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Lindtner RA, Mueller M, Schmid R, Spicher A, Zegg M, Kammerlander C, Krappinger D. Monosegmental anterior column reconstruction using an expandable vertebral body replacement device in combined posterior-anterior stabilization of thoracolumbar burst fractures. Arch Orthop Trauma Surg 2018; 138:939-951. [PMID: 29623406 PMCID: PMC5999121 DOI: 10.1007/s00402-018-2926-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Indexed: 12/26/2022]
Abstract
INTRODUCTION In combined posterior-anterior stabilization of thoracolumbar burst fractures, the expandable vertebral body replacement device (VBRD) is typically placed bisegmentally for anterior column reconstruction (ACR). The aim of this study, however, was to assess feasibility, outcome and potential pitfalls of monosegmental ACR using a VBRD. In addition, clinical and radiological outcome of monosegmental ACR was related to that of bisegmental ACR using the same thoracoscopic technique. METHODS Thirty-seven consecutive neurologically intact patients with burst fractures of the thoracolumbar junction (T11-L2) treated by combined posterior-anterior stabilization were included. Monosegmental ACR was performed in 18 and bisegmental ACR in 19 patients. Fracture type and extent of vertebral body comminution were determined on preoperative CT scans. Monosegmental and bisegmental kyphosis angles were analyzed preoperatively, postoperatively and at final radiological follow-up. Clinical outcome was assessed after a minimum of 2 years (74 ± 45 months; range 24-154; follow-up rate 89.2%) using VAS Spine Score, RMDQ, ODI and WHOQOL-BREF. RESULTS Monosegmental ACR resulted in a mean monosegmental and bisegmental surgical correction of - 15.6 ± 7.7° and - 14.7 ± 8.1°, respectively. Postoperative monosegmental and bisegmental loss of correction averaged 2.7 ± 2.7° and 5.2 ± 3.7°, respectively. Two surgical pitfalls of monosegmental ACR were identified: VBRD positioning (1) onto the weak cancellous bone (too far cranially to the inferior endplate of the fractured vertebra) and (2) onto a significantly compromised inferior endplate with at least two (even subtle) fracture lines. Ignoring these pitfalls resulted in VBRD subsidence in five cases. When relating the clinical and radiological outcome of monosegmental ACR to that of bisegmental ACR, no significant differences were found, except for frequency of VBRD subsidence (5 vs. 0, P = 0.02) and bisegmental loss of correction (5.2 ± 3.7° vs. 2.6 ± 2.5°, P = 0.022). After exclusion of cases with VBRD subsidence, the latter did not reach significance anymore (4.9 ± 4.0° vs. 2.6 ± 2.5°, P = 0.084). CONCLUSIONS This study indicates that monosegmental ACR using a VBRD is feasible in thoracolumbar burst fractures if the inferior endplate is intact (incomplete burst fractures) or features only a single simple split fracture line (burst-split fractures). If the two identified pitfalls are avoided, monosegmental ACR may be a viable alternative to bisegmental ACR in selected thoracolumbar burst fractures to spare a motion segment and to reduce the distance for bony fusion.
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Affiliation(s)
- Richard A Lindtner
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Max Mueller
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Rene Schmid
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Anna Spicher
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Michael Zegg
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Christian Kammerlander
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
- Department of General, Trauma and Reconstructive Surgery, Ludwig Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Dietmar Krappinger
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
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202
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Çetin E, Şenköylü A, Acaroğlu E. Assessment of variability in Turkish spine surgeons' trauma practices. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2018; 52:1-6. [PMID: 29290537 PMCID: PMC6136338 DOI: 10.1016/j.aott.2017.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 11/28/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study was to analyse the variability among Turkish spinal surgeons in the management of thoracolumbar fractures by carrying out a web survey. METHODS An invitation text and web-link of the survey were sent to the members of the Turkish Spine Society mail group. A fictitious spine trauma vignette, a 23 year-old male with a L1 burst fracture, was presented and 25 questions were asked to participants. Variability of answers in a given question was assessed with the Index of Qualitative Variation (IQV). Questions with high IQV values (>%80) were selected to evaluate the relation between participant factors (speciality, age, degree and experience level of the surgeon, type of the work centre and volume of the trauma patients). RESULTS Sixty-four (88%) among the 73 participating surgeons completed the survey. 45 (70%) of them were orthopaedic surgeons and 19 (30%) were neurosurgeons. 11 questions had very high variability (IQV ≥ 0.80), 5 had high variability (0.58-0.75) and 2 had low variability (IQV≤0.20). The question with the highest variability was related to the use of brace after surgery (IQV = 0.93). Following one was about the selection of fixation levels (IQV = 0.91). Neurosurgeons were more likely to use brace postoperatively and professors were less likely to perform decompression. CONCLUSION This survey shows that thoracolumbar spine trauma practice significantly varies among Turkish spine surgeons. Surgeons' characteristics affected some specific answers. Lack of enough knowledge about spine trauma care, fracture classifications and surgical techniques and/or ethical factors may be other reasons for this variability.
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Affiliation(s)
- Engin Çetin
- Gaziosmanpaşa Taksim Training and Research Hospital, Istanbul, Turkey.
| | - Alpaslan Şenköylü
- Gazi University Faculty of Medicine, Orthopaedics and Traumatology Department, Ankara, Turkey.
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A Retrospective Study of Thoracolumbar Fractures Treated with Fixation and Nonfusion Surgery of Intravertebral Bone Graft Assisted with Balloon Kyphoplasty. World Neurosurg 2017; 108:798-806. [DOI: 10.1016/j.wneu.2017.08.093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/13/2017] [Accepted: 08/14/2017] [Indexed: 11/23/2022]
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Choi JH, Kang HD, Park JH, Gu BS, Jung SK, Oh SH. The Efficacy of Fentanyl Transdermal Patch as the First-Line Medicine for the Conservative Treatment of Osteoporotic Compression Fracture. Korean J Neurotrauma 2017; 13:130-136. [PMID: 29201847 PMCID: PMC5702748 DOI: 10.13004/kjnt.2017.13.2.130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 10/09/2017] [Accepted: 10/10/2017] [Indexed: 01/13/2023] Open
Abstract
Objective There are no strong guidelines on how long or how we should undertake conservative treatment during the acute period of an osteoporotic vertebral compression fracture (VCF). Methods We treated 202 patients with conservative treatment on VCF from March 2012 to August 2015. On inclusion criteria, 75 patients (22 males and 53 females) were included in the final analysis. After admission, a transdermal fentanyl patch with low dose (12.5 µg) application was attempted in all patients. In an unresponsive patient, the fentanyl patch was increased by 25 µg. After identifying the tolerable toilet ambulation of the patient without any assistance, hospital discharge was recommended. We classified two patient groups into one favorable group and one unfavorable group and compared several clinical and radiological factors. Results Among 75 patients, the clinical outcome of 57 patients (76%) was favorable, but that of 18 patients (24%) was unfavorable. In clinical outcomes, the numeric rating scale at 6 and 12 months and Odom's criteria at 12 months was significantly different between the favorable and the unfavorable groups. The dose of the patches used showed statistically significant differences between the two groups (p=0.001). Conclusion The only statistically significant affecting factor for an unfavorable outcome was the use of a higher dose fentanyl patch. Our data inferred that the unresponsiveness to a low-dose fentanyl patch could be helpful to select patients necessary for percutaneous vertebroplasty or kyphoplasty.
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Affiliation(s)
- June Ho Choi
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hui Dong Kang
- Department of Emergency Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Jin Hoon Park
- Department of Neurological Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Bon Sub Gu
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Ku Jung
- Department of Emergency Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Se Hyun Oh
- Department of Emergency Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
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Weinberg DS, Hedges BZ, Belding JE, Moore TA, Vallier HA. Risk factors for pulmonary complication following fixation of spine fractures. Spine J 2017; 17:1449-1456. [PMID: 28495240 DOI: 10.1016/j.spinee.2017.05.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 02/27/2017] [Accepted: 05/02/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Previous studies have suggested pulmonary complications are common among patients undergoing fixation for traumatic spine fractures. This leads to prolonged hospital stay, worse functional outcomes, and increased economic burden. However, only limited prognostic information exists regarding which patients are at greatest risk for pulmonary complications. PURPOSE This study aimed to identify factors predictive of perioperative pulmonary complications in patients undergoing fixation of spine fractures. STUDY DESIGN/SETTING A retrospective review in a level 1 trauma center was carried out. PATIENT SAMPLE The patient sample comprised 302 patients with spinal fractures who underwent operative fixation. OUTCOME MEASURES The outcome measures were postoperative pulmonary complications (physiological and functional measures). MATERIALS AND METHODS Demographic and injury features were recorded, including age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, mechanism of injury, injury characteristics, and neurologic status. Treatment details, including surgery length, timing, and approach were reviewed. Postoperative pulmonary complications were recorded after a minimum of 6 months' follow-up. RESULTS Forty-seven pulmonary complications occurred in 42 patients (14%), including pneumonia (35), adult respiratory distress syndrome (ARDS) (10), and pulmonary embolism (2). Logistic regression found spinal cord injury (SCI) to be most predictive of pulmonary complications (odds ratio [OR]=4.4, 95% confidence interval [CI] 1.9-10.1), followed by severe chest injury (OR 2.7, 95% CI 1.1-6.9), male gender (OR 2.7, 95% CI 1.1-6.8), and ASA classification (OR 2.3, 95% CI 1.4-4.0). Pulmonary complications were associated with significantly longer hospital stays (23.9 vs. 7.7 days, p<.01), stays in the intensive care unit (ICU) (19.9 vs. 3.4 days, p<.01), and increased ventilator times (13.8 days vs. 1.9 days, p<.01). CONCLUSIONS Several factors predicted development of pulmonary complications after operative spinal fracture, including SCI, severe chest injury, male gender, and higher ASA classification. Practitioners should be especially vigilant for of postoperative complications and associated injuries following upper-thoracic spine fractures. Future study must focus on appropriate interventions necessary for reducing complications in these high-risk patients.
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Affiliation(s)
- Douglas S Weinberg
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Dr., Cleveland, OH 44109, USA
| | - Brian Z Hedges
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Dr., Cleveland, OH 44109, USA
| | - Jonathan E Belding
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Dr., Cleveland, OH 44109, USA
| | - Timothy A Moore
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Dr., Cleveland, OH 44109, USA
| | - Heather A Vallier
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Dr., Cleveland, OH 44109, USA.
