The influence of correction loss in thoracolumbar fractures treated by posterior instrumentation: A minimum 7-year follow-up (original) (raw)
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African Journal of Pharmacy and Pharmacology, 2011
A retrospective study of clinical and radiological results of nonfusion operative treatment for thoracolumbar fractures. In this study, we aimed to demonstrate that fusion was not always required in the surgical treatment with posterior instrumentation for thoracolumbar vertebral fractures and to show the success of surgical treatment without fusion. Fusion was added considering failure of the implant and inability to maintain the corrected kyposis angle after posterior instrumentation for thoracolumbar vertebral fractures. Fusion related problems such as the fusion-induced loss of stability in posterior elements, graft donor site problems, increased blood loss, allograft associated infections, and prolonged operation time, focus attention on surgical treatment without fusion. We intended to demonstrate the alignment and stability of the spine in the coronal and sagittal planes after treatment without fusion. Kyphosis angle and the extent of the collapse were measured in preoperative, postoperative and final examination films of 60 patients with thoracolumbar vertebral fractures. Based on the computerized tomography and magnetic resonance images of the patients, we evaluated intracanal fragments, the presence of pedicle and laminar fractures, posterior ligamentous complex status and the presence of medullary edema. With an aim to evaluate pain and quality of life of the patients, the oswestry disability ındex (ODI) and Roland morris disability questionnairre were tested. The obtained results were evaluated and the final postoperative conditions of the patients were investigated. For the statistical analysis of local kyphosis angle, sagittal index and percentage of anterior collapse that were measured in preoperative, postoperative and final examinations of the patients, descriptive analysis and one way analysis of variance for related samples were conducted. And Pearson's correlation test was used for the analysis of the relationship between radiological measurements and clinical functions. It can be concluded that the patients derived radiological and statistically significant benefit from the surgery in terms of restoration of anterior column height and that postoperative radiological values were maintained with minimal reduction until the final examination (p>0.05) and that the surgery was effective in remodeling of the vertebral body. When evaluated in terms of the clinical results, a negative relationship (r = 0.300) between Oswestry scores and percentage of anterior collapse was found to be statistically significant (p<0.05). Our findings that the patients derived statistically significant benefit radiologically, in terms of local kyphosis angle and sagittal index correction from the posterior instrumentation without fusion and that postoperative radiological values were maintained with minimal increase (p>0.05) until the final examination, support our conclusion that fusion is not required. Hence, we can eliminate complications of fusion surgery.
Open Journal of Orthopedics, 2015
Background: The different methods of anterior reconstruction and posterior instrumentation in surgical management of thoracolumbar spine fractures are PLIF, TLIF, lateral extracaviatary and transpedicular techniques which are increasingly used to perform partial or total corpectomies and anterior reconstructions from a posterior approach. These techniques were being alternative to the standard anterior approach with less morbidity and mortality. Patients and Methods: This study was performed between 2011 and 2014 on 100 patients with acute unstable thoracolumbar spine fractures which were divided into four groups: 30 patients underwent (TLIF), 28 patients underwent (PLIF), 28 patients underwent (PA) and 14 patients underwent (TPA). Neurological outcome, complications, operative times, kyphotic angle, vertebral height loss, spinal canal compromise, pulmonary functions, Denis pain and work scale, VAS score, ODI score, hospital stay, and estimated blood loss (EBL) were evaluated and compared in between the four groups. Results: There was a higher complication rate, increased EBL, and longer operative time with posteroanterior (PA) compared with PLIF, TLIF and (TPA). Patients undergoing PLIF, TLIF and TPA had a greater recovery of neurological function than those in whom PA were performed. Conclusion: TPA appeared to have more favorable results in improving the clinical and radiological outcome and no complications were reported apart from superficial wound infection which healed rapidly. The PLIF, TLIF and TPA appeared to have a comparable morbidity rate to PA. The different methods of anterior reconstruction from posterior approach are more favorable, applicable and convenient than PA approach.
