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Duan Y, Feng D, Chen J, Wu Y, Li T, Jiang L, Huang Y. Anterior, Posterior and Anterior-Posterior Approaches for the Treatment of Thoracolumbar Burst Fractures: A Network Meta-Analysis of Randomized Controlled Trials. J INVEST SURG 2024; 37:2301794. [PMID: 38199978 DOI: 10.1080/08941939.2024.2301794] [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: 10/26/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE To compare the clinical and radiological results of the anterior approach versus the posterior approach versus the anterior-posterior approach for the treatment of thoracolumbar burst fractures. METHODS The network meta-analysis was performed in accordance with the PRISMA Statement. Electronic searches of PubMed and Embase were conducted up to June 22, 2023, for relevant randomized controlled trials. STATA13.0 was used to perform network meta-analysis. p < .05 was considered significant. RESULTS Nine RCTs with a total of 550 patients receiving surgical treatment in at least two of the three approaches, including anterior, posterior and anterior-posterior approaches, were included. The surgical duration and intraoperative bleeding volume in the posterior approach were significantly lower than those in the anterior (SMD, -1.72; 95% CI, -2.82, -0.62) and anterior-posterior approaches (SMD, 3.33; 95% CI, 1.65, 5.00). The surgical duration in the anterior approach was significantly lower than that in the anterior-posterior approach (SMD, 1.61; 95% CI, 0.12, 3.10). The Cobb angle in the anterior-posterior approach was significantly lower than that in the anterior approach (MD, -4.83; 95% CI, -9.60, -0.05). The VAS score in the posterior approach was significantly higher than that in the anterior approach (MD, 0.85; 95% CI, 0.55, 1.16) and anterior-posterior approach (MD, -0.84; 95% CI, -1.12, -0.55). No significant difference was identified among the three surgical approaches in implant failure rate and infection rate. CONCLUSION All three approaches were safe approaches with advantages and disadvantages. The selection of surgical approaches for the treatment of thoracolumbar burst fractures may be individualized.
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Affiliation(s)
- Yuchen Duan
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Dagang Feng
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Jun Chen
- Department of Critical Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Yamei Wu
- Sichuan Academy of Chinese Medicine Sciences, Chengdu, China
| | - Tong Li
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Leiming Jiang
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Yong Huang
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
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Aydin E, Schenk P, Jacobi A, Mendel T, Klauke F, Ullrich BW. Percutaneous reduction of thoracolumbar fractures using monoaxial screws: Comparison of two instruments based on initial reduction and loss of reduction. BRAIN & SPINE 2024; 4:102778. [PMID: 38584864 PMCID: PMC10995800 DOI: 10.1016/j.bas.2024.102778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/07/2024] [Accepted: 02/28/2024] [Indexed: 04/09/2024]
Abstract
Introduction Percutaneous techniques for the surgical treatment of vertebral fractures are constantly progressing. There are different biomechanics involved. Research question Two percutaneous, monoaxial fixation systems with different reduction tools were analyzed in relation to their reduction capacity. Additionally, the impact of anterior fusion, fracture severity and bone quality on reduction and loss of reduction were examined. Material and methods 117 cases were retrospectively included in the monocentric study. The subsample (N = 53) with complete data at follow-up times was used to analyze the influence of anterior fusion. The dependencies on fracture severity and bone quality were determined using Spearman and Pearson correlation. Results Both systems achieved equally good reduction (9° mean, 95%-CI: 8°-11°, p < 0.001). Anterior fused patients showed not significant (p = 0.057) less loss of reduction over time. Fracture severity had neither an influence on reduction or loss of reduction. Bone quality was positively correlated with greater amount of reduction and less loss of reduction. Early reduction within two days correlated with a greater amount of reduction (p = 0.006). Screw diameters and the patient's weight had no influence on loss of reduction. Complications occurred only in "V2" group. Discussion and conclusion Both systems are equivalent in reduction ability. The additional anterior fusion did not result in significantly lower reduction losses. The subsample being small, is a limitation. Good bone quality correlates with better initial reduction and less reduction loss. A preoperative bone density measurement can lead to optimization of surgical techniques.
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Affiliation(s)
- Esra Aydin
- Department of Internal Medicine – Cardiology, DRK Kliniken Köpenick, Berlin, Germany
| | - Philipp Schenk
- Department of Science, Research and Education, BG Klinikum Bergmannstrost Halle gGmbH, 06112, Halle, Germany
| | - Arija Jacobi
- Department of Orthopedic and Trauma Surgery, DIAKO Ev. Diakonie-Krankenhaus gGmbH, 28239, Bremen, Germany
| | - Thomas Mendel
- Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle, Germany
- Clinic for Trauma, Hand and Reconstructive Surgery, University Hospital Halle, Martin Luther University Halle-Wittenberg, Germany
| | - Friederike Klauke
- Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle, Germany
| | - Bernhard Wilhelm Ullrich
- Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle, Germany
- Clinic for Trauma, Hand and Reconstructive Surgery, University Hospital Halle, Martin Luther University Halle-Wittenberg, Germany
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Vercoulen TF, Niemeyer MJ, Peuker F, Verlaan JJ, Oner FC, Sadiqi S. Surgical treatment of traumatic fractures of the thoracic and lumbar spine: A systematic review. BRAIN & SPINE 2024; 4:102745. [PMID: 38510618 PMCID: PMC10951763 DOI: 10.1016/j.bas.2024.102745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/27/2023] [Accepted: 01/03/2024] [Indexed: 03/22/2024]
Abstract
Introduction The treatment of traumatic thoracic and lumbar spine fractures remains controversial. To date no consensus exists on the correct choice of surgical approach and technique. Research question to provide a comprehensive up-to-date overview of the available different surgical methods and their quantified outcomes. Methods PubMed and EMBASE were searched between 2001 and 2020 using the term 'spinal fractures'. Inclusion criteria were: adults, ≥10 cases, ≥12 months follow-up, thoracic or lumbar fractures, and surgery <3 weeks of trauma. Studies were categorized per surgical technique: Posterior open (PO), posterior percutaneous (PP), stand-alone vertebral body augmentation (SA), anterior scopic (AS), anterior open (AO), posterior percutaneous and anterior open (PPAO), posterior percutaneous and anterior scopic (PPAS), posterior open and anterior open (POAO) and posterior open and anterior scopic (POAS). The PO group was used as a reference group. Results After duplicate removal 6042 articles were identified. A total of 102 articles were Included, in which 137 separate surgical technique cohorts were described: PO (n = 75), PP, (n = 39), SA (n = 12), AO (n = 5), PPAO (n = 1), PPAS (n = 1), POAO (n = 2) and POAS (n = 2). Discussion and conclusion For type A3/A4 burst fractures, without severe neurological deficit, posterior percutaneous (PP) technique seems the safest and most feasible option in the past two decades. If needed, PP can be combined with anterior augmentation to prevent secondary kyphosis. Furthermore, posterior open (PO) technique is feasible in almost all types of fractures. Also, this technique can provide for an additional posterior decompression or fusion. Overall, no neurologic deterioration was reported following surgical intervention.
