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Kudo Y, Okano I, Toyone T, Kanzaki K, Segami K, Kawamura N, Sekimizu M, Maruyama H, Yamamura R, Hayakawa C, Tsuchiya K, Tani S, Ishikawa K, Inagaki K. Distal junctional failure after corrective surgery without pelvic fixation for thoracolumbar junctional kyphosis due to osteoporotic vertebral fracture. J Orthop Sci 2024; 29:781-787. [PMID: 36931977 DOI: 10.1016/j.jos.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/23/2023] [Accepted: 03/01/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Thoracolumbar junctional kyphosis (TLJK) due to osteoporotic vertebral fracture (OVF) negatively impacts patients' quality of life. The necessity of pelvic fixation in corrective surgery for TLJK due to OVF remains controversial. This study aimed to: 1) evaluate the surgical outcomes of major corrective surgery for thoracolumbar junctional kyphosis due to osteoporotic vertebral fracture, and 2) identify the risk factors for distal junctional failure to identify potential candidates for pelvic fixation. METHODS Patients who underwent surgical correction (fixed TLJK>40°, OVF located at T11-L2, the lowermost instrumented vertebra at or above L5) were included. Sagittal vertical axis, pelvic tilt, pelvic incidence, thoracic kyphosis, lumbar lordosis (L1-S1), local kyphosis, and lower lumbar lordosis (L4-S1) were assessed. Proximal and distal junctional kyphosis (P/DJK) and failures (P/DJF) were evaluated. Pre/postoperative spinopelvic parameters were compared between DJF and non-DJF patients. RESULTS Thirty-one patients (mean age: 72.3 ± 7.9 years) were included. PJK was observed in five patients (16.1%), while DJK in 11 (35.5%). Twelve cases (38.7%) were categorized as failure. Among the patients with PJK, there was only one patient (20%) categorized as PJF and required an additional surgery. Contrary, all of eleven patients with DJK were categorized as DJF, among whom six (54.5%) required additional surgery for pelvic fixation. In comparisons between DJF and non-DJF patients, there was no significant difference in pre/postoperative LK (pre/post, p = 0.725, p = 0.950). However, statistically significant differences were observed in the following preoperative alignment parameters: SVA (p = 0.014), LL (p = 0.001), LLL (p = 0.006), PT (p = 0.003), and PI-LL (p < 0.001). CONCLUSIONS Spinopelvic parameters, which represent the compensatory function of lumbar hyperlordosis and pelvic retroversion, have notable impacts on surgical outcomes in correction surgery for TLJK due to OVF. Surgeons should consider each patient's compensatory function when choosing a surgical approach.
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Affiliation(s)
- Yoshifumi Kudo
- Department of Orthopedic Surgery, Showa University, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8666, Japan.
| | - Ichiro Okano
- Department of Orthopedic Surgery, Showa University, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8666, Japan
| | - Tomoaki Toyone
- Department of Orthopedic Surgery, Showa University, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8666, Japan
| | - Koji Kanzaki
- Department of Orthopedic Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama City, Kanagawa 227-8501, Japan
| | - Kazuyuki Segami
- Department of Orthopedic Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama City, Kanagawa 227-8501, Japan
| | - Naohiro Kawamura
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Tokyo, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan
| | - Masaya Sekimizu
- Department of Orthopedic Surgery, Showa University, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8666, Japan; Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Tokyo, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan
| | - Hiroshi Maruyama
- Department of Orthopedic Surgery, Showa University, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8666, Japan
| | - Ryo Yamamura
- Department of Orthopedic Surgery, Showa University, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8666, Japan
| | - Chikara Hayakawa
- Department of Orthopedic Surgery, Showa University, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8666, Japan
| | - Koki Tsuchiya
- Department of Orthopedic Surgery, Showa University, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8666, Japan
| | - Soji Tani
- Department of Orthopedic Surgery, Showa University, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8666, Japan
| | - Koji Ishikawa
- Department of Orthopedic Surgery, Showa University, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8666, Japan
| | - Katsunori Inagaki
- Department of Orthopedic Surgery, Showa University, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8666, Japan
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Liu J, Zhang X, Zhang H, Zhang J, Wang Q, Li G. Prevalence, Features, and Predictive Factors of Spontaneous Spinal Arthrodesis in Posttraumatic Thoracolumbar Kyphosis. World Neurosurg 2024; 185:e676-e682. [PMID: 38417620 DOI: 10.1016/j.wneu.2024.02.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVE Spontaneous spinal arthrodesis (SSA) is a phenomenon of spontaneous fusion, and SSA is not rare in posttraumatic thoracolumbar kyphosis (PTK). However, few reports have focused on SSA in patients with PTK. The objective of this study was to investigate the prevalence, features, and predictive factors of SSA in patients with PTK. METHODS In this retrospective study, 70 patients with PTK were included. Data on the clinical and radiologic parameters were obtained and evaluated. According to whether there was SSA or not, patients were divided into an SSA group (n = 45) or a non-SSA group (n = 25). A binary logistic regression analysis was used to identify the predictive factors for SSA. RESULTS The incidence of SSA in PTK was 64%. Among 45 patients with PTK with SSA, SSA was present as a solid bridging anterior osteophyte along the vertebral bodies in 11 patients, posterior contiguous bony growth through the facet joints bilaterally in 13 patients, bony formation in both anterior and posterior elements in 18 patients, and direct contiguous bony formation from the injured vertebral body to the adjacent one in 3 patients. Patients with longer disease duration, larger local Cobb angle, and anterior wall height loss (AWHL) ratio of injured vertebral body, and less kyphosis flexibility index were significantly more likely to develop SSA. The parameter of AWHL remained significant in binary logistic regression analysis. CONCLUSIONS SSA in PTK was common, and the SSA sign presented in various patterns, which might have implications for surgical decisions. AWHL was the independent predictor for SSA.
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Affiliation(s)
- Jincheng Liu
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China; Department of Orthopaedics, Xichang People's Hospital, Xichang, China
| | - Xiaofei Zhang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Hao Zhang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jian Zhang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Qing Wang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Guangzhou Li
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
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Marie-Hardy L, Mohsinaly Y, Pietton R, Bonaccorsi R, Vialle R, Pascal-Moussellard H. Defining threshold for sagittal correction in lumbar fractures. 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 2024; 33:1550-1555. [PMID: 38315226 DOI: 10.1007/s00586-024-08138-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 12/04/2023] [Accepted: 01/10/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE Surgical indications for thoraco-lumbar fractures are driven both by neurological status, fractures instability and kyphotic deformity. Regarding kyphotic deformity, an angulation superior to 20° is considered by many surgeons as a surgical indication to reduce the disability induced by post-traumatic kyphosis. However, there is a lack of data reporting the ideal or theoretical lordosis that one must have in a particular lumbar segment on CT-scan. The main goal of this study was to determine the mean value for segmental lumbar lordosis according to pelvic incidence (PI) on a cohort of normal subjects. METHODS The consecutive CT-scan of 171 normal adult subjects were retrospectively analyzed. The PI and the segmental lordosis (L4S1, L3L5, L2L4, L3L1, L2T12 and T11-L1) were measured on all CT-scan. The mean values were calculated for the global cohort and a sub-group analysis according to IP ranges (< 45°, 45 < IP < 60° and > 60°) was performed. RESULTS The mean angular values for the whole cohort were IP: 54, 9°; L4S1: - 38, 1°; L3L5: - 30, 6°; L2L4: - 14, 1°; L1L3: - 4, 9°; T12L2: + 1, 9° and T11L1: + 5, 4°. The segmental values vary significatively with PI ranges, as for L3L5: - 26, 8° (PI < 45°); - 30° (45 < PI < 60°) and - 35, 1° (PI > 60°). CONCLUSION These results provide a referential of theoretical values of segmental lordosis according to PI. This abacus may help spinal surgeon in their decision-making process regarding lumbar fractures, to determine the amount of sagittal correction needed, according to the PI range, to be adapted to the sagittal morphology of the patient. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Laura Marie-Hardy
- Spine Surgery Unit, Orthopaedic Department, Pitié-Salpétrière Hospital, 43-87 Bd de l'Hôpital, 75013, Paris, France.
| | - Yann Mohsinaly
- Spine Surgery Unit, Orthopaedic Department, Pitié-Salpétrière Hospital, 43-87 Bd de l'Hôpital, 75013, Paris, France
| | - Raphaël Pietton
- Spine Surgery Unit, Orthopaedic Department, Pitié-Salpétrière Hospital, 43-87 Bd de l'Hôpital, 75013, Paris, France
| | - Raphaël Bonaccorsi
- Spine Surgery Unit, Orthopaedic Department, Pitié-Salpétrière Hospital, 43-87 Bd de l'Hôpital, 75013, Paris, France
| | - Raphaël Vialle
- Pediatric Orthopaedic Department, Trousseau Hospital, 26 Av. du Dr Arnold Netter, 75012, Paris, France
| | - Hugues Pascal-Moussellard
- Spine Surgery Unit, Orthopaedic Department, Pitié-Salpétrière Hospital, 43-87 Bd de l'Hôpital, 75013, Paris, France
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Alsayed MA, Elaal MA. Surgical management of posttraumatic thoracolumbar Kyphosis: A review. J Family Med Prim Care 2024; 13:814-818. [PMID: 38736793 PMCID: PMC11086765 DOI: 10.4103/jfmpc.jfmpc_689_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/17/2023] [Accepted: 07/25/2023] [Indexed: 05/14/2024] Open
Abstract
Kyphosis is a condition in which there is a curvature of the spine that causes a bowing of the back, which in turn leads to slouching posture or hunchback. There are several types of Kyphosis, including posttraumatic Kyphosis, which usually occurs in the thoracic region. There are several techniques used for the surgical management of posttraumatic thoracolumbar Kyphosis. We aimed to discuss the surgical treatment of posttraumatic thoracolumbar Kyphosis. We searched for articles included in this review through scientific websites using different keywords. The articles were chosen based on inclusion criteria. The articles included in this review were published between 2006 and 2018. The review was written under titles in the discussion part. The outcome of the surgical management of posttraumatic thoracolumbar Kyphosis depends on the accurate selection of the proper surgical approach.
