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Shi J, Yang B, Zhang C, Guo W, Cao F, Wang F. Posterior treatment of ankylosing spinal diseases with thoracolumbar fractures: a network meta-analysis. BMC Musculoskelet Disord 2025; 26:436. [PMID: 40312373 PMCID: PMC12044753 DOI: 10.1186/s12891-025-08700-1] [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: 07/10/2024] [Accepted: 04/24/2025] [Indexed: 05/03/2025] Open
Abstract
OBJECTIVE The implementation of diverse surgical techniques plays a crucial role in managing ankylosing spinal diseases (ASDs), serving as invaluable tools. Presently, posterior surgery stands out as the predominant approach owing to its familiarity with anatomical structures; however, it comprises various methodologies that require a thorough comprehension for their suitable application. Henceforth, we performed a network meta-analysis to assess and prioritize the efficacy and safety of surgical interventions for ASDs. METHODS The databases PubMed, EMBASE, Cochrane Library, and CNKI (China National Knowledge Infrastructure) were systematically searched for both randomized and non-randomized studies. No restrictions were placed on the initial time periods or languages of the searches. Patients with thoracolumbar fractures accompanied by ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis were included in this study. RevMan 5.4 and Stata 14.2 software programs were utilized for assessing literature quality and conducting data analysis. RESULTS A total of 20 trials involving 1116 patients with ASDs were included, encompassing 4 posterior approaches. Network meta-analysis revealed that Percutaneous puncture demonstrated favorable outcomes in terms of surgical duration, intraoperative blood loss, postoperative bed rest time, and hospital stay. Both percutaneous internal fixation and 3D assisted fixation exhibited alternating advantages in postoperative functional recovery. CONCLUSIONS Based on the available evidence, it is evident that percutaneous instrumentation offers clear advantages over other forms of instrumentation. However, the quality of some studies is suboptimal and further high-quality randomized controlled trials are necessary to provide additional verification.
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Affiliation(s)
- Jiaxiao Shi
- Department of Orthopaedics, Hebei Province Cangzhou Hospital of Integrated Traditional Chinese Medicine-Western Medicine, Cangzhou, China.
- Hebei Key Laboratory of Integrated Traditional and Western Medicine in Osteoarthrosis Research (Preparing), Cangzhou, China.
| | - Bo Yang
- Department of Orthopaedics, Tianjin Medical University General Hospital, No 154 Anshan Road, Heping District, Tianjin, 300052, PR China
| | - Chaochao Zhang
- Department of Orthopaedics, Hebei Province Cangzhou Hospital of Integrated Traditional Chinese Medicine-Western Medicine, Cangzhou, China
- Hebei Key Laboratory of Integrated Traditional and Western Medicine in Osteoarthrosis Research (Preparing), Cangzhou, China
| | - Wei Guo
- Department of Orthopaedics, Hebei Province Cangzhou Hospital of Integrated Traditional Chinese Medicine-Western Medicine, Cangzhou, China
- Hebei Key Laboratory of Integrated Traditional and Western Medicine in Osteoarthrosis Research (Preparing), Cangzhou, China
| | - Fujiang Cao
- Department of Orthopaedics, Tianjin Medical University General Hospital, No 154 Anshan Road, Heping District, Tianjin, 300052, PR China
| | - Fangfang Wang
- Department of Orthopaedics, Hebei Province Cangzhou Hospital of Integrated Traditional Chinese Medicine-Western Medicine, Cangzhou, China
- Hebei Key Laboratory of Integrated Traditional and Western Medicine in Osteoarthrosis Research (Preparing), Cangzhou, China
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Al-Naseem AO, Mehkri Y, Chakravarti S, Johnson E, Kelly-Hedrick M, Kuo C, Erickson M, Than KD, Rocos B, Bhowmick D, Shaffrey CI, Foster N, Baaj A, Dahdaleh N, Goodwin CR, Williamson TL, Lu Y, Abd-El-Barr MM. Comparison of intraoperative and postoperative outcomes between open, wiltse, and percutaneous approach to traumatic thoracolumbar spine fractures without neurological injury: A systematic review and meta-analysis. NORTH AMERICAN SPINE SOCIETY JOURNAL 2024; 20:100547. [PMID: 39329024 PMCID: PMC11426394 DOI: 10.1016/j.xnsj.2024.100547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 08/04/2024] [Accepted: 08/06/2024] [Indexed: 09/28/2024]
Abstract