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Affiliation(s)
- Timon F.G. Vercoulen
- Diakonessenhuis, Department of Orthopedic Surgery, Bosboomstraat 1, 3582, KE, Utrecht, the Netherlands
- University Medical Center Utrecht, Department of Orthopedic Surgery, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - Menco J.S. Niemeyer
- University Medical Center Utrecht, Department of Orthopedic Surgery, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - Felix Peuker
- University Medical Center Utrecht, Department of Orthopedic Surgery, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - Jorrit-Jan Verlaan
- University Medical Center Utrecht, Department of Orthopedic Surgery, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - F. Cumhur Oner
- University Medical Center Utrecht, Department of Orthopedic Surgery, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - Said Sadiqi
- University Medical Center Utrecht, Department of Orthopedic Surgery, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
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Thelen S, Oezel L, Hilss L, Grassmann JP, Betsch M, Wild M. Is restoration of vertebral body height after vertebral body fractures and minimally-invasive dorsal stabilization with polyaxial pedicle screws just an illusion? Arch Orthop Trauma Surg 2024; 144:239-250. [PMID: 37838983 PMCID: PMC10774198 DOI: 10.1007/s00402-023-05082-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 09/18/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION Thoracolumbar spine fractures often require surgical treatment as they are associated with spinal instability. Optimal operative techniques and treatment are discussed controversially. Aim of our prospective cohort study was to investigate the sagittal alignment after reduction, the secondary loss of reduction and the subjective outcome as well as the causal correlation of these parameters after minimally invasive stabilization of thoracic and lumbar fractures with polyaxial pedicle screws. MATERIALS AND METHODS In a single-center study, a total of 78 patients with an average age of 61 ± 17 years who suffered a fracture of the thoracic or lumbar spine were included and subjected to a clinical and radiological follow-up examination after 8.5 ± 8 months. The kyphotic deformity was measured by determining the vertebral body angle, the mono- and bi-segmental wedge angle at three time points. The patients' subjective outcome was evaluated by the VAS spine score. RESULTS After surgical therapy, a significant reduction of the traumatic kyphotic deformity was shown with an improvement of all angles (vertebral body angle: 3.2° ± 4.4°, mono- and bi-segmental wedge angle: 3.1° ± 5.6°, 2.0° ± 6.3°). After follow-up, a significant loss of sagittal alignment was observed for all measured parameters with a loss of correction. However, no correlation between the loss of reduction and the subjective outcome regarding the VAS spine scale could be detected. CONCLUSION The minimally invasive dorsal stabilization of thoracic and lumbar spine fractures with polyaxial pedicle screws achieved a satisfactory reduction of the fracture-induced kyphotic deformity immediately postoperatively with a floss of reduction in the further course. However, maybe the main goal of this surgical procedure should be the prevention of a complete collapse of the vertebral body instead of a long-lasting restoration of anatomic sagittal alignment. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Simon Thelen
- Department of Orthopaedics and Trauma Surgery, University Hospital Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Lisa Oezel
- Department of Orthopaedics and Trauma Surgery, University Hospital Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.
| | - Lena Hilss
- Department of Orthopaedics, Trauma- and Hand Surgery, Klinikum Darmstadt, Darmstadt, Germany
| | - Jan-Peter Grassmann
- Department of Orthopaedics and Trauma Surgery, University Hospital Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Marcel Betsch
- Department of Orthopaedics and Trauma Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Michael Wild
- Department of Orthopaedics, Trauma- and Hand Surgery, Klinikum Darmstadt, Darmstadt, Germany
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Hu B, Wang L, Song Y, Yang X, Liu L, Zhou C. Long-term outcomes of the nano-hydroxyapatite/polyamide-66 cage versus the titanium mesh cage for anterior reconstruction of thoracic and lumbar corpectomy: a retrospective study with at least 7 years of follow-up. J Orthop Surg Res 2023; 18:482. [PMID: 37408000 DOI: 10.1186/s13018-023-03951-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/23/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND The nano-hydroxyapatite/polyamide-66 (n-HA/PA66) cage is a biomimetic cage with a lower elastic modulus than the titanium mesh cage (TMC). This study aimed to compare the long-term outcomes of the n-HA/PA66 cage and TMC in the anterior reconstruction of thoracic and lumbar fractures. METHODS We retrospectively studied 113 patients with acute traumatic thoracic or lumbar burst fractures, comprising 60 patients treated with the TMC and 53 treated with the n-HA/PA66 cage for anterior reconstruction following single-level corpectomy. The radiographic data (cage subsidence, fusion status, segmental sagittal alignment) and clinical data (visual analogue scale (VAS) for pain and Oswestry Disability Index (ODI) for function) were evaluated preoperatively, postoperatively, and at final follow-up after a minimum 7-year period. RESULTS The n-HA/PA66 and TMC groups had similar final fusion rates (96.2% vs. 95.0%). The cage subsidence at final follow-up was 2.3 ± 1.6 mm with subsidence of more than 3 mm occurring in 24.5% in the n-HA/PA66 group, which was significantly lower than the respective values of 3.9 ± 2.5 mm and 58.3% in the TMC group. The n-HA/PA66 group also had better correction of the bisegmental kyphotic angle than the TMC group (7.1° ± 7.5° vs 1.9° ± 8.6°, p < 0.01), with lower loss of correction (2.9° ± 2.5° vs 5.2° ± 4.1°, p < 0.01). The mean ODI steadily decreased after surgery in both groups. At final follow-up, the ODI and VAS were similar in the TMC and n-HA/PA66 groups. CONCLUSIONS The n-HA/PA66 cage is associated with excellent radiographic fusion, better maintenance of the height of the fused segment, and better correction of kyphosis than the TMC during 7 years of follow-up after one-level anterior corpectomy. With the added benefit of radiolucency, the n-HA/PA66 cage may be superior to the TMC in anterior reconstruction of thoracic or lumbar fractures.