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Tsai PJ, Hsieh MK, Fan KF, Chen LH, Yu CW, Lai PL, Niu CC, Tsai TT, Chen WJ. Is additional balloon Kyphoplasty safe and effective for acute thoracolumbar burst fracture? BMC Musculoskelet Disord 2017; 18:393. [PMID: 28893205 PMCID: PMC5594435 DOI: 10.1186/s12891-017-1753-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 09/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Burst fracture is a common thoracolumbar injury that is treated using posterior pedicle instrumentation and fusion combined with transpedicular intracorporeal grafting after reduction. In this study, we compared the outcome of these two techniques by using radiologic imaging and functional outcome. METHODS Sixty-one patients with acute thoracolumbar burst fracture were operated with kyphoplasty (n = 31) or vertebroplasty (n = 30) and retrospectively reviewed in our institution between 2011 and 2014. All 61 patients underwent surgery within 5 days after admission to the hospital and then followed-up for 12 to 24 months after surgery. RESULTS Significant improvement was found in the anterior vertebral height (92 ± 8.9% in the kyphoplasty group, 85.6 ± 7.2% in the vertebroplasty group, p < 0.01) at 1 month post-operatively and (89 ± 7.9% in the kyphoplasty group, 78 ± 6.9% in the vertebroplasty group, p < 0.01) at the 24-month follow-up. Significant improvement was also observed in the kyphotic angle (1.2 ± 0.5° in the kyphoplasty group, 10.5 ± 1.2° in the vertebroplasty group, p < 0.01) at 1 month post-operatively and (5.4 ± 1.2° in the kyphoplasty group, 11.5 ± 8.5° in the vertebroplasty group, p < 0.01) at the 24-month follow-up. Both operations led to significant improvement of the patients' pain and the Oswestry disability index (p < 0.01). Cement leakage was noted in 29% of patients after kyphoplasty and 77% of patients after vertebroplasty (p < 0.01). Only one implant failure (3.3%), which required further surgical intervention, was reported in the vertebroplasty group. CONCLUSIONS Reduction with additional balloon at the fractured site is better than indirect reduction only by posterior instrumentation. The better reduction of kyphotic angle and the lower cement leakage rate in the kyphoplasty group indicate that additional balloon kyphoplasty is safe and effective for acute thoracolumbar burst fracture.
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Affiliation(s)
- Ping-Jui Tsai
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ming-Kai Hsieh
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan. .,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan. .,, 5, Fu-Hsin Street, Kweishan Shiang, Taoyuan ,333, Linkou, Taiwan.
| | - Kuo-Feng Fan
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Lih-Huei Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chia-Wei Yu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Po-Liang Lai
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chi-Chien Niu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Tsung-Ting Tsai
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Wen-Jer Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
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Wang B, Fan Y, Dong J, Wang H, Wang F, Liu Z, Liu H, Feng Y, Chen F, Huang Z, Chen R, Lei W, Wu Z. A retrospective study comparing percutaneous and open pedicle screw fixation for thoracolumbar fractures with spinal injuries. Medicine (Baltimore) 2017; 96:e8104. [PMID: 28930858 PMCID: PMC5617725 DOI: 10.1097/md.0000000000008104] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the effectiveness between percutaneous and open pedicle screw fixation for treating thoracolumbar fractures with spinal injuries. METHODS A total of 105 patients with thoracolumbar fractures and spinal injuries were divided into a percutaneous pedicle screw fixation (PPSF) group with 56 patients, who underwent percutaneous pedicle screw fixation, and an open pedicle screw fixation (OPSF) group with 49 patients, who underwent open pedicle screw fixation in accordance with the treatment project. Relative operation indexes, radiologic, and effectiveness parameters were assessed and compared between the 2 groups. RESULTS Demographic and clinical features including age, body mass index, gender, fracture level, fracture classification, and Frankel grade in both groups were not significantly different (all P >.05). The PPSF group exhibits significantly lower operation time, intraoperative blood loss, postoperative drainage volume, and hospital stay on average compared with the OPSF group (all P < .05). Besides, the average postoperative radiologic parameters, including Cobb angle (CA), vertebral wedge angle (VWA), vertebral front height percentage (VFHP), and sagittal index (SI), in both the groups were not significantly different (all P > .05). Nevertheless, both visual analogue scale (VAS) and Oswestry disability index (ODI) after surgery decreased more substantially in the PPSF group than in the OPSF group (all P < .05) while no significant difference in VAS scores or ODI during the last follow-up period was demonstrated in both the groups (both P > .05). Frankel classifications were stimulated in both the groups during the last follow-up period. CONCLUSION PPSF has a smaller incision, less intraoperative blood loss, shorter recovery time, higher safety measures on average compared with OPSF with respect to managing thoracolumbar fractures with spinal injuries.
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Affiliation(s)
- Bowen Wang
- Department of Orthopedics, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi
- Department of Orthopedics, Chenggong Hospital Affiliated to Xiamen University (the 174 Hospital of PLA), Xiamen, Fujian
| | - Yong Fan
- Department of Orthopedics, Honghui Hospital Affiliated to Xi’an Jiaotong University College of Medicine
| | - Jingjing Dong
- Lintong Aeromedical Evaluation and Training Center of Chinese Airforce, Xi’an, Shaanxi, China
| | - Hu Wang
- Department of Orthopedics, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi
| | - Faqi Wang
- Department of Orthopedics, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi
| | - Zhichen Liu
- Department of Orthopedics, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi
| | - Haoyuan Liu
- Department of Orthopedics, Chenggong Hospital Affiliated to Xiamen University (the 174 Hospital of PLA), Xiamen, Fujian
| | - Yafei Feng
- Department of Orthopedics, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi
| | - Fengrong Chen
- Department of Orthopedics, Chenggong Hospital Affiliated to Xiamen University (the 174 Hospital of PLA), Xiamen, Fujian
| | - Zheyuan Huang
- Department of Orthopedics, Chenggong Hospital Affiliated to Xiamen University (the 174 Hospital of PLA), Xiamen, Fujian
| | - Ruisong Chen
- Department of Orthopedics, Chenggong Hospital Affiliated to Xiamen University (the 174 Hospital of PLA), Xiamen, Fujian
| | - Wei Lei
- Department of Orthopedics, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi
| | - Zixiang Wu
- Department of Orthopedics, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi
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Zhang D, Chen T, Li G, Zhang K, Zhang R, Huang Z. [Comparative study of decompression and non-decompression surgeries in treatment of thoracolumbar fractures with intraspinal occupying and without neurological symptoms]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:970-975. [PMID: 29806435 DOI: 10.7507/1002-1892.201701101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effectiveness of posterior non-decompression surgery in the treatment of thoracolumbar fractures without neurological symptoms by comparing with the conventional posterior decompression surgery. Methods Between October 2008 and October 2015, a total of 97 patients with thoracolumbar fractures with intraspinal occupying 1/3-1/2 and without neurological symptoms were divided into the decompression surgery group (51 cases) and the non-decompression surgery group (46 cases). There was no significant difference in gender, age, cause of injury, injury segment, the thoracolumbar injury severity score (TLICS), combined injury, disease duration, and preoperative relative anterior vertebral height, kyphosis Cobb angle, intraspinal occupying percentage, visual analogue scale (VAS), Oswestry disability index (ODI), and Japanese Orthopaedic Association (JOA) score between 2 groups ( P>0.05). The operation time, intraoperative blood loss volume, postoperative drainage, bed rest time, hospitalization time, and relative anterior vertebral height, kyphosis Cobb angle, intraspinal occupying percentage, and VAS score, ODI, JOA score at preoperative and postoperative 3 days and 1 year were recorded and compared. Results The operation time, intraoperative blood loss volume, and postoperative drainage in non-decompression surgery group were significantly less than those in decompression surgery group ( P<0.05). There was no significant difference in the postoperative bed rest time and hospitalization time between 2 groups ( P>0.05). In decompression surgery group, 4 cases had cerebrospinal fluid leakage and healed after conservative treatment. All incisions healed by first intention, and no nerve injury or infection of incision occurred. All patients were followed up 10-18 months (mean, 11.7 months). The recovery of vertebral body height was satisfactory in 2 groups, without secondary kyphosis and secondary nerve symptoms. The imaging indexes and effectiveness scores of 2 groups at 3 days and 1 year after operation were significantly improved when compared with preoperative ones ( P<0.05). The intraspinal occupying percentage, VAS score, and ODI at 1 year after operation were significantly lower than those at 3 days after operation in 2 groups ( P<0.05), and JOA score at 1 year after operation was significantly higher than that at 3 days after operation ( P<0.05). Relative anterior vertebral height at 1 year after operation was significantly higher than that at 3 days after operation in non-decompression surgery group ( P<0.05); and there was no significant difference in decompression surgery group ( P>0.05). At 3 days, the intraspinal occupying percentage and JOA score in non-decompression surgery group were higher than those in decompression surgery group ( P<0.05), and VAS score and ODI at 3 days in non-decompression surgery group were lower than those in decompression surgery group ( P<0.05). No significant difference was found in the other indexes between 2 groups at 3 days and 1 year after operation ( P>0.05). Conclusion Compared with the posterior decompression surgery, posterior non-decompression surgery has the advantages of less bleeding, less trauma, less postoperative pain, and so on. It is an ideal choice for the treatment of thoracolumbar fractures with intraspinal occupying 1/3-1/2 and without neurological symptoms under the condition of strict indication of operation.
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Affiliation(s)
- Dawei Zhang
- Department of Spine Surgery, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai Guangdong, 519000, P.R.China
| | - Tao Chen
- Department of Spine Surgery, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai Guangdong, 519000, P.R.China
| | - Guowei Li
- Department of Spine Surgery, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai Guangdong, 519000, P.R.China
| | - Kuibo Zhang
- Department of Spine Surgery, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai Guangdong, 519000, P.R.China
| | - Rongkai Zhang
- Department of Spine Surgery, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai Guangdong, 519000, P.R.China
| | - Zongwen Huang
- Department of Spine Surgery, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai Guangdong, 519000,
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Karmakar A, Acharya S, Biswas D, Sau A. Evaluation of Percutaneous Vertebroplasty for Management of Symptomatic Osteoporotic Compression Fracture. J Clin Diagn Res 2017; 11:RC07-RC10. [PMID: 28969223 DOI: 10.7860/jcdr/2017/25886.10461] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 06/24/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Osteoporotic vertebral compression fractures are a leading cause of disability and associated morbidities among Indian population. Worldwide, approximately 20% of elderly population above 70 years and 16% of postmenopausal women are suffering from it. Vertebral compression fractures should be aggressively treated with minimally invasive techniques such as Percutaneous Vertebroplasty (PVP) or Percutaneous Kyphoplasty (PKP) to minimize pain and disability associated with it. AIM To evaluate the PVP in terms of pain reduction and restoration of functional abilities among the patients suffering from symptomatic osteoporotic vertebral compression fracture. MATERIALS AND METHODS PVP using polymethyl methacrylate bone cement was performed between 2011 to 2013, on 25 patients admitted for symptomatic osteoporotic vertebral compression fracture in the Department of Orthopaedics, Institute of Post Graduate Medical Education and Research (IPGMER) and SSKM Hospital, Kolkata, West Bengal, India. All of them were followed up for one year. Pain and disability were evaluated with Visual Analogue Scale (VAS) and Oswestry Disability Questionnaire (ODQ) score respectively. Repeated measures ANOVA with Bonferroni post-hoc test was applied for significance testing. RESULTS Reduction in pain was reported by 56% of patients within 10 minutes of operation. Mean VAS score at presentation was 8.24 (±1.16). It reduced to 6.31 (±1.21) and 2.38 (±0.08) at immediate postoperative period and after 12 months respectively. There was significant reduction (p<0.05) in pain, as measured by VAS score, started at immediate postoperative period to end of follow up period up to one year. Disability, measured by ODQ score, significantly decrease (p<0.05) over time from one week to 12-month postoperatively. At presentation, ODQ score was 93.01 (±4.54). It reduced to 76.84 (±3.76), one week after operation and 16.23 (±1.17), one year after operation. CONCLUSION The PVP with polymethayl methacrylate bone cement is still a justified treatment procedure for osteoporotic vertebral compression fractures as it provides excellent pain relief, internal stability to the fractured vertebra thus preventing further collapse and progression of kyphosis, allowing the patients to regain normal activity at the earliest, and at a very reasonable cost with minimal complication.