Background Traumatic thoracolumbar fracture fixation without neurological injury can be performed using the traditional open, mini-open Wiltse, and percutaneous approaches. This systematic review and meta-analysis aims to compare perioperative outcomes between these approaches. Methods PubMed, Web of Science, Scopus, Embase, and the Cochrane Library were searched for all relevant observational comparative studies. Results 5 randomized trials and 22 comparative cohort studies were included. Compared to the traditional open approach (n=959), the Wiltse approach (n=410) was associated with significantly lower operative time, intraoperative estimated blood loss (EBL), and length of stay (LOS). There was no significant difference between the two in terms of postoperative visual analog scale (VAS) and Cobb angle. Compared to the percutaneous approach (n=980), the Wiltse approach was associated with shorter operative and fluoroscopy time, as well as significantly improved Cobb and vertebral body angles. The percutaneous approach was associated with improved vertebral body height. There was no significant difference between the two for blood loss, postoperative VAS, or LOS. Compared to the traditional open approach, the percutaneous approach was associated with shorter operative time, lower EBL, shorter LOS and better postoperative VAS and Oswestry Disability Index. There was no difference between the two in postoperative Cobb angle, vertebral angle, or vertebral body height. Overall study heterogeneity was high. Conclusions Utilization of minimally invasive surgical approaches holds great promise for lowering patient morbidity and optimizing care. A prospective trial is needed to assess outcomes and guide surgical decision making.
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Affiliation(s)
| | - Yusuf Mehkri
- Department of Neurosurgery, University of Florida College of Medicine, Gainesville, FL, United States
| | - Sachiv Chakravarti
- Dana-Farber Cancer Institute, Brigham Cancer Center, Boston, MA, United States
| | - Eli Johnson
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, United States
| | - Margot Kelly-Hedrick
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, United States
| | - Cathleen Kuo
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY, United States
| | - Melissa Erickson
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, United States
| | - Khoi D. Than
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, United States
| | - Brett Rocos
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, United States
| | - Deb Bhowmick
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, United States
| | | | - Norah Foster
- Premier Orthopedics at Miami Valley Hospital South Campus, Centerville, OH, United States
| | - Ali Baaj
- Department of Neurosurgery, Banner University Medical Center, Phoenix, AZ, United States
| | - Nader Dahdaleh
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - C. Rory Goodwin
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, United States
| | - Theresa L. Williamson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, United States
| | - Yi Lu
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, United States
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Sanada K, Tanaka J, Ohta H, Kida Y, Shiokawa T, Shibata T, Hagihara S, Yamamoto T. Outcomes of Balloon Kyphoplasty for Vertebral Compression Fractures in Patients with Diffuse Idiopathic Skeletal Hyperostosis at the Distal End or Adjacent Vertebra of the Fused Segments. Asian Spine J 2024; 18:244-250. [PMID: 38454753 PMCID: PMC11065510 DOI: 10.31616/asj.2023.0316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/03/2023] [Accepted: 12/10/2023] [Indexed: 03/09/2024] Open
Abstract
STUDY DESIGN A retrospective cohort study. PURPOSE To investigate the outcomes of balloon kyphoplasty (BKP) for vertebral compression fractures (VCFs) at the distal end or adjacent vertebra of the fused segments in patients with diffuse idiopathic skeletal hyperostosis (DISH). OVERVIEW OF LITERATURE Vertebral fractures in the midportion of the fused segments in patients with DISH are generally unstable; thus, immobilization is recommended. However, VCFs classified as type A in the AO classification are observed at the distal end and adjacent vertebra of the fused segments, and treatment strategies for VCFs associated with DISH remain controversial. METHODS The outcomes of 72 patients who underwent BKP for VCFs between 2015 and 2021 were retrospectively investigated. Patients with DISH were assigned to group D (n=21), whereas those without DISH were assigned to group ND (n=51). Back pain, incidence of subsequent adjacent fractures, reoperation rates, and local kyphosis were statistically analyzed. RESULTS VCFs in group D occurred at the distal end or adjacent vertebra of the fused segments, and no fractures occurred in the midportion of the fused segment. Back pain improved in both groups, with no significant differences between them. Subsequent adjacent fractures were observed in three of the 21 patients in group D and 11 of the 51 patients in group ND, with no significant difference between them. Reoperation was performed in one patient each in groups D and ND, with no significant difference between the groups. Postoperatively, local kyphosis progressed significantly in group D. CONCLUSIONS Although local kyphosis is more advanced in patients with DISH, BKP is effective for VCFs at the distal end or adjacent vertebra of the fused segments and may be useful in older patients with high complication rates.