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Affiliation(s)
- Bowen Hu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, 610041, Sichuan, China
| | - Liang Wang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, 610041, Sichuan, China
| | - Yueming Song
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, 610041, Sichuan, China
| | - Xi Yang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, 610041, Sichuan, China.
| | - Limin Liu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, 610041, Sichuan, China
| | - Chunguang Zhou
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, 610041, Sichuan, China
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Mugge L, Dang DD, Awan O, Vaughan M, Mui W, Brewer C, Dominick C, Hamilton J. Advantages of Short-Segment Fusion in the Surgical Management of Thoracolumbar Traumatic Fractures: A Case Series and Review of the Literature. Cureus 2023; 15:e39535. [PMID: 37366461 PMCID: PMC10290893 DOI: 10.7759/cureus.39535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 06/28/2023] Open
Abstract
INTRODUCTION Spine trauma is a common pathology that frequently requires neurosurgical intervention. Few studies have examined short-segment, 360-degree stabilization of traumatic thoracolumbar fractures. METHODS A retrospective review was completed of adult and pediatric patients who underwent surgical correction for thoracolumbar fractures between December 2011 and December 2021. RESULTS Forty patients met the inclusion criteria. The majority of patients presented with an American Spinal Injury Association (ASIA) score of D (n = 11) or E (n = 21). The most common level of injury was L1 (n = 20). The average length of stay was 11.7 days. Postoperatively, two patients had pulmonary emboli or deep venous thrombosis, and two had surgical site infections. Most patients were discharged to home (n = 21) or acute rehab (n = 14). The fusion rate at six months was 97.5%. Neurologically, all patients regained ambulation by >18 months follow-up. For the ASIA scale, most had a score of D (n = 4) or E (n = 32) at six months. The same trend was observed with the Frankel score, where most patients had either D (n = 5) or E (n = 31), improving to only two having a score of D at >18 months. CONCLUSIONS Corpectomy followed by posterior fusion has a number of biomechanical benefits. This construct permits circumferential decompression, larger surface area for fusion, improved reconstitution of vertebral body height, reduced kyphosis, and an overall shorter segment. This results in fewer levels needing to be fused while enabling the greatest changes of successful fusion.
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Affiliation(s)
- Luke Mugge
- Neurological Surgery, Inova Neuroscience and Spine Institute, Falls Church, USA
| | - Danielle D Dang
- Neurological Surgery, Inova Fairfax Medical Campus, Falls Church, USA
| | - Omar Awan
- Neurological Surgery, Inova Fairfax Medical Campus, Falls Church, USA
| | - Megan Vaughan
- Neurosurgery, Inova Neuroscience and Spine Institute, Falls Church, USA
| | - Wenli Mui
- Neurosurgery, Inova Neuroscience and Spine Institute, Falls Church, USA
| | - Cristie Brewer
- Neurosurgery, Inova Neuroscience and Spine Institute, Falls Church, USA
| | - Conner Dominick
- Neurological Surgery, Inova Neuroscience and Spine Institute, Falls Church, USA
| | - John Hamilton
- Neurological Surgery, Inova Neuroscience and Spine Institute, Falls Church, USA
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Biomechanical evaluation of position and bicortical fixation of anterior lateral vertebral screws in a porcine model. Sci Rep 2023; 13:454. [PMID: 36624133 PMCID: PMC9829755 DOI: 10.1038/s41598-023-27433-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 01/02/2023] [Indexed: 01/10/2023] Open
Abstract
Although an anterior approach with anterior lateral screw fixation has been developed for stabilizing the thoracolumbar spine clinically, screw loosening still occurs. In this novel in vitro study, we attempted to elucidate the optimal screw position in the lateral lumbar vertebra and the effect of bicortical fixation. A total of 72 fresh-frozen lumbar vertebrae from L1-6 were harvested from 12 mature pigs and randomly assigned to two modalities: bicortical fixation (n = 36) and unicortical fixation (n = 36). Six groups of screw positions in the lateral vertebral body in each modality were designated as central-anterior, central-middle, central-posterior, lower-anterior, lower-middle, and lower- posterior; 6 specimens were used in each group. The correlations between screw fixation modalities, screw positions and axial pullout strength were analyzed. An appropriate screw trajectory and insertional depth were confirmed using axial and sagittal X-ray imaging prior to pullout testing. In both bicortical and unicortical fixation modalities, the screw pullout force was significantly higher in the posterior or middle position than in the anterior position (p < 0.05), and there was no significant differences between the central and lower positions. The maximal pullout forces from the same screw positions in unicortical fixation modalities were all significantly lower, decreases that ranged from 32.7 to 74%, than those in bicortical fixation modalities. Our study using porcine vertebrae showed that screws in the middle or posterior position of the lateral vertebral body had a higher pullout performance than those in the anterior position. Posteriorly positioned lateral vertebral screws with unicortical fixation provided better stability than anteriorly positioned screws with bicortical fixation.
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Wiendieck K, Dörfler A, Sommer B. Extended salvage surgery after high-dose chemoradiation therapy for tumors in the cervico-thoracic junction with invasion of the chest wall and the spine: a case series. J Surg Case Rep 2022; 2022:rjac581. [PMID: 36601096 PMCID: PMC9800033 DOI: 10.1093/jscr/rjac581] [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: 10/30/2022] [Accepted: 11/26/2022] [Indexed: 12/31/2022] Open
Abstract
The treatment of malignant tumors localized in the upper thoracic cavity and involving the spine at the cervico-thoracic junction (CTJ) is challenging. We report on three patients with malignant tumors invading the thoracic inlet and the spine at the CTJ. All three patients underwent radical tumor resection and 360° spine fusion following the posterior pedicle screw instrumentation and anterior vertebrectomy combined with implantation of an expandable titanium cage. Postoperatively, a mild paresis with hypesthesia of the ipsilateral arm occurred in one patient because of brachial plexus involvement. Two patients were still alive at last follow-up after 83 and 143 months, the third patient succumbed to tumor progression 13 months after extended salvage surgery. We display the possibilities of extended 'salvage' therapy in well-selected patients that were deemed hopeless regarding neurological function, biomechanical stability and tumor control after multiple courses of combined radio-chemotherapy.
