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Brembilla C, Fanti A, Rampini AD, Dorelli G, Sicignano AM, Cracchiolo G, Bernucci C. The effectiveness of short hybrid stabilization with sublaminar bands and transpedicular screws in the treatment of thoracolumbar spine fractures. J Neurosurg Sci 2024; 68:412-421. [PMID: 35766204 DOI: 10.23736/s0390-5616.22.05661-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
BACKGROUND Long constructs have always been widely recommended for the treatment of thoracolumbar fractures, due to their biomechanical stability and minimal postoperative loss of correction. However, short constructs have significant advantages, since they enable for better postoperative lumbar mobility and reduce the risk of adjacent segment degeneration. The purpose of this study is to evaluate the safety and efficacy of hybrid screw/sublaminar bands short constructs, used for the treatment of thoracolumbar fractures. METHODS From June 2015 until November 2017, 20 consecutive patients (14 male, 6 female) with an average age of 52.9 years, exhibiting at least one traumatic fracture in the thoracolumbar region, were treated with hybrid screw/sublaminar bands short constructs. The data for analysis included: duration of the intervention, intraoperative blood loss, complications, and clinical and radiographic postoperative results, compared with the standard for thoracolumbar fixation. RESULTS The use of this type of construct allowed for simple reduction, stabilization of the fractures, and restoration of the physiological spine curvatures. During the postoperative period none of the patients had neurological worsening. 18 out of 20 patients were followed up for two years. One patient sustained implant failure six months after surgery and underwent a surgical implant revision with traditional long fixation. After two years, stability and fusion were obtained in all patients, along with correct spine alignment. CONCLUSIONS Hybrid screw/sublaminar bands short constructs seem to be effective in the treatment of thoracolumbar fractures, providing the same clinical results of the state-of-the-art pedicular screw/rod long constructs, but in addition they allow for better postoperative lumbar mobility and subsequently reduce the risk of adjacent segments degeneration. The results of this clinical case series might support the initiation of prospective randomized trials with more patients, a longer follow-up period, and control groups.
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Affiliation(s)
- Carlo Brembilla
- Department of Neuroscience and Surgery of the Nervous System, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy -
| | - Andrea Fanti
- Department of Neuroscience and Surgery of the Nervous System, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Angela D Rampini
- Department of Neurosurgery, School of Specialization in Neurosurgery, University of Pavia, Pavia, Italy
| | - Gianluigi Dorelli
- School of Medicine in Sport and Exercise, University of Verona, Verona, Italy
| | - Angelo M Sicignano
- Department of Neuroscience and Surgery of the Nervous System, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Giorgio Cracchiolo
- School of Medicine and Surgery, University of Milano-Bicocca, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Claudio Bernucci
- Department of Neuroscience and Surgery of the Nervous System, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
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Pan J, Gu Y, Zhang F. One step excision combined with unilateral transforaminal intervertebral fusion via minimally invasive technique in the surgical treatment of spinal dumbbell-shaped tumors: A retrospective study with a minimum of 5 years’ follow-up. Front Surg 2022; 9:939505. [PMID: 36176344 PMCID: PMC9513348 DOI: 10.3389/fsurg.2022.939505] [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: 05/09/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionSpinal dumbbell-shaped tumors are rare, usually benign tumors with intraspinal and paravertebral components connected through intervertebral foramen. Complete excision is often performed through traditional open surgery (TOS). The efficacy and long-term outcomes of minimally invasive surgery (MIS) have not been reported to date in resection of dumbbell-shaped spinal tumors.PurposeThe purpose was to evaluate the efficacy and long-term outcomes of minimally invasive resection combined with unilateral transforaminal