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Affiliation(s)
- Arnab Karmakar
- Assistant Professor, Department of Orthopaedics, Institute of Post Graduate Medical Education and Research (IPGMER) and S.S.K.M. Hospital, Kolkata, West Bengal, India
| | - Suchi Acharya
- Senior Resident, Department of Paediatrics, Institute of Child Health, Kolkata, West Bengal, India
| | - Dibyendu Biswas
- Assistant Professor, Department of Orthopaedics, Institute of Post Graduate Medical Education and Research (IPGMER) and S.S.K.M. Hospital, Kolkata, West Bengal, India
| | - Arkaprabha Sau
- Junior Resident, Department of Community Medicine, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India
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Wei Y, Tian W, Zhang GL, Lv YW, Cui GY. Thoracolumbar kyphosis is associated with compressive vertebral fracture in postmenopausal women. Osteoporos Int 2017; 28:1925-1929. [PMID: 28251286 DOI: 10.1007/s00198-017-3971-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 02/14/2017] [Indexed: 01/18/2023]
Abstract
UNLABELLED The main aim of this retrospective cross-sectional study was to examine the relationship between vertebral compression fracture and thoracolumbar Cobb angles. Fracture prevalence was found to be significantly higher for patients with moderate [odds ratio (OR) = 4.78 (2.88-7.95)] or severe kyphosis [OR = 10.7 (5.11-22.40)] than for patients with mild kyphosis. The relationship between degree of thoracolumbar kyphosis and vertebral compression fracture was analyzed. INTRODUCTION The hypothesis that vertebral compression fracture in women is related to thoracolumbar kyphosis severity was tested, and a clinically important cutoff degree of sagittal thoracolumbar Cobb angle (TLCobb) was determined. METHODS Demographic data, clinical data, and quantitative computed tomography (QCT) findings were compiled for 212 postmenopausal women with thoracolumbar fracture (study group) and 150 postmenopausal women with degenerative lumbar disease (control group). Group proportions and characteristics were compared with chi-squared tests and unpaired t tests, respectively. RESULTS In this retrospective cross-sectional study cohort, 17 patients had T11 fractures, 79 had T12 fractures, 89 had L1 fractures, and 27 had L2 fractures. QCT findings and TLCobb differed between the study and control groups (both p < 0.001). No significant differences were found in body mass index (BMI), disk height, or coronal TLCobb. After adjustment for age, BMI, and QCT findings, fracture prevalence was found to be higher in the thoracolumbar kyphosis study group than in the control group [OR = 6.16, 95% confidence interval (CI) 3.88-9.78]. Sagittal TLCobbs of 7.5-15° and >15° were associated with an increased fracture prevalence, with ORs of 4.78 (2.88-7.95) and 10.7 (5.11-22.40), respectively. CONCLUSION Vertebral fracture prevalence in postmenopausal women was found to be associated with thoracolumbar kyphosis. A TLCobb sagittal angle >15° should be considered an indicator for vertebral fracture assessment.
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Affiliation(s)
- Y Wei
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - W Tian
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China.
| | - G L Zhang
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Y W Lv
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - G Y Cui
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China
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211
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Hoppe S, Aghayev E, Ahmad S, Keel MJB, Ecker TM, Deml M, Benneker LM. Short Posterior Stabilization in Combination With Cement Augmentation for the Treatment of Thoracolumbar Fractures and the Effects of Implant Removal. Global Spine J 2017; 7:317-324. [PMID: 28815159 PMCID: PMC5546680 DOI: 10.1177/2192568217699185] [Citation(s) in RCA: 6] [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: 12/16/2022] Open
Abstract
STUDY DESIGN Retrospective case series. OBJECTIVE Short posterior stabilization with vertebroplasty is one treatment option for thoracolumbar burst fractures (AO A3). Whether it avoids progression in segmental kyphosis, especially after implant removal, is unclear. In a retrospective case-control study, its stability and the effect on intervertebral discs with and without implant removal was studied. METHODS Fifty-nine consecutive patients were treated with bisegmental short posterior instrumentation and additional vertebroplasty of the fractured vertebra. Twenty-nine patients (male/female 17/12; age: 41.7 ± 15.4 years) underwent implant removal. Changes of segmental kyphosis and disc heights between both groups (with and without implant removal) were compared on lateral X-rays preoperative, postoperative, after 1 year and after implant removal. Risk factors for loss of reduction were analyzed. RESULTS Kyphosis increased up to 12 months after implant removal. The loss of bisegmental correction was 6.0 ± 4.2 (range 0° to 16°) 12 months after implant removal. Risk factors for loss of reduction are younger patient age, fractures of the thoracolumbar junction (Th12), and degree of traumatic kyphosis. Intervertebral discs traversed by the stabilization lose height and don't recover within 1 year after implant removal. Without implant removal, disc height of the lower adjacent level is reduced after 24 months. CONCLUSIONS Short posterior stabilization in combination with vertebroplasty is a treatment alternative for thoracic and lumbar AO A3 fractures. After implant removal kyphosis increases, predominantly in the segment above the augmented vertebra. Risk factors for loss of reduction include younger age, fractures of the thoracolumbar junction (T12), and higher fracture kyphosis.
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Affiliation(s)
- Sven Hoppe
- Inselspital, Department of Orthopedic Surgery, University of Bern, Bern, Switzerland,Sven Hoppe, Department of Orthopedic Surgery and Traumatology, Inselspital Bern, CH-3010 Bern, Switzerland.
| | - Emin Aghayev
- Institute of Social and Preventative Medicine, University of Bern, Bern, Switzerland
| | - Sufian Ahmad
- Inselspital, Department of Orthopedic Surgery, University of Bern, Bern, Switzerland
| | | | - Timo Michael Ecker
- Inselspital, Department of Orthopedic Surgery, University of Bern, Bern, Switzerland
| | - Moritz Deml
- Inselspital, Department of Orthopedic Surgery, University of Bern, Bern, Switzerland
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212
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Vilà-Canet G, García de Frutos A, Covaro A, Ubierna MT, Caceres E. Thoracolumbar fractures without neurological impairment: A review of diagnosis and treatment. EFORT Open Rev 2017; 1:332-338. [PMID: 28507775 PMCID: PMC5414848 DOI: 10.1302/2058-5241.1.000029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
An appropriate protocol and unified management of thoracolumbar fractures without neurological impairment has not been well defined. This review attempts to elucidate some controversies regarding diagnostic tools, the ability to define the most appropriate treatment of classification systems and the evidence for conservative and surgical methods based on the recent literature.
Cite this article: Vilà-Canet G, García de Frutos A, Covaro A, Ubierna MT, Caceres E. Thoracolumbar fractures without neurological impairment: a review of diagnosis and treatment. EFORT Open Rev 2016;1:332-338. DOI: 10.1302/2058-5241.1.000029
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Affiliation(s)
- G Vilà-Canet
- ICATME, Institut Universitari Quirón-Dexeus, Barcelona, Spain
| | | | - A Covaro
- ICATME, Institut Universitari Quirón-Dexeus, Barcelona, Spain
| | - M T Ubierna
- ICATME, Institut Universitari Quirón-Dexeus, Barcelona, Spain
| | - E Caceres
- ICATME, Institut Universitari Quirón-Dexeus, Barcelona, Spain.,Universitat Autónoma de Barcelona, Spain
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213
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Insufficient stability of pedicle screws in osteoporotic vertebrae: biomechanical correlation of bone mineral density and pedicle screw fixation strength. 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 2017; 26:2891-2897. [PMID: 28391382 DOI: 10.1007/s00586-017-5091-x] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 03/20/2017] [Accepted: 04/05/2017] [Indexed: 01/23/2023]
Abstract
PURPOSE Loosening of pedicle screws is one major complication of posterior spinal stabilisation, especially in the patients with osteoporosis. Augmentation of pedicle screws with cement or lengthening of the instrumentation is widely used to improve implant stability in these patients. However, it is still unclear from which value of bone mineral density (BMD) the stability of pedicle screws is insufficient and an additional stabilisation should be performed. The aim of this study was to investigate the correlation of bone mineral density and pedicle screw fatigue strength as well as to define a threshold value for BMD below which an additional stabilisation is recommended. METHODS Twenty-one human T12 vertebral bodies were collected from donors between 19 and 96 years of age and the BMD was measured using quantitative computed tomography. Each vertebral body was instrumented with one pedicle screw and mounted in a servo-hydraulic testing machine. Fatigue testing was performed by implementing a cranio-caudal sinusoidal, cyclic (0.5 Hz) load with stepwise increasing peak force. RESULTS A significant correlation between BMD and cycles to failure (r = 0.862, r 2 = 0.743, p < 0.001) as well as for the linearly related fatigue load was found. Specimens with BMD below 80 mg/cm3 only reached 45% of the cycles to failure and only 60% of the fatigue load compared to the specimens with adequate bone quality (BMD > 120 mg/cm3). CONCLUSIONS There is a close correlation between BMD and pedicle screw stability. If the BMD of the thoracolumbar spine is less than 80 mg/cm3, stability of pedicle screws might be insufficient and an additional stabilisation should be considered.