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Affiliation(s)
- Kurt Wiendieck
- Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany,Department of Spine Surgery, Kliniken Dr. Erler gGmbH, Nürnberg, Germany
| | - Arnd Dörfler
- Department of Neuroradiology, University Hospital Erlangen, Erlangen, Germany
| | - Björn Sommer
- Correspondence address. Department of Neurosurgery, University Hospital Augsburg, Stenglinstraße 2, 86156 Augsburg, Germany. Tel: +49 821 400165684; Fax: +49 821 400 3314; E-mail:
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Optimization of Spinal Reconstructions for Thoracolumbar Burst Fractures to Prevent Proximal Junctional Complications: A Finite Element Study. Bioengineering (Basel) 2022; 9:bioengineering9100491. [DOI: 10.3390/bioengineering9100491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/17/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022] Open
Abstract
The management strategies of thoracolumbar (TL) burst fractures include posterior, anterior, and combined approaches. However, the rigid constructs pose a risk of proximal junctional failure. In this study, we aim to systemically evaluate the biomechanical performance of different TL reconstruction constructs using finite element analysis. Furthermore, we investigate the motion and the stress on the proximal junctional level adjacent to the constructs. We used a T10-L3 finite element model and simulated L1 burst fracture. Reconstruction with posterior instrumentation (PI) alone (U2L2 and U1L1+(intermediate screw) and three-column spinal reconstruction (TCSR) constructs (U1L1+PMMA and U1L1+Cage) were compared. Long-segment PI resulted in greater global motion reduction compared to constructs with short-segment PI. TCSR constructs provided better stabilization in L1 compared to PI alone. Decreased intradiscal and intravertebral pressure in the proximal level were observed in U1L1+IS, U1L1+PMMA, and U1L1+Cage compared to U2L2. The stress and strain energy of the pedicle screws decreased when anterior reconstruction was performed in addition to PI. We showed that TCSR with anterior reconstruction and SSPI provided sufficient immobilization while offering additional advantages in the preservation of physiological motion, the decreased burden on the proximal junctional level, and lower risk of implant failure.
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Tanasansomboon T, Kittipibul T, Limthongkul W, Yingsakmongkol W, Kotheeranurak V, Singhatanadgige W. Thoracolumbar burst fracture without neurological deficit: Review of the controversies and current evidence of treatment. World Neurosurg 2022; 162:29-35. [DOI: 10.1016/j.wneu.2022.03.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/13/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
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Ruf M, Pitzen T, Nennstiel I, Volkheimer D, Drumm J, Püschel K, Wilke HJ. The effect of posterior compression of the facet joints for initial stability and sagittal profile in the treatment of thoracolumbar fractures: a biomechanical 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 2021; 31:28-36. [PMID: 34773149 DOI: 10.1007/s00586-021-07034-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 08/01/2021] [Accepted: 10/11/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Surgical treatment of thoracolumbar A3-fractures usually comprises posterior fixation-in neutral position or distraction-potentially followed by subsequent anterior support. We hypothesized that additional posterior compression in circumferential stabilization may increase stability by locking the facets, and better restore the sagittal profile. METHODS Burst fractures Type A3 were created in six fresh frozen cadaver spine segments (T12-L2). Testing was performed in a custom-made spinal loading simulator. Loads were applied as pure bending moments of ± 3.75 Nm in all six movement axes. We checked range of motion, neutral zone and Cobb's angle over the injured/treated segment within the following conditions: Intact, fractured, instrumented in neutral alignment, instrumented in distraction, with cage left in posterior distraction, with cage with posterior compression. RESULTS We found that both types of instrumentation with cage stabilized the segment compared to the fractured state in all motion planes. For flexion/extension and lateral bending, flexibility was decreased even compared to the intact state, however, not in axial rotation, being the most critical movement axis. Additional posterior compression in the presence of a cage significantly decreased flexibility in axial rotation, thus achieving stability comparable to the intact state even in this movement axis. In addition, posterior compression with cage significantly increased lordosis compared to the distracted state. CONCLUSION Among different surgical modifications tested, circumferential fixation with final posterior compression as the last step resulted in superior stability and improved sagittal alignment. Thus, posterior compression as the last step is recommended in these pathologies.
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Affiliation(s)
- Michael Ruf
- Center for Spine Surgery, Orthopedics, and Traumatology, SRH Klinikum Karlsbad-Langensteinbach, Guttmannstrasse 1, 76307, Karlsbad, Germany
| | - Tobias Pitzen
- Center for Spine Surgery, Orthopedics, and Traumatology, SRH Klinikum Karlsbad-Langensteinbach, Guttmannstrasse 1, 76307, Karlsbad, Germany
| | - Ivo Nennstiel
- Center for Orthopedic Surgery and Traumatology, SRH Central Hospital Suhl, Albert-Schweitzer-Strasse 2, 98527, Suhl, Germany
| | - David Volkheimer
- Institute of Orthopaedic Research and Biomechanics, University of Ulm, Helmholtzstrasse 14, 89901, Ulm, Germany
| | - Jörg Drumm
- Center for Spine Surgery, Orthopedics, and Traumatology, SRH Klinikum Karlsbad-Langensteinbach, Guttmannstrasse 1, 76307, Karlsbad, Germany
| | - Klaus Püschel
- Department of Legal Medicine, University Hospital Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Germany
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, University of Ulm, Helmholtzstrasse 14, 89901, Ulm, Germany.