intervertebral fusion (TIF) through comparing with TOS in the treatment of spinal dumbbell-shaped tumors.MethodsFifteen patients underwent MIS and 18 patients underwent TOS. Thoracic dumbbell-shaped tumors were directly exposed after removal of costotransverse joints, adjacent rib components, unilateral hemilamina, and facet joints. Lumbar dumbbell-shaped tumors were completely exposed after removal of transverse processes, unilateral hemilamina, and facet joints. Whether for minimally invasive resection or traditional open removal, dumbbell-shaped tumors were completely excised and unilateral TIF was performed to guarantee spinal stability. All patients were followed up for 5 years at least.ResultsThe mean length of surgical incision for two groups was 3.47 ± 0.37 vs. 6.49 ± 0.39 cm (p < 0.05). The average duration of the operation was 131.67 ± 26.90 vs. 144.17 ± 23.59 min (p > 0.05). The mean blood loss was 172.00 ± 48.79 vs. 285.83 ± 99.31 ml (p < 0.05). No blood transfusions were required in the two groups. The median length of hospitalization was 6 vs. 10 days (range: 5–8 vs. 7–14 days). The patients of two groups were monitored for an average of 65.93 ± 3.88 vs. 65.78 ± 3.56 months. At 5-year follow-up, all patients presented with normal neurological function (American Spinal Injury Association scale E). The Oswestry Disability Index in the MIS group decreased significantly more than the TOS group. No spondylolisthesis or spinal instability were found in the follow-up period. There was no recurrence of any spinal tumor 5 years after surgery.ConclusionsSpinal dumbbell-shaped tumors can be safely and effectively treated with minimally invasive resection combined with unilateral TIF. Compared with TOS, MIS offers a reduced length of surgical incision, blood loss, hospital stay, and postoperative pain. This surgical protocol might provide an alternative for the treatment of spinal dumbbell-shaped tumors.
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Affiliation(s)
- Jianfeng Pan
- Department of Orthopedic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
- Department of Orthopedic Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yutong Gu
- Department of Orthopedic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
- Shanghai Southwest Spine Surgery Center, Shanghai, China
- Correspondence: Yutong Gu
| | - Feng Zhang
- Shanghai Southwest Spine Surgery Center, Shanghai, China
- Joseph M. Still Burn and Reconstructive Center, Jackson, Mississippi, United States
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Yang JH, Kim HJ, Chang DG, Suh SW. Comparative Analysis of Radiologic and Clinical Outcomes Between Conventional Open and Minimally Invasive Scoliosis Surgery for Adolescent Idiopathic Scoliosis. World Neurosurg 2021; 151:e234-e240. [PMID: 33866028 DOI: 10.1016/j.wneu.2021.04.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To compare radiologic and clinical outcomes between conventional open scoliosis surgery (COSS) and minimally invasive scoliosis surgery (MISS) for adolescent idiopathic scoliosis (AIS). METHODS Forty-nine AIS patients who underwent scoliosis surgery were retrospectively analyzed in 2 groups: the COSS (n = 25) and MISS (n = 24) groups. COSS procedures used monoaxial screws with a rod derotation (RD) maneuver through a long linear incision. In the MISS group, the technique was applied via 2 or 3 incisions of about 3 cm in length, and a muscle-splitting approach and correction were performed using polyaxial screws with an RD maneuver. RESULTS In the analysis of the coronal (Cobb angle of the main curve) and sagittal planes (thoracic kyphosis and lumbar lordosis), correction was significantly superior in the COSS group (all P values >0.05). However, in the coronal balance and spinal vertical axis, which are global balance factors, there were no significant differences between the groups (P = 0.331 and P = 0.750). There were significant differences between the COSS and MISS groups in terms of mean hospital stay duration (P < 0.001), operative time (P < 0.001), estimated blood loss (P < 0.001), and scar length (P < 0.001). There was no significant difference in the various Scoliosis Research Society-22 questionnaire scores between the groups. CONCLUSIONS Although COSS for AIS was superior for correcting the main curve, MISS was associated with shorter hospitalization, less blood loss, and superior cosmesis as well as providing adequate correction in both the coronal and sagittal planes.
