Clinical efficacy of semi-laminectomy and posterior stabilization for treatment of thoracolumbar burst fracture

The Impact of Urgent (<8 Hours) Decompression on Neurologic Recovery in Traumatic Spinal Cord Injury: A Meta-Analysis

OBJECTIVE

The relationship between urgent decompression and neurologic recovery for traumatic spinal cord injury (TSCI) remains controversial. This meta-analysis was conducted to determine the beneficial effects of surgery within 8 hours for patients with TSCI.

METHODS

A systematic search in EMBASE, MEDLINE, Cochrane Library, and PubMed for relevant studies was conducted from the earliest records until December 2019. Studies that compared outcomes of early (<8 hours) surgery versus late (≥8 hours) surgery for patients with TSCI were selected for analysis.

RESULTS

Nine cohort studies involving 716 participants met the eligibility criteria. Early (<8 hours) surgery for patients showed a more significant improvement in American Spinal Injury Association scores (standardized mean difference, 0.75, 95% confidence interval [CI], 0.51-0.99; P < 0.05). Especially for patients with initial complete TSCI, neurologic improvement rate significantly increased in the early surgery group (relative ratio [RR], 3.96; 95% CI, 2.02-7.76; P < 0.05), whereas in patients with initial incomplete TSCI, no significant differences were found between the 2 groups in neurologic improvement rate (RR, 1.41; 95% CI, 0.95-2.10; P > 0.05). There were no significant differences between the 2 groups in length of hospital stay (standardized mean difference, 0.34; 95% CI, -0.24 to 0.92; P > 0.05) and complications (RR, 0.92; 95% CI, 0.70-1.22; P > 0.05).

CONCLUSIONS

This meta-analysis provides evidence of benefits from urgent (<8 hours) decompression for patients with TSCI in terms of neurologic recovery. The improvement effect is more definite in patients with initial complete TSCI.

Management of Pediatric Posttraumatic Thoracolumbar Vertebral Body Burst Fractures by Use of Single-Stage Posterior Transpedicular Approach

PURPOSE

The posterior transpedicular approach (PTA) is a posterior approach that has the advantage of achieving circumferential arthrodesis by a single posterior-only approach. The purpose of this study was to analyze our experience with PTA in the management of pediatric traumatic thoracolumbar burst fractures (TTLBFs).

METHODS

Consecutive pediatric patients (age ≤18 years) with TTLBFs treated with PTA for 6 years were included in this retrospective study. Correction of kyphotic deformity and change in neurologic status were analyzed to assess outcome. The Cobb angle and American Spinal Injury Association (ASIA) grade were used for this purpose.

RESULTS

There were 6 male and 8 female patients. Five patients had complete injury (ASIA-A), and 9 had incomplete injury. The mean Thoracolumbar Injury Classification and Severity score was 6.71. The mean preoperative Cobb angle was 14.71° and improved to -3.35° postoperatively (mean kyphosis correction -18.05°). Two of the patients experienced iatrogenic nerve root injury. There was 1 postoperative mortality due to complications unrelated to the surgery. The mean Cobb angle was -0.07° at the 32.2-month follow-up visit. Six patients experienced cage subsidence, but none required revision surgery. Postoperatively, 11 (78.5%) patients showed neurologic improvement, and none experienced deterioration. The average ASIA score improved from 2.5 to 3.78. A fusion rate of 100% (n = 12) was observed at the last follow-up visit.

CONCLUSIONS

The present study demonstrates that PTA is a feasible approach in selected pediatric patients with unstable traumatic thoracolumbar burst fractures, with results comparable with those in the adult population. This study demonstrates in detail the procedure, along with the neurologic and radiologic outcomes of this approach in the pediatric population.