procedures for osteoporotic delayed vertebral collapse: anterior and posterior combined surgery versus posterior spinal fusion with vertebroplasty. Spine (Phila Pa 1976) 2015; 40:E120-6. [PMID: 25341987 DOI: 10.1097/brs.0000000000000661] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective comparative study. OBJECTIVE To compare the surgical results of anterior and posterior combined surgery (AP) and posterior fixation with vertebroplasty (VP) for treating osteoporotic delayed vertebral collapse. SUMMARY OF BACKGROUND DATA The optimal treatment of osteoporotic delayed vertebral collapse has been controversial. Because of aged patients' numerous comorbid medical complications and frequent instrumentation failure secondary to osteoporosis, it is challenging for surgeons to manage osteoporotic delayed vertebral collapse. In spite of this, there have been few reports comparing the surgical results. METHODS A total of 93 patients with osteoporotic delayed vertebral fracture who underwent spinal surgery were enrolled at 6 hospitals. Sixty-five patients underwent AP surgery in 3 hospitals, and 28 patients underwent VP surgery in the other 3 hospitals. We restricted the spinal-fracture level to thoracolumbar lesion (T10-L2) and excluded patients followed up more than 2 years after surgery. The final numbers of patients included in this study were 24 in the AP group and 21 in the VP group. There were no significant differences between the 2 groups in terms of age, sex, disease duration, or duration of follow-up. RESULTS Operative time was significantly longer and intraoperative blood loss significantly greater in the AP group. No significant difference between the 2 groups was observed in neurological improvement or the angle of kyphosis correction. However, the loss of correction was significantly greater in the VP group. There were no significant differences in perioperative respiratory or other complications. Implant-related complications and pseudarthrosis were more often observed in the VP group. One patient in the VP group underwent additional surgery for progression kyphosis. CONCLUSION AP surgery provides stable spinal fixation and reduces implant failure particularly at the thoracolumbar junction because of load bearing of anterior spinal elements. Surgery-related complications in AP surgery were as few in number as with the VP group, and AP surgery is useful for osteoporotic delayed vertebral fracture.
Collapse
|
21
|
Wang XB, Yang M, Li J, Xiong GZ, Lu C, Lü GH. Thoracolumbar fracture dislocations treated by posterior reduction, interbody fusion and segmental instrumentation. Indian J Orthop 2014; 48:568-73. [PMID: 25404768 PMCID: PMC4232825 DOI: 10.4103/0019-5413.144219] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Literature describing the application of modern segmental instrumentation to thoracic and lumbar fracture dislocation injuries is limited and the ideal surgical strategy for this severe trauma remains controversial. The purpose of this article was to investigate the feasibility and efficacy of single-stage posterior reduction with segmental instrumentation and interbody fusion to treat this type of injury. MATERIALS AND METHODS A retrospective review of 30 patients who had sustained fracture dislocation of the spine and underwent single stage posterior surgery between January 2007 and December 2011 was performed. All the patients underwent single stage posterior pedicle screw fixation, decompression and interbody fusion. Demographic data, medical records and radiographic images were reviewed thoroughly. RESULTS Ten females and 20 males with a mean age of 39.5 years were included in this study. Based on the AO classification, 13 cases were Type B1, 4 cases were B2, 4 were C1, 6 were C2 and 3 cases were C3. The average time of the surgical procedure was 220 min and the average blood loss was 550 mL. All of the patients were followed up for at least 2 years, with an average of 38 months. The mean preoperative kyphosis was 14.4° and reduced to -1.1° postoperatively. At the final followup, the mean kyphosis was 0.2°. The loss of correction was small (1.3°) with no significant difference compared to postoperative kyphotic angle (P = 0.069). Twenty seven patients (90%) achieved definitive bone fusion on X-ray or computed tomography imaging within 1 year followup. The other three patients were suspected possible pseudarthrosis. They remained asymptomatic without hardware failure or local pain at the last followup. CONCLUSION Single stage posterior reduction using segmental pedicle screw instrumentation, combined with decompression and interbody fusion for the treatment of thoracic or lumbar fracture-dislocations is a safe, less traumatic and reliable technique. This procedure can achieve effective reduction, sagittal angle correction and solid fusion.
Collapse
Affiliation(s)
- Xiao-Bin Wang
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P. R. China
| | - Ming Yang
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P. R. China
| | - Jing Li
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P. R. China,Address for correspondence: Dr. Jing Li, Department of Spine Surgery, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan 410011, P. R. China. E-mail:
| | - Guang-Zhong Xiong
- Department of Emergency, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P. R. China
| | - Chang Lu
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P. R. China
| | - Guo-Hua Lü
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P. R. China
| |
Collapse
|
22
|
Machino M, Yukawa Y, Ito K, Kanbara S, Morita D, Kato F. Posterior ligamentous complex injuries are related to fracture severity and neurological damage in patients with acute thoracic and lumbar burst fractures. Yonsei Med J 2013; 54:1020-5. [PMID: 23709440 PMCID: PMC3663221 DOI: 10.3349/ymj.2013.54.4.1020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The proposed the thoracolumbar injury classification system (TLICS) for thoracolumbar injury cites the integrity of the posterior ligamentous complex (PLC). However, no report has elucidated the severity of damage in thoracic and lumbar injury with classification schemes by presence of the PLC injury. The purpose of this study was to accurately assess the severity of damage in thoracic and lumbar burst fractures with the PLC injuries. MATERIALS AND METHODS One hundred consecutive patients treated surgically for thoracic and lumbar burst fractures were enrolled in this study. There were 71 men and 29 women whose mean age was 36 years. Clinical and radiologic data were investigated, and the thoracolumbar injury classification schemes were also evaluated. All patients were divided into two groups (the P group with PLC injuries and the C group without PLC injuries) for comparative examination. RESULTS Fourth-one of 100 cases showed PLC injuries in MRI study. The load sharing classification score was significantly higher in the P group [7.8±0.2 points for the P group and 6.9±1.1 points for the C group (p<0.001)]. The TLICS (excluded PLC score) score was also significantly higher in the P group [6.2±1.1 points for the P group and 4.0±1.4 points for the C group (p<0.001)]. CONCLUSION The presence of PLC injury significantly influenced the severity of damage. In management of thoracic lumbar burst fractures, evaluation of PLC injury is important to accurately assess the severity of damage.