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214
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Posterior Distraction and Instrumentation Cannot Always Reduce Displaced and Rotated Posterosuperior Fracture Fragments in Thoracolumbar Burst Fracture. Clin Spine Surg 2017; 30:E317-E322. [PMID: 28323718 DOI: 10.1097/bsd.0000000000000192] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN A retrospective clinical study. OBJECTIVE To determine the imaging features that can be used to predict failure of reduction of a retropulsed fracture fragment by posterior ligamentotaxis in thoracolumbar burst fractures. SUMMARY OF BACKGROUND DATA Posterior instrumentation and distraction with ligamentotaxis has been successfully used to shift retropulsed fragments anteriorly in thoracolumbar burst fractures. However, posterior longitudinal ligament rupture can lead to treatment failure. The exact preoperative radiographical parameters associated with failure of reduction remain unknown. MATERIALS AND METHODS A total of 85 patients who suffered from thoracolumbar burst fractures with significant retropulsion of fragments into the spinal canal, as confirmed by preoperative computed tomography and followed by postoperative computed tomography, were retrospectively analyzed. Seventy-three patients (85.9%) in whom the fragments were reduced by ligamentotaxis were included in the reduced group. In 12 patients (14.1%), the fracture fragment in the spinal canal was not reduced, and these patients were included in the nonreduced group. Neurologic status was classified according to the scoring system of the American Spinal Injury Association (ASIA). The displaced distance and rotation angle of the fracture fragment were measured at the fractured segment. RESULTS Preoperatively,the average displacement distances into the spinal canal of rotated posterosuperior fragments was 0.53 cm in the reduced group and 0.94 cm in the nonreduced group (P=0.002). The average rotation angles of the fracture fragments were 43.2 degrees in the reduced group and 61.7 degrees in the nonreduced group (P=0.012). "Double cortical surfaces" of the fragment were observed in the nonreduced patients. Neurological function was evaluated and recorded at the 2-year follow-up examination. There was no significant difference in the ASIA recovery grade between the 2 groups (P=0.668). CONCLUSIONS Displaced and rotated posterosuperior fracture fragments in thoracolumbar burst fracture cannot always be reduced by posterior ligamentotaxis. The 2 criteria for treatment failure that were most consistently present in our series were a displacement distance greater than 0.85 cm and a rotation angle greater than 55 degrees.
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215
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Suzuki S, Fujita N, Hikata T, Iwanami A, Ishii K, Nakamura M, Matsumoto M, Watanabe K. Asymmetrical pedicle subtraction osteotomy for progressive kyphoscoliosis caused by a pediatric Chance fracture: a case report. SCOLIOSIS AND SPINAL DISORDERS 2017; 12:8. [PMID: 28331905 PMCID: PMC5351051 DOI: 10.1186/s13013-017-0115-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 02/27/2017] [Indexed: 11/10/2022]
Abstract
Background Although most pediatric Chance fractures (PCFs) can be treated successfully with casting and bracing, some PCFs cause progressive spinal deformities requiring surgical treatment. There are only few reports of asymmetrical osteotomy for PCF-associated spinal deformities. Case presentation We here report a case of a 10-year-old girl who suffered an L2 Chance fracture from an asymmetrical flexion-distraction force, accompanied by abdominal injuries. She was treated conservatively with a soft brace. However, a progressive spinal deformity became evident, and 10 months after the injury, examination showed segmental kyphoscoliosis with a Cobb angle of 36°, a kyphosis angle of 31°, and a coronal imbalance of 30 mm. Both the coronal and sagittal deformities were successfully corrected by asymmetrical pedicle subtraction osteotomy. Conclusions Initial kyphosis and posterior ligament complex should be evaluated at some point when treating PCFs. Asymmetrical pedicle subtraction osteotomy can be a useful surgical option when treating rigid kyphoscoliosis associated with a PCF.
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Affiliation(s)
- Satoshi Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582 Japan
| | - Nobuyuki Fujita
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582 Japan
| | - Tomohiro Hikata
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582 Japan
| | - Akio Iwanami
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582 Japan
| | - Ken Ishii
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582 Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582 Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582 Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582 Japan
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216
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Delgado-López PD, Rodríguez-Salazar A, Martín-Velasco V, Martín-Alonso J, Castilla-Díez JM, Galacho-Harriero A, Araús-Galdós E. [Rationale and complications of the anterior-lateral extrapleural retroperitoneal approach for unstable thoracolumbar fractures: Experience in 86 consecutive patients]. Neurocirugia (Astur) 2017; 28:218-234. [PMID: 28342638 DOI: 10.1016/j.neucir.2017.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 01/16/2017] [Accepted: 01/17/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To describe the rationale, pros and cons, and complications of the anterior-lateral extrapleural retroperitoneal approach for unstable (TLICS>4) thoracolumbar fractures. PATIENTS AND METHODS Clinical and radiological data and outcomes from a cohort treated surgically via said approach were retrospectively reviewed. All patients were operated on exclusively by 5 neurosurgeons trained in spine surgery. RESULTS Between June 1999 and December 2015, 86 patients underwent surgery (median age 42years, most common level: L1). Approximately 32.5% presented with a preoperative neurological defect. After surgery (mean duration: 275minutes), 75.6% presented with no neurological sequelae and only one-third required blood transfusion. Median postoperative stay was 7days. Correction of kyphosis was considered adequate and suboptimal but acceptable in 91% and 9% of the patients, respectively. Complications occurred in 36 patients, the majority being transient. We observed failure of the construct in 2 cases (collapse of an expandable cage and extrusion of a locking screw). No infections, vascular or visceral lesions, permanent neurological worsening or mortality occurred during hospitalisation. One patient ultimately needed additional posterior fixation due to persistence of pain. Median follow-up was 252days (27.9% was lost to follow-up). CONCLUSIONS The extrapleural extraperitoneal approach provides solid anterior reconstruction, allows wide decompression of the spinal canal, and permits adequate and long-lasting correction of kyphosis. The rates of infection, construct failure, need for reoperation and vascular or visceral lesions are minimal.
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Affiliation(s)
| | | | | | | | | | | | - Elena Araús-Galdós
- Servicio de Neurofisiología Clínica, Hospital Universitario de Burgos, Burgos, España
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217
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Development of the AOSpine Patient Reported Outcome Spine Trauma (AOSpine PROST): a universal disease-specific outcome instrument for individuals with traumatic spinal column injury. 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 2017; 26:1550-1557. [DOI: 10.1007/s00586-017-5032-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 03/06/2017] [Indexed: 11/27/2022]
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218
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Kapoor CS, Mehta AK, Golwala PP, Merh AA, Jhaveri MR. A Study of Traumatic Dorsal and Lumbar Vertebral Injuries with Neurological Deficit. APOLLO MEDICINE 2017. [DOI: 10.1016/j.apme.2017.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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219
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Harrop JS, Rymarczuk GN, Vaccaro AR, Steinmetz MP, Tetreault LA, Fehlings MG. Controversies in Spinal Trauma and Evolution of Care. Neurosurgery 2017; 80:S23-S32. [DOI: 10.1093/neuros/nyw076] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 01/30/2017] [Indexed: 11/13/2022] Open
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220
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Weiser L, Dreimann M, Huber G, Sellenschloh K, Püschel K, Morlock MM, Rueger JM, Lehmann W. Cement augmentation versus extended dorsal instrumentation in the treatment of osteoporotic vertebral fractures: a biomechanical comparison. Bone Joint J 2017; 98-B:1099-105. [PMID: 27482024 DOI: 10.1302/0301-620x.98b8.37413] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 04/05/2016] [Indexed: 11/05/2022]
Abstract
AIMS Loosening of pedicle screws is a major complication of posterior spinal stabilisation, especially in the osteoporotic spine. Our aim was to evaluate the effect of cement augmentation compared with extended dorsal instrumentation on the stability of posterior spinal fixation. MATERIALS AND METHODS A total of 12 osteoporotic human cadaveric spines (T11-L3) were randomised by bone mineral density into two groups and instrumented with pedicle screws: group I (SHORT) separated T12 or L2 and group II (EXTENDED) specimen consisting of T11/12 to L2/3. Screws were augmented with cement unilaterally in each vertebra. Fatigue testing was performed using a cranial-caudal sinusoidal, cyclic (1.0 Hz) load with stepwise increasing peak force. RESULTS Augmentation showed no significant increase in the mean cycles to failure and fatigue force (SHORT p = 0.067; EXTENDED p = 0.239). Extending the instrumentation resulted in a significantly increased number of cycles to failure and a significantly higher fatigue force compared with the SHORT instrumentation (EXTENDED non-augmented + 76%, p < 0.001; EXTENDED augmented + 87%, p < 0.001). CONCLUSION The stabilising effect of cement augmentation of pedicle screws might not be as beneficial as expected from biomechanical pull-out tests. Lengthening the dorsal instrumentation results in a much higher increase of stability during fatigue testing in the osteoporotic spine compared with cement augmentation. Cite this article: Bone Joint J 2016;98-B:1099-1105.
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Affiliation(s)
- L Weiser
- University Medical Center Göttingen, Göttingen, Germany
| | - M Dreimann
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Huber
- Institute of Biomechanics, TUHH Hamburg University of Technology, Hamburg, Germany
| | - K Sellenschloh
- Institute of Biomechanics, TUHH Hamburg University of Technology, Hamburg, Germany
| | - K Püschel
- Institute of Forensic Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M M Morlock
- Institute of Biomechanics, TUHH Hamburg University of Technology, Hamburg, Germany
| | - J M Rueger
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - W Lehmann
- University Medical Center Göttingen, Göttingen, Germany
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221
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Chu JK, Rindler RS, Pradilla G, Rodts GE, Ahmad FU. Percutaneous Instrumentation Without Arthrodesis for Thoracolumbar Flexion-Distraction Injuries: A Review of the Literature. Neurosurgery 2017; 80:171-179. [PMID: 28173564 DOI: 10.1093/neuros/nyw056] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 11/10/2016] [Indexed: 11/12/2022] Open
Abstract
Background Flexion-distraction injuries (FDI) represent 5% to 15% of traumatic thoracolumbar fractures. Treatment depends on the extent of ligamentous involvement: osseous/Magerl type B2 injuries can be managed conservatively, while ligamentous/Magerl type B1 injuries undergo stabilization with arthrodesis. Minimally invasive surgery without arthrodesis can achieve similar outcomes to open procedures. This has been studied for burst fractures; however, its role in FDI is unclear. Objective To conduct a systematic review of the literature that examined minimally invasive surgery instrumentation without arthrodesis for traumatic FDI of the thoracolumbar spine. Methods Four electronic databases were searched, and articles were screened using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines for patients with traumatic FDI of the thoracolumbar spine treated with percutaneous techniques without arthrodesis and had postoperative follow-up. Results Seven studies with 44 patients met inclusion criteria. There were 19 patients with osseous FDI and 25 with ligamentous FDI. When reported, patients (n = 39) were neurologically intact preoperatively and at follow-up. Osseous FDI patients underwent instrumentation at 2 levels, while ligamentous injuries at approximately 4 levels. Complication rate was 2.3%. All patients had at least 6 mo of follow-up and demonstrated healing on follow-up imaging. Conclusion Percutaneous instrumentation without arthrodesis represents a low-risk intermediate between conservative management and open instrumented fusion. This “internal bracing” can be used in osseous and ligamentous FDIs. Neurologically intact patients who do not require decompression and those that may not tolerate or fail conservative management may be candidates. The current level of evidence cannot provide official recommendations and future studies are required to investigate long-term safety and efficacy.
