Reduction and retention of thoracolumbar fractures by minimally invasive stabilisation versus open posterior instrumentation (original) (raw)
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Journal of Clinical Neuroscience, 2011
We retrospectively studied patients who underwent posterior pedicle screw instrumentation for thoracolumbar fractures to explore the relationship between correction loss after the operation and clinical outcome. The study included 52 patients, with a minimum postoperative follow-up of 7 years (mean of 9.8 years). From the analysis of radiological and clinical outcomes, we found that the relevant factors related to functional outcome were: (i) preoperative anterior vertebral height (AVH; regression coefficient [B] = À0.075, p = 0.045); and (ii) the latest follow-up AVH (B = À0.100, p = 0.043). This indicates that function is likely to be worse if the anterior vertebral column is compressed more severely at the time of injury, and that function will also be worse if the AVH is decreased at the latest follow-up. However, loss of AVH was not correlated with functional outcome. Therefore, we recommend that the AVH should be restored as much as possible by posterior instrumentation during the treatment of thoracolumbar fractures. Reducing the loss of correction to maintain the postoperative AVH is also critical to maintain the AVH at latest follow-up.
2007
Surgical procedures design ed to decompress and stabilize unstable trauma-related thoracolumbar fractures are primarily anterior or posterior operative approaches combined with anterior or posterior instrumentation. Our goal is to identHy patients that are likely to benefit from either fixation system. Two treatment groups were studied. The first group of 20 patients underwent posterior instrumentation and fusion. Also, eighteen patients with evidence of neural compression were treated with posterior decompressive surgery. The second group, consisting of 10 patients with neurological deficits, was managed with single-stage anterior decompression, interbody strut grafting, and anterior instrumentation. There were no statistically significant differences between the groups with regard to postoperative neurological outcome (Mann-Whitney V, P>0.05),pain assessment and ability to return to work (Chisquare, P>0.05), rate of instrument failure (Chi-square, P>0,05), rate of solid f...
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, 2018
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). 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. 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 fixa...
A Comparative Outcome Analysis of Two Posterior Only Approach for Thoracolumbar Fracture
Indian Journal of Neurotrauma
Objectives Most common surgical intervention in thoracolumbar fracture is pedicle screw fixation with posterior decompression through traditional posterior approach. Nowadays, we are doing combined anteroposterior decompression with anteroposterior fixation through posterior only approach. So, we attempt to compare these two approaches in terms of surgical and functional outcome. Method This is a retrospective study. We included 47 patients of traumatic thoracolumbar fracture between September 2016 and January 2018. Fourteen patients were treated by three-column fixation through posterior only approach and 33 patients were treated with traditional posterior approach. In three-column fixation, transpedicular corpectomy with dynamic mesh cage placement with B/L pedicle screw fixation with 360 canal decompression was done, whereas in traditional posterior approach, only posterior decompression with B/L pedicle screw fixation was done. Parameters for comparison include patients’ paramet...
Anterior Versus Posterior Approach in the Treatment of Chronic Thoracolumbar Fractures
Orthopedics, 2012
The purpose of this study was to compare the results of anterior approach vs posterior approach in the treatment of chronic thoracolumbar fractures. A total of 36 patients with chronic thoracolumbar fractures were divided into 2 groups. Group A was treated by an anterior approach and group B was treated by a posterior approach. During the minimum 24-month follow-up period (range, 24-62 months), all patients were prospectively evaluated for clinical and radiologic outcomes. Intraoperative blood loss, operative time, operative complications, pulmonary function, Frankel scale, and American Spinal Injury Association (ASIA) motor score were used for clinical evaluation, and Cobb angle was examined for radiologic outcome. All patients in this study achieved solid fusion, with signifi cant neurologic improvement. Operative time, perioperative blood loss, ASIA score on admission and at fi nal follow-up, and complications of respiratory tract infection and intercostal nerve pain were not signifi cantly different between the 2 groups (PϾ.05), but complications of hemopneumothorax, abdominal distension, and constipation were fewer in group B (PϽ.05). Postoperative pulmonary function (PϽ.05) and correction of posttraumatic kyphosis were better in group B (PϽ.05).
Thoracolumbar fractures: Three column stabilization through posterior only approach
Interdisciplinary Neurosurgery, 2016
The combination of anterior and posterior approaches when indicated in unstable thoracolumbar fractures provides the most stable reconstruction. However, the use of both approaches on a trauma patient is associated with significant morbidity. We evaluated the clinical outcome, morbidity and feasibility of single stage posterior midline approach for decompression and three column stabilization using expandable cage and pedicle screws. Methods: The cases of fifteen patients with severe traumatic thoracolumbar fractures/dislocations that were managed with single-stage decompression, reconstruction and three column stabilization using an expandable cage via an entirely posterior approach were included in this study. Data on age, sex, mechanism of injury neurological status, surgical technique, radiological and clinical outcome were reviewed retrospectively. Observation: There was no difference between the preoperative and immediate postoperative neurological status of the patients. The average blood loss was 580 ml and average operating time was 4 h 30 minutes. Adequate decompression, fixation and anterior column correction were achieved in all the patients. After a mean follow up period of 21.4 months, no patient complained of local pain and no significant loss of corrections or hardware failure was observed. Conclusion: Our experience proves that single stage posterior approach using pedicle screws and an expandable cage is a safe and biomechanically reliable method for treating thoracolumbar fractures.
Archives of Orthopaedic and Traumatic Surgery, 1986
Seventy-five surgically treated patients with thoracolumbar fractures and fracture dislocations, operated on between 1978 and 1982 at the Orthopedic Department of the University of Basel, were analyzed The follow-up ranged from 18 months to 6 years There were 45 men and 21 women, and 60 % of the patients were not more than 30 years old Additional injuries were common: 30 % of the patients had craniocerebral injuries and 20 % were polytraumatized Ninety-six percent of all patients reached a hospital within 6 h, but only 23 % initially presented at a center for spinal surgery Sixteen patients had anterior surgery (fusion alone or with plating), and two of these had laminectomy as a second operation Fifty-seven patients had posterior surgery, in 34 cases combined with a laminectomy The Harrington instrumentation was used 45 times (29 distraction, 14 compression, and two combinations of distraction and compression rods) Luque rods with segmental sublaminar wiring was used seven times, the locking-hook distraction-rod system of Jacobs twice, and miscellaneous procedures five times A total of 24 patients (> 30 %) presenting neurological deficits improved postoperatively None of the 18 patients with normal neurological findings deteriorated during the operation Neurological improvement was seen more frequently after early than after delayed surgery, but the difference was not statistically significant Laminectomy had no statistically significant effect on postoperative neurological status Twentytwo patients required reoperation because of insufficient or failed instrumentation Luque instrumentation had the highest rate of reoperations Anterior surgery did not prove superior to posterior proce
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.
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.