Global Spine Journal, 2021
Study Design: Retrospective comparative study. Objectives: To compare radiological and functional outcomes of patients with fixation constructs utilizing pedicle screw stabilization at the fracture level (FL group) versus patients with non-fracture level (NFL group) fixation in single level fractures of the thoracolumbar junction (T11-L1). Methods: 53 patients of whom fracture level screw was used in 34 (FL group) were compared to 19 patients in NFL group. Radiological parameters analyzed were sagittal index, bi-segmental kyphosis (Cobb) angle and degree of vertebral height restoration. Prospectively collected patient reported functional outcomes and post-operative complications were also studied. Stepwise regression analysis adjusted by age, gender and functional scores was performed to account for the small numbers and unequal sizes of the groups. Results: Back pain score was significantly lower in the FL group ( P < 0.025). Core Outcome Measures Index scores and leg pain score...
Evaluation of Functional and Radiographic Outcomes of Thoracolumbar Fractures
Shafa Orthopedic Journal, 2015
Background: Thoracolumbar fractures are the most common fractures of the spinal column. There is no consensus about treatment method of choice among authors. Objectives: The purpose of this study was to compare radiographic and functional outcomes of conservative management with that of surgical treatment in thoracolumbar spine fractures. Patients and Methods: Forty-nine patients with single level acute thoracolumbar fractures and normal neurological examination were evaluated, of those 21 patients underwent surgery and 28 treated with orthosis. Radiographic outcomes were evaluated by measuring sagittal kyphotic angle, anterior vertebral body collapse and functional outcomes were assessed using SF36 health survey questionnaire and the Denis work and pain scales. Results: Among the surgically treated patients, sagittal kyphotic angle was significantly corrected immediately after operation and in the last follow-up compared to preoperative measurements (P < 0.001), functional results of SF36 score and pain scale were satisfactory. Among those received conservative management, sagittal kyphotic angle and anterior vertebral collapse were not significantly different before and after bracing (P = 0.4 and P = 0.8, respectively); functional outcome of SF36 scores were satisfactory and functional and radiographic results had no correlation. Conclusions: Functional outcome in both groups with surgical and non-surgical treatment was satisfactory. Radiographic indices were improved with surgical treatment and no correlation was found between functional and radiographic outcome.
European Spine Journal, 2018
Purpose To determine the health-related quality of life (QOL), safety and radiologic parameters after thoracoscopic treatment of traumatic thoracolumbar fractures using a distractible cage in patients without spinal cord injury (SCI). Methods Retrospective cohort study of patients treated between 2004 and 2012 in a university level-one trauma center. Patient and treatment characteristics were collected from the hospital information system. All available radiographic material was assessed for fracture characteristics and Cobb angle at consecutive times. Patients completed the SF-36 and EQ-5D QOL questionnaires at follow-up. Results 105 patients were treated with a distractible cage, which was performed thoracoscopically in 86 cases, including 16 patients with SCI. Of 70 eligible patients, 46 were available for follow-up and completed the questionnaires at median 49 months after surgery. QOL was lower on most domains compared to the general population. Compared to patients who underwent solely posterior fixation for less severe fractures, QOL did not differ significantly. The complication rate was low (10%) with one re-operation. Mean loss of correction was 6.8° and bony fusion on CT scan was present in 98% of patients. Maintenance of kyphosis correction was significantly better for two segments anterior fixation compared to one segment. Conclusions Thoracoscopic anterior stabilization leads to a high percentage of bony fusion in highly unstable thoracic and thoracolumbar fractures with limited post-operative loss of correction and no hardware failure. QOL of these patients does not return to normal population values but is comparable to that of patients with less severe fractures treated with solely posterior instrumentation. Graphical abstract These slides can be retrieved under Electronic Supplementary Material.