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Affiliation(s)
- Jason K Chu
- Department of Neurological Surgery, Emory University, Atlanta, Georgia, USA
| | - Rima S Rindler
- Department of Neurological Surgery, Emory University, Atlanta, Georgia, USA
| | - Gustavo Pradilla
- Department of Neurological Surgery, Emory University, Atlanta, Georgia, USA
| | - Gerald E Rodts
- Department of Neurological Surgery, Emory University, Atlanta, Georgia, USA
| | - Faiz U Ahmad
- Department of Neurological Surgery, Emory University, Atlanta, Georgia, USA
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Direct Midline Posterior Corpectomy and Fusion of a Lumbar Burst Fracture with Retrospondyloptosis. World Neurosurg 2017; 99:809.e11-809.e14. [PMID: 28089837 DOI: 10.1016/j.wneu.2016.12.129] [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: 08/08/2016] [Revised: 12/28/2016] [Accepted: 12/29/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Traumatic burst fractures of the lumbar spine can result in significant neurologic injury and mechanical instability. The ideal surgical approach for the treatment of unstable lumbar spine burst fractures remains debatable. CASE DESCRIPTION A 37-year-old man presented with severe neurologic injury including loss of motor function below the level of the iliopsoas muscles bilaterally, saddle anesthesia, and absent rectal tone, after a fall from 18.28 m (60 ft). Computed tomography showed an L4 vertebral body comminuted burst fracture with complete posterior translation of L4 over L5. The patient was taken to the operating room for an L4 corpectomy and L2-S1 posterior fusion. The L4 vertebral body was visualized posterior to the posterior elements of L5 and resected in a piecemeal fashion. Because the thecal sac had been completely transected, a visible path down the L3-L4 and L4-L5 disk spaces was apparent, allowing direct posterior discectomies at these levels and completion of the L4 segment resection. The use of a direct posterior approach resulted in minimal blood loss, correction of sagittal alignment, and satisfactory outcomes comparable with the standard posterior transpedicular approach. Construct stability and solid bony fusion have been maintained for 4 years postoperatively. CONCLUSIONS The use of a direct midline posterior corpectomy approach may be considered for patients with lumbar burst fractures, high-grade neurologic injury, and transection of the thecal sac.
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223
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Li C, Pan J, Gu Y, Dong J. Minimally invasive pedicle screw fixation combined with percutaneous vertebroplasty for the treatment of thoracolumbar burst fracture. Int J Surg 2016; 36:255-260. [DOI: 10.1016/j.ijsu.2016.11.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/27/2016] [Accepted: 11/01/2016] [Indexed: 11/30/2022]
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224
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Acute traumatic intraosseous fluid sign predisposes to dynamic fracture mobility. Emerg Radiol 2016; 24:149-155. [PMID: 27830346 DOI: 10.1007/s10140-016-1460-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 10/24/2016] [Indexed: 10/20/2022]
Abstract
The intraosseous fluid sign (IFS) in chronic osteoporotic vertebral fractures is attributed to fluid accumulation within non-healing intervertebral clefts. IFS can also be seen in acute traumatic fractures, not previously described. We hypothesize a pathophysiological mechanism for the acute traumatic intraosseous fluid sign (ATIFS) and its predisposition to dynamic fracture mobility with axial loading on upright radiographs. Retrospective analysis was performed of 41 acute thoracic and lumbar compression or stable burst fractures with both supine CT and upright plain films completed within 1 week of each other. The presence of an intravertebral cleft with fluid attenuation and vertebral body height loss was assessed on CT scans. Changes in the fractured vertebral body height and angulation were measured on upright radiographs. The ATIFS was identified in 18 (44%) of the 41 acute fractures. Mean kyphotic angle increase was significantly greater (p = 0.000) for ATIFS fractures (8.2°, SD ±4.2) than fractures without ATIFS (1.6°, SD ±3.4). There was significantly greater mean anterior (p = 0.0009) and central (p = 0.026) height loss in ATIFS fractures (4.3 mm, SD ±3.76 and 1.89 mm, SD ±4.44, respectively) compared to fractures without ATIFS (0.59 mm, SD ±2.24 and -0.52 mm, SD ±2.01, respectively). The IFS can be seen in acute traumatic vertebral fractures and show dynamic mobility. These ATIFS fractures show statistically significant greater mean height loss ratio differences and have significantly greater changes in kyphotic angulation on upright imaging when compared to fractures without ATIFS.
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225
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Lee S, Park MS, Kim YC, Kim TH. Osteoporotic thoracolumbar junctional fracture accompanied by spinous process fracture without posterior ligament injury: its clinical and radiologic significances. 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; 25:3478-3485. [PMID: 27260251 DOI: 10.1007/s00586-016-4634-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 04/27/2016] [Accepted: 06/01/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the clinical and radiologic outcome of osteoporotic thoracolumbar junctional fracture accompanied by spinous process fracture (SPF) without posterior ligament injury. METHODS A total of 391 patients with single-level osteoporotic thoracolumbar junctional (T10-L2) fracture were selectively enrolled. The patients were divided into two groups by absence (group I) or presence (group II) of SPF. Clinical and radiologic parameters were compared between the two groups. RESULTS Group I comprised of 332 patients with only vertebral body fracture, and group II comprised of 59 patients with both vertebral body and SPFs. In all cases of group II, SPFs were located just one level above the fractured vertebral body, and the injury of the posterior ligament was not found. At the time of injury, group II patients showed worse outcomes in anterior vertebral body compression percentage, kyphotic Cobb angle, cranial disk status, and the rate of the initial neurologic injury. Kyphotic alignment changes during 1-year follow-up were compared between the conservative subgroups of groups I and II. At the time of injury, there were no statistical differences in anterior vertebral body compression percentage and Cobb angle between the two conservative subgroups. However, the difference was significant after 1-year follow-up. Comparison of kyphotic alignment change at 12 months after diagnosis within group II was done according to the treatment method. Vertebroplasty subgroup in group II did not show benefit even in preventing such kyphotic alignment change, whereas instrumentation subgroup in group II showed lordotic alignment restoration despite more severe kyphotic alignment at the time of injury. CONCLUSIONS Osteoporotic thoracolumbar junctional fracture accompanied by spinous process fracture without posterior ligament injury represented more severe injury with flexion forces on the anterior column and tensile forces on the posterior column, and was related with more severe posttraumatic kyphotic changes during the 12-month follow-up.
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Affiliation(s)
- Seonjong Lee
- Spine Center, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896, Pyeongchon-Dong, Anyang City, Gyeonggi-Do, 431-070, Korea
| | - Moon Soo Park
- Spine Center, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896, Pyeongchon-Dong, Anyang City, Gyeonggi-Do, 431-070, Korea
| | - Yong-Chan Kim
- Spine Center, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896, Pyeongchon-Dong, Anyang City, Gyeonggi-Do, 431-070, Korea
| | - Tae-Hwan Kim
- Spine Center, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896, Pyeongchon-Dong, Anyang City, Gyeonggi-Do, 431-070, Korea.
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Health-care costs of conservative management of spine fractures in trauma patients. 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; 26:1438-1446. [DOI: 10.1007/s00586-016-4806-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 09/18/2016] [Accepted: 10/03/2016] [Indexed: 10/20/2022]
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227
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Minimally Invasive Posterior Decompression Combined With Percutaneous Pedicle Screw Fixation for the Treatment of Thoracolumbar Fractures With Neurological Deficits: A Prospective Randomized Study Versus Traditional Open Posterior Surgery. Spine (Phila Pa 1976) 2016; 41 Suppl 19:B23-B29. [PMID: 27656782 DOI: 10.1097/brs.0000000000001814] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective randomized cohort study. OBJECTIVE To compare the surgical results of minimally invasive posterior decompression combined with percutaneous pedicle screws fixation (minimally invasive surgery [MIS]) and posterior open surgery (OS) for the treatment of thoracolumbar fracture with neurological deficits. SUMMARY OF BACKGROUND DATA Thoracolumbar fracture with neurological deficits usually undergoes surgical intervention. OS can achieve satisfied results, but the main disadvantage is approach-related complications. No study, however, focused on the treatment of this disease by MIS through posterior approach. METHODS Sixty consecutive cases of thoracolumbar fractures with neurological deficits were randomized into MIS group and OS group. Incision length, blood loss, postoperative drainage volume, hospitalization days, blood transfusion rate, analgesic use rate, and x-ray exposure time were used to evaluate the perioperative information and Visual Analog Scale (VAS), Japanese Orthopedics Association (JOA) score, and American Spinal Injury Association grade for patients' symptom. For radiological assessment, sagittal Cobb angle, percentage of vertebral height, and vertebral wedging angle were measured. RESULTS Fifty-nine of sixty patients were followed-up for at least 12 months. MIS group was superior in perioperative information (P < 0.05), except in the operative time (P = 0.165) and x-ray time (P = 0.000). The operative time seemed longer in MIS group, but no significant difference was found. The x-ray time was significantly higher in MIS group. The mean Visual Analog Scale and Japanese Orthopedics Association scores of the final follow-up in MIS group were better than that in OS group (P < 0.05). Patients in both group achieved a similar neurological recovery according to American Spinal Injury Association grade (P = 0.760). A broken screw was found in one patient in MIS group and a broken rod in one patient in OS group. CONCLUSION MIS group has achieved the similar effect of OS group and it can minimize the approach-related complication. It also faced with some shortages, such as larger radiation dose and longer learning curve. LEVEL OF EVIDENCE 2.