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Affiliation(s)
- Jae Hyuk Yang
- Department of Orthopedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Korea
| | - Hong Jin Kim
- Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | - Dong-Gune Chang
- Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea.
| | - Seung Woo Suh
- Department of Orthopedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Korea
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Raheja A, Tandon V, Garg K, Sinha S. A Review of Minimally Invasive Techniques in Thoracolumbar Trauma. INDIAN JOURNAL OF NEUROTRAUMA 2021. [DOI: 10.1055/s-0040-1716429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AbstractThe development of endoscopy, microscopy, and image guidance system provided the impetus for the adoption of minimally invasive surgery (MIS) techniques in the management of spinal trauma patients. The underlying drive has been an attempt to achieve the functional and biomechanical goals inherent to trauma care but through MIS techniques. Broadly the MIS techniques for spinal trauma can be divided into two categories—fusion and nonfusion methods. Fusion methods include mini-open or keyhole approaches that allow for discectomy and/or corpectomy and cage reconstruction via an anterior/lateral/posterior operative corridor. The nonfusion methods primarily include percutaneous pedicle screw fixation, kyphoplasty, and vertebroplasty, all without placement of bone graft or other attempts at inducing arthrodesis. In this review article, we have stratified the MIS techniques based on the operative corridor used and briefly described the decision-making process, technical nuances, pros, and cons of each technique.
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Affiliation(s)
- Amol Raheja
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Tandon
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sumit Sinha
- Department of Neurosurgery and Spine Surgery, Paras Hospital, Gurugram, Haryana, India
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Chung WH, Eu WC, Chiu CK, Chan CYW, Kwan MK. Minimally invasive reduction of thoracolumbar burst fracture using monoaxial percutaneous pedicle screws: Surgical technique and report of radiological outcome. J Orthop Surg (Hong Kong) 2020; 28:2309499019888977. [PMID: 31876259 DOI: 10.1177/2309499019888977] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To describe the reduction technique of thoracolumbar burst fracture using percutaneous monoaxial screws and its radiological outcomes compared to polyaxial screws. METHODS All surgeries were performed by minimally invasive technique with either percutaneous monoaxial or percutaneous polyaxial screws inserted at adjacent fracture levels perpendicular to both superior end plates. Fracture reduction is achieved with adequate rod contouring and distraction maneuver. Radiological parameters were measured during preoperation, postoperation, and follow-up. RESULTS A total of 21 patients were included. Eleven patients were performed with monoaxial pedicle screws and 10 patients performed with polyaxial pedicle screws. Based on AO thoracolumbar classification system, 10 patients in the monoaxial group had A3 fracture type and 1 had A4. In the polyaxial group, six patients had A3 and four patients had A4. Total correction of anterior vertebral height (AVH) ratio was 0.30 ± 0.10 and 0.08 ± 0.07 in monoaxial and polyaxial groups, respectively (p < 0.001). Total correction of posterior vertebral height (PVH) ratio was 0.11 ± 0.05 and 0.02 ± 0.02 in monoaxial and polyaxial groups, respectively (p < 0.001). Monoaxial group achieved more correction of 13° (62.6%) in local kyphotic angle compared to 8.2° (48.0%) in polyaxial group. Similarly, in regional kyphotic angle, 16.5° (103.1%) in the monoaxial group and 8.1° (76.4%) in the polyaxial group were achieved. CONCLUSIONS Monoaxial percutaneous pedicle screws inserted at adjacent fracture levels provided significantly better fracture reduction compared to polyaxial screws in thoracolumbar fractures.