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Affiliation(s)
- Kyoichi Sanada
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka,
Japan
| | - Jun Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka,
Japan
| | | | | | - Teruaki Shiokawa
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka,
Japan
| | - Tatsuya Shibata
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka,
Japan
| | - Shusuke Hagihara
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka,
Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka,
Japan
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Ye Z, Shan B, Wei X, Zhao X, Shan H, Zhou Z, Dai J, Du S, Zhou X. Clinical Observation of Posterior Approach for Surgical Treatment of Thoracolumbar Pseudarthrosis in Ankylosing Spinal Disorders. World Neurosurg 2024; 183:e963-e970. [PMID: 38266990 DOI: 10.1016/j.wneu.2024.01.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 01/14/2024] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE The objective of this study was to evaluate the surgical effectiveness of posterior procedure with long segment stabilization for treating thoracolumbar pseudarthrosis associated with ankylosing spinal disorders (ASDs) without anterior fusion or osteotomy. METHODS Twelve patients with thoracolumbar pseudarthrosis in ASD were enrolled. All patients underwent posterior long-segment stabilization procedures. In some patients, the percutaneous technique or the aid of a robot or O-arm navigation was utilized for pedicle screw implantation. The clinical results were evaluated by means of the visual analog scale and Oswestry Disability Index. Radiological outcomes were evaluated for bone fusion, anterior column defect, local kyphotic correction, and position of the pedicle screws. RESULTS All patients experienced effective bone fusion at the sites of pseudarthrosis. The mean operative time was 161.7 ± 57.1 minutes, and the average amount of blood loss was 305.8 ± 293.2 mL. For 6 patients who underwent surgery with the assistance of a robot or O-arm navigation, there was no statistically significant difference observed in terms of operative time and mean blood loss compared to those who used the freehand technique (P > 0.05). The visual analog scale score, Oswestry Disability Index value, and mean local kyphotic angle showed significant improvements at the final follow-up (P < 0.05). The accuracy of pedicle screw placement was 96%. CONCLUSIONS Posterior surgery with long-segment fixation, without anterior fusion or osteotomy, can achieve satisfactory outcomes in ASD patients with thoracolumbar pseudarthrosis. The application of percutaneous techniques, as well as the assistance of robots or navigation technique may be a good choice for the treatment of pseudarthrosis in ASD patients.
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Affiliation(s)
- Zhiyuan Ye
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China; Department of Orthopedics, Sihong Hospital, Sihong, Jiangsu Provience, China
| | - Bingchen Shan
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiufang Wei
- Department of Orthopedics, Sihong Hospital, Sihong, Jiangsu Provience, China
| | - Xushen Zhao
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Huajian Shan
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhentao Zhou
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jun Dai
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Shengyang Du
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China; Department of Orthopedics, First People's Hospital of Xuzhou, Xuzhou, China
| | - Xiaozhong Zhou
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China.