Collapse
Affiliation(s)
- Masaaki Machino
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Labor Health and Welfare Organization, 1-10-6 Komei, Minato-ku, Nagoya, Aichi 455-8530, Japan.
| | | | | | | | | | | |
Collapse
|
23
|
Smith JS, Shaffrey CI, Ames CP, Demakakos J, Fu KMG, Keshavarzi S, Li CMY, Deviren V, Schwab FJ, Lafage V, Bess S. Assessment of symptomatic rod fracture after posterior instrumented fusion for adult spinal deformity. Neurosurgery 2013; 71:862-7. [PMID: 22989960 DOI: 10.1227/neu.0b013e3182672aab] [Citation(s) in RCA: 182] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Improved understanding of rod fracture (RF) in adult spinal deformity could be valuable for implant design, surgical planning, and patient counseling. OBJECTIVE To evaluate symptomatic RF after posterior instrumented fusion for adult spinal deformity. METHODS A multicenter, retrospective review of RF in adult spinal deformity was performed. Inclusion criteria were spinal deformity, age older than 18 years, and more than 5 levels posterior instrumented fusion. Rod failures were divided into early (≤12 months) and late (>12 months). RESULTS Of 442 patients, 6.8% had symptomatic RF. RF rates were 8.6% for titanium alloy, 7.4% for stainless steel, and 2.7% for cobalt chromium. RF incidence after pedicle subtraction osteotomy (PSO) was 15.8%. Among patients with a PSO and RF, 89% had RF at or adjacent to the PSO. Mean time to early RF (63%) was 6.4 months (range, 2-12 months). Mean time to late RF (37%) was 31.8 months (range, 14-73 months). The majority of RFs after PSO (71%) were early (mean, 10 months). Among RF cases, mean sagittal vertical axis improved from preoperative (163 mm) to postoperative (76.9 mm) measures (P<.001); however, 16 had postoperative malalignment (sagittal vertical axis>50 mm; mean, 109 mm). CONCLUSION Symptomatic RF occurred in 6.8% of adult spinal deformity cases and in 15.8% of PSO patients. The rate of RF was lower with cobalt chromium than with titanium alloy or stainless steel. Early failure was most common after PSO and favored the PSO site, suggesting that RF may be caused by stress at the PSO site. Postoperative sagittal malalignment may increase the risk of RF.
Collapse
Affiliation(s)
- Justin S Smith
- Department of Neurosurgery, University of Virginia, Health Sciences Center, Charlottesville, Virginia 22908, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Machino M, Yukawa Y, Ito K, Kanbara S, Kato F. The complement of the load-sharing classification for the thoracolumbar injury classification system in managing thoracolumbar burst fractures. J Orthop Sci 2013; 18:81-6. [PMID: 23053588 DOI: 10.1007/s00776-012-0319-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 09/14/2012] [Indexed: 01/08/2023]
Abstract
BACKGROUND The classification and therapeutic strategy for thoracolumbar burst fractures are controversial. The load-sharing classification (LSC) and thoracolumbar injury classification system (TLICS) are both quantitative evaluation systems for thoracolumbar burst fractures. We hypothesized that their combination would be helpful not only for surgical indications but also for deciding on the surgical approach. However, no reports have evaluated the relationship between them. The purpose of this study was to clarify the relationship between the LSC and TLICS and investigate the clinical usefulness of their combination. METHODS This study included 100 consecutive patients surgically treated for thoracolumbar burst fractures (71 men and 29 women; mean age 36 years). Clinical and radiographical data as well as thoracolumbar injury classification systems were evaluated. RESULTS LSC and TLICS scores were found to be statistically correlated. The mean LSC score with a TLICS score of 5 or more (surgical treatment recommended) was 7.3 ± 1.2 points, and the mean LSC score with a TLICS score of 3 or less (conservative treatment recommended) was 6.1 ± 1.3 points. The mean TLICS score with an LSC score of 7 or more (additional anterior reconstruction recommended) was 6.6 ± 2.7 points, and the mean TLICS score with an LSC score of 6 or less (expectation of good clinical results with posterior short fusion) was 5.0 ± 2.5 points. The TLICS score was 3 or less, and the LSC score was 7 or more in 13 patients (13 %). CONCLUSION Although the TLICS scores correlated with the LSC scores, a single application of TLICS might not be sufficient to identify those patients who have a TLICS score of 3 or less and an LSC score of 7 or more as surgically indicated. However, an additional LSC evaluation avoided deviations as the two classifications complemented each other, and it was useful in determining the best treatment options for thoracolumbar burst fractures.
Collapse
Affiliation(s)
- Masaaki Machino
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Labor Health and Welfare Organization, 1-10-6 Komei, Minato-ku, Nagoya, Aichi 455-8530, Japan.
| | | | | | | | | |
Collapse
|