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Affiliation(s)
- Weng Hong Chung
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Wei Cheong Eu
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Safaee MM, Shah V, Tenorio A, Uribe JS, Clark AJ. Minimally Invasive Pedicle Screw Fixation With Indirect Decompression by Ligamentotaxis in Pathological Fractures. Oper Neurosurg (Hagerstown) 2020; 19:210-217. [PMID: 32255471 DOI: 10.1093/ons/opaa045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 01/13/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The spine is the most common site of bony metastases. Associated pathological fractures can result in pain, neurological deficit, biomechanical instability, and deformity. OBJECTIVE To present a minimally invasive technique for indirect decompression by ligamentotaxis in pathological fractures. METHODS A minimally invasive approach was utilized to perform percutaneous pedicle screw fixation in patients who required stabilization for pathological fractures. Preoperative and postoperative computed tomography and magnetic resonance imaging were used to compare spinal canal area and midsagittal canal diameter. RESULTS Two patients with newly diagnosed pathological fractures underwent minimally invasive treatment. Each presented with minimal epidural disease and a chief complaint of intractable back pain without neurological deficit. They underwent minimally invasive pedicle screw fixation with indirect decompression by ligamentotaxis. In each case, postoperative imaging demonstrated an increase in spinal canal area and midsagittal canal diameter by an independent neuroradiologist. There were no perioperative complications, and each patient was neurologically stable without evidence of hardware failure at their 5- and 6-mo follow-up visits. CONCLUSION Minimally invasive percutaneous fixation can be used to stabilize pathological fractures and provide indirect decompression by ligamentotaxis. This procedure is associated with minimal blood loss, low morbidity, and rapid initiation of radiation therapy. Only patients with minimal epidural disease, stenosis caused primarily by bony retropulsion, and mild-to-moderate deformity should be considered candidates for this approach.
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Affiliation(s)
- Michael M Safaee
- Department of Neurological Surgery, University of California-San Francisco, San Francisco, California
| | - Vinil Shah
- Division of Neuroradiology, Department of Radiology, University of California-San Francisco, San Francisco, California
| | - Alexander Tenorio
- Department of Neurological Surgery, University of California-San Francisco, San Francisco, California
| | | | - Aaron J Clark
- Department of Neurological Surgery, University of California-San Francisco, San Francisco, California
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Camacho JE, Usmani MF, Strickland AR, Banagan KE, Ludwig SC. The use of minimally invasive surgery in spine trauma: a review of concepts. JOURNAL OF SPINE SURGERY 2019; 5:S91-S100. [PMID: 31380497 DOI: 10.21037/jss.2019.04.13] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Traumatic injuries to the spine can be common in the setting of blunt trauma and delayed diagnosis can have a deleterious effect on patients' health. The goals of treatment in managing spine trauma are prevention of neurological injury, providing stability to the spine, and correcting post-traumatic deformity. Minimally invasive spine surgery (MISS) techniques are an alternative to open spine surgery for treatment of spine fractures. MISS is also a viable treatment in the setting of damage control orthopedics, when patients with multiple traumatic injuries may be unable to tolerate a traditional open approach. MISS techniques have been used in the treatment of unstable fractures with or without spinal cord injury, flexion and extension-distraction injuries, and unstable sacral fractures. Traditional open surgeries have been associated with increased blood loss, longer operative times, and a higher risk for surgical site infection (SSI). MISS techniques have the potential to reduce open approach-associated morbidity, and improve postoperative care and rehabilitation. MISS techniques for spine trauma are an indispensable option in the treatment armamentarium of spine surgeons.