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Affiliation(s)
- Mokhtar A. Alsayed
- Department of Orthopedic Surgery, Armed Forces Hospital, Taif, Saudi Arabia
| | - Mohamed Abd Elaal
- Department of Orthopaedic Surgery, The National Institute of Neuro-Motor System, Giza, Egypt
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Sasagawa T, Hayashi H, Takagi Y. Factors Associated with Intradiscal Vacuum Phenomenon after Traumatic Thoracolumbar Fracture. Asian J Neurosurg 2023; 18:621-625. [PMID: 38152516 PMCID: PMC10749830 DOI: 10.1055/s-0043-1775551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Introduction Posttraumatic kyphosis of the thoracolumbar spine is a possible cause of deterioration of activities of daily living. Thus, postoperative kyphosis is an important issue in treating traumatic thoracolumbar fractures. The intradiscal vacuum phenomenon (IVP) after a traumatic thoracolumbar fracture is considered an important predictor of severe kyphosis after implant removal. However, the associated factors are not yet clear. Methods The study included data from 94 intervertebral discs on the cephalocaudal side of 47 fractured vertebrae of 45 patients for traumatic thoracolumbar fracture due to high-energy trauma. We assessed the demographics of patients (age, sex, cause of injury, location of injured vertebra, fracture type, cephalocaudal side), imaging finding (kyphosis angle of fractured vertebra at the injury, endplate fracture on computed tomography [CT], intervertebral injury on magnetic resonance image [MRI]), and IVP on CT conducted more than 6 months after surgery. We divided the intervertebral discs into an IVP group and a non-IVP group. To identify factors associated with an IVP, univariate analysis and multivariate logistic regression analysis were conducted. Results IVP was observed in 27 (29%) of 94 intervertebral discs on CTs conducted at an average of 14.0 months postoperatively. In univariate analysis, the IVP group ( n = 27) had a significantly more cephalic side of the injured vertebra, endplate fracture on CT, and disc injury on MRI compared with the non-IVP group ( n = 67). A multivariate logistic regression analysis was conducted to identify factors associated with IVP. The cephalic side (odds ratio [OR] = 4.183, 95% confidence interval [CI] = 1.269-13.785) and endplate fracture on CT (OR = 9.564, 95% CI = 1.940-47.143) were identified as independent factors associated with IVP. Conclusions IVP was observed in 27 (29%) of 94 intervertebral discs. The cephalic side and endplate fracture on CT were identified as independent factors associated with IVP.
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Affiliation(s)
- Takeshi Sasagawa
- Department of Orthopedic Surgery, Toyama Prefectural Central Hospital, Toyama City, Toyama Prefecture, Japan
| | - Hiroyuki Hayashi
- Department of Orthopedic Surgery, Tonami General Hospital, Tonami City, Toyama Prefecture, Japan
| | - Yasutaka Takagi
- Department of Orthopedic Surgery, Tonami General Hospital, Tonami City, Toyama Prefecture, Japan
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De Gendt EEA, Schroeder GD, Joaquim A, Tee J, Kanna RM, Kandziora F, Dhakal GR, Vialle EN, El-Sharkawi M, Schnake KJ, Rajasekaran S, Vaccaro AR, Muijs SPJ, Benneker LM, Oner FC. Spinal Post-traumatic Deformity: An International Expert Survey Among AO Spine Knowledge Forum Members. Clin Spine Surg 2023; 36:E94-E100. [PMID: 35994038 DOI: 10.1097/bsd.0000000000001376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/29/2022] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN Survey among spine experts. OBJECTIVE To investigate the different views and opinions of clinically relevant spinal post-traumatic deformity (SPTD). SUMMARY OF BACKGROUND DATA There is no clear definition of clinically relevant SPTD. This leads to a wide variation in characteristics used for diagnosis and treatment indications of SPTD. To understand the current concepts of SPTD a survey was conducted among spine trauma surgeons. METHODS Members of the AO Spine Knowledge Forum Trauma participated in an online survey. The survey was divided in 4 domains: Demographics, criteria to define SPTD, risk factors, and management. The data were collected anonymously and analyzed using descriptive statistics, absolute, and relative frequencies. Consensus on dichotomous outcomes was set to 80% of agreement. RESULTS Fifteen members with extensive experience in treatment of spinal trauma participated, representing the 5 AO Spine Regions. Back pain was the only criterion for definition of SPTD with complete agreement. Consensus (≥80%) was reached for kyphotic angulation outside normative ranges and impaired function. Eighty-seven percent and 100% agreed that a full-spine conventional radiograph was necessary in diagnosing and treating SPTD, respectively. The "missed B-type injury" was rated at most important by all but 1 participant. There was no agreement on other risk factors leading to clinically relevant SPTD. Concerning the management, all participants agreed that an asymptomatic patient should not undergo surgical treatment and that neurological deficit is an absolute surgical indication. For most of the participants the preferred surgical treatment of acute injury in all spine regions but the subaxial region is posterior fixation. CONCLUSION Some consensus exists among leading experts in the field of spine trauma care concerning the definition, diagnosis, risk factors, and management of SPTD. This study acts as the foundation for a Delphi study among the global spine community.
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Affiliation(s)
- Erin E A De Gendt
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Greg D Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Andrei Joaquim
- Department of Neurosurgery, State University of Campinas, Campinas Cidade Universitária Zeferino Vaz-Barão Geraldo, Campinas-SP, Brazil
| | - Jin Tee
- Departement of Neurosurgery, The Alfred Hospital, Melbourne, VIC, Australia
| | - Rishi M Kanna
- Department of Orthopaedic and Spine Surgery, 1. Ganga Medical Centre and Hospitals Pvt Ltd, Coimbatore, IN
| | - Frank Kandziora
- Center for Spinal Surgery and Neurotraumatology, BG Unfallklinik Frankfurt am Main gGmbH, Frankfurt am Main, Germany
| | - Gaurav R Dhakal
- National Trauma Center, Bir Hospital, National Academy of Medical Sciences, Mahankal Marg, Kathmandu, Nepal
| | - Emiliano N Vialle
- Department of Orthopaedics, Cajuru Hospital, Catholic University of Paraná, Curitiba-PR, Brazil
| | - Mohammad El-Sharkawi
- Department of Orthopaedic and Trauma Surgery, Assiut University Medical School, Assiut, Egypt
| | - Klaus J Schnake
- Center for Spinal and Scoliosis Therapy, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany
| | - Shanmuganathan Rajasekaran
- Department of Orthopaedic and Spine Surgery, 1. Ganga Medical Centre and Hospitals Pvt Ltd, Coimbatore, IN
| | - Alex R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Sander P J Muijs
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lorin M Benneker
- Spine Service, Orthopedic Department Sonnenhofspital, Bern, Switzerland
| | - F Cumhur Oner
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands
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Wang Q, Tang C, Wang G, Li G, Zhong D, Wang S, Ma F. Treatment of rigid post-traumatic thoracolumbar kyphosis by a novel technique of spinal joints release. J Orthop Surg Res 2023; 18:124. [PMID: 36803182 PMCID: PMC9942384 DOI: 10.1186/s13018-023-03599-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/09/2023] [Indexed: 02/22/2023] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the feasibility of a novel technique named spinal joints release (SJR) and observe its efficacy in treating rigid post-traumatic thoracolumbar kyphosis (RPTK). METHODS RPTK patients who were treated by SJR with facet resection, limited laminotomy, clearance of the intervertebral space, and release of the anterior longitudinal ligament through the intervertebral foramen and disc of injury segment from August 2015 to August 2021 were reviewed. Intervertebral space release, internal fixation segment, operation time, and intraoperative blood loss were recorded. The intraoperative, postoperative, and final follow-up complications were observed. An improvement in the VAS score and ODI index was observed. Spinal cord functional recovery was evaluated by American Spinal Injury Association Impairment Scale (AIS). Improvement of local kyphosis (Cobb angle) was evaluated by radiography. RESULTS Forty-three patients were successfully treated by the SJR surgical technique. Open-wedge anterior intervertebral disc space was performed in 31 cases, and repeated release and dissection of the anterior longitudinal ligament and callus were performed in 12 cases. There was no lateral annulus fibrosis release in 11 cases, the anterior half release of lateral annulus fibrosis in 27 cases, and complete release in five cases. There were five cases of screw placement failure in one or two side pedicles of the injured vertebrae due to excessive resection of the facets and improper pre-bending of the rod. Sagittal displacement occurred in four cases at the released segment due to the complete release of bilateral lateral annulus fibrosus. Autologous granular bone + Cage was implanted in 32 cases, and autologous granular bone was implanted in 11 cases. There were no serious complications. The average operation time was 224 ± 31 min, and intraoperative blood loss was 450 ± 225 mL. All the patients were followed up with an average of 26 ± 8.5 months. The VAS scores and ODI index improved significantly at the final follow-up. All of the 17 patients with incomplete spinal cord injury achieved more than one grade of neurological recovery at the final follow-up. An 87% correction rate of kyphosis was achieved and maintained, with the Cobb angle decreasing from 27.7° preoperatively to 5.4° at the final follow-up. CONCLUSION Posterior SJR surgery for patients with RPTK has the advantages of less trauma and less blood loss, and kyphosis correction is satisfactory.