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Skoch J, Zoccali C, Zaninovich O, Martirosyan N, Walter CM, Maykowski P, Baaj AA. Bracing After Surgical Stabilization of Thoracolumbar Fractures: A Systematic Review of Evidence, Indications, and Practices. World Neurosurg 2016; 93:221-8. [DOI: 10.1016/j.wneu.2016.05.067] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 05/21/2016] [Accepted: 05/23/2016] [Indexed: 10/21/2022]
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229
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Li J, Guo L, Li Y, Lei Z, Liu Y, Shi W, Li T, Li W, Liu C. A device mimicking the biomechanical characteristics of crocodile skull for lumbar fracture reduction. BIOINSPIRATION & BIOMIMETICS 2016; 11:056004. [PMID: 27529133 DOI: 10.1088/1748-3190/11/5/056004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Open surgery is currently the main treatment method for the lumbar burst fracture with neurological deficit but may irreversibly disrupt the lumbar anatomy. The minimally invasive surgery (MIS) techniques have recently gained increasing attention. However, their use is still limited to lumbar burst fractures mainly due to their difficulties in burst fracture reduction and decompression. Here we present a novel bio-inspired MIS device which can be used with an endoscope to reset the bone fragments retropulsed into the spinal canal within the wounded vertebral body. Its head jaw mimics the biomechanical characteristics of a crocodile rostrum to improve the performance in gripping and moving bone pieces in the confined space of a vertebral body. This study may be capable of converting the posterior open surgeries to the MIS procedures, and expands the use of the MIS techniques in the treatment of lumbar burst fractures.
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Affiliation(s)
- Jingmin Li
- Key Laboratory for Micro/Nano Technology and System of Liaoning Province, Dalian University of Technology, Dalian,116024, People's Republic of China
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Burst Fractures in the Thoracolumbar Junction: What Do We Know About Their Treatment? ARCHIVES OF NEUROSCIENCE 2016. [DOI: 10.5812/archneurosci.39949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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231
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Yuan WH, Hsu HC, Lai KL. Vertebroplasty and balloon kyphoplasty versus conservative treatment for osteoporotic vertebral compression fractures: A meta-analysis. Medicine (Baltimore) 2016; 95:e4491. [PMID: 27495096 PMCID: PMC4979850 DOI: 10.1097/md.0000000000004491] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Although the majority of available evidence suggests that vertebroplasty and kyphoplasty can relieve pain associated with vertebral compression fractures (VCFs) and improve function, some studies have suggested results are similar to those of placebo. The purpose of this meta-analysis was to compare the outcomes of vertebroplasty and kyphoplasty with conservative treatment in patients with osteoporotic VCFs. METHODS Medline, Cochrane, and Embase databases were searched until January 31, 2015 using the keywords: vertebroplasty, kyphoplasty, compression fracture, osteoporotic, and osteoporosis. Inclusion criteria were randomized controlled trials (RCTs) in which patients with osteoporosis, and VCFs were treated with vertebroplasty/kyphoplasty or conservative management. Outcome measures were pain, function, and quality of life. Standardized differences in means were calculated as a measure of effect size. MAIN RESULTS Ten RCTs were included. The total number of patients in the treatment and control groups was 626 and 628, respectively, the mean patient age ranged from 64 to 80 years, and the majority was female. Vertebroplasty/kyphoplasty was associated with greater pain relief (pooled standardized difference in means = 0.82, 95% confidence interval [CI]: 0.374-1.266, P < 0.001) and a significant improvement in daily function (pooled standardized difference in means = 1.273, 95% CI: 1.028-1.518, P < 0.001) as compared with conservative treatment. The pooled estimate indicated vertebroplasty/kyphoplasty was associated with higher quality of life (pooled standardized difference in means = 1.545, 95% CI: 1.293-1.798, P < 0.001). Subgroup analysis of 8 vertebroplasty studies and 2 kyphoplasty studies that reported pain data, however, indicated that vertebroplasty provided greater pain relief than conservative treatment but kyphoplasty did not. CONCLUSION Vertebroplasty may provide better pain relief than balloon kyphoplasty in patients with osteoporotic VCFs, both may improve function, and their effect on quality of life is less clear.
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Affiliation(s)
- Wei-Hsin Yuan
- Division of Radiology, Taipei Municipal Gan-Dau Hospital (Managed by Taipei Veterans General Hospital)
- School of Medicine, National Yang Ming University
- Department of Radiology, Taipei Veterans General Hospital
- Correspondence: Wei-Hsin Yuan, Division of Radiology, Taipei Municipal Gan-Dau Hospital (Managed by Taipei Veterans General Hospital), No.12, 225 Lane, Zhi-Sing Road, Taipei 11260 Taiwan ROC (e-mail: )
| | - Hui-Chen Hsu
- Medical Imaging Department, Taipei Beitou Health Management Hospital
| | - Kaun-Lin Lai
- School of Medicine, National Yang Ming University
- Department of Neurology, Taipei Municipal Gan-Dau Hospital (Managed by Taipei Veterans General Hospital), Taipei, Taiwan, ROC
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232
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Katsuura Y, Osborn JM, Cason GW. The epidemiology of thoracolumbar trauma: A meta-analysis. J Orthop 2016; 13:383-8. [PMID: 27504058 DOI: 10.1016/j.jor.2016.06.019] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 06/24/2016] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To describe the epidemiology of thoracolumbar fractures and associated injuries in blunt trauma patients. METHODS A systematic review and metaanalysis was performed based on a MEDLINE database search using MeSH terms for studies matching our inclusion criteria. The search yielded 21 full-length articles, each sub-grouped according to content. Data extraction and multiple analyses were performed on descriptive data. RESULTS The rate of thoracolumbar fracture in blunt trauma patients was 6.90% (±3.77, 95% CI). The rate of spinal cord injury was 26.56% (±10.70), and non-contiguous cervical spine fracture occurred in 10.49% (±4.17). Associated injury was as follows: abdominal trauma 7.63% (±9.74), thoracic trauma 22.64% (±13.94), pelvic trauma 9.39% (±6.45), extremity trauma 18.26% (±5.95), and head trauma 12.96% (±2.01). Studies that included cervical spine fracture with thoracolumbar fracture had the following rates of associated trauma: 3.78% (±5.94) abdominal trauma, 21.65% (±16.79) thoracic trauma, 3.62% (±1.07) pelvic trauma, 18.36% (±4.94) extremity trauma, and 15.45% (±11.70) head trauma. A subgroup of flexion distraction injuries showed an associated intra-abdominal injury rate of 38.70% (±13.30). The most common vertebra injured was L1 at a rate of 34.40% (±15.90). T7 was the most common non-junctional vertebra injured at 3.90% (±1.09). Burst/AO type A3 fractures were the most common morphology 39.50% (±16.30) followed by 33.60% (±15.10) compression/AO type A1, 14.20% (±8.08) fracture dislocation/AO type C, and 6.96% (±3.50) flexion distraction/AO type B. The most common etiology for a thoracolumbar fracture was motor vehicle collision 36.70% (±5.35), followed by high-energy fall 31.70% (±6.70). CONCLUSIONS Here we report the incidence of thoracolumbar fracture in blunt trauma and the spectrum of associated injuries. To our knowledge, this paper provides the first epidemiological road map for blunt trauma thoracolumbar injuries.
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Affiliation(s)
- Yoshihiro Katsuura
- University of Tennessee College of Medicine Chattanooga, Department of Orthopaedic Surgery, 975 East Third Street, Box 260, Chattanooga, TN 37403, USA
| | - James Michael Osborn
- University of Tennessee College of Medicine Chattanooga, Department of Orthopaedic Surgery, 975 East Third Street, Box 260, Chattanooga, TN 37403, USA
| | - Garrick Wayne Cason
- University of Tennessee College of Medicine Chattanooga, Department of Orthopaedic Surgery, 975 East Third Street, Box 260, Chattanooga, TN 37403, USA
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233
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Waqar M, Van-Popta D, Barone DG, Bhojak M, Pillay R, Sarsam Z. Short versus long-segment posterior fixation in the treatment of thoracolumbar junction fractures: a comparison of outcomes. Br J Neurosurg 2016; 31:54-57. [DOI: 10.1080/02688697.2016.1206185] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Mueez Waqar
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Dmitri Van-Popta
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Manchester, UK
| | | | - Maneesh Bhojak
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Robin Pillay
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Zaid Sarsam
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
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234
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Marcia S, Saba L, Marras M, Suri JS, Calabria E, Masala S. Percutaneous stabilization of lumbar spine: a literature review and new options in treating spine pain. Br J Radiol 2016; 89:20150436. [PMID: 27351691 DOI: 10.1259/bjr.20150436] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Vertebral fracture (VF) is a common condition with >160,000 patients affected every year in North America and most of them with affected lumbar vertebrae. The management of VF is well known and defined by many protocols related to associated clinical neurological symptoms, especially in case of the presence or absence of myelopathy or radicular deficit. In this article, we will explore the percutaneous stabilization of the lumbar spine by showing the newest approaches for this condition.
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Affiliation(s)
- Stefano Marcia
- 1 Department of Radiology, SS Trinità Hospital, Cagliari, Italy
| | - Luca Saba
- 2 Department of Radiology, Azienda Ospedaliero, Universitaria (AOU) di Cagliari-Polo di Monserrato, Cagliari, Italy
| | | | - Jasjit S Suri
- 4 Diagnostic and Monitoring Division, AtheroPoint™ LLC, Roseville, CA, USA.,5 Department of Biomedical Engineering, University of Idaho (Affiliated), ID, USA
| | - Eros Calabria
- 6 Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiation Therapy, University of Rome Tor Vergata, Rome, Italy
| | - Salvatore Masala
- 6 Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiation Therapy, University of Rome Tor Vergata, Rome, Italy
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235
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Yu Y, Wang J, Shao G, Wang Q, Li B. Comparing Single Versus Double Screw-Rod Anterior Instrumentation for Treating Thoracolumbar Burst Fractures with Incomplete Neurological Deficit: A Prospective, Randomized Controlled Trial. Med Sci Monit 2016; 22:1687-93. [PMID: 27197020 PMCID: PMC4918524 DOI: 10.12659/msm.898347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Following a thoracolumbar burst fracture (TCBF), anterior screw-rods apply pressure upon the graft site. However, there is limited evidence comparing single screw-rod anterior instrumentation (SSRAI) to double screw-rod anterior instrumentation (DSRAI) for TCBFs. Our objective was to compare SSRAI versus DSRAI for TCBFs with incomplete neurological deficit. Material/Methods A total of 51 participants with T11-L2 TCBFs (AO classification: A3) were randomly assigned to receive SSRAI or DSRAI. Key preoperative, perioperative, and postoperative data were collected. Statistical analysis was conducted to determine the independent factors associated with inferior clinical outcomes, as well as the comparative efficacy of SSRAI and DSRAI. Results There were no significant differences in the key demographic and clinical characteristics between the two groups (all p>0.05). Smoking status was significantly associated with inferior three-month and six-month Denis pain scores (Wald statistic=4.246, p=0.039). Both SSRAI and DSRAI were significantly effective in improving three-month and six-month postoperative degree of kyphosis, three-month and six-month postoperative ASIA impairment scale scores, three-month and six-month postoperative Denis pain score, and three-month and six-month postoperative Denis work score (all p<0.001). Although there were no significant differences between DSRAI and SSRAI with respect to all outcomes (all p>0.05), DSRAI displayed significantly longer operating times, as well as significantly larger operative blood losses (both p<0.001). Conclusions SSRAI may be preferable over DSRAI for TCBFs with incomplete neurological deficit due to its lower operating time and amount of operative blood loss.