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Affiliation(s)
- Jael E Camacho
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - M Farooq Usmani
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ashely R Strickland
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kelley E Banagan
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Steven C Ludwig
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
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Francaviglia N, Villa A, Maiello M, Costantino G, Alessandrello RF, Meli F, Odierna Contino A, Lipani R, Fiorenza V, Lo Duca B, Ascanio F, Iacopino DG, Maugeri R. Reconstruction of vertebral body in thoracolumbar AO type A post-traumatic fractures by balloon kyphoplasty. A series of 85 patients with a long follow-up and review of literature. J Neurosurg Sci 2019; 66:193-199. [PMID: 31037935 DOI: 10.23736/s0390-5616.19.04628-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Traumatic fractures of the thoracolumbar spine are common injuries, accounting for approximately 90% of all spinal traumas. Optimal management of these fractures still gives rises to much debate in the literature. Currently, one of the treatment options in young patients with stable traumatic vertebral fractures is conservative treatment using braces. Kyphoplasty as a minimally invasive procedure has been shown to be effective in stabilizing vertebral body fractures, resulting in immediate pain relief and improved physical function with early return to work activity. The aim of the study is to report VAS, ODI scores, and kyphosis correction following treatment. METHODS This is a retrospective study to investigate the clinical and radiological results 10 years after percutaneous balloon kyphoplasty followed by cement augmentation with polymethylmethacrylate (PMMA) or calcium phosphate cements (CPC), according to age, in 85 consecutive patients affected by 91 AOSpine type A traumatic fractures of the thoracolumbar spine (A1, A2, and A3). Clinical follow-up was performed with the Visual Analogic Scale (VAS) at the preoperative visit and in the postoperative follow-up after 1 week, 1, 6, 12 months, and each year up to 10 years. Additionally, the Oswestry Disability Index (ODI) improvement was calculated as the difference between the ODI scores at the preoperative visit and at final follow-up. Finally, the Cobb angle from this cohort was assessed before surgery, immediately postoperatively, and at the end of follow-up. RESULTS Kyphoplasty markedly improved pain and resulted in statistically significant vertebral height restoration and normalization of morphologic shape indexes that remained stable for at least 10 years following treatment. CONCLUSIONS The present study showed that kyphoplasty and cement augmentation are an effective method of treatment for selected type A fractures.
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Affiliation(s)
| | - Alessandro Villa
- Division of Neurosurgery, ARNAS Civico Hospital, Palermo, Italy -
| | - Marco Maiello
- Neurosurgical Unit, "Elio Tartarini" Centre of Neurosciences, Santa Corona Hospital, Pietra Ligure, Savona, Italy
| | | | | | - Francesco Meli
- Division of Neurosurgery, ARNAS Civico Hospital, Palermo, Italy
| | | | - Rita Lipani
- Division of Neurosurgery, Sant'Elia General Hospital, Caltanissetta, Italy
| | - Vito Fiorenza
- Division of Neurosurgery, ARNAS Civico Hospital, Palermo, Italy
| | | | | | - Domenico G Iacopino
- Department of Experimental Biomedicine and Clinical Neurosciences, Neurosurgical Clinic, School of Medicine, University of Palermo, Palermo, Italy
| | - Rosario Maugeri
- Department of Experimental Biomedicine and Clinical Neurosciences, Neurosurgical Clinic, School of Medicine, University of Palermo, Palermo, Italy
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Paredes I, Panero I, Cepeda S, CastaÑo-Leon AM, Jimenez-Roldan L, Perez-NuÑez Á, AlÉn JA, Lagares A. Accuracy of percutaneous pedicle screws for thoracic and lumbar spine fractures compared with open technique. J Neurosurg Sci 2018; 65:38-46. [PMID: 29905430 DOI: 10.23736/s0390-5616.18.04439-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study aimed to compare the accuracy of screw placement between open pedicle screw fixation and percutaneous pedicle screw fixation (MIS) for the treatment of thoracolumbar spine fractures (TSF). METHODS forty-nine patients with acute TSF who were treated with transpedicular screw fixation from January 2013 to December 2016 were retrospectively reviewed. The patients were divided into Open and MIS groups. Laminectomy was performed in either group if needed. The accuracy of the screw placement, the evolution of the Cobb sagittal angle postoperatively and at 12-month follow-up and the neurological status were recorded. AO type of fracture and TLICS score were also recorded. RESULTS Mean age was 42 years old. Mean TLICS score was 6.29 and 5.96 for open and MIS groups respectively. Twenty-five MIS and 24 open surgeries were performed, and 350 (175 in each group) screws were inserted (7.14 per patient). Twenty-four and 13 screws were considered "out" in the open and MIS groups respectively (Odds ratio 1.98. 0.97-4,03 P=0.056). The Cobb sagittal angle went from 13.3º to 4.5º and from 14.9º to 8.2º in the Open and MIS groups respectively (both P<0.0001). Loss of correction at 12-month follow-up was 3.2º and 4.2º for the open and MIS groups, respectively. No neurological worsening was observed. CONCLUSIONS For the treatment of acute thoracolumbar fractures, the MIS technique seems to achieve similar results to the open technique in relation to neurological improvement and deformity correction, while placing the screws more accurately.