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McCarty S, Bruckner JJ, Camacho JE, Jauregui JJ, Thomson AE, Ye I, Cavanaugh DL, Koh EY, Ludwig SC, Gelb DE. Comparison of Outcomes in Percutaneous Fixation of Traumatic Fractures between Ankylosing Spondylitis and Diffuse Idiopathic Skeletal Hyperostosis. Global Spine J 2023; 13:1821-1828. [PMID: 34668427 PMCID: PMC10556924 DOI: 10.1177/21925682211052003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES This study aims to analyze outcomes and complications of patients with thoracic and lumbar fractures in the setting of ankylosing spinal disorders (ASD) treated with minimally invasive surgery (MIS). METHODS The operative logs from 2012 to 2019 from one academic, Level I trauma center were reviewed for cases of thoracic and lumbar spinal fractures in patients with ASD treated with a MIS approach. Variables were compared between patients with ankylosing spondylitis (AS), diffuse idiopathic skeletal hyperostosis (DISH), and advanced spondylosis. RESULTS A total of 48 patients with ASD and concomitant thoracic or lumbar spinal fracture managed with an MIS approach were identified. A total of 11 patients were identified with AS, 21 with DISH, and 16 with advanced spondylosis. A total of 27 (56.3%) patients experienced complications. Complications differed between groups; DISH patients experienced a greater number of post-operative complications compared to AS and advanced spondylosis patients (P = .009). There was no significant difference in length of surgery, estimated blood loss, length of stay, readmission, and reoperation rates between AS and DISH patients. There were 3 mortalities unrelated to the surgery. CONCLUSION Percutaneous stabilization of patients with ankylosing spinal disorder fractures remains a viable management method. Operative characteristics were similar between AS, DISH, and advanced spondylosis patients; however, DISH patients experienced a greater number of post-operative complications.
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Affiliation(s)
- Scott McCarty
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, MI, USA
| | - Jacob J. Bruckner
- Spine Surgery Division, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jael E. Camacho
- Spine Surgery Division, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Julio J. Jauregui
- Spine Surgery Division, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Alexandra E. Thomson
- Spine Surgery Division, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ivan Ye
- Spine Surgery Division, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Daniel L. Cavanaugh
- Spine Surgery Division, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Eugene Y. Koh
- Spine Surgery Division, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Steven C. Ludwig
- Spine Surgery Division, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Daniel E. Gelb
- Spine Surgery Division, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
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Masson D, Mezjan I, Pretat PH, Colnat-Coulbois S, Civit T, Mansouri N. Mono-segmental percutaneous screw fixation in the management of AoSpine thoracolumbar type B fracture in patients with ankylosing spondylitis: A new treatment. Neurochirurgie 2023; 69:101464. [PMID: 37393989 DOI: 10.1016/j.neuchi.2023.101464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/10/2023] [Accepted: 06/13/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE To assess the viability and effectiveness of mono-segmental percutaneous screw fixation in the treatment of unstable type B thoracolumbar fracture due to ankylosing spondylitis. METHODS We report here all 40 patients treated by mono-segmental screw fixation in this indication, between January 2018 and January 2022, with follow-up at 3 and 9 months. Study variables comprised operating time, length of stay, fusion, stabilization quality, and peri-operative morbidity and mortality. RESULTS One patient showed early displacement of rods caused by technical error. None of the others showed secondary displacement of rods or screws. Mean age was 73 years (range 18-93), mean hospital stay 4.8 days (range 2-15), mean operative time 52minutes (range 26-95minutes) and mean estimated blood loss 40ml. There were 2 deaths caused by intensive care unit complications. All patients except those in intensive care were verticalized within 24hours after surgery. Parker score was unchanged for each patient before and after surgery and during follow-up. CONCLUSION Mono-segmental percutaneous screw fixation in the treatment of unstable type B thoracolumbar fracture due to ankylosing spondylitis was safe and effective. This study showed that this surgery reduced length of hospital stay, operative time, blood loss and complications compared to open or extended percutaneous surgery, and allowed fast rehabilitation in this vulnerable population.
