1
|
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.
Collapse
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
| |
Collapse
|
2
|
The Efficiency and Reliability of Minimally Invasive Anterior Corpectomy and Percutaneous Posterior Stabilization for the Treatment of Unstable Thoracolumbar Burst Fractures. World Neurosurg 2022; 167:e310-e316. [PMID: 35961588 DOI: 10.1016/j.wneu.2022.08.010] [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: 05/21/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the radiological and clinical outcomes of minimally invasive anterior corpectomy and percutaneous posterior stabilization for treating unstable thoracolumbar burst fractures. METHODS Patients with unstable thoracolumbar burst fractures who underwent minimally invasive anterior corpectomy and percutaneous posterior stabilization between 2012 and 2019 at a tertiary hospital were enrolled. Radiological outcomes such as endplate subsidence and fusion status were identified on preoperative and postoperative plain radiographs and computed tomography images. Preoperative and postoperative neurological statuses were evaluated using the American Spinal Injury Association impairment scale. Furthermore, operation-related parameters were analyzed. RESULTS In total, 21 patients (mean follow-up period, 21.7 months) were included in this study. Of them, 17 (80.95%) patients exhibited complete fusion according to the Bridwell's criteria at the final follow-up, and only 1 patient exhibited nonunion at the surgical level. Endplate subsidence was observed in 6 (28.57%) patients; however, there were no definite symptoms that would have necessitated a revision surgery. Of 15 patients with preoperative neurological impairment, 7 exhibited neurological improvement during follow-up. None of the patients experienced postoperative neurological deterioration. Regarding operation-related parameters, the mean operative time and intraoperative blood loss were 266.19 ± 51.54 min and 520.71 ± 190.86 ml, respectively. The mean length of hospital stays and days to postoperative ambulation were 12.14 and 4.20 days, respectively. CONCLUSIONS Minimally invasive anterolateral corpectomy with percutaneous pedicle screw fixation is a reliable surgical treatment option for unstable thoracolumbar burst fractures.
Collapse
|
3
|
Kweh BTS, Tan T, Lee HQ, Hunn M, Liew S, Tee JW. Implant Removal Versus Implant Retention Following Posterior Surgical Stabilization of Thoracolumbar Burst Fractures: A Systematic Review and Meta-Analysis. Global Spine J 2022; 12:700-718. [PMID: 33926307 PMCID: PMC9109574 DOI: 10.1177/21925682211005411] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVES To compare biomechanical and functional outcomes between implant removal and implant retention following posterior surgical fixation of thoracolumbar burst fractures. METHODS A search of the MEDLINE, EMBASE, Google Scholar and Cochrane Databases was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Of the 751 articles initially retrieved, 13 published articles pooling 673 patients were included. Meta-analysis revealed there was a statistically significant improvement in sagittal Cobb Angle by 16.48 degrees (9.13-23.83, p < 0.01) after surgical stabilization of thoracolumbar burst fractures. This correction decremented to 9.68 degrees (2.02-17.35, p < 0.01) but remained significant at the time of implant removal approximately 12 months later. At final follow-up, the implant removal group demonstrated a 10.13 degree loss (3.00-23.26, p = 0.13) of reduction, while the implant retention group experienced a 10.17 degree loss (1.79-22.12, p = 0.10). There was no statistically significant difference in correction loss between implant retention and removal cohorts (p = 0.97). Pooled VAS scores improved by a mean of 3.32 points (0.18 to 6.45, p = 0.04) in the combined removal group, but by only 2.50 points (-1.81 to 6.81, p = 0.26) in the retention group. Oswestry Disability Index scores also improved after implant removal by 7.80 points (2.95-12.64, p < 0.01) at 1 year and 11.10 points (5.24-16.96, p < 0.01) at final follow-up. CONCLUSIONS In younger patients with thoracolumbar burst fractures who undergo posterior surgical stabilization, planned implant removal results in superior functional outcomes without significant difference in kyphotic angle correction loss compared to implant retention.
Collapse
Affiliation(s)
- Barry Ting Sheen Kweh
- National Trauma Research
Institute, Melbourne, Victoria, Australia,Department of Neurosurgery, Royal
Melbourne Hospital, Parkville, Victoria, Melbourne,Department of Neurosurgery, The Alfred Hospital, Melbourne, Victoria, Australia,Barry Kweh, National Trauma Research
Institute, Melbourne, Victoria, Australia; Department of Neurosurgery, Royal
Melbourne Hospital, Parkville, Victoria, Melbourne; Department of Neurosurgery,
The Alfred Hospital, Melbourne, Victoria, Australia.