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Affiliation(s)
- Igor Paredes
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain -
| | - Irene Panero
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - Santiago Cepeda
- Department of Neurosurgery, Rio Hortega University Hospital, Valladolid, Spain
| | - Ana M CastaÑo-Leon
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - Luis Jimenez-Roldan
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - Ángel Perez-NuÑez
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - Jose A AlÉn
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - Alfonso Lagares
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
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Chang W, Zhang D, Liu W, Lian X, Jiao Z, Chen W. Posterior paraspinal muscle versus post-middle approach for the treatment of thoracolumbar burst fractures: A randomized controlled trial. Medicine (Baltimore) 2018; 97:e11193. [PMID: 29924040 PMCID: PMC6024482 DOI: 10.1097/md.0000000000011193] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 05/25/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND This randomized controlled trial (RCT) aimed to compare the clinical outcomes of thoracolumbar burst fractures (TLBFs) treated with open reduction and internal fixation via the posterior paraspinal muscle approach (PPMA) and the post-middle approach (PA). METHODS Patients with a traumatic single-level TLBFs (T10-L2), treated at our hospital between December 2009 and December 2014, were randomly allocated to Group A (PPMA) and Group B (PA). Sex, age, time from injury to surgery, the American Spinal Injury Association Impairment Scale score (ASIAIS), comorbidities, vertebral level, pre- and postoperative kyphotic angle (KA), visual analog scale (VAS) pain score, and the Oswestry Disability Index (ODI) scores were included in the analysis. Operative time, intraoperative blood loss, x-ray exposure time, postoperative drainage volume, superficial infection, and occurrence of deep infection were documented. The patients were followed up at 2 weeks; 1, 3, and 6 months; 1 and 2 years; and every 6 months thereafter. Radiological assessments were performed to assess fracture union and detect potential loosening and breakage of the pedicle screws and rods at each follow-up. Postoperative VAS and ODI scores were used to evaluate the clinical outcomes. RESULTS A total of 62 patients were enrolled (30 in Group A and 32 in Group B, respectively). The operative time (P < .001) and x-ray exposure time (P < .001) in Group A were significantly longer than those in Group B. However, compared to Group B, there were less intraoperative blood loss (P < .001), lower postoperative drainage volume (P < .001), lower VAS scores (2-week (P = .029), 1-month (P = .023), 3-month (P = .047), and 6-month follow-up (P = .010)), and lower ODI scores (2-week, P = .010; 1-month, P < .001; 3-month, P = .028; and 6-month follow-up, P = .033) in Group A. CONCLUSIONS Although PPMA required a longer operative time and x-ray exposure time, PPMA provided several advantages over PA, including less intra-operative blood loss and lower postoperative drainage volume, and greater satisfaction with postoperative pain relief and functional improvement, than PA, especially at the 6-month follow-up after surgery. Further high-quality multicenter studies are warranted to validate our findings.