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Jordan MC, Jansen H, Meffert RH, Heintel TM. Comparing porous tantalum fusion implants and iliac crest bone grafts for spondylodesis of thoracolumbar burst fractures: Prospectice Cohort study. Sci Rep 2021; 11:17409. [PMID: 34465811 PMCID: PMC8408264 DOI: 10.1038/s41598-021-96400-w] [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: 06/29/2021] [Accepted: 08/10/2021] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to compare two different techniques of performing one-level spondylodesis for thoracolumbar burst fractures using either an autologous iliac crest bone graft (ICBG) or a porous tantalum fusion implant (PTFI). In a prospective nonrandomized study, 44 patients (20 women, 24 men; average age 43.1 ± 13.2 years) suffering from severe thoracolumbar burst fractures were treated with combined anterior–posterior stabilization. An ICBG was used in 21 cases, and a PTFI was used in the other 23 cases. A two-year clinical and radiographic follow-up was carried out. There were no statistically significant differences in age, sex, localization/classification of the fracture, or visual analog scale (VAS) before injury between the two groups. All 44 patients were followed up for an average period of 533 days (range 173–1567). The sagittal spinal profile was restored by an average of 11.1° (ICBG) vs. 14.3° (PTFI) (monosegmental Cobb angle). Loss of correction until the last follow-up tended to be higher in the patients treated with ICBG than in those treated with PTFI (mean: 2.8° vs. 1.6°). Furthermore, significantly better restoration of the sagittal profile was obtained with the PTFI than with the iliac bone graft at the long-term follow-up (mean: ICBG 7.8°, PTFI 12.3°; p < 0.005). Short-segment posterior instrumentation combined with anterior one-level spondylodesis using either an ICBG or a PTFI resulted in sufficient correction of posttraumatic segmental kyphosis. PTFI might be a good alternative for autologous bone grafting and prevent donor site morbidities.
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Affiliation(s)
- Martin C Jordan
- Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Julius-Maximilians-University, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
| | - Hendrik Jansen
- Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Julius-Maximilians-University, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Rainer H Meffert
- Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Julius-Maximilians-University, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Timo M Heintel
- Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Julius-Maximilians-University, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
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Hughes H, Carthy AM, Sheridan GA, Donnell JM, Doyle F, Butler J. Thoracolumbar Burst Fractures: A Systematic Review and Meta-Analysis Comparing Posterior-Only Instrumentation Versus Combined Anterior-Posterior Instrumentation. Spine (Phila Pa 1976) 2021; 46:E840-E849. [PMID: 34228696 DOI: 10.1097/brs.0000000000003934] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Meta-analysis. OBJECTIVE To compare the clinical, functional, and radiological outcomes of posterior-only versus combined anterior-posterior instrumentation in order to determine the optimal surgical intervention for thoracolumbar burst fractures. SUMMARY OF BACKGROUND DATA Unstable thoracolumbar burst fractures warrant surgical intervention to prevent neurological deterioration and progressive kyphosis, which can lead to significant pain and functional morbidity. The available literature remains largely inconclusive in determining the optimal instrumentation strategy. METHODS Electronic searches of MEDLINE (1948-May 2020), EMBASE (1947-May 2020), The Cochrane Library (1991-May 2020), and other databases were conducted. Cochrane Collaboration guidelines were used for data extraction and quality assessment. Outcomes of interest were divided into three categories: radiological (degree of postoperative kyphosis correction; loss of kyphosis correction at final follow-up), functional (visual analogue scale [VAS] pain score; Oswestry Disability Index [ODI] score), and clinical (intraoperative blood loss; length of stay [LOS]; operative time; the number and type of postoperative complications). RESULTS Four randomized control trials (RCTs) were retrieved, including 145 randomized participants. Seventy-three patients underwent posterior-only instrumentation and 72 underwent combined instrumentation. No significant difference was found in the degree of postoperative kyphosis correction (P = 0.39), VAS (centimeters) at final follow-up (P = 0.67), ODI at final follow-up (P = 0.89) or the number of postoperative complications between the two approaches (P = 0.49). Posterior-only instrumentation was associated with lower blood loss (P < 0.001), operative time (P < 0.001), and LOS (P = 0.01). Combined instrumentation had a lower degree of kyphosis loss at final follow-up (P = 0.001). There was heterogeneity in the duration of follow-up between the included studies (mean follow-up range 24-121 months). CONCLUSION The available literature remains largely inconclusive. In order to reliably inform practice in this area, there is a need for large, high-quality, multicenter RCTs with standardized reporting of outcomes, with a particular focus on outcomes relating to patient function and severe complications causing long-term morbidity.Level of Evidence: 2.
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Affiliation(s)
- Hannah Hughes
- Department of Trauma and Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Andrea Mc Carthy
- Department of Trauma and Orthopaedic Surgery, Cork University Hospital, Wilton, Cork, Ireland
| | - Gerard Anthony Sheridan
- Department of Trauma and Orthopaedic Surgery, Cork University Hospital, Wilton, Cork, Ireland
| | - Jake Mc Donnell
- Department of Trauma and Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Frank Doyle
- Faculty of Medicine and Health Sciences, School of Postgraduate Studies, Royal College of Surgeons in Ireland, Ireland
| | - Joseph Butler
- Department of Trauma and Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
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[Local spinal profile following operative treatment of thoracolumbar and lumbar fractures : Impact of reduction technique and bone quality]. Unfallchirurg 2021; 125:295-304. [PMID: 34110429 PMCID: PMC8940758 DOI: 10.1007/s00113-021-01013-7] [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] [Subscribe] [Scholar Register] [Accepted: 04/22/2021] [Indexed: 01/14/2023]
Abstract
Hintergrund Ziel der Operation von Wirbelsäulenverletzungen ist eine stabile Ausheilung in physiologischer Stellung. Für offene und perkutane Operationen stehen unterschiedliche Techniken zur Verfügung. Fragestellung Das Ausmaß der offenen Reposition und das Retentionspotenzial der Techniken nach AOSpine (AT) und nach Kluger (KT) sollen verglichen werden. Der Einfluss von Frakturmorphologie, Alter, Geschlecht und Knochenqualität auf Reposition und Retention werden untersucht. Material und Methoden In dieser monozentrischen retrospektiven Kohortenstudie wurden Daten von Patienten mit traumatischen thorakolumbalen und lumbalen Frakturen untersucht, welche entweder mit AT oder KT reponiert wurden. Mittels bisegmentalen Grund-Deckplatten-Winkels (bGDW) wurde die Stellung des verletzten Wirbelsäulenabschnitts beschrieben. Normalwerte für die bGDW wurden anhand von Literaturdaten angenommen. Die Veränderung des bGDW im zeitlichen Verlauf wurde unter Einbeziehung der Knochenqualität in Hounsfield Units (HU), der Verletzungsschwere nach AOSpine und des Patientenalters und -geschlechts analysiert. Ergebnisse Es wurden 151 Datensätze ausgewertet. Beide Methoden reponieren vom Umfang nicht unterschiedlich (AT 10 ± 6°, KT 11 ± 8°; p = 0,786). Im Follow-up trat ein Korrekturverlust von −5 ± 4° auf. Die Technik (p = 0,998) hatte keinen Einfluss darauf. Die Frakturmorphologie zeigte einen knapp signifikanten Einfluss (p = 0,043). Niedrige HU korrelierten mit geringerem Repositionsumfang (r = 0,241, p < 0,003) und größerem Korrekturverlust (r = 0,272, p < 0,001) signifikant, aber schwach. In der Altersgruppe 50 bis 65 Jahre wiesen 21 % der Männer und 43 % der Frauen eine Knochenqualität von HU < 110 auf. Alter und HU korrelieren signifikant (r = −0,701, p < 0,001). Diskussion Die Techniken sind gleichwertig bezüglich der Repositions- und Retentionseigenschaften. Der hohe Anteil von Patienten mit HU < 110 in der Gruppe unter 65 Jahren bei Frauen und Männern und der Einfluss auf Reposition und Retention weisen auf die Notwendigkeit einer präoperativen Knochendichtemessung hin.