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Affiliation(s)
- D Masson
- Service de neurochirurgie, CHRU de Nancy, université de Lorraine, Nancy, France.
| | - I Mezjan
- Service de neurochirurgie, CHRU de Nancy, université de Lorraine, Nancy, France
| | - P-H Pretat
- Service de neurochirurgie, CHRU de Nancy, université de Lorraine, Nancy, France
| | - S Colnat-Coulbois
- Service de neurochirurgie, CHRU de Nancy, université de Lorraine, Nancy, France
| | - T Civit
- Service de neurochirurgie, CHRU de Nancy, université de Lorraine, Nancy, France
| | - N Mansouri
- Service de neurochirurgie, CHRU de Nancy, université de Lorraine, Nancy, France
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Dave BR, Kulkarni M, Patidar V, Devanand D, Mayi S, Reddy C, Singh M, Rai RR, Krishnan A. Results of in situ fixation of Andersson lesion by posterior approach in 35 cases. Musculoskelet Surg 2022; 106:385-395. [PMID: 34037925 DOI: 10.1007/s12306-021-00712-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 05/11/2021] [Indexed: 02/05/2023]
Abstract
STUDY OBJECTIVE Due to the rarity of the Andersson lesion (AL), the literature is ambiguous regarding the type of surgical fixation, need for debridement and deformity correction. The purpose of this retrospective study is to evaluate the efficacy, feasibility and functional outcome of posterior fixation in AL. MATERIALS AND METHODS This study included 35 patients having thoracolumbar AL operated for in situ fixation and fusion with minimum of 24-month follow-up. VAS (Visual Analogue Score) back pain, ODI (Oswestry Disability Index), Frankel's grade were compared and analyzed. Union status was noted with complications. RESULTS The mean age of 35 patients was 56.34(± 11.3) years with average follow-up of 51.49 months. Two patients had AL at two levels. 27/37 AL were at discal level. Average estimated blood loss (EBL) was 276.43 ml and duration of surgery was 130.43 min. On an average, operated segments needed 7.77 screws. There were ten minor complications without long-term sequel. Neurological improvement was noted in 30 patients. Average preoperative VAS score improved from 8.69 to 3.14, ODI score improved from 68.76 to 18.77 at final follow-up which were significant (p < 0.05). There was significant improvement in Frankel's grading (Z = - 4.354, P = 0.00). CONCLUSIONS Surgical management of AL by posterior approach and posterior stabilization can give satisfactory results without the need of extensive anterior reconstruction, bone grafting or deformity correction procedures without added morbidity and complications.
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Affiliation(s)
- B R Dave
- Stavya Spine Hospital and Research Institute, Nr Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, 380006, India
| | - M Kulkarni
- Stavya Spine Hospital and Research Institute, Nr Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, 380006, India
| | - V Patidar
- Stavya Spine Hospital and Research Institute, Nr Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, 380006, India
| | - D Devanand
- Stavya Spine Hospital and Research Institute, Nr Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, 380006, India
| | - S Mayi
- Stavya Spine Hospital and Research Institute, Nr Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, 380006, India
| | - C Reddy
- Stavya Spine Hospital and Research Institute, Nr Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, 380006, India
| | - M Singh
- Stavya Spine Hospital and Research Institute, Nr Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, 380006, India
| | - R R Rai
- Stavya Spine Hospital and Research Institute, Nr Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, 380006, India
| | - A Krishnan
- Stavya Spine Hospital and Research Institute, Nr Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, 380006, India.
- BIMS Hospital, Opp. Sir T Hospital, Near Charan Boarding, Jail Rd, Bhavnagar, Gujarat, 364001, India.
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Burke JF, Tadepalli V, Chi J, Li XJ. Reduction and Stabilization of an Extension-Distraction Injury in a Patient with Ankylosing Spondylitis: A Case Report. JBJS Case Connect 2022; 12:01709767-202212000-00006. [PMID: 36240290 DOI: 10.2106/jbjs.cc.22.00368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/11/2022] [Indexed: 06/16/2023]
Abstract
CASE The authors reported a case of an 83-year-old man with ankylosing spondylitis throughout the cervical, thoracic, and lumbar spine who sustained a three-column T10 osteoligamentous extension-distraction injury after low-energy trauma. A closed reduction was performed using incremental flexion on a variable flexion-extension table and subsequent stabilization with robotic-assisted percutaneous pedicle screw placement. Postoperative radiographs at 7-month follow-up showed intact implants with adequate alignment with the patient remaining at neurological baseline. CONCLUSION A closed reduction method using a variable flexion-extension table with stabilization through percutaneous pedicle screw placement is a safe and appropriate method to achieve spinal realignment in select patients.