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Affiliation(s)
- Wenli Chang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University
| | - Dianling Zhang
- Department of General Surgery, Hebei Youfu Hospital, Shijiazhuang
| | - Wei Liu
- Department of Orthopaedic Surgery, Cangzhou People's Hospital, Cangzhou, PR China
| | - Xiaodong Lian
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University
| | - Zhenqing Jiao
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University
| | - Wei Chen
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University
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Ghobrial GM, Crandall KM, Lau A, Williams SK, Levi AD. Minimally invasive direct pars repair with cannulated screws and recombinant human bone morphogenetic protein: case series and review of the literature. Neurosurg Focus 2017; 43:E6. [DOI: 10.3171/2017.5.focus17153] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe objective of this study was to describe the use of a minimally invasive surgical treatment of lumbar spondylolysis in athletes by a fluoroscopically guided direct pars screw placement with recombinant human bone morphogenetic protein–2 (rhBMP-2) and to report on clinical and radiographic outcomes.METHODSA retrospective review was conducted of all patients treated surgically for lumbar spondylolysis via a minimally invasive direct pars repair with cannulated screws. Demographic information, clinical features of presentation, perioperative and intraoperative radiographic imaging, and postoperative data were collected. A 1-cm midline incision was performed for the placement of bilateral pars screws utilizing biplanar fluoroscopy, followed by placement of a fully threaded 4.0-mm-diameter titanium cannulated screw. A tubular table-mounted retractor was utilized for direct pars fracture visualization and debridement through a separate incision. The now-visualized pars fracture could then be decorticated, with care taken not to damage the titanium screw when using a high-speed drill. Local bone obtained from the curettage was then placed in the defect with 1.05 mg rhBMP-2 divided equally between the bilateral pars defects.RESULTSNine patients were identified (mean age 17.7 ± 3.42 years, range 14–25 years; 6 male and 3 female). All patients had bilateral pars fractures of L-4 (n = 4) or L-5 (n = 5). The mean duration of preoperative symptoms was 17.22 ± 13.2 months (range 9–48 months). The mean operative duration was 189 ± 29 minutes (range 151–228 minutes). The mean intraoperative blood loss was 17.5 ± 10 ml (range 10–30 ml). Radiographic follow-up was available in all cases; the mean length of time from surgery to the most recent imaging study was 30.8 ± 23.3 months (range 3–59 months). The mean hospital length of stay was 1.13 ± 0.35 days (range 1–2 days). There were no intraoperative complications.CONCLUSIONSLumbar spondylolysis treatment with a minimally invasive direct pars repair is a safe and technically feasible option that minimizes muscle and soft-tissue dissection, which may particularly benefit adolescent patients with a desire to return to a high level of physical activity.
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Harrop JS, Rymarczuk GN, Vaccaro AR, Steinmetz MP, Tetreault LA, Fehlings MG. Controversies in Spinal Trauma and Evolution of Care. Neurosurgery 2017; 80:S23-S32. [DOI: 10.1093/neuros/nyw076] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 01/30/2017] [Indexed: 11/13/2022] Open
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Koh I, Marini G, Widmer RP, Brandolini N, Helgason B, Ferguson SJ. In silico investigation of vertebroplasty as a stand-alone treatment for vertebral burst fractures. Clin Biomech (Bristol, Avon) 2016; 34:53-61. [PMID: 27070845 DOI: 10.1016/j.clinbiomech.2016.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 02/21/2016] [Accepted: 03/22/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND The use of percutaneous vertebroplasty as a stand-alone treatment for stable vertebral burst fractures has been investigated in vitro and in clinical studies. These studies present inconsistent results on the mechanical response of vertebroplasty-treated burst fractures. In addition, observations of the loss of sagittal alignment after vertebroplasty raise questions on the applicability of vertebroplasty for burst fractures. Therefore, the aim of this study was to investigate the mechanical stability of burst fractures after stand-alone treatment by vertebroplasty. METHODS Finite element simulations were performed with models generated from two laboratory-induced burst fractures in human thoracolumbar specimens. The burst fracture models were virtually injected with various cement volumes using a unipedicular or bipedicular approach. The models were subjected to four individual loads (compression, lateral bending, extension and torsion) and a multi-axial load case in the physiological range. FINDINGS All treated burst fractures showed improvements in stiffness and a reduction in inter-fragmentary displacements, thus potentially providing a suitable mechanical environment for fracture healing. However, large volumes of the trabecular bone (<43%), cement (<53%) and bone-cement composite (<58%) were predicted to experience strain levels exceeding the yield point. While damage was not specifically modeled, this implies a potential collapse of the treated vertebra due to local failure. INTERPRETATION To improve the primary stability and to prevent the collapse of treated burst fractures, the use of posterior instrumentation is suggested as an adjunct to vertebroplasty.