| | - Terence Tan
- National Trauma Research
Institute, Melbourne, Victoria, Australia,Department of Neurosurgery, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Hui Qing Lee
- National Trauma Research
Institute, Melbourne, Victoria, Australia,Department of Neurosurgery, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Martin Hunn
- Department of Neurosurgery, The Alfred Hospital, Melbourne, Victoria, Australia,Central Clinical School, Faculty of
Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria,
Australia
| | - Susan Liew
- Central Clinical School, Faculty of
Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria,
Australia,Department of Orthopaedics, The
Alfred Hospital, Melbourne, Victoria, Australia
| | - Jin Wee Tee
- National Trauma Research
Institute, Melbourne, Victoria, Australia,Department of Neurosurgery, The Alfred Hospital, Melbourne, Victoria, Australia,Central Clinical School, Faculty of
Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria,
Australia
| |
Collapse
|
4
|
Todeschi J, Ganau M, Zaed I, Bozzi MT, Mallereau CH, Gallinaro P, Cebula H, Ollivier I, Spatola G, Chaussemy D, Coca HA, Proust F, Chibbaro S. Managing Incomplete and Complete Thoracolumbar Burst Fractures (AO Spine A3 and A4). Results from a Prospective Single-Center Study Comparing Posterior Percutaneous Instrumentation plus Mini-Open Anterolateral Fusion versus Single-Stage Posterior Instrumented Fusion. World Neurosurg 2021; 150:e657-e667. [PMID: 33757885 DOI: 10.1016/j.wneu.2021.03.069] [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: 01/04/2021] [Revised: 03/13/2021] [Accepted: 03/15/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The treatment strategy for thoracolumbar burst fractures is still debated. The aim of this study is to evaluate clinical and radiologic outcomes of a 2-stage strategy with immediate posterior percutaneous instrumentation and delayed anterolateral fusion (group A) versus a single-stage open posterior instrumented fusion (group B). METHODS Demographics and clinical and surgical data of patients operated for AO Spine A3 and A4 fractures were prospectively collected. Vertebral height and deformity were evaluated before and after surgery. Visual analog scale score for back pain, Oswestry Disability Index, and 12-Item Short Form Health Survey results for quality-of-life assessment were collected during follow-up. RESULTS Among the 110 patients enrolled, 66 were allocated to group A and 44 to group B; the most common fractured level was T12 (34%). Postoperative complications were higher in group B, especially the wound infection rate (18% vs. 3%), and pseudomeningocele (14% vs. 0%). The 2-stage approach allowed an average long-term gain of 15.8° at the local kyphosis of fractured vertebra and 5.8° at the regional level (Cobb angle), versus 15.4° and 5.5° in group B. At 2 years follow-up, both groups showed significant functional improvements; however, the visual analog scale and Oswestry Disability Index metrics seemed more favorable for group A patients (P < 0.0001 vs. P < 0.003). A complete fusion rate was obtained in 100% of group A vs. 65% of group B. CONCLUSIONS Our study indicates that percutaneous instrumentation and anterior fusion or an expandable cage lead to excellent long-term clinical and radiologic outcomes with a lower complication rate and higher fusion rate than those of open posterior approaches.
Collapse
Affiliation(s)
- Julien Todeschi
- Department of Neurosurgery, Hautepierre Regional Hospital, University of Strasbourg, Strasbourg, France
| | - Mario Ganau
- Department of Neurosurgery, Hautepierre Regional Hospital, University of Strasbourg, Strasbourg, France
| | - Ismail Zaed
- Department of Neurosurgery, Hautepierre Regional Hospital, University of Strasbourg, Strasbourg, France.