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Affiliation(s)
- John Francis Burke
- Department of Orthopaedic Surgery, The University of Virginia Health System, Charlottesville, Virginia
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Wang W, Huang Y, Zhang L, Yang H. Percutaneous kyphoplasty for the treatment of diffuse idiopathic skeletal hyperostosis with vertebral fractures: A case report and treatment review. Front Surg 2022; 9:922139. [PMID: 35910472 PMCID: PMC9334769 DOI: 10.3389/fsurg.2022.922139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 06/28/2022] [Indexed: 11/26/2022] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is a systemic metabolic condition characterized by new bone formation mainly at the anterolateral spine. Surgery such as screw fixation is commonly used for DISH patients who also suffer from vertebral fractures. In this case report, we share a DISH case with lumbar vertebral fracture and osteoporosis who underwent percutaneous kyphoplasty plus braces and medication. Percutaneous kyphoplasty, considered as minimally invasive surgery, may be another treatment option with the advantages of less trauma and faster recovery. The clinical information and radiological findings are described and treatments for DISH with vertebral fractures are then briefly reviewed.
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One-Year Clinical Outcomes of Minimal-Invasive Dorsal Percutaneous Fixation of Thoracolumbar Spine Fractures. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58050606. [PMID: 35630022 PMCID: PMC9144472 DOI: 10.3390/medicina58050606] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/15/2022] [Accepted: 04/26/2022] [Indexed: 11/17/2022]
Abstract
Introduction: Minimal-invasive instrumentation techniques have become a workhorse in spine surgery and require constant clinical evaluations. We sought to analyze patient-reported outcome measures (PROMs) and clinicopathological characteristics of thoracolumbar fracture stabilizations utilizing a minimal-invasive percutaneous dorsal screw-rod system. Methods: We included all patients with thoracolumbar spine fractures who underwent minimal-invasive percutaneous spine stabilization in our clinics since inception and who have at least 1 year of follow-up data. Clinical characteristics (length of hospital stay (LOS), operation time (OT), and complications), PROMs (preoperative (pre-op), 3-weeks postoperative (post-op), 1-year postoperative: eq5D, COMI, ODI, NRS back pain), and laboratory markers (leucocytes, c-reactive protein (CRP)) were analyzed, finding significant associations between these study variables and PROMs. Results: A total of 68 patients (m: 45.6%; f: 54.4%; mean age: 76.9 ± 13.9) were included. The most common fracture types according to the AO classification were A3 (40.3%) and A4 (40.3%), followed by B2 (7.46%) and B1 (5.97%). The Median American Society of Anesthesiologists (ASA) score was 3 (range: 1−4). Stabilized levels ranged from TH4 to L5 (mean number of targeted levels: 4.25 ± 1.4), with TH10-L2 (12/68) and TH11-L3 (11/68) being the most frequent site of surgery. Mean OT and LOS were 92.2 ± 28.2 min and 14.3 ± 6.9 days, respectively. We observed 9/68 complications (13.2%), mostly involving screw misalignments and loosening. CRP increased from 24.9 ± 33.3 pre-op to 34.8 ± 29.9 post-op (p < 0.001), whereas leucocyte counts remained stable. All PROMs showed a marked significant improvement for both 3-week and 1-year evaluations compared to the preoperative situation. Interestingly, we did not find an impact of OT, LOS, lab markers, complications, and other clinical characteristics on PROMs. Notably, a higher number of stabilized levels did not affect PROMs. Conclusions: Minimal-invasive stabilization of thoracolumbar fractures utilizing a dorsal percutaneous approach resulted in significant PROM outcome improvements, although we observed a complication rate of 13.2% for up to 1 year of follow-up. PROMs were not significantly associated with clinicopathological characteristics, technique-related variables, or the number of targeted levels.
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