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Affiliation(s)
- Qing Wang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Lu Zhou, Sichuan, 646000, China.
| | - Chao Tang
- grid.488387.8Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Lu Zhou, Sichuan, 646000 China ,grid.410570.70000 0004 1760 6682Department of Orthopedics, Xin Qiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - GaoJu Wang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Lu Zhou, Sichuan, 646000, China.
| | - GuangZhou Li
- grid.488387.8Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Lu Zhou, Sichuan, 646000 China
| | - DeJun Zhong
- grid.488387.8Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Lu Zhou, Sichuan, 646000 China
| | - Song Wang
- grid.488387.8Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Lu Zhou, Sichuan, 646000 China
| | - Fei Ma
- grid.488387.8Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Lu Zhou, Sichuan, 646000 China
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Wang Y, Zhu W, Sun K, Kong C, Wang W, Lu S. Selecting proper distal fusion level in severe thoracolumbar kyphosis secondary to late osteoporotic vertebral compression fracture to limit distal complications. J Orthop Sci 2022; 27:1177-1184. [PMID: 34531084 DOI: 10.1016/j.jos.2021.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/18/2021] [Accepted: 07/16/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Surgical treatment of severe thoracolumbar kyphosis (TLK) secondary to late osteoporotic vertebral compression fracture (OVCF) presents several challenges to spine surgeons. Proper selection of distal fusion level is an important issue in surgical planning to decrease the likelihood of distal mechanical complications. This study was designed to compare the clinical and radiographic outcomes in elderly patients suffering from severe TLK related with late OVCF between different distal fusion strategies and to recommend a superior distal fusion level for these patients. METHODS A total of 57 consecutive subjects with a minimum follow-up of two years were retrospectively reviewed. TLK was defined as the hyperkyphosis with an apex below T10. Severe TLK was defined as the Cobb angle of kyphosis ≥60°. Patients fused to sagittal stable vertebra (SSV) were assigned to Group SSV, while those fused to the vertebra above and below SSV were assigned to Groups SSV- and SSV+, respectively. Bone cement was used to enhance pedicle screw fixation. Clinical and radiographic results were collected and compared between different groups. RESULTS Deformity corrections and living quality improvements at the latest follow-up were superior in Group SSV than Group SSV- with shorter fusion levels, while to the equal extent with Group SSV+ with longer fusion levels. 7 cases of distal complications were observed in Group SSV-. Negatively balanced lowest instrumented vertebra was revealed to be the independent factor predicting distal complications. Patients' satisfaction of their surgical management was greater in Group SSV than Group SSV- (83.2 ± 4.4% vs. 70.5 ± 10.9%, P = 0.024), while comparable with Groups SSV + SSV+ (84.8 ± 5.7%). CONCLUSIONS Fusion to SSV with cement-augmented pedicle screws could limit the development of distal junctional mechanical complications after surgical treatment for severe TLK secondary to late OVCF in elderly patients, while achieves satisfactory deformity correction with the preservation of necessary lumbar motility.
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Affiliation(s)
- Yu Wang
- Department of Orthopaedic Surgery, Capital Medical University Xuanwu Hospital, Beijing, China; National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Weiguo Zhu
- Department of Orthopaedic Surgery, Capital Medical University Xuanwu Hospital, Beijing, China; National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Kang Sun
- Department of Orthopaedic Surgery, Capital Medical University Xuanwu Hospital, Beijing, China; National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Chao Kong
- Department of Orthopaedic Surgery, Capital Medical University Xuanwu Hospital, Beijing, China; National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Wei Wang
- Department of Orthopaedic Surgery, Capital Medical University Xuanwu Hospital, Beijing, China; National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Shibao Lu
- Department of Orthopaedic Surgery, Capital Medical University Xuanwu Hospital, Beijing, China; National Clinical Research Center for Geriatric Diseases, Beijing, China.
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Zhang H, Li T, Sun H, Zhang J, Hao D. Retrospective analysis of reasons and revision strategy for failed thoracolumbar fracture surgery by posterior approach: a series of 31 cases. Am J Transl Res 2022; 14:6323-6331. [PMID: 36247239 PMCID: PMC9556505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 07/25/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES This study aimed to analyze the reasons for failed thoracolumbar fracture treated with posterior surgical approaches and to discuss the revision strategies for the surgical treatment. METHODS We retrospectively studied the patients that received failed thoracolumbar fracture (T11-L2) treatment with posterior approach and underwent revision surgery in our spine department from March 2010 to December 2020. RESULTS A total of 31 patients were included in this study. There were 4 (12.9%) cases of A3, 2 (6.5%) cases of B1, 5 (16.1%) cases of B2, 7 (22.6%) cases of B3, and 13 (41.9%) cases of C, according to the AO classification for thoracolumbar injuries. For load sharing classification, 26 (83.9%) cases ≥7, and 5 (16.1%) cases < 7. Regarding to the reasons for surgery failure, 26 cases (83.9%) were due to fracture of the internal fixation (pedicle screw or connecting rod) and kyphosis, 3 cases (9.7%) were due to misplacement of the posterior pedicle screw, 1 case (3.2%) was due to incomplete posterior decompression, and 1 case (3.2%) was due to scoliosis after the removal of the internal fixation. The revision surgery methods included: 2 cases (6.5%) with anterior approach, 17 cases (54.8%) with posterior approach, and 12 cases (38.7%) with posterior and anterior approach. All the patients were followed-up for 12-24 months after the revision surgery, and successful bony fusion with no internal fixation failure was observed. The kyphosis angle improved significantly after the revision surgery in 26 patients at the last follow-up, and the final correction rate was 91.8%. Frankel grading system, visual analog scale (VAS), Oswestry Disability Index (ODI) showed significant improvement at the last follow-up. CONCLUSIONS Types B and C of thoracolumbar fracture, load sharing classification ≥7, and the posterior approach could lead to a high failure rate. Fracture of the internal fixation was the main reason for surgery failure. Performing the posterior approach is inappropriate for every thoracolumbar fracture. Reasonable revision surgery can achieve good results for posterior surgery failure in most cases.
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Affiliation(s)
- Haiping Zhang
- Department of Spine Surgery, Honghui Hospital of Xi’an Jiaotong University Health Science CenterXi’an, China
| | - Tao Li
- Department of Spine Surgery, Honghui Hospital of Xi’an Jiaotong University Health Science CenterXi’an, China
| | - Honghui Sun
- Department of Spine Surgery, Honghui Hospital of Xi’an Jiaotong University Health Science CenterXi’an, China
| | - Jun Zhang
- Department of Trauma Surgery, Honghui Hospital of Xi’an Jiaotong University Health Science CenterXi’an, China
| | - Dingjun Hao
- Department of Spine Surgery, Honghui Hospital of Xi’an Jiaotong University Health Science CenterXi’an, China
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10
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Meng F, Zhang X, Chen T, Li Z, Fang Y, Zhao W, Xu J. Posterior hemivertebra resection and reconstruction for the correction of old AO type B2.3 thoracic fracture kyphosis: A case report. Front Surg 2022; 9:945140. [PMID: 36439531 PMCID: PMC9697181 DOI: 10.3389/fsurg.2022.945140] [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: 05/16/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Post-traumatic malunion is one of the main causes of kyphosis and usually has serious consequences. We report a case of kyphosis caused by an old AO type B2.3 thoracic fracture, which was corrected with posterior hemivertebra resection and reconstruction. Case presentation A 41-year-old male was diagnosed with kyphosis caused by an old AO type B2.3 thoracic fracture. Preoperative examination and preparation were performed. His exam images showed a comminuted fracture in the left half of the T12 vertebral body, while chance-type fractures were seen in the right half of T12 vertebral body and its accessories. During the operation, posterior hemivertebra resection and reconstruction techniques were used to remove nearly half of the left vertebral body of the affected vertebra, preserve the right vertebral body and the facet joints of the affected vertebra, correct the kyphosis, and rebuild spinal stability. The patient's low back pain was completely relieved, and his thoracic kyphosis was corrected at the seventh post-operative day. CT reconstruction of the spine showed that the residual vertebrae healed well during his nine- and 18-month follow-ups. Continuous callus formation was observed inside and outside of the titanium cage at the reconstructed site, and there was no sign of subsidence of the titanium cage. The heights between the vertebrae were restored to within normal ranges and the physiological curvature of the thoracolumbar spine was achieved. The patient recovered well. Conclusion This operation preserved the hemivertebral body and facet joints, and maintains intervertebral height and local stability, thus avoiding titanium cage collapse, titanium cage movement, and other complications. This surgical approach is ideal for treating complex thoracic vertebral kyphosis caused by old fractures, and is worth utilizing in the clinic.
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Affiliation(s)
- Fanchao Meng
- Department of Orthopedics, The First Affiliated Hospital of Harbin Medical University, HarbinChina
| | - Xun Zhang
- Department of Orthopedics, The First Affiliated Hospital of Harbin Medical University, HarbinChina
| | - Tiantian Chen
- Department of Orthopedics, Foresea Life Insurance Guangzhou General Hospital, Guangzhou, China
| | - Zhao Li
- Department of Orthopedics, The First Affiliated Hospital of Harbin Medical University, HarbinChina
| | - Yushi Fang
- Department of Orthopedics, The First Affiliated Hospital of Harbin Medical University, HarbinChina
| | - Wei Zhao
- Department of Orthopedics, The First Affiliated Hospital of Harbin Medical University, HarbinChina
- Correspondence: Wei Zhao , Jiaxing Xu
| | - Jiaxing Xu
- Department of Orthopedics, The First Affiliated Hospital of Harbin Medical University, HarbinChina
- Correspondence: Wei Zhao , Jiaxing Xu
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Choi HY, Jo DJ. Partial Pedicle Subtraction Osteotomy for Patients with Thoracolumbar Fractures : Comparative Study between Burst Fracture and Posttraumatic Kyphosis. J Korean Neurosurg Soc 2021; 65:64-73. [PMID: 34879643 PMCID: PMC8752884 DOI: 10.3340/jkns.2021.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/17/2021] [Indexed: 11/28/2022] Open
Abstract
Objective To evaluate the surgical outcomes of partial pedicle subtraction osteotomy (PPSO) in patients with thoracolumbar fractures and compare the outcomes of PPSO for burst fractures with those for posttraumatic kyphosis (PTK).
Methods From June 2013 to May 2019, 20 consecutive adult patients underwent PPSO for thoracolumbar fractures at the levels of T10 to L2. Of these patients, 10 underwent surgery for acute fractures (burst fractures), and 10 for sequelae of thoracolumbar fractures (PTK). Outcomes of PPSO were evaluated and compared between the groups.