European Journal of Orthopaedic Surgery & Traumatology, 2004
Following fracture reduction and initial reconstitution of spinal alignment, loss of correction over time is frequently observed after posterior instrumentation. The degree of stability to provide a favorable environment for protection of initial correction is not known. A total of 36 patients with thoracolumbar burst fractures were divided into three groups. Group 1 included 12 patients treated by two-levels fixation, group 2 included ten patients treated by four-levels fixation, and group 3 included 14 patients treated by four-levels plus offsethook fixation. Preoperative, early postoperative, and 1year follow-up lateral spinal radiographs were evaluated by measuring the local kyphosis angle (LKA), the percentage of anterior body-height compression (%ABC), and the sagittal index (SI). For protecting the initial correction of LKA, group 3 was superior to the other groups (P<0.05). For protecting the initial correction of %ABC, groups 2 and 3 were the same (P>0.05), and these two groups were superior to group 1 (P<0.05). For protecting the initial correction of SI, group 3 was superior to group 1 (P<0.05), and the other groups were the same (P>0.05). Group 1 had a significant failure rate compared to the other groups (P<0.05). Two-levels fixation was the least stable system, and four-levels fixation plus offset hook was the most stable.
Very short segment posterior instrumentation in thoracolumbar spine fractures
Traditional techniques (in situ bone grafting associated with a halo-cast ± wiring techniques) are associated with an important rate of non-fusion, in particular in patients having constitutional bone diseases, in trisomy 21 or in the presence of important bony defects. The aims of the study were to evaluate the effectiveness on the bony fusion and the safety of the use of a rigid internal fixation. Material and method: This is a retrospective study including 22 patients of mean age 10 years 10 months. Eight patients had a congenital malformation, six patients had a mucopolysaccharidoses, three patients had a trisomy 21, one patient had a vertebral tumor, one patient had a juvenile rheumatoid arthritis, one patient had Ehler-Danlos disease, one patient had an iatrogenic instability after resection of an occipital chondrosarcoma, and one patient had osteogenesis imperfecta. The posterior instrumentation consisted of a precontoured titanium plate rod associating an occipital fixation by hooks or screws and a vertebral fixing by screws and hooks. Ten patients had C2 pedicle screws. The posterior iliac crest was used as a graft in 18 patients and the calvaria in 4 patients. The postoperative immobilization evolved with the experience of the surgeons from a halo-cast to an occipitocervical brace in young children and simply a rigid cervical collar in the older children. The mean follow-up was 50 months (27-85 months). Results: Nineteen patients (91 %) had a complete fusion. There was no incidence of implant failure and there was no vertebral artery injury. We had four major complications, two due to deep wound infection, one due to post-operative hematoma, and one due to loss of reduction. All the patients, except one with the post-operative hematoma and one with the deep infection, had neurological improvement. Conclusion: Rigid internal fixation, in particular the use of C2 pedicle screws and occipital hooks, is safe in the young child without increase in surgical complications, and significantly increases the union rate of occipito-cervical arthrodesis.
Asian spine journal, 2014
Study Design: Prospective clinical study. Purpose: The present prospective study aims to evaluate the clinical, radiological, and functional and quality of life outcomes in patients with fresh thoracolumbar fractures managed by posterior instrumentation of the spine, using pedicle screw fixation and monosegmental fusion. Overview of Literature: The goals of treatment in thoracolumbar fractures are restoring vertebral column stability and obtaining spinal canal decompression, leading to early mobilization of the patient. Methods: Sixty-six patients (46 males and 20 females) of thoracolumbar fractures with neurological deficit were stabilized with pedicle screw fixation and monosegmental fusion. Clinical, radiological and functional outcomes were evaluated. Results: The mean preoperative values of Sagittal index, and compression percentage of the height of the fractured vertebra were 22.75° and 46.73, respectively, improved (statistically significant) to 12.39°, and 24.91, postoperatively. The loss of correction of these values at one year follow-up was not statistically significant. The mean preoperative canal compromise (%) improved from 65.22±17.61 to 10.06±5.31 at one year follow-up. There was a mean improvement in the grade of 1.03 in neurological status from the preoperative to final follow-up at one year. Average Denis work scale index was 4.1. Average Denis pain scale index was 2.5. Average WHOQOL-BREF showed reduced quality of life in these patients. Patients of early surgery group (operated within 7 days of injury) had a greater mean improvement of neurological grade, radiological and functional outcomes than those in the late surgery group, but it was not statistically significant. Conclusions: Posterior surgical instrumentation using pedicle screws with posterolateral fusion is safe, reliable and effective method in the management of fresh thoracolumbar fractures. Fusion helps to decrease the postoperative correction loss of radiological parameters. There is no correlation between radiographic corrections achieved for deformities and functional outcome and quality of life post spinal cord injury.