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Affiliation(s)
- Yu Yu
- Department of Orthopedics, Yongchuan Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Juan Wang
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Gaohai Shao
- Department of Orthopedics, Yongchuan Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Qunbo Wang
- Department of Orthopedics, Yongchuan Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Bo Li
- Department of Orthopedics, Yongchuan Hospital of Chongqing Medical University, Chongqing, China (mainland)
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Risk factors of kyphosis recurrence after implant removal in thoracolumbar burst fractures following posterior short-segment fixation. INTERNATIONAL ORTHOPAEDICS 2016; 40:1253-60. [DOI: 10.1007/s00264-016-3180-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 03/27/2016] [Indexed: 11/26/2022]
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237
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Sugiura K, Sakai T, Adachi K, Inoue K, Endo S, Tamaki Y, Sairyo K, Nagamachi A. Complete Fracture-Dislocation of the Thoracolumbar Spine with No Critical Neurological Deficit: A Case Report. THE JOURNAL OF MEDICAL INVESTIGATION 2016; 63:122-6. [PMID: 27040066 DOI: 10.2152/jmi.63.122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Fractures at the thoracolumbar junction are the most common spinal column fractures. Among type C fractures in the Arbeitsgemeinschaft für Osteosynthesefragen Spine Classification, cases with complete fracture-dislocations of the spinal column often result in a critical neurological deficit despite surgical treatment. We present a case of an 18-year-old man who had a complete fracture-dislocation of the T12 vertebral body and multiple injuries following high-energy trauma but no critical neurological deficits. Because of active bleeding in the left thoracic cavity, the patient underwent open reduction of the T12 vertebral body and anterior spinal fusion of the T11-L1 vertebral bodies via an anterior approach between the T9 and T10 ribs within 24 h of the accident. Four months postoperatively, the patient could ambulate independently, with a slight disturbance of light touch. At 6 months postoperatively, plain computed tomography scans showed bony union of the T12 vertebral body. We postulated two reasons for the absence of critical neurological dysfunction: (1) spontaneous spinal canal sparing because of the fracture of the right superior articular process in the L1 vertebral body and (2) fracture morphology, that is, a rotational fracture with mild to moderately strong shearing stress to the dura mater.
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238
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Thoracolumbar spine model with articulated ribcage for the prediction of dynamic spinal loading. J Biomech 2016; 49:959-966. [DOI: 10.1016/j.jbiomech.2015.10.010] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 10/09/2015] [Accepted: 10/10/2015] [Indexed: 11/18/2022]
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Wei F, Zhou Z, Wang L, Liu S, Zhong R, Liu X, Cui S, Pan X, Gao M, Zhao Y. Biomechanical evaluation of monosegmental pedicle instrumentation in a calf spine model and the role of fractured vertebrae in screw stability. BMC Vet Res 2016; 12:57. [PMID: 26993472 PMCID: PMC4797180 DOI: 10.1186/s12917-016-0677-9] [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: 09/24/2014] [Accepted: 03/07/2016] [Indexed: 11/23/2022] Open
Abstract
Background Monsegmental pedicle instrumentation (MSPI) has been used to treat thoracolumbar fractures. However, there are few reports about the biomechanical characteristics of MSPI compared with traditional short-segment pedicle instrumentation (SSPI) in management of unstable thoracolumbar fractures, and the influence of vertebral fracture on screw stability is still unclear. Methods This study was to compare the immediate stability between MSPI and SSPI in management of unstable L1 fracture, and to evaluate the role of fractured vertebrae in screw stability. Two studies were performed: in the first study, sixteen fresh calf spines (T11-L3) were divided into two groups, in which unstable fractures at L1 were produced and then instrumented with MSPI or SSPI respectively. The range of motion (ROM) and lax zone (LZ) of specimens were evaluated with pure moment of 6 Nm loaded. The second study measured and compared the pullout strength of screws inserted in to 16 intact and fractured vertebrae of calf spines (L1-3) respectively. The correlation of pullout strength with load sharing classification (LSC) of fractured vertebrae was analyzed. Results No significant difference in the ROM and LZ of the destabilized segments after fixation between MSPI and SSPI, except in axial rotation of ROM (P < 0.05). After fatigue cyclic loading, the MSPI showed a significant increase of ROM during lateral bending and axial rotation (P < 0.05); however, there were no significant differences in the LZ during all loading models between groups (P > 0.05). The mean pullout strength of pedicle screws in fractured vertebrae decreased by 13.7 %, compared with that of intact vertebrae (P > 0.05), and had a low correlation with LSC of the fractured vertebrae (r = 0.293, P > 0.05). Conclusions MSPI can provide effective immediate stability for management of unstable thoracolumbar fractures; however, it has less fatigue resistance during lateral bending and axial rotation compared with SSPI. LSC score of fractured vertebrae is not a major influence on the pullout strength of screws.
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Affiliation(s)
- Fuxin Wei
- Department of Spine Surgery, the First Affiliated Hospital and Orthopedic Research, Institute of Sun Yat-sen University, Guangzhou, China
| | - Zhiyu Zhou
- Department of Spine Surgery, the First Affiliated Hospital and Orthopedic Research, Institute of Sun Yat-sen University, Guangzhou, China.,The medical school of Shenzhen University, Shenzhen, China
| | - Le Wang
- Department of Spine Surgery, the First Affiliated Hospital and Orthopedic Research, Institute of Sun Yat-sen University, Guangzhou, China
| | - Shaoyu Liu
- Department of Spine Surgery, the First Affiliated Hospital and Orthopedic Research, Institute of Sun Yat-sen University, Guangzhou, China.
| | - Rui Zhong
- Department of Spine Surgery, the First Affiliated Hospital and Orthopedic Research, Institute of Sun Yat-sen University, Guangzhou, China
| | - Xizhe Liu
- Department of Spine Surgery, the First Affiliated Hospital and Orthopedic Research, Institute of Sun Yat-sen University, Guangzhou, China
| | - Shangbin Cui
- Department of Spine Surgery, the First Affiliated Hospital and Orthopedic Research, Institute of Sun Yat-sen University, Guangzhou, China
| | - Ximin Pan
- Department of Radiology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Manman Gao
- Department of Spine Surgery, the First Affiliated Hospital and Orthopedic Research, Institute of Sun Yat-sen University, Guangzhou, China
| | - Yajing Zhao
- The medical school of Sun Yat-sen University, Guangzhou, China
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Assunção Filho CA, Simões FC, Prado GO. THORACOLUMBAR BURST FRACTURES, SHORT X LONG FIXATION: A META-ANALYSIS. COLUNA/COLUMNA 2016. [DOI: 10.1590/s1808-185120161501154925] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT The number of fixed segments in the surgical treatment of thoracolumbar burst fractures remains controversial. This study aims to compare the results of short and long fixation in thoracolumbar burst fractures through a meta-analysis of studies published recently. MEDLINE and Cochrane databases were used. Randomized controlled trials and non-randomized comparative studies (prospective and retrospective) were selected. Data were analyzed with the software Review Manager. There was no statistically significant difference in the Cobb angle of preoperative kyphosis. Long fixation showed lower average measurements postoperatively (MD = 1.41; CI = 0.73-2.08; p<0.0001) and in the last follow-up (MD = 3.98; CI = 3.22-4.75; p<0.00001). The short fixation showed the highest failure rates (RD = 4.03; CI = 1.33-12.16; p=0.01) and increased loss of height of the vertebral body (MD = 1.24; CI = 0.49-1.98; p=0.001), with shorter operative time (MD = -24.54; CI = -30.16 - -18.91; p<0.00001). There was no significant difference in blood loss and clinical outcomes. The high rates of kyphosis correction loss with short fixation and the lower correction rate in the immediate postoperative period were validated. There was no significant difference in the blood loss rates because arthrodesis was performed in a short segment in the analyzed studies. The short fixation was performed in a shorter operative time, as expected. No study has shown superior clinical outcomes. The short fixation had worse rates of kyphosis correction in the immediate postoperative period, and increased loss of correction in long-term follow-up, making the long fixation an effective option in the management of this type of fracture.
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A novel approach for biomechanical spine analysis: Mechanical response of vertebral bone augmentation by kyphoplasty to stabilise thoracolumbar burst fractures. J Mech Behav Biomed Mater 2016; 59:291-303. [PMID: 26896762 DOI: 10.1016/j.jmbbm.2016.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 01/31/2016] [Accepted: 02/01/2016] [Indexed: 11/22/2022]
Abstract
Kyphoplasty has been shown as a well-established technique for spinal injuries. This technique allows a vertebral bone augmentation with a reduction of morbidity and does not involve any adjacent segment immobilisation. There is a lack of biomechanical information resulting in major gaps of knowledge such as: the evaluation of the "quality" of stabilisation provided by kyphoplasty as a standalone procedure in case of unstable fracture. Our objective is to analyse biomechanical response of spine segments stabilised by Kyphoplasty and PMMA cement after experiencing burst fractures. Six fresh-frozen cadaveric spine specimens constituted by five vertebra (T11-L3) and four disks were tested. A specific loading setup has been developed to impose pure moments corresponding to loadings of flexion-extension, lateral bending and axial rotation. Tests were performed on each specimen in an intact state and post kyphoplasty following a burst fracture. Strain measurements and motion variations of spinal unit are measured by a 3D optical method. Strain measurements on vertebral bodies after kyphoplasty shows a great primary stabilisation. Comparisons of mobility and angles variations between the intact and post kyphoplasty states do not highlight significant difference. Percutaneous kyphoplasty offers a good primary stability in case of burst fracture. Kinematics analysis during physiological movements shows that this stabilisation solution preserve disk mobility in each adjacent spinal unit.
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242
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Li Y, Hai Y, Li L, Feng Y, Wang M, Cao G. Early effects of vertebroplasty or kyphoplasty versus conservative treatment of vertebral compression fractures in elderly polytrauma patients. Arch Orthop Trauma Surg 2015; 135:1633-6. [PMID: 26559063 DOI: 10.1007/s00402-015-2311-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This study aims to assess the early effects of operatively and nonoperatively managed vertebral compression fractures (VCFs) in elderly polytrauma patients. METHODS A multi-center retrospective cohort study of operative treatment [vertebroplasty (VP) or kyphoplasty (KP)] versus nonoperative treatment (bed rest). RESULTS A total of 40 patients received operative treatment and 59 patients received nonoperative treatment. The mean length of hospital stay was 15.53 ± 6.994 days in the operative and 19.54 ± 12.012 days in the nonoperative group (P = 0.039). The incidence of complication was higher in the nonoperative group than the operative group (P = 0.009), especially the incidence of bed rest complication (P = 0.024). Mortality rate was not significant difference between two groups (P = 0.172). CONCLUSIONS For VCFs in elderly polytrauma patients, VP or KP can reduce length of hospital stay and complications, especially bed rest complication compared with nonoperative treatment.