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Affiliation(s)
- Ilsoo Koh
- Institute for Biomechanics, ETH-Zurich, Zurich, Switzerland.
| | - Giacomo Marini
- Institute for Biomechanics, ETH-Zurich, Zurich, Switzerland
| | - René P Widmer
- Institute for Biomechanics, ETH-Zurich, Zurich, Switzerland
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Clinical Performance and Safety of 108 SpineJack Implantations: 1-Year Results of a Prospective Multicentre Single-Arm Registry Study. BIOMED RESEARCH INTERNATIONAL 2015; 2015:173872. [PMID: 26844224 PMCID: PMC4710926 DOI: 10.1155/2015/173872] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 12/02/2015] [Indexed: 12/11/2022]
Abstract
This prospective, consecutive, multicentre observational registry aimed to confirm the safety and clinical performance of the SpineJack system for the treatment of vertebral compression fractures (VCF) of traumatic origin. We enrolled 103 patients (median age: 61.6 years) with 108 VCF due to trauma, or traumatic VCF with associated osteoporosis. Primary outcome was back pain intensity (VAS). Secondary outcomes were Oswestry Disability Index (ODI), EuroQol-VAS, and analgesic consumption. 48 hours after surgery, a median relative decrease in pain intensity of 81.5% was observed associated with a significant reduction in analgesic intake. Improvements in disability (91.3% decrease in ODI score) and in quality of life (increase 21.1% of EQ-VAS score) were obtained 3 months after surgery. All results were maintained at 12 months. A reduction in the kyphotic angulation was observed postoperatively (-5.4 ± 6.3°; p < 0.001), remained at 12 months (-4.4 ± 6.0°, p = 0.002). No adverse events were implant-related and none required device removal. Three patients (2.9%) experienced procedure-related complications. The overall adjacent fracture rate up to 1 year after surgery was 2.9%. The SpineJack procedure is an effective, low-risk procedure for patients with traumatic VCF allowing a fast and sustained improvement in quality of life over 1 year after surgery.
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Li Y, Hai Y, Li L, Feng Y, Wang M, Cao G. Early effects of vertebroplasty or kyphoplasty versus conservative treatment of vertebral compression fractures in elderly polytrauma patients. Arch Orthop Trauma Surg 2015; 135:1633-6. [PMID: 26559063 DOI: 10.1007/s00402-015-2311-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This study aims to assess the early effects of operatively and nonoperatively managed vertebral compression fractures (VCFs) in elderly polytrauma patients. METHODS A multi-center retrospective cohort study of operative treatment [vertebroplasty (VP) or kyphoplasty (KP)] versus nonoperative treatment (bed rest). RESULTS A total of 40 patients received operative treatment and 59 patients received nonoperative treatment. The mean length of hospital stay was 15.53 ± 6.994 days in the operative and 19.54 ± 12.012 days in the nonoperative group (P = 0.039). The incidence of complication was higher in the nonoperative group than the operative group (P = 0.009), especially the incidence of bed rest complication (P = 0.024). Mortality rate was not significant difference between two groups (P = 0.172). CONCLUSIONS For VCFs in elderly polytrauma patients, VP or KP can reduce length of hospital stay and complications, especially bed rest complication compared with nonoperative treatment.
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Affiliation(s)
- Yonggang Li
- Department of Orthopaedics, Fuxing Hospital, Capital Medical University, Beijing, 100038, China
| | - Yong Hai
- Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, No.8 Gongti Nan Road, Chaoyang District, Beijing, 100020, China.
| | - Liping Li
- Department of Orthopaedics, Fuxing Hospital, Capital Medical University, Beijing, 100038, China
| | - Yi Feng
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Taiyuan, 030001, China
| | - Mingbo Wang
- Department of Orthopaedics, The Second Affiliated Hospital of Inner Mongolia Medical University, Huhehaote, 010030, China
| | - Guanglei Cao
- Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
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