Egyptian Journal of Neurosurgery, 2019
Background: The thoracolumbar spine is vulnerable to fracture in falls or motor vehicle accidents. Thoracolumbar spine fracture can be associated with neurological deficits, long-term pain and disability. The optimal management for these injuries remains a considerable subject for research. Objectives: To evaluate short-term surgical and functional outcome of posterior short-segment fixation with implanting pedicle screw in the fractured level (short same-segment fixation) for treatment of recent single-level traumatic thoracolumbar fracture. Methods: This prospective study included 36 patients with radiologically confirmed single-level thoracolumbar fracture. Patients were evaluated preoperatively, at time of discharge, and at follow-up visit after 1 year clinically using the Low-Back Outcome Scale of Greenough and Fraser Score, the American Spinal Injury Association (ASIA) for neurological evaluation, and the AO fracture classification for injury severity evaluation. Radiological evaluation included calculation of the sagittal index (SI) of injured vertebral body, anterior body compression (ABC) according to Mumford's equation, and regional kyphosis using Cobb angle. All patients underwent posterior trans-pedicular screw insertions into a vertebral body one level above and below the fracture site, and an additional pedicle screw was inserted at the level of the fracture. Postoperative clinical and radiological evaluations were compared to the preoperative. Results: All surgeries were conducted uneventfully within 129.7 ± 33.9 min with mean operative blood loss of 351.4 ± 140.5 ml. Wound infection was encountered in two patients and responded to conservative treatment. Mean duration of postoperative hospital stay and follow-up were 17.7 ± 4.4 days and 26.5 ± 5.1 months, respectively. After 1 year, mean low-back pain scores were significantly higher than preoperative and early postoperative scores and frequency of patients with excellent-good postoperative status was significantly higher at early postoperative evaluation and after 1 year compared to the preoperative status. Eight patients had neurological deficit, after 1-year follow-up; six patients were improved by one grade, while the other two cases remained stationary. Mean SI and ABC calculated at discharge and after 1 year were significantly higher compared to the preoperative measures. Mean Cobb angle was significantly decreased compared to the preoperative angle. Mean improvement of kyphosis angle at discharge and after 1 year was 60.9% and 48.1%, respectively; however, there was loss of kyphosis correction by about 4.2°after 1-year follow-up compared to the early postoperative finding.
European Spine Journal
Purpose In the surgical treatment of osteoporotic spine fractures, there is no clear recommendation, which treatment is best for the individual patient with vertebra plana and/or neurological deficit requiring instrumentation. The aim of this study was to evaluate clinical and radiological outcomes after dorsal or 360° instrumentation of osteoporotic fractures of the thoracolumbar spine in a cohort of patients representing clinical reality. Methods A total of 116 consecutive patients were operated on between 2008 and 2020. Inclusion criteria were osteoporotic fracture, thoracolumbar location, and dorsal instrumentation. In 79 cases, vertebral body replacement (VBR) was performed additionally. Patient outcomes including complications, EQ-5D at follow-up, and sagittal correction were analyzed. Results Medical and surgical complications occurred in 59.5% of patients with 360° instrumentation compared to 64.9% of patients with dorsal instrumentation only (p = 0.684). Dorsal instrumentat...