Results Twenty patients (each 10 patients of burst fractures and PTK) with a mean age of 64.7±11.1 years were included. The mean follow-up period was 21.8±11.0 months. The mean correction of the thoracolumbar angle was -34.9°±18.1° (from 37.8°±20.5°preoperatively to 2.8°±15.2° postoperatively). The mean angular correction at the PPSO site was -38.4°±13.6° (from 35.5°±13.6° preoperatively to -2.9°±14.1° postoperatively). The mean preoperative sagittal vertical axis was 93.5±6.7 cm, which was improved to 37.6±35.0 cm postoperatively. The mean preoperative kyphotic angle at the PPSO site was significant greater in patients with PTK (44.8°±7.2°) than in patients with burst fractures (26.2°±12.2°, p=0.00). However, the mean postoperative PPSO angle did not differ between the two groups (-5.9°±15.7° in patients with burst fractures and 0.2°±12.4° in those with PTK, p=0.28). The mean angular correction at the PPSO site was significantly greater in patients with PTK (-44.6°±10.7°) than in those with burst fractures (-32.1°±13.7°, p=0.04). The mean operation time was 188.1±37.6 minutes, and the mean amount of surgical bleeding was 1030.0±533.2 mL. There were seven cases of perioperative complications occurred in five patients (25%), including one case (5%) of neurological deficit. The operation time, surgical bleeding, and complication rates did not differ between groups.
Conclusion In cases of burst fracture, PPSO provided enough spinal cord decompression without corpectomy and produced sagittal correction superior to that achieved with corpectomy. In case of PTK, PPSO achieved satisfactory curve correction comparable to that achieved with conventional PSO, with less surgical time, less blood loss, and lower complication rates. PPSO could be a viable surgical option for both burst fractures and PTK.
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Affiliation(s)
- Ho Yong Choi
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea.,Department of Neurosurgery, College of Medicine, Kangwon National University, Chuncheon, Korea
| | - Dae Jean Jo
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
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12
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De Gendt EEA, Vercoulen TFG, Joaquim AF, Guo W, Vialle EN, Schroeder GD, Schnake KS, Vaccaro AR, Benneker LM, Muijs SPJ, Oner FC. The Current Status of Spinal Posttraumatic Deformity: A Systematic Review. Global Spine J 2021; 11:1266-1280. [PMID: 33280414 PMCID: PMC8453678 DOI: 10.1177/2192568220969153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Systematic Review. OBJECTIVE To systematically analyze the definitions and descriptions in literature of "Spinal Posttraumatic Deformity" (SPTD) in order to support the development of a uniform and comprehensive definition of clinically relevant SPTD. METHODS A literature search in 11 international databases was performed using "deformity" AND "posttraumatic" and its synonyms. When an original definition or a description of SPTD (Patient factors, Radiological outcomes, Patient Reported Outcome Measurements and Surgical indication) was present the article was included. The retrieved articles were assessed for methodological quality and the presented data was extracted. RESULTS 46 articles met the inclusion criteria. "Symptomatic SPTD" was mentioned multiple times as an entity, however any description of "symptomatic SPTD" was not found. Pain was mentioned as a key factor in SPTD. Other patient related parameters were (progression of) neurological deficit, bone quality, age, comorbidities and functional disability. Various ways were used to determine the amount of deformity on radiographs. The amount of deformity ranged from not deviant for normal to >30°. Sagittal balance and spinopelvic parameters such as the Pelvic Incidence, Pelvic Tilt and Sacral Slope were taken into account and were used as surgical indicators and preoperative planning. The Visual Analog Scale for pain and the Oswestry Disability Index were used mostly to evaluate surgical intervention. CONCLUSION A clear-cut definition or consensus is not available in the literature about clinically relevant SPTD. Our research acts as the basis for international efforts for the development of a definition of SPTD.
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Affiliation(s)
- Erin E. A. De Gendt
- Department of Orthopedics, University Medical Center Utrecht, the Netherlands,Erin E. A. De Gendt, Department of Orthopedics, University Medical Centre Utrecht, Postbus 85500, 3508 GA Utrecht, the Netherlands.
| | | | - Andrei F. Joaquim
- Department of Neurosurgery, State University of Campinas, Campinas, Cidade Universitária Zeferino Vaz—Barão Geraldo, Campinas—SP, Brazil
| | - Wei Guo
- Department of Orthopedics, Sun Yat-sen University, Guangzhou, Haizhu District, Guangdong Province, China
| | - Emiliano N. Vialle
- Department of Orthopaedics, Cajuru Hospital, Catholic University of Paraná, Curitiba, Av. São José, Brazil
| | - Gregory D. Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, PA, USA
| | | | - Alexander R. Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, PA, USA
| | | | - Sander P. J. Muijs
- Department of Orthopedics, University Medical Center Utrecht, the Netherlands
| | - F. Cumhur Oner
- Department of Orthopedics, University Medical Center Utrecht, the Netherlands
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13
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Olivares OB, Carrasco MV, Pinto GI, Tonda FN, Riera Martínez JA, González AS. Preoperative and Postoperative Sagittal Alignment and Compensatory Mechanisms in Patients With Posttraumatic Thoracolumbar Deformities Who Undergo Corrective Surgeries. Int J Spine Surg 2021; 15:585-590. [PMID: 33963023 DOI: 10.14444/8079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Secondary posttraumatic spinal kyphosis is a fixed deformity that has an asymptomatic presentation in most patients, but in some, persistent pain and disability can develop refractory to conservative treatment, which may result in the need for corrective surgery. Our aim was to analyze the modification of sagittal alignment and the variation in compensation mechanisms of spinal-pelvic segments before and after surgical correction in a group of patients with symptomatic posttraumatic kyphosis. METHODS A retrospective cohort study of 16 consecutive patients from the beginning of 2007 until the beginning of 2017 who underwent surgery due to thoracolumbar sagittal deformities was performed. Regional kyphosis (RK), thoracic kyphosis (TK), lumbar lordosis (LL), lower lumbar lordosis (LLL), lumbar lordosis under the deformity (LLUD), pelvic incidence (PI), pelvic tilt (PT), sagittal vertical axis (SVA), and PI-LL were measured in preoperative and postoperative lateral full spine x rays. Statistical analysis was performed with the nonparametric Wilcoxon test to compare preoperative and postoperative radiologic variables. RESULTS Sixteen patients were included with a median age of 47.5 years (32-62 years), the median time elapsed from the accident until corrective surgery was 7 months (2-33 months), the median follow-up time was 16.5 months (6-80 months), and the most used corrective strategy was pedicle subtraction osteotomy (11/16 patients). Statistically and radiologically significant improvements were observed in RK (33.5° versus 12°, P < .001) and LLUD (68.5° versus 61°, P = .017), with a noticeable decrease in PI-LL (15° versus 9.5°, P = .233). There were no statistically significant results regarding TK, LL, LLL, PI, PT, or SVA. CONCLUSIONS Osteotomies are an effective tool to correct angular deformities at a local level after spine trauma. Posttraumatic kyphosis results in the compensation of sagittal imbalance through modification of segmental alignment of the mobile spine under the deformity. LEVEL OF EVIDENCE 3. CLINICAL RELEVANCE This work shows the compensation mechanisms after post-traumatic kyphosis in patients with previously healthy spines.
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Affiliation(s)
| | - Manuel Valencia Carrasco
- Mutual de Seguridad, Spine Surgical Unit, Santiago, Chile.,Clínica Alemana - Universidad del Desarrollo, Santiago, Chile
| | | | - Felipe Novoa Tonda
- Mutual de Seguridad, Spine Surgical Unit, Santiago, Chile.,Clínica Alemana - Universidad del Desarrollo, Santiago, Chile
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Orthosis in Thoracolumbar Fractures: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Spine (Phila Pa 1976) 2020; 45:E1523-E1531. [PMID: 32858744 DOI: 10.1097/brs.0000000000003655] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Systematic review and meta-analysis of randomized controlled trial (RCT). OBJECTIVE The aim of this study was to evaluate radiological and clinical outcomes of acute traumatic thoracolumbar fractures in skeletally mature patients treated with orthosis, versus no immobilization. SUMMARY OF BACKGROUND DATA Orthosis is traditionally used in conservative treatment of thoracolumbar fractures. However, recent studies suggest no benefit, and a possible negative impact in recovery. METHODS Databases were searched from inception to June 2019. Studies were selected in two phases by two blinded reviewers; disagreements were solved by consensus. Inclusion criteria were: RCT; only patients with acute traumatic thoracolumbar fractures; primary conservative treatment; comparison between orthosis and no orthosis. Exclusion criteria were inclusion of nonacute fractures, patients with other significant known diseases and comparison of groups different than use of an orthosis. Two independent reviewers performed data extraction and quality assessment. Fixed-effects models were used upon no heterogeneity, and random-effects model in the remaining cases. A previous plan for extraction of radiological (kyphosis progression; loss of anterior height) and clinical (pain; disability; length of stay) outcomes was applied. PRISMA guidelines were followed. RESULTS Eight articles/five studies were included (267 participants). None reported significant differences in pain, kyphosis progression, and loss of anterior height. One reported a better ODI with orthosis at 12 but not at 24 weeks. No other study reported differences in disability. All authors concluded an equivalence between treatments.Meta-analysis showed a significant increase of 3.47days (95% confidence interval 1.35-5.60) in mean admission time in orthosis group. No differences were found in kyphosis at 6 and 12 months; kyphosis progression between 0 to 6 and 0 to 12 months; loss of anterior height 0 to 6 months; VAS for pain at 6 months; VAS change 0 to 6 months. CONCLUSION Orthosis seems to add no benefit in conservative treatment of acute thoracolumbar fractures. This should be considered in guidelines and reviews of health care policies. LEVEL OF EVIDENCE 3.