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Affiliation(s)
- Yonggang Li
- Department of Orthopaedics, Fuxing Hospital, Capital Medical University, Beijing, 100038, China
| | - Yong Hai
- Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, No.8 Gongti Nan Road, Chaoyang District, Beijing, 100020, China.
| | - Liping Li
- Department of Orthopaedics, Fuxing Hospital, Capital Medical University, Beijing, 100038, China
| | - Yi Feng
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Taiyuan, 030001, China
| | - Mingbo Wang
- Department of Orthopaedics, The Second Affiliated Hospital of Inner Mongolia Medical University, Huhehaote, 010030, China
| | - Guanglei Cao
- Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
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Abstract
STUDY DESIGN Multinational survey of spine trauma surgeons. OBJECTIVES To survey spine trauma surgeons, examine the variety of management practices for thoracolumbar fractures, and investigate the need for future areas of study. BACKGROUND Attempts to develop a universal thoracolumbar classification system represent the first step in standardizing treatment of thoracolumbar injuries, but there is little consensus regarding diagnosis and management of these injuries. METHODS A survey questionnaire regarding a fictional neurologically intact patient with a burst fracture was administered to 46 spine surgeons. The questionnaire consisted of 2 domains: management of thoracolumbar fractures and management of postoperative infection. Survey results were compiled and evaluated and consensus arbitrarily assumed when the majority of surgeons agreed on a single question answer. RESULTS Although majority consensus was reached on most questions, the interobserver reliability was poor. Consensus was achieved that magnetic resonance imaging should be performed during initial imaging. The majority would also operate regardless of magnetic resonance imaging findings, and would not operate at night. The favored technique was a posterior approach with decompression. Percutaneous fusion was considered a viable option by the majority of surgeons. No consensus was reached regarding instrumentation levels or construct length. The majority would use posterolateral bone grafting, and would not remove instrumentation nor perform an anterior reconstruction. Consensus was reached that postoperative bracing is unnecessary. Regarding management of infection, consensus was reached to use intraoperative vancomycin powder but not culture the nares before surgery. The majority used a set time period for antibiotic treatment when a drain was required, and would not apply supplementary bone graft at the time of final debridement and closure. CONCLUSIONS There is lack of consensus regarding the appropriate management of thoracolumbar fractures. In the future, multicenter prospective studies are necessary to establish guidelines for the management of thoracolumbar fractures.
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Loriaut P, Mercy G, Moreau PE, Sariali E, Boyer P, Dallaudière B, Pascal-Moussellard H. Initial disc structural preservation in type A1 and A3 thoracolumbar fractures. Orthop Traumatol Surg Res 2015; 101:833-7. [PMID: 26494617 DOI: 10.1016/j.otsr.2015.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 08/01/2015] [Accepted: 08/27/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE Despite a sizable amount of literature, the optimal management of thoracolumbar fractures remains controversial and many authors assume the existence of disc lesions in Magerl type A fractures. The purpose of the study was to assess the intervertebral discs in these fractures at the time of trauma. The hypothesis was that there was no change in shape and signal intensity of the discs initially. METHODS Fifty-one patients diagnosed with 87 types A1 and A3 thoracolumbar fractures were enrolled in a prospective study. MRI analysis involved evaluation of disc signal, height and morphological modifications according to Oner's classification. RESULTS No signal intensity modification was identified on MRI. Disc morphology was either normal or altered with creeping of discal tissue in the vertebral endplate depression. Overall, 98% of the discs were either type 1 or type 3. Mean disc height on MRI was 1.03 ± 0.36 initially. CONCLUSIONS In this study, MRI showed that no loss of height occurred in discs adjacent to fractured vertebra and that there was no major alteration of the disc in terms of signal intensity and morphology. Therefore, the intervertebral disc should not be removed in Magerl type A fractures. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- P Loriaut
- Service de chirurgie orthopédique et de traumatologie, université Pierre-et-Marie-Curie, hôpital Pitié-Salpêtrière, 47, boulevard de l'Hôpital, 75013 Paris, France.
| | - G Mercy
- Service de radiologie, université Pierre-et-Marie-Curie, hôpital Pitié-Salpêtrière, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - P E Moreau
- Service de chirurgie orthopédique et de traumatologie, université Pierre-et-Marie-Curie, hôpital Pitié-Salpêtrière, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - E Sariali
- Service de chirurgie orthopédique et de traumatologie, université Pierre-et-Marie-Curie, hôpital Pitié-Salpêtrière, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - P Boyer
- Service de chirurgie orthopédique et de traumatologie, hôpital Bichat - Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France
| | - B Dallaudière
- Service de radiologie, clinique du sport, Bordeaux Mérignac, 2, rue Negrevergne, 33700 Mérignac, France; Service de radiologie, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - H Pascal-Moussellard
- Service de chirurgie orthopédique et de traumatologie, université Pierre-et-Marie-Curie, hôpital Pitié-Salpêtrière, 47, boulevard de l'Hôpital, 75013 Paris, France
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Two-Nation Comparison of Classification and Treatment of Thoracolumbar Fractures: An Internet-Based Multicenter Study Among Spine Surgeons. Spine (Phila Pa 1976) 2015; 40:1749-56. [PMID: 26555841 DOI: 10.1097/brs.0000000000001143] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Web-based multicenter study. OBJECTIVE The aim of the study was to assess and compare the management strategy for traumatic thoracolumbar fractures between German and Dutch spine surgeons. SUMMARY OF BACKGROUND DATA To date, there is no evidence-based treatment algorithm for thoracolumbar spine fractures, thereby an international controversy concerning optimal treatment exists. METHODS In this web-based multicenter study (www.spine.hostei.com), computed tomography scans of traumatic thoracolumbar fractures (T12-L2) were evaluated by German and Dutch spine surgeons. Supplementary case-specific information such as age, sex, height, weight, neurological status, and injury mechanism were provided.By using a questionnaire, fractures were classified according to the AO-Magerl Classification, followed by 6 questions concerning the treatment algorithm. Data were analyzed using SPSS (Version 21, 76, Chicago, IL). The interobserver agreement was determined by using Cohen κ. Statistical significance was defined as P < 0.05. RESULTS Twelve surgeons (6 per country) evaluated each 91 cases. The fractures were classified as AO Type A in 82% (898 votes), Type B in 14% (150 votes), and Type C in 4% (44 votes). No significant difference concerning the AO Classification between German and Dutch spine surgeons was found. Overall German spine surgeons had a lower threshold concerning the indication for surgical treatment (Ger 87% vs. NL 30%; P < 0.05). There was a consensus about operative stabilization of AO Type B and C injuries and injuries with neurologic deficit, whereas a discrepancy in the therapeutic algorithm for AO Type A fractures was observed. This difference was most pronounced regarding the indication for posterior (Ger 96.6%; NL 41.2%; P < 0.05) and circumferential stabilization (Ger 53.4%; NL 0%; P < 0.05) for burst fractures. CONCLUSION There is a consensus to stabilize AO Type B and C fractures, whereas country-specific differences in the treatment of Type A fractures, especially in case of burst fractures, occur. Prospective, controlled multicenter outcome studies may provide more evidence in optimal treatment for thoracolumbar fractures. LEVEL OF EVIDENCE 2.
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Safaie Yazdi A, Omidi-Kashani F, Baradaran A. Intrapelvic Lumbosacral Fracture Dislocation in a Neurologically Intact Patient: A Case Report. ARCHIVES OF TRAUMA RESEARCH 2015; 4:e25439. [PMID: 26566508 PMCID: PMC4636544 DOI: 10.5812/atr.25439] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 02/07/2015] [Accepted: 04/18/2015] [Indexed: 11/23/2022]
Abstract
Introduction: Lumbosacral fracture dislocation is a rare entity mainly occurred in high-energy trauma accidents. In this unstable injury, anatomical separation of the spinal column from pelvis is usually associated with severe neurological deficits. Case Presentation: We described a 16-year-old girl with extremely severe axial trauma to the lumbosacral spine who presented with fracture dislocation of the lumbosacral spine and its intrusion to the pelvic space. Despite violent lumbosacral joint dissociation on imaging studies, the patient was neurologically intact. She was treated with spinopelvic fusion and instrumentation. Conclusions: Although spinopelvic fracture dislocation injuries are severe high-energy entities, in cases with traumatic spondylolytic spondylolisthesis due to widening of the vertebral canal, neurologic deficit may not be seen at all.
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Affiliation(s)
- Ahmad Safaie Yazdi
- Department of Neurosurgery, Farabi Hospital, Islamic Azad University, Mashhad, IR Iran
| | - Farzad Omidi-Kashani
- Orthopedic Research Center, Orthopedic Department, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Corresponding author: Farzad Omidi-Kashani, Orthopedic Research Center, Orthopedic Department, Imam Reza Hospital,Mashhad University of Medical Sciences, Mashhad,IR Iran. P.O.Box: 9137913316. Tel: +98-5137646500, Fax: +98-5138595023, E-mail:
| | - Aslan Baradaran
- Orthopedic Research Center, Orthopedic Department, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
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Hirschfeld M, Rodriguez M, Cerván A, Ortega J, Rivas-Ruiz F, Guerado E. Concordance in the radiological diagnosis of thoracolumbar spine fractures. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015. [DOI: 10.1016/j.recote.2015.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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248
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Fu MC, Nemani VM, Albert TJ. Operative Treatment of Thoracolumbar Burst Fractures: Is Fusion Necessary? HSS J 2015; 11:187-9. [PMID: 26140041 PMCID: PMC4481260 DOI: 10.1007/s11420-015-9439-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 03/03/2015] [Indexed: 02/07/2023]
Affiliation(s)
- Michael C. Fu
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Venu M. Nemani
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Todd J. Albert
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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Hirschfeld M, Rodriguez M, Cerván A, Ortega J, Rivas-Ruiz F, Guerado E. Concordancia en el diagnóstico radiológico de las fracturas del raquis toracolumbar. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015; 59:238-44. [DOI: 10.1016/j.recot.2014.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 09/07/2014] [Accepted: 09/28/2014] [Indexed: 11/30/2022] Open
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250
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Sadro CT, Sandstrom CK, Verma N, Gunn ML. Geriatric Trauma: A Radiologist’s Guide to Imaging Trauma Patients Aged 65 Years and Older. Radiographics 2015; 35:1263-85. [DOI: 10.1148/rg.2015140130] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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