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15
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Eliseyev AS, Bokov AE, Mlyavykh SG, Mordvinov AA. [Philosophy of some problems of spine neurosurgery]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2021; 85:28-35. [PMID: 33560618 DOI: 10.17116/neiro20218501128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The development of spine neurosurgery raises some questions concerning the methodology, practical significance, treatment and diagnosis of spinal diseases. In this regard, we inevitably turn to the methods of philosophical knowledge as a basis for analysis and synthesis of scientific information. This approach allows you to avoid mistakes in practice, which can have negative ethical and socio-economic consequences for society. Some controversial issues of spine surgery are discussed in the manuscript. Advisability of syndromic approach in the treatment of spine diseases, determining the length of spine fusion for injury, prediction of postoperative segmental instability due to osteoporosis and extrapolation of the principles of spine fusion surgery to arthroplasty are considered through the prism of philosophical categories.
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Affiliation(s)
- A S Eliseyev
- Privolzhsky Research Medical University, Nizhniy Novgorod, Russia
| | - A E Bokov
- Privolzhsky Research Medical University, Nizhniy Novgorod, Russia
| | - S G Mlyavykh
- Privolzhsky Research Medical University, Nizhniy Novgorod, Russia
| | - A A Mordvinov
- Privolzhsky Research Medical University, Nizhniy Novgorod, Russia
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16
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Hoffmann C, Spiegl UJ, Paetzold R, Devitt B, Hauck S, Weiss T, Bühren V, Gonschorek O. Long-term results after thoracoscopic anterior spondylodesis with or without posterior stabilization of unstable incomplete burst fractures of the thoracolumbar junction: a prospective cohort study. J Orthop Surg Res 2020; 15:412. [PMID: 32933516 PMCID: PMC7493159 DOI: 10.1186/s13018-020-01807-2] [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: 05/14/2020] [Accepted: 07/16/2020] [Indexed: 11/18/2022] Open
Abstract
Background Minimally invasive, thoracoscopic anterior spondylodesis (MIAS) is an established treatment for burst fractures of the thoracolumbar spine. Good restoration of the local sagittal alignment and good functional results have been reported. The aim of this study was to evaluate long-term results of MIAS in patients with incomplete burst fractures and to analyze the influence on global sagittal alignment, clinical outcomes, and adjacent segment degeneration. Methods From 2002 to 2003, 18 patients were treated with MIAS for incomplete thoracolumbar burst fractures. Mono-segmental spondylodesis was performed with an iliac crest bone graft and bisegmental spondylodesis with a titanium cage. In this single-center prospective cohort study, 15 patients were available for follow-up (FU) after an average of 12.9 years (12.1–14.4). Seven patients were treated with a combined anterior and posterior instrumentation and eight patients with anterior spondylodesis only. The primary clinical outcome parameter was the Oswestry Disability Index (ODI); secondary parameters were the Short Form 36 (SF36) and the visual analog scale (VAS spine). Full spine radiographs were assessed for bisegmental Cobb angle, alignment parameters, and signs of adjacent segment degeneration (ASD). Results ODI evaluation showed a mean impairment of 11.7% with minimal limitations in 13 patients. Neither a significant deterioration over time nor significant differences between both therapy strategies were found in the clinical scores at the latest follow-up. The mean bisegmental increase of regional malalignment of reduction was 8.8° (± 7.3°) with no significant correlation to any clinical outcome scores. The majority of patients had no signs of adjacent segment degeneration. Two patients showed minor radiologic changes. All patients had a balanced sagittal spine profile. Conclusions In conclusion, MIAS leads to good clinical results with—in majority—minimal spine-related impairment at the latest follow-up. No significant deterioration at 12-year FU was detectable compared to the 6-year results for the SF36 and VAS spine scores. There was no association between sagittal alignment, clinical outcome scores, and ASD. Trial registration The study was retrospectively registered in the German Clinical Trials Register (Nr.00015656).
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Affiliation(s)
- Christof Hoffmann
- Department of Orthopaedic and Trauma Surgery, BG Trauma Center Murnau, Professor Küntscher Str. 8, 82418, Murnau, Germany.