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Liu FY, Gu ZF, Zhao ZQ, Ren L, Wang LM, Yu JH, Hou SB, Ding WY, Sun XZ. Modified grade 4 osteotomy for the correction of post-traumatic thoracolumbar kyphosis: A retrospective study of 42 patients. Medicine (Baltimore) 2020; 99:e22204. [PMID: 32925797 PMCID: PMC7489674 DOI: 10.1097/md.0000000000022204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Many surgical procedures have been developed for the treatment of post-traumatic thoracolumbar kyphosis. But there is a significant controversy over the ideal management. The aim of this study was to illustrate the technique of modified grade 4 osteotomy for the treatment of post-traumatic thoracolumbar kyphosis and to evaluate clinical and radiographic results of patients treated with this technique.From May 2013 to May 2018, 42 consecutive patients experiencing post-traumatic thoracolumbar kyphosis underwent the technique of modified grade 4 osteotomy, and their medical records were retrospectively collected. Preoperative and postoperative sagittal Cobb angle, visual analog scale (VAS), Oswestry disability index (ODI), and American Spinal Injury Association (ASIA) were recorded. The average follow-up period was 29.7 ± 14.2 months.The operation time was 185.5 ± 26.8 minutes, the intraoperative blood loss was 545.2 ± 150.1 mL. The Cobb angles decreased from 38.5 ± 3.8 degree preoperatively to 4.2 ± 2.6 degree 2 weeks after surgery (P < .001). The VAS reduced from 6.5 ± 1.1 preoperatively to 1.5 ± 0.9 at final follow-up (P < .001), and the ODI reduced from 59.5 ± 15.7 preoperatively to 15.9 ± 5.8 at final follow-up (P < .001). Kyphotic deformity was successfully corrected and bony fusion was achieved in all patients. Neurologic function of 7 cases was improved to various degrees.Modified grade 4 osteotomy, upper disc, and upper one-third to half of pedicle are resected, is an effective treatment option for post-traumatic thoracolumbar kyphosis. However, the long-term clinical effect still needs further studies.
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Affiliation(s)
- Feng-Yu Liu
- Department of Spine Surgery, The Third Hospital of Shijiazhuang
| | - Zhen-Fang Gu
- Department of Spine Surgery, The Third Hospital of Shijiazhuang
| | - Zheng-Qi Zhao
- Department of Spine Surgery, The Third Hospital of Shijiazhuang
| | - Liang Ren
- Department of Spine Surgery, The Third Hospital of Shijiazhuang
| | - Li-Min Wang
- Department of Spine Surgery, The Third Hospital of Shijiazhuang
| | - Jin-He Yu
- Department of Spine Surgery, The Third Hospital of Shijiazhuang
| | - Shu-Bing Hou
- Department of Spine Surgery, The Third Hospital of Shijiazhuang
| | - Wen-Yuan Ding
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xian-Ze Sun
- Department of Spine Surgery, The Third Hospital of Shijiazhuang
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16
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Shetty AP, Rajavelu R, Viswanathan VK, Watanabe K, Chhabra HS, Kanna RM, Cheung JPY, Hai Y, Kwan MK, Wong CC, Liu G, Basu S, Nene A, Naresh-Babu J, Garg B. Validation Study of Rajasekaran's Kyphosis Classification System: Do We Clearly Understand Single- and Two-Column Deficiencies? Asian Spine J 2020; 14:475-488. [PMID: 32493003 PMCID: PMC7435303 DOI: 10.31616/asj.2020.0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 05/22/2020] [Indexed: 11/23/2022] Open
Abstract
Study Design Multicenter validation study. Purpose To evaluate the inter-rater reliability of Rajasekaran’s kyphosis classification through a multicenter validation study. Overview of Literature The classification of kyphosis, developed by Rajasekaran, incorporates factors related to curve characteristics, including column deficiency, disc mobility, curve magnitude, and osteotomy requirements. Although the classification offers significant benefits in determining prognosis and management decisions, it has not been subjected to multicenter validation. Methods A total of 30 sets of images, including plain radiographs, computed tomography scans, and magnetic resonance imaging scans, were randomly selected from our hospital patient database. All patients had undergone deformity correction surgery for kyphosis. Twelve spine surgeons from the Asia-Pacific region (six different countries) independently evaluated and classified the deformity types and proposed their surgical recommendations. This information was then compared with standard deformity classification and surgical recommendations. Results The kappa coefficients for the classification were as follows: 0.88 for type 1A, 0.78 for type 1B, 0.50 for type 2B, 0.40 for type 3A, 0.63 for type 3B, and 0.86 for type 3C deformities. The overall kappa coefficient for the classification was 0.68. Regarding the repeatability of osteotomy recommendations, kappa values were the highest for Ponte’s (Schwab type 2) osteotomy (kappa 0.8). Kappa values for other osteotomy recommendations were 0.52 for pedicle subtraction/disc-bone osteotomy (Schwab type 3/4), 0.42 for vertebral column resection (VCR, type 5), and 0.30 for multilevel VCRs (type 6). Conclusions Excellent accuracy was found for types 1A, 1B, and 3C deformities (ends of spectrum). There was more variation among surgeons in differentiating between one-column (types 2A and 2B) and two-column (types 3A and 3B) deficiencies, as surgeons often failed to recognize the radiological signs of posterior column failure. This failure to identify column deficiencies can potentially alter kyphosis management. There was excellent consensus among surgeons in the recommendation of type 2 osteotomy; however, some variation was observed in their choice for other osteotomies.
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Affiliation(s)
| | - Rajesh Rajavelu
- Department of Spine Surgery, Ganga Hospital, Coimbatore, India
| | | | - Kota Watanabe
- Division of Spine and Spinal Cord, Keio University, Tokyo, Japan
| | | | | | - Jason Pui Yin Cheung
- Department of Orthopedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Yong Hai
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University of China, Beijing, China
| | - Mun Keong Kwan
- Department of Orthopedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chung Chek Wong
- Deaprtment of Orthopedics, Sarawak General Hospital, Kuching, Sarawak, Malaysia
| | - Gabriel Liu
- Spine Division, Department of Orthopedics, National University Hospital, Singapore
| | - Saumajit Basu
- Department of Spine Surgery, Kothari Medical Center, Kolkata, India.,Department of Spine Surgery, Park Clinic, Kolkata, India
| | - Abhay Nene
- Department of Spine, Wockhardt Hospital, Mumbai, India.,Department of Orthopaedics, Hinduja Healthcare Surgical, Mumbai, India.,Department of Orthopaedic Surgery, Lilavati Hospital & Research Centre, Mumbai, India.,Department of Orthopaedics, Breach Candy Hospital Trust, Mumbai, India.,Department of Orthopedics, Wadia Children's Hospital, Mumbai, India
| | - J Naresh-Babu
- Department of Spine Surgery, Mallika Spine Center, Guntur, India
| | - Bhavuk Garg
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
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[Posttraumatic deformity of the thoracolumbar spine]. Unfallchirurg 2020; 123:143-154. [PMID: 32016493 DOI: 10.1007/s00113-019-00764-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Posttraumatic kyphotic deformities of the thoracolumbar spine may result in significant clinical complaints. If conservative treatment is not successful, surgical correction of the kyphosis becomes an option. In contrast to degenerative deformities, posttraumatic kyphotic deformities are usual limited to few segments and can be treated with shorter constructs. The surgical strategy depends on the rigidity and the localization of the posttraumatic kyphotic deformity. In this respect purely posterior approaches and combined posteroanterior surgical approaches are available each with different advantages and disadvantages.
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Avila JMJ, García OS, Vergara PA, Cisneros ACG. SURGICAL CORRECTION OF POST-TRAUMATIC KYPHOSIS WITH OSTEOTOMIES IN THE SPINE. COLUNA/COLUMNA 2019. [DOI: 10.1590/s1808-185120191801215074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To analyze the clinical and radiological evolution, indications and complications of the types of osteotomies in patients with disturbed sagittal balance (SB) resulting from post-traumatic kyphosis. The SB can be measured with a plumb line from the center of the body of C7 to S1, which allows recognizing the misalignment. The imbalance can be corrected by osteotomy. Methods: Thirty patients with SB loss due to post-traumatic kyphosis were studied from January 2014 to December 2017. SPO, PSO and VCR were performed to evaluate the degree of kyphosis before and after surgery, the Oswestry questionnaire was applied and the degree of correction, the days of hospital stay and transoperative bleeding were assessed. Results: Age, 50 years, SD = 14, follow-up time: 2-3 years. We performed 11 (36.7%) osteotomies of S-P, 17 (56.7%) pedicle subtractions and 2 (6.6%) vertebrectomies. Most of the lesions were found between levels L1 and L2; the complications were dehiscence of the surgical wound in 4 patients (13.3%) and infection in 2 (6.6%). The minimum surgical time was 3 hours; the Oswestry questionnaire did not showed statistically significant difference during the preoperative period, however, considerable improvement was observed 2 years after surgery. Conclusions: The use of corrective vertebral osteotomies significantly re-establishes the spinopelvic balance altered by different pathologies. It allows correcting in a single surgery the sagittal balance, achieving corrections from 10° to 40°, depending on the type of osteotomy performed, being a safe and effective procedure, which allows to restore the spinopelvic balance, improving the quality of life of the patients. Level of Evidence IIb; Prospective cohort study.
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Clinical application and cases examples of a new treatment algorithm for treating thoracic and lumbar spine trauma. Spinal Cord Ser Cases 2018; 4:56. [PMID: 29977607 DOI: 10.1038/s41394-018-0093-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/01/2018] [Accepted: 06/02/2018] [Indexed: 11/08/2022] Open
Abstract
Study design Review of illustrative cases of a new algorithm to help in the treatment decision of thoracolumbar spine trauma. Objectives To illustrate the use of the new algorithm for managing thoracic and lumbar spine trauma. Settings Recently, a new algorithm for helping in the decision of the best treatment modality for thoracolumbar spine trauma (TLST) was published. The algorithm considers injury morphology, neurological status, clinical status (pain and disability), and also multimodal radiological evaluation (MMRE) in the decision for non-operative versus operative treatment for TLST. Injuries were classified in three groups: (1) stable injuries, (2) potentially unstable injuries/ delayed instability, or (3) clearly unstable injuries. Methods Cases examples of the algorithm application were presented and discussed. Results Stable injuries (minor fractures without instability) are non-surgically treated; potentially unstable injuries or associated with delayed instability may be initially managed non-surgically and operative treatment is an option, especially in the setting of important pain, deformity or a new neurological deficit. Clearly unstable injuries are treated surgically as soon as possible to avoid neurological worsening, severe pain, and/ or progressive spinal deformity. Conclusions Clinical examples of TLST were presented, discussed and classified as stable, potentially unstable and clearly unstable injuries. Further studies addressing the reliability and safety of this algorithm are necessary.
