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The Mini-Open Wiltse Approach with Pedicle Screw Fixation Versus Percutaneous Pedicle Screw Fixation for Treatment of Neurologically Intact Thoracolumbar Fractures: A Systematic Review and Meta-Analysis. World Neurosurg 2022; 164:310-322. [PMID: 35659586 DOI: 10.1016/j.wneu.2022.05.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The purpose of the present study was to compare the clinical outcomes and complications between the mini-open Wiltse approach with pedicle screw fixation (MWPSF) and percutaneous pedicle screw fixation (PPSF) in treating neurologically intact thoracolumbar fractures. METHODS We comprehensively searched PubMed, Web of Science, Embase, and the Cochrane Library and performed a systematic review and meta-analysis of all randomized controlled trials and retrospective comparative studies assessing these important indexes of the 2 methods using Review Manager, version 5.4. The clinical outcomes are presented as the risk difference for dichotomous outcomes and the mean difference for