| | - Ulrich Josef Spiegl
- Department of Orthopaedics, Trauma Surgery and Reconstructive Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Robert Paetzold
- Department of Orthopaedic and Trauma Surgery, BG Trauma Center Murnau, Professor Küntscher Str. 8, 82418, Murnau, Germany
| | - Brian Devitt
- OrthoSport Victoria, Richmond, Victoria, Australia
| | - Stefan Hauck
- Department of Orthopaedic and Trauma Surgery, BG Trauma Center Murnau, Professor Küntscher Str. 8, 82418, Murnau, Germany
| | - Thomas Weiss
- Department of Orthopaedic and Trauma Surgery, BG Trauma Center Murnau, Professor Küntscher Str. 8, 82418, Murnau, Germany
| | - Volker Bühren
- Department of Orthopaedic and Trauma Surgery, BG Trauma Center Murnau, Professor Küntscher Str. 8, 82418, Murnau, Germany
| | - Oliver Gonschorek
- Department of Orthopaedic and Trauma Surgery, BG Trauma Center Murnau, Professor Küntscher Str. 8, 82418, Murnau, Germany
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Xue X, Zhao S. Posterior monoaxial screw fixation combined with distraction-compression technology assisted endplate reduction for thoracolumbar burst fractures: a retrospective study. BMC Musculoskelet Disord 2020; 21:17. [PMID: 31918703 PMCID: PMC6953158 DOI: 10.1186/s12891-020-3038-6] [Citation(s) in RCA: 4] [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] [Received: 08/28/2019] [Accepted: 01/02/2020] [Indexed: 11/29/2022] Open
Abstract
Background The management of thoracolumbar burst fractures traditionally involves posterior pedicle screw fixation, but it has some drawbacks. The aim of this study is to evaluate the clinical and radiological outcomes of patients with thoracolumbar burst fractures. They were treated by a modified technique that monoaxial pedicle screws instrumentation and distraction-compression technology assisted end plate reduction. Methods From March 2014 to February 2016, a retrospective study including 42 consecutive patients with thoracolumbar burst fractures was performed. The patients had undergone posterior reduction and instrumentation with monoaxial pedicle screws. The fractured vertebrae were also inserted screws as a push point. The distraction -compression technology was used as assisting end plate reduction. All patients were followed up at a minimum of 2 years. These parameters including segmental kyphosis, severity of fracture, neurological function, canal compromise and back pain were evaluated in preoperatively, postoperatively and at the final follow-up. Results The average follow-up period was 28.9 ± 4.3 months (range, 24-39mo). No patients had postoperative implant failure at recent follow-up. The mean Cobb angle of the kyphosis was improved from 14.2°to 1.1° (correction rate 92.1%). At final follow-up there was 1.5% loss of correction. The mean preoperative wedge angle was improved from 17.1 ± 7.9°to 4.4 ± 3.7°(correction rate 74.3%). The mean anterior and posterior vertebral height also showed significant improvements postoperatively, which were maintained at the final follow-up(P < 0.05). The mean visual analogue scale (VAS) scores was 8 and 1.6 in preoperation and at the last follow-up, and there was significant difference (p < 0.05). Conclusion Based on our experience, distraction-compression technology can assist reduction of collapsed endplate directly. Satisfactory fracture reduction and correction of segmental kyphosis can be achieved and maintained with the use of monoaxial pedicle screw fixation including the fractured vertebra. It may be a good treatment approach for thoracolumbar burst fractures.
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Affiliation(s)
- Xuhong Xue
- Department of Orthopedics, The Second Hospital of Shanxi Medical University, No. 382 Wuyi Road, Taiyuan, Shanxi, 030001, People's Republic of China
| | - Sheng Zhao
- Department of Orthopedics, The Second Hospital of Shanxi Medical University, No. 382 Wuyi Road, Taiyuan, Shanxi, 030001, People's Republic of China.
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Liu J, He X, Gao Z, Niu B, Lv D, Gao Y. Design and preliminary biomechanical analysis of a novel motion preservation device for lumbar spinal disease after vertebral corpectomy. Arch Orthop Trauma Surg 2019; 139:751-760. [PMID: 30747259 DOI: 10.1007/s00402-018-03106-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To design a novel prosthesis, a movable artificial lumbar complex (MALC), for non-fusion reconstruction after lumbar subtotal corpectomy and to evaluate the stability, range of motion and load-bearing strength in the human cadaveric lumbar spine. METHODS Biomechanical tests were performed on lumbar spine specimens from 15 healthy cadavers which were divided in three groups: non-fusion, fusion and intact group. The range of motion (ROM), stability and load-bearing strength were measured. RESULTS The prosthesis was composed of three parts: the upper and lower artificial lumbar discs and the middle artificial vertebra. Both the MALC and titanium mesh cage re-established vertebral height, and no spinal cord compression or prosthesis dislocation was observed at the operative level. Regarding stability, there was no significant difference in all directions between the intact group and non-fusion group (P > 0.05). Segment movements of the specimens in the non-fusion group revealed significantly decreased T12-L1 ROM and significantly increased L1-2 and L2-3 ROM in flexion/extension and lateral bending compared with those in the fusion group (P < 0.05). Regarding load-bearing strength, when the lumbar vertebra was ruptured, there was no damage to the MALC and titanium mesh cage, but the maximum load in the non-fusion group was larger (P > 0.05). CONCLUSIONS Compared with titanium cages, the MALC prosthesis not only restored the vertebral height and effectively preserved segment movements without any abnormal gain of mobility in adjacent inter-vertebral spaces but also bore the lumbar load and reduced the local stress load of adjacent vertebral endplates.
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Affiliation(s)
- Jiantao Liu
- Department of Spine and Spinal Cord, Henan Provincial People's Hospital, No.7, the Weft Fifth Road, Jinshui District, Zhengzhou, Henan, People's Republic of China
| | - Xijing He
- Department of Orthopedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Zhengchao Gao
- Department of Orthopedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Binbin Niu
- Department of Orthopedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Dongbo Lv
- Department of Spine and Spinal Cord, Henan Provincial People's Hospital, No.7, the Weft Fifth Road, Jinshui District, Zhengzhou, Henan, People's Republic of China
| | - Yanzheng Gao
- Department of Spine and Spinal Cord, Henan Provincial People's Hospital, No.7, the Weft Fifth Road, Jinshui District, Zhengzhou, Henan, People's Republic of China.