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Rajasekaran S, Rajoli SR, Aiyer SN, Kanna R, Shetty AP. A Classification for Kyphosis Based on Column Deficiency, Curve Magnitude, and Osteotomy Requirement. J Bone Joint Surg Am 2018; 100:1147-1156. [PMID: 29975269 PMCID: PMC6075880 DOI: 10.2106/jbjs.17.01127] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is a lack of a classification system providing uniformity in description and guiding management decisions for kyphotic spinal deformities. We developed such a classification based on column deficiency, flexibility of disc spaces, curve magnitude, and correlation with the corrective osteotomy required. METHODS A classification was developed based on analysis of 180 patients with thoracolumbar kyphosis requiring osteotomy. The deformity was classified as Type I if the anterior and posterior columns were intact (IA indicated mobile disc spaces and IB, ankylosed segments). Type II indicated deficiency of only 1 column (IIA = anterior column and IIB = posterior column). Type III indicated deficiency of both columns (IIIA = kyphosis of ≤60°, IIIB = kyphosis of >60°, and IIIC = buckling collapse). A prospective analysis of 76 patients was performed to determine interobserver variability and the ability of the classification to guide selection of osteotomies of increasing complexity, including the Ponte osteotomy, pedicle subtraction osteotomy, disc bone osteotomy, single vertebrectomy, multiple vertebrectomies, and anterior in situ strut fusion procedure. RESULTS The mean age of the 76 patients was 21.2 years, the mean kyphosis was 69.9° (range, 26° to 120°), and the mean follow-up duration was 30 months. Six deformities were classified as IA, 5 as IB, 5 as IIA, 2 as IIB, 13 as IIIA, 35 as IIIB, and 10 as IIIC. Four surgeons classifying the deformities had a high agreement rate (kappa = 0.83), with the highest agreement for Types IA, IB, and IIIB. A correlation between the type of deformity and the osteotomy performed demonstrated that the classification could indicate the type of osteotomy required. All 18 patients with Type-I or II kyphosis were treated with Ponte, pedicle subtraction, or disc bone osteotomy. Forty-three (90%) of the 48 patients with Type IIIA or IIIB underwent vertebrectomy (single in 27 [56%] and multiple in 16 [33%]), and only 5 (10%) underwent disc bone osteotomy. Seven of the 10 patients with Type-IIIC kyphosis were treated with multiple vertebrectomies, with 5 of them needing preoperative halo gravity traction; the other 3 patients underwent an anterior in situ strut fusion procedure. CONCLUSIONS The proposed classification based on the morphology of column deficiency, flexibility, and curve magnitude demonstrated a high interobserver agreement and ability to guide selection of the appropriate osteotomy. CLINICAL RELEVANCE A novel classification system for kyphosis based on spinal column deficiency, flexibility of disc spaces, and curve magnitude would bring uniformity in management and help guide surgeons in the choice of the appropriate corrective osteotomy.
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Affiliation(s)
- S. Rajasekaran
- Department of Spine Surgery, Ganga Hospital, Coimbatore, India
| | | | | | - Rishi Kanna
- Department of Spine Surgery, Ganga Hospital, Coimbatore, India
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Luna LM, Villazón FG, Oviedo JES, Castorena IOC. SAGITTAL BALANCE AFTER POSTERIOR INSTRUMENTATION IN LUMBAR FRACTURES. COLUNA/COLUMNA 2018. [DOI: 10.1590/s1808-185120181702189432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: When a lumbar fractures developes a significant deformity, the sagittal balance is altered which can lead to clinical consequences. The aim of this study was to measure and analyze the sagittal balance in patients with lumbar fractures operated with posterior instrumentation after three months and analyze their correlation with the different variables of the patient and the fracture. Methods: Sixty-three medical records of patients with lumbar fracture operated with posterior instrumentation were analyzed, excluding those with previous spinal pathology, or inability to stand upright. The parameters of pelvic incidence, sacral slope, pelvic tilt, lumbar lordosis, lumbar lordosis/pelvic incidence (LL/ PI) ratio, as well as the pre and postoperative status of segmental kyphosis and residual pain were measured. Results: Eighteen women, 44 men, with mean age of 42 years, with lumbar fractures: 29 in L1, 19 in L2, 10 in L3, 3 in L4 and 1 in L5. AOSpine Clasification: 2 type A1, 2 type A2, 37 type A3, 19 type A4, 2 type B. All patients were operated with a transpedicular polyaxial system. More than 80% of patients with spinopelvic balance within parameters considered normal. More than 70% with lumbar lordosis and LL/PI ratio within parameters. All with improvement of segmental kyphosis (average correction of 8.5°, p<.000). Final mean VAS of 1.85. Conclusions: The posterior instrumentation with a polyaxial system allows acceptable corrections of the segmental kyphosis of lumbar fractures. No statistically significant correlation was found between sagittal balance parameters, and characteristics of the patient and fracture. Level of Evidence IV; Case series.
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Mazel C, Ajavon L. Malunion of post-traumatic thoracolumbar fractures. Orthop Traumatol Surg Res 2018; 104:S55-S62. [PMID: 29191468 DOI: 10.1016/j.otsr.2017.04.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/14/2017] [Accepted: 04/13/2017] [Indexed: 02/02/2023]
Abstract
Thoracolumbar malunion is the result of loss of correction, insufficient correction or even no correction (both in the frontal and sagittal planes) of a thoracolumbar fracture. The main causes are incorrect assessment of the fracture's complexity (burst fracture), its potential progression to kyphosis and associated disc or ligament damage. It can also be the result of a poorly conducted initial treatment. The types of malunion have changed over the years because of the introduction of vertebroplasty and kyphoplasty. The malunion can be well tolerated if there is only a moderate deformity. However, the functional and pain-related limitations can be severe with large deformities. Functional limitation is mainly related to sagittal imbalance, but also to sequelae associated with the injury in various ways (non-union, disc degeneration, spinal cord compression, syringomyelia, etc.). The deformity and its consequences are evaluated globally using full-body standing radiographs (EOS), CT scan and MRI. Comparison of MRI images taken in a lying position to weight bearing views or even dynamic ones is an additional means to evaluate whether the lesions are reducible. Differences in spine morphology and compensatory mechanisms to combat the sagittal imbalance induced by the deformity must also be analyzed. These provide more complete information about the consequences of the malunion and help to establish the best corrective strategy. These compensatory mechanisms consist of accentuation of lumbar lordosis along with reduction of thoracic kyphosis. As a last resort, the pelvis and femur contribute to this compensation when there is a large deformity or a stiff spine due to preexisting osteoarthritis. Treatment strategies are fairly well standardized. When the deformity is reducible, a two-stage surgery is indicated. When the deformity is not reducible, posterior transpedicular closed wedge osteotomy is the gold standard. Nevertheless, the best way to treat thoracolumbar malunion is to prevent it.
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Affiliation(s)
- C Mazel
- Department of orthopedics and spine, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France.
| | - L Ajavon
- Department of orthopedics and spine, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
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Li S, Li Z, Hua W, Wang K, Li S, Zhang Y, Ye Z, Shao Z, Wu X, Yang C. Clinical outcome and surgical strategies for late post-traumatic kyphosis after failed thoracolumbar fracture operation: Case report and literature review. Medicine (Baltimore) 2017; 96:e8770. [PMID: 29245233 PMCID: PMC5728848 DOI: 10.1097/md.0000000000008770] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Thoracic-lumbar vertebral fracture is very common in clinic, and late post-traumatic kyphosis is the main cause closely related to the patients' life quality, which has evocated extensive concern for the surgical treatment of the disease. This study aimed to analyze the clinical outcomes and surgical strategies for late post-traumatic kyphosis after failed thoracolumbar fracture operation. PATIENT CONCERNS All patients presented back pain with kyphotic apex vertebrae between T12 and L3. According to Frankel classification grading system, among them, 3 patients were classified as grade D, with the ability to live independently. DIAGNOSES A systematic review of 12 case series of post-traumatic kyphosis after failed thoracolumbar fracture operation was involved. INTERVENTIONS Wedge osteotomy was performed as indicated-posterior closing osteotomy correction in 5 patients and anterior open-posterior close correction in 7 patients.Postoperatively, thoracolumbar x-rays were obtained to evaluate the correction of kyphotic deformity, visual analog scales (VAS) and Frankel grading system were used for access the clinical outcomes. OUTCOMES All the patients were followed up, with the average period of 38.5 months (range 24-56 months). The Kyphotic Cobb angle was improved from preoperative (28.65 ± 11.41) to postoperative (1.14 ± 2.79), with the correction rate of 96.02%. There was 1 case of intraoperative dural tear, without complications such as death, neurological injury, and wound infection. According to Frankel grading system, no patient suffered deteriorated neurological symptoms after surgery, and 2 patients (2/3) experienced significant relief after surgery. The main VAS score of back pain was improved from preoperative (4.41 ± 1.08) to postoperative (1.5 ± 0.91) at final follow-up, with an improvement rate of 65.89%. LESSONS Surgical treatment of late post-traumatic kyphosis after failed thoracolumbar fracture operation can obtain good radiologic and clinical outcomes by kyphosis correction, decompression, and posterior stability.