| | - Maria Teresa Bozzi
- Department of Neurosurgery, Hautepierre Regional Hospital, University of Strasbourg, Strasbourg, France
| | - Charles-Henry Mallereau
- Department of Neurosurgery, Hautepierre Regional Hospital, University of Strasbourg, Strasbourg, France
| | - Paolo Gallinaro
- Department of Neurosurgery, Hautepierre Regional Hospital, University of Strasbourg, Strasbourg, France
| | - Helene Cebula
- Department of Neurosurgery, Hautepierre Regional Hospital, University of Strasbourg, Strasbourg, France
| | - Irene Ollivier
- Department of Neurosurgery, Hautepierre Regional Hospital, University of Strasbourg, Strasbourg, France
| | - Giogio Spatola
- Department of Neurosurgery, Hautepierre Regional Hospital, University of Strasbourg, Strasbourg, France
| | - Dominique Chaussemy
- Department of Neurosurgery, Hautepierre Regional Hospital, University of Strasbourg, Strasbourg, France
| | - Hugo-Andres Coca
- Department of Neurosurgery, Hautepierre Regional Hospital, University of Strasbourg, Strasbourg, France
| | - François Proust
- Department of Neurosurgery, Hautepierre Regional Hospital, University of Strasbourg, Strasbourg, France
| | - Salvatore Chibbaro
- Department of Neurosurgery, Hautepierre Regional Hospital, University of Strasbourg, Strasbourg, France
| |
Collapse
|
5
|
Subsidence Rates After Lateral Lumbar Interbody Fusion: A Systematic Review. World Neurosurg 2018; 122:599-606. [PMID: 30476670 DOI: 10.1016/j.wneu.2018.11.121] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 11/14/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The evidence regarding the consequences of subsidence with lateral lumbar interbody fusion (LLIF) has been sparse. The objective of this study is to calculate the incidence of subsidence and reoperation for subsidence after LLIF. A secondary outcome examined the quantitative degree of subsidence by calculating the percent change in the height of the intervertebral space secondary to interbody subsidence at various postoperative follow-up times. METHODS Following the MOOSE (Meta-analysis [and Systematic Review] Of Observational Studies in Epidemiology) guidelines, a systematic review searched for all cohort studies that focused on subsidence rates after LLIF, including extreme lateral interbody fusions (XLIFs) and direct lateral interbody fusion. Neoplastic, infectious, and/or metabolic indications for LLIF were similarly excluded because these diseases may compromise bone quality and, thus, confound the rate of cage subsidence. Corpectomies were removed from the systematic review because 1) indications for removal of vertebral body typically reflect those excluded diseases and 2) subsidence refers to a different biomechanical process. RESULTS This systematic review identified a subsidence incidence with LLIF of 10.3% (N = 141/1362 patients in 14 articles) and reoperation rate for subsidence of 2.7% (N = 41/1470 patients in 16 articles). In the secondary outcome measure, the disc height decreased from 5.6% after 3 months, 6.0% after 6 months, and 10.2% after 12 months, to 8.9% after 24 months (P < 0.001). CONCLUSIONS Subsidence after LLIF carries a nonnegligible risk that may be incorporated in surgical consent discussions in selected patients.
Collapse
|
6
|
Vanni D, Pantalone A, Magliani V, Salini V, Berjano P. Corpectomy and expandable cage replacement versus third generation percutaneous augmentation system in case of vertebra plana: rationale and recommendations. JOURNAL OF SPINE SURGERY (HONG KONG) 2017; 3:379-386. [PMID: 29057346 PMCID: PMC5637192 DOI: 10.21037/jss.2017.08.06] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
BACKGROUND To evaluate the role of third generation percutaneous vertebral augmentation systems (Spine Jack®) as alternative to the corpectomies and expandable cages replacement (X-Core® Adjustable VBR System) in the treatment of vertebra plana (VP) as complication of the osteoporosis vertebral fracture (OVF). METHODS Spine Jack® is a new device for mechanical kyphoplasty (MK). It is a titanium implant designed to restore the height of the vertebral body in OVF, primary or secondary bone tumors, or traumatic fractures. The X-Core® adjustable VBR System is a vertebral body replacement device indicated for use in the thoracolumbar spine (T1 to L5). The preoperative radiographic exams, computed tomography (CT), and magnetic resonance imaging (MRI) were performed in all cases. Clinical outcome measures included preoperative and postoperative Oswestry Disability Index (ODI), Visual Analog Scale pain score (VAS), neurologic examination, complications, estimated blood loss, and operating time. Postoperative radiographic evaluations were made at 1, 6, and 12 months. RESULTS The anterior and middle column reconstruction by Spine Jack represents a valid alternative to the corpectomy in the patients affected by VP, especially in case elderly and/or high operative risk. In case of Spine Jack use, the correct indications must be respected: the hyperintense signal in STIR MRI sequences to the level of the fractures must be present. The eventual posterior spinal cord compression represents a relative contraindication. In case it would be superior to 1/3 and 2/3 respectively in case of fractures level above and below the spinal cord, a direct posterior spinal cord decompression must be performed. CONCLUSIONS Avoiding the corpectomy, it is possible to reduce the operating time and the associated risks, as well as reducing blood loss.
Collapse
Affiliation(s)
- Daniele Vanni
- Orthopaedic and Traumatology Department, “G. D’Annunzio” University, Chieti, Italy
| | - Andrea Pantalone
- Orthopaedic and Traumatology Department, “G. D’Annunzio” University, Chieti, Italy
| | - Vincenzo Magliani
- Neurotraumatology and Vertebro-Medullary Surgery Department, Renzetti Hospital, Lanciano, Italy
| | - Vincenzo Salini
- Orthopaedic and Traumatology Department, “G. D’Annunzio” University, Chieti, Italy
| | - Pedro Berjano
- IVth Spine Division, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| |
Collapse
|