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19
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Spiegl UJ, Devitt BM, Kasivskiy I, Jarvers JS, Josten C, Heyde CE, Fakler HM. Comparison of combined posterior and anterior spondylodesis versus hybrid stabilization in unstable burst fractures at the thoracolumbar spine in patients between 60 and 70 years of age. Arch Orthop Trauma Surg 2018; 138:1407-1414. [PMID: 30008109 DOI: 10.1007/s00402-018-2993-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Surgical treatment of unstable burst fractures of the thoracolumbar spine in the elderly population is highly variable with combined posterior and anterior stabilization (CPAS) and posterior augmented stabilization with cementation of the vertebral body (hybrid) being two commonly used techniques. The aim of this study was to compare the clinical and radiographic outcomes of CPAS versus hybrid stabilization for the treatment of unstable burst fractures of the thoracolumbar spine in patients aged between 60 and 70 years. MATERIALS AND METHODS A retrospective analysis was performed of all thoracolumbar burst fractures treated surgically in a single level I trauma center between June 2013 and February 2015. Two commonly used strategies of surgical stabilization were compared; the first consisted of initial posterior reduction and bisegmental stabilization, followed by additional anterior spondylodesis (CPAS); the second method comprised a hybrid technique with a posterior cement augmented bisegmental minimally invasive stabilization and kyphoplasty of the fractured vertebral body. Patients were evaluated clinically after a minimum follow-up of 18 months. The primary endpoint was the Oswestry Disability Index (ODI) at the latest follow-up. Secondary parameters of interest were length of in-hospital stay (LIHS), duration of surgery (DS), surgical revisions (SR), pain level (P-VAS), satisfaction level and the SF-36 score (PSC, MSC), the bisegmental postoperative Cobb angle, the reduction loss (RL), and all alignment parameters (pelvic tilt, pelvic incidence, sacral slope, lumbar lordosis, C7 plumb line). RESULTS A total of 29 patients were included (17 females, 12 males, mean age 65.6 years ± 3.4 years). The following vertebral bodies were fractured: thoracic level (T) 12: n = 6; lumbar (L) 1: n = 14; L 2: n = 6; L 3: n = 3. CPAS was performed in 10 patients (34%), whereas the hybrid was carried out in 19 patients (66%). There were no statistical significant differences between both study groups regarding age, gender, trauma energy, fracture level, and fracture morphology. The latest follow-up was performed after a mean of 27 months (range 18-53 months). The LIHS between the treatment methods was statistically significant (p < 0.01); CPAS-mean 24 days versus hybrid-mean 12 days. DS was also significantly longer in patients treated with CPAS, 254 versus 95 min for the hybrid group (p < 0.01). No SR were necessary in either group. No significant differences were found regarding the clinical and radiological outcomes between the groups. The mean ODI score was 13.6 in the CPAS patients compared to 10.8 in the hybrid patients without significant differences between the groups. The majority of patients had no (80%) or minor (13%) limitations according to the ODI score. The P-VAS was 2.8 in CPAS and 2.9 in the hybrid group. RL was 7.1° in CPAS and 4.2° in the hybrid group. CONCLUSIONS CPAS and hybrid stabilization provide safe and promising short- and middle-term results in patients between 60 and 70 years of age. The majority of patients demonstrated no disability or minimal limitations with either technique. CPAS resulted in prolonged inpatient hospital stays, longer duration of surgery compared to hybrid stabilization without significant differences in clinical and radiological outcome.
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Affiliation(s)
- Ulrich J Spiegl
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
| | - Brian M Devitt
- Department of Hip Arthroscopy, Hip Arthroscopy Australia, 21-23 Erin Street, Melbourne, VIC, 3121, Australia
| | - Ihor Kasivskiy
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Jan-Sven Jarvers
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Christoph Josten
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Christoph-Eckhard Heyde
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Hannes M Fakler
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
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20
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Verheyden AP, Spiegl UJ, Ekkerlein H, Gercek E, Hauck S, Josten C, Kandziora F, Katscher S, Kobbe P, Knop C, Lehmann W, Meffert RH, Müller CW, Partenheimer A, Schinkel C, Schleicher P, Scholz M, Ulrich C, Hoelzl A. Treatment of Fractures of the Thoracolumbar Spine: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU). Global Spine J 2018; 8:34S-45S. [PMID: 30210959 PMCID: PMC6130107 DOI: 10.1177/2192568218771668] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
STUDY DESIGN consensus paper with systematic literature review. OBJECTIVE The aim of this study was to establish recommendations for treatment of thoracolumbar spine fractures based on systematic review of current literature and consensus of several spine surgery experts. METHODS The project was initiated in September 2008 and published in Germany in 2011. It was redone in 2017 based on systematic literature review, including new AOSpine classification. Members of the expert group were recruited from all over Germany working in hospitals of all levels of care. In total, the consensus process included 9 meetings and 20 hours of video conferences. RESULTS As regards existing studies with highest level of evidence, a clear recommendation regarding treatment (operative vs conservative) or regarding type of surgery (posterior vs anterior vs combined anterior-posterior) cannot be given. Treatment has to be indicated individually based on clinical presentation, general condition of the patient, and radiological parameters. The following specific parameters have to be regarded and are proposed as morphological modifiers in addition to AOSpine classification: sagittal and coronal alignment of spine, degree of vertebral body destruction, stenosis of spinal canal, and intervertebral disc lesion. Meanwhile, the recommendations are used as standard algorithm in many German spine clinics and trauma centers. CONCLUSION Clinical presentation and general condition of the patient are basic requirements for decision making. Additionally, treatment recommendations offer the physician a standardized, reproducible, and in Germany commonly accepted algorithm based on AOSpine classification and 4 morphological modifiers.
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Affiliation(s)
- Akhil P. Verheyden
- Clinic for Trauma, Orthopaedic and Spine Surgery, Lahr, Germany,These authors contributed equally to this article.,Akhil P. Verheyden, Clinic for Trauma, Orthopaedic and Spine Surgery, Lahr, 77933, Germany.
| | - Ulrich J. Spiegl
- Klinik für Orthopädie, Unfallchirurgie und plastische Chirurgie, Leipzig, Germany,These authors contributed equally to this article
| | | | - Erol Gercek
- Zentrum für Unfallchirurgie und Orthopädie, Koblenz, Germany
| | - Stefan Hauck
- Clinic for Trauma, Orthopaedic and Spine Surgery, Lahr, Germany
| | - Christoph Josten
- Klinik für Orthopädie, Unfallchirurgie und plastische Chirurgie, Leipzig, Germany
| | - Frank Kandziora
- Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, Frankfurt am Main, Germany
| | - Sebastian Katscher
- Leitender Arzt Orthopädie / Unfallchirurgie, Sana Klinikum Borna, Borna, Germany
| | - Philipp Kobbe
- Sektion Becken- und Wirbelsäulenchirurgie, Uniklinik RWTH Aachen, Aachen, Germany
| | - Christian Knop
- Klinik für Unfallchirurgie und Orthopädie, Klinikum Stuttgart, Katharinenhospital, Stuttgart, Germany
| | - Wolfgang Lehmann
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Goettingen, Göttingen, Germany
| | - Rainer H. Meffert
- Klinik und Poliklinik für Unfall-, Hand-, Plastische- und Wiederherstellungschirurgie, Universitätsklinik Würzburg, Würzburg, Germany
| | - Christian W. Müller
- Unfallchirurgische Klinik, Medizinische Hochschule Hannover, Hannover, Germany
| | | | - Christian Schinkel
- Klinik für Unfallchirurgie, Handchirurgie und Orthopädie, Klinikum Memmingen, Memmingen, Germany
| | - Philipp Schleicher
- Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, Frankfurt am Main, Germany
| | - Matti Scholz
- Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, Frankfurt am Main, Germany
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