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Affiliation(s)
- Suyun Li
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Zhi Li
- Department of Orthopaedics, Wuhan General Hospital of Guangzhou Command, Wuhan, China
| | - Wenbin Hua
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Kun Wang
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Shuai Li
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Yunkun Zhang
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Zhewei Ye
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Zengwu Shao
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Xinghuo Wu
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Cao Yang
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
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Pesce A, Frati A, Caruso R, Wierzbicki V, Raco A. Morgagni Spine Fractures-Dislocations per Anatomen Indagatis: Since the Dawn of Modern Medicine A Taxonomy and Pathomorphology Problem. World Neurosurg 2016; 96:171-176. [PMID: 27609446 DOI: 10.1016/j.wneu.2016.08.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 08/23/2016] [Accepted: 08/26/2016] [Indexed: 11/17/2022]
Abstract
The aim of this study is to retrieve and bring back to light a part of the astonishing and painstaking work of the legendary Italian father of modern pathology Giovanni Battista Morgagni, concerning one of most discussed topics in spine surgery: spine fractures-dislocations. All the excerpts selected for this study are contained in De sedibus et causis morborum per anatomen indagatis, the summa maxima of the entire production of Morgagni. This treatise encloses the enormous experience of Morgagni in anatomic dissections and pathologic investigations. With the aid of a strict dissection and description methodology, Morgagni identified and described many of the most important aspects of spinal fractures-dislocations, from the importance of the mechanism of injury, to the relevance of ligamentous complex, or the risk of posttraumatic kyphosis and the clinical expression of spinal cord injury.
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Affiliation(s)
- Alessandro Pesce
- A.O. "Sant'Andrea", Neurosurgery Division, Rome, Italy; NESMOS Department, "Sapienza" University, Rome, Italy.
| | - Alessandro Frati
- NESMOS Department, "Sapienza" University, Rome, Italy; IRCCS "Neuromed", Pozzilli, Isernia, Italy
| | - Riccardo Caruso
- NESMOS Department, "Sapienza" University, Rome, Italy; Rome Army Hospital "Celio", Neurosurgery Division, Dipartimento Scienze Neurosensoriali, Rome, Italy
| | - Venceslao Wierzbicki
- Rome Army Hospital "Celio", Neurosurgery Division, Dipartimento Scienze Neurosensoriali, Rome, Italy
| | - Antonino Raco
- A.O. "Sant'Andrea", Neurosurgery Division, Rome, Italy; NESMOS Department, "Sapienza" University, Rome, Italy
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Adelved A, Tötterman A, Glott T, Hellund JC, Madsen JE, Røise O. Long-term functional outcome after traumatic lumbosacral dissociation. A retrospective case series of 13 patients. Injury 2016; 47:1562-8. [PMID: 27126767 DOI: 10.1016/j.injury.2016.04.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 04/09/2016] [Indexed: 02/02/2023]
Abstract
STUDY DESIGN Retrospective case series. INTRODUCTION Traumatic lumbosacral dissociation (TLSD) is a rare subgroup of sacral fractures caused by high-energy trauma in healthy adults. There are no accepted treatment algorithms for these injuries. Neurologic deficits and pain are commonly associated with these injuries, however, little is known about the long-term functional outcome in patients with TLSD. The objective of this study was to assess long-term functional outcome in patients with traumatic lumbosacral dissociation (TLSD) injuries. MATERIALS AND METHODS Thirteen patients with TLSD were retrospectively identified and followed with clinical and radiological examination mean 7.7 (3-12) years after the injury. Five were treated operatively, and eight non-operatively. Sensorimotor impairments in the lower extremities were classified according to ASIA. Urinary function was assessed with uroflowmetry, and bowel- and sexual functions were assessed using a structured interview. Pain was assessed using a visual analogue scale (VAS), and patient-reported health with SF-36. CT images were scrutinized for non-union and kyphotic angulation across the fracture. RESULTS Eleven patients had neurologic deficits corresponding to L5 and sacral roots. Urinary dysfunction was observed in nine, and bowel dysfunction in three patients. Eight patients reported problems associated with sexual activities, with pain during intercourse and erectile dysfunction being the most common problems. Twelve patients reported pain in the lumbosacral area, in combination with radiating pain in the majority. The overall patient-reported health (SF-36) was significantly lower than the normal population. All sacral fractures were united as seen on CT. Sacral kyphotic angulation was present in 11, which had increased in three patients comparing with the initial radiographs. CONCLUSION In this long-term follow-up, functional impairments, pain, and poor patient-reported health were common findings among patients with TLSD. High rates of neurologic, urinary and sexual dysfunctions were reported. Extended follow-up several years after the injury with a special focus on urogenital dysfunctions and pain management may be beneficial to these patients.
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Affiliation(s)
- Aron Adelved
- Department of Orthopaedic Surgery, Oslo University Hospital, Ullevaal, Oslo, Norway; Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway; Faculty of Medicine, University of Oslo, Norway.
| | - Anna Tötterman
- Department of Orthopaedic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Thomas Glott
- Department of Spinal Cord Injury and Multitrauma Unit, Sunnaas Hospital, Nesodden, Norway
| | - Johan C Hellund
- Department of Radiology, Oslo University Hospital, Ullevaal, Oslo, Norway
| | - Jan Erik Madsen
- Department of Orthopaedic Surgery, Oslo University Hospital, Ullevaal, Oslo, Norway; Faculty of Medicine, University of Oslo, Norway
| | - Olav Røise
- Department of Orthopaedic Surgery, Oslo University Hospital, Ullevaal, Oslo, Norway; Faculty of Medicine, University of Oslo, Norway; Division of Surgery and Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
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Modified partial pedicle subtraction osteotomy for the correction of post-traumatic thoracolumbar kyphosis. Spine J 2015; 15:2009-15. [PMID: 25957537 DOI: 10.1016/j.spinee.2015.04.047] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 02/21/2015] [Accepted: 04/29/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Pedicle subtraction osteotomy (PSO) is the most commonly recommended technique for the correction of local post-traumatic thoracolumbar deformity; however, the surgical results are not always satisfactory because the possibly damaged upper disc is preserved, and all the posterior elements are resected. PURPOSE The aim was to compare the results of standard PSO and modified PSO in the treatment of post-traumatic thoracolumbar kyphosis. STUDY DESIGN This was a retrospective multicenter comparative clinical study. PATIENT SAMPLE A total of 86 patients were included in the final analysis. OUTCOME MEASURES The outcome measures included local Cobb angle of the kyphosis, visual analog scale (VAS) score, and Oswestry disability index (ODI) score. METHODS The upper disc was resected, and the inferior wall of the index pedicle and the lower facet joint were preserved in the modified PSO. Patients with focal kyphosis greater than 30° who were treated with one-level osteotomy, without the presence of spine neoplasm, infection, or previous surgery, were included. The measurements included the VAS score, ODI score, and preoperative and postoperative Cobb angles. RESULTS Forty-two patients in the modified PSO group and 44 in the standard PSO group were included in the final analysis. The mean surgical time and blood loss were similar between the two groups. Both the VAS and ODI scores had improved significantly at the final follow-up in the two groups. The mean Cobb angle significantly improved from 39.6° to 5.6° in the modified PSO group and from 39.1° to 4.8° in the standard PSO group, with no significant difference between the two groups preoperatively or at the final follow-up. CONCLUSIONS The modified PSO provides an alternative method with which to correct kyphotic deformity in patients with post-traumatic thoracolumbar kyphosis.
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Lopez AJ, Scheer JK, Abode-Iyamah K, Smith ZA, Hitchon PW, Dahdaleh NS. Management of delayed posttraumatic cervical kyphosis. J Clin Neurosci 2015; 23:152-159. [PMID: 26321304 DOI: 10.1016/j.jocn.2015.05.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 05/02/2015] [Indexed: 11/30/2022]
Abstract
We describe three patients with misdiagnosed unstable fractures of the cervical spine, who were treated conservatively and developed kyphotic deformity, myelopathy, and radiculopathy. All three patients were then managed with closed reductions by crown halo traction, followed by instrumented fusions. Their neurologic function was regained without permanent disability in any patient. Unstable fractures of the cervical spine will progress to catastrophic neurologic injuries without surgical fixation. Posttraumatic kyphosis and the delayed reduction of partially healed fracture dislocations by preoperative traction are not well characterized in the subaxial cervical spine. The complete evaluation of any subaxial cervical spine fracture requires CT scanning to assess for bony fractures, and MRI to assess for ligamentous injury. This allows for assessment of the degree of instability and appropriate management. In patients with delayed posttraumatic cervical kyphosis, preoperative closed reduction provided adequate realignment, facilitating subsequent operative stabilization.
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Affiliation(s)
- Alejandro J Lopez
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Suite 2210, 676 North Saint Clair Street, Chicago, IL 60611, USA
| | - Justin K Scheer
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Suite 2210, 676 North Saint Clair Street, Chicago, IL 60611, USA
| | - Kingsley Abode-Iyamah
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Carver School of Medicine, Iowa City, IA, USA
| | - Zachary A Smith
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Suite 2210, 676 North Saint Clair Street, Chicago, IL 60611, USA
| | - Patrick W Hitchon
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Carver School of Medicine, Iowa City, IA, USA
| | - Nader S Dahdaleh
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Suite 2210, 676 North Saint Clair Street, Chicago, IL 60611, USA.
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Kanayama M, Oha F, Iwata A, Hashimoto T. Does balloon kyphoplasty improve the global spinal alignment in osteoporotic vertebral fracture? INTERNATIONAL ORTHOPAEDICS 2015; 39:1137-43. [PMID: 25787683 DOI: 10.1007/s00264-015-2737-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 03/03/2015] [Indexed: 12/29/2022]
Abstract
PURPOSE Balloon kyphoplasty (BKP) has been a well-accepted procedure in the treatment of osteoporotic vertebral compression fracture (OVCF), whereas it remains unclear whether or not this procedure has an impact on the global spinal alignment. The purpose of this study is to evaluate the effect of BKP on the global spinal alignment in OVCF. METHODS Fifty-six consecutive patients who had undergone BKP for symptomatic OVCF were retrospectively reviewed with a mean follow-up of 32 months. They were seven males and 49 females with a mean age of 75 years. Radiographic assessment was performed using upright whole spine radiographs. The parameters included vertebral kyphosis, mid-vertebral body height and global sagittal spinal alignment (C7 plumb line deviation). Clinical outcomes were evaluated using visual analog scale of back pain. RESULTS Fifty-one of 56 patients (91.1 %) achieved immediate pain relief. Vertebral kyphosis significantly decreased from 18 to 14 degrees, but 43 patients (76.8 %) still had more than 10 degrees of local kyphosis. Subsequent vertebral compression fractures were observed in seven patients (12.5 %). Anterior deviation of a C7 plumb line (C7PL) was 3.1 cm pre-operatively, 3.1 cm postoperatively, and significantly increased to 5.9 cm at the final follow-up. Consistent results were obtained in those with pre-operative sagittal imbalance (>5 cm anterior deviation of C7PL) and with pre-existing OVCFs. CONCLUSIONS BKP contributed to immediate pain relief, but did not improve the global sagittal spinal alignment after OVCF. This procedure should be solely indicated for painful OVCF or non-union, and could not be expected to restore the global sagittal alignment.
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Affiliation(s)
- Masahiro Kanayama
- Spine Center, Hakodate Central General Hospital, Hon-cho 33-2, Hakodate, Hokkaido, 040-8585, Japan,
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Closing-opening wedge osteotomy for thoracolumbar traumatic kyphosis. Eur J Med Res 2014; 19:59. [PMID: 25367356 PMCID: PMC4231190 DOI: 10.1186/s40001-014-0059-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Accepted: 10/20/2014] [Indexed: 11/21/2022] Open
Abstract
Background Surgical treatment modalities for post-traumatic kyphosis (PTK) remain controversial. Like vertebral column resection, closing-opening wedge osteotomy (COWO) can achieve satisfactory results for kyphosis with multiple etiologies. However, few studies have assessed this procedure for PTK. Our purpose was to evaluate the radiographic and clinical outcomes of COWO in a selected series of patients with PTK via a single posterior approach. Methods In this retrospective case series, seven patients with symptomatic PTK in the thoracolumbar spine were reviewed. Five patients underwent surgery at the time of initial injury, and the other two initially underwent conservative treatment. All seven patients underwent COWO procedures through a single posterior approach. The Cobb angle was assessed preoperatively, postoperatively, and at the final follow-up. A visual analog scale (VAS) and the American Spinal Injury Association scale were used to evaluate back pain and neurological function preoperatively and at final follow-up, respectively. Operation-associated complications were also recorded. Results The mean follow-up period was 34.3 months (range, 24 to 43 months). The mean kyphotic angle was significantly (P <0.05) reduced from 57.7° (range, 36° to 100°) preoperatively to 8° postoperatively (range, −12° to 50°). The mean VAS improved from 5.9 to 2.1 (P <0.05). Three patients exhibited improved neurological function. Bony fusion was achieved in all patients. No significant correction loss or permanent complication was noted. Conclusions Though technically demanding, COWO via a single posterior approach can provide satisfactory outcomes for selected patients with PTK. Additional studies are required to improve patient selection and outcomes for this condition.
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Poureisa M, Daghighi MH, Yousefi J, Hagigi A. Correlation of Axial Vertebral Rotation with Nerve Root Involvement: The First Clinical Study in Literature. JOURNAL OF MEDICAL SCIENCES 2014. [DOI: 10.3923/jms.2014.235.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Cecchinato R, Berjano P, Damilano M, Lamartina C. Spinal osteotomies to treat post-traumatic thoracolumbar deformity. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2014; 24 Suppl 1:S31-7. [DOI: 10.1007/s00590-014-1464-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 04/10/2014] [Indexed: 10/25/2022]
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Aebli N, Timm K, Patrick M, Krebs J. Short-segment posterior instrumentation combined with anterior spondylodesis using an autologous rib graft in thoracolumbar burst fractures. Acta Orthop 2014; 85:84-90. [PMID: 24359027 PMCID: PMC3940997 DOI: 10.3109/17453674.2013.871137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 10/11/2013] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE There are very few data concerning the outcome after short-segment posterior stabilization and anterior spondylodesis with rib grafts in patients suffering from unstable thoracolumbar burst fractures. We have therefore investigated the clinical and radiographic outcome after posterior bisegmental instrumentation and monosegmental anterior spondylodesis using an autologous rib graft for unstable thoracolumbar burst fractures. PATIENTS AND METHODS This was a retrospective analysis of 32 consecutive patients at a single center. The monosegmental Cobb angle was measured preoperatively, postoperatively, then 6 and 12 months postoperatively, and also after implant removal. Anterior vertebral fusion was graded on conventional radiographs according to the criteria proposed by Molinari. RESULTS Segmental kyphosis at the fracture site was corrected from a median of -20° (95% CI: -21.2 to -18.8) to -1.0° (95% CI: -2.7 to 0.7) postoperatively. 1 year after surgery, the segmental angle had decreased by a median of 2.0° (95% CI: 0.2 to 2.8). The spondylodesis fused in all patients, which was evident from incorporation and remodeling of the rib grafts. The median correction loss after implant removal was 0.0° (95% CI: -0.5 to 0.5). 26 of the 32 patients reported having no back complaints at the last follow-up (2 years postoperatively). 1 patient suffered from intercostal neuralgia, and 5 patients reported mild to moderate back pain. INTERPRETATION Short-segment posterior instrumentation and anterior spondylodesis using an autologous rib graft resulted in sufficient correction of posttraumatic segmental kyphosis. There was no clinically relevant correction loss, and the majority of patients had no back complaints at the 2-year follow-up.
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Affiliation(s)
- Nikolaus Aebli
- Spinal Medicine and Surgery , AndreasKlinik, Cham , Switzerland
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A case of intestinal obstruction caused by prominent kyphosis resulting in compression of the intestine by the costal arch. Int Surg 2013; 98:254-8. [PMID: 23971780 DOI: 10.9738/intsurg-d-12-00003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
An 85-year-old woman with no history of abdominal surgery complained of abdominal pain and vomiting and was referred to us with a diagnosis of intestinal obstruction a few days later. Upon admission to our facility, she presented with marked abdominal swelling and prominent kyphosis. Because of the kyphosis, most of the dilated bowel was compressing her thoracic cavity. No obvious strangulation or free air was observed via abdominal computed tomography imaging. We attempted decompression using a nasogastric tube, but the symptoms persisted. Surgery was performed 2 days after admission. The origin of the obstruction was a compression of the ileocecal region by the costal arch. The bowel was discolored, and thus surgically excised. There were no major postsurgical complications other than a mild wound infection. Until now, there have been no reports of advanced kyphosis inducing ileus, but there are concerns of an increase in similar cases as society continues to age.
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Aw GE, Mobbs RJ. A unique approach to fixed occipito-cervico-thoracic deformity. J Clin Neurosci 2013; 20:608-11. [PMID: 23313528 DOI: 10.1016/j.jocn.2012.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 03/10/2012] [Indexed: 10/27/2022]
Abstract
We discuss a unique approach to a patient who presented with severe kyphosis and laterolisthesis of the cranio-cervico-thoracic spine, following a history of neck trauma 24months prior to presentation. The patient had organized voluntary euthanasia if no treatment could be performed. Our approach included a three-part procedure over a 3-week time interval, including: initial traction, division of anterior neck muscles, multilevel anterior fusion and, finally, posterior occipito-cervico-thoracic fusion. Follow-up at 6months revealed a patient in neutral sagittal and coronal balance of the neck.
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Affiliation(s)
- G E Aw
- Department of Neurosurgery, Prince of Wales Hospital, Barker St, Randwick New South Wales 2031, Australia.
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El-Sharkawi MM, Koptan WMT, El-Miligui YH, Said GZ. Comparison between pedicle subtraction osteotomy and anterior corpectomy and plating for correcting post-traumatic kyphosis: a multicenter study. 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 2011; 20:1434-40. [PMID: 21336510 PMCID: PMC3175905 DOI: 10.1007/s00586-011-1720-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Revised: 11/20/2010] [Accepted: 02/06/2011] [Indexed: 11/25/2022]
Abstract
Kyphosis is a common sequel of inadequately managed thoracolumbar fractures. This study compares between pedicle subtraction osteotomy (PSO) and anterior corpectomy and plating (ACP) for correcting post-traumatic kyphosis. Forty-three patients with symptomatic post-traumatic kyphosis of the thoracolumbar spine were treated with PSO and prospectively followed for a minimum of 2 years. Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were used to assess clinical improvement and radiographs were obtained at 2, 6, 12 and 24 months. The recorded clinical and radiological outcomes were compared to a control group of 37 patients, who were treated earlier by the same authors with ACP. The mean correction of the kyphotic angle was 29.8° for the PSO group and 22° for the ACP group (P = 0.001). PSO group showed significantly better improvement in the VAS score and the ODI. At final follow-up, patients reported very good satisfaction (93% in PSO vs. 81% in ACP) and good function (90% in PSO vs. 73% in ACP). Complications in the PSO group included pulling out of screws and recurrence of deformity requiring revision and longer fixation (1 patient), and transient lower limb paraesthesia (2 patients). Recorded complications in the ACP group included an aortic injury (1 patient) that was successfully repaired, pseudarthrosis (1 patient), persistent graft donor site morbidity (3 patients), and incisional hernia (1 patient). PSO and ACP are demanding procedures. PSO seems to be equally safe but more effective than ACP for correcting post-traumatic kyphosis.
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Affiliation(s)
- Mohammad M El-Sharkawi
- Department of Orthopaedic and Trauma Surgery, Assiut University School of Medicine, Assiut 71511, Egypt.
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Kandziora F, Schnake KJ. Correction of post-traumatic hyperkyphosis of the upper thoracic spine by multiple Chevron osteotomies. 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 2011; 19:2229-30. [PMID: 21188759 DOI: 10.1007/s00586-010-1621-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Charles YP, Zairi F, Vincent C, Fuentes S, Bronsard N, Court C, Le Huec JC. Minimally invasive posterior surgery for thoracolumbar fractures. New trends to decrease muscle damage. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2011. [DOI: 10.1007/s00590-011-0781-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mulholland RC. The Michel Benoist and Robert Mulholland yearly European Spine Journal Review: a survey of the "surgical and research" articles in the European Spine Journal, 2010. 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 2011; 20:163-70. [PMID: 21249508 DOI: 10.1007/s00586-010-1679-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Indexed: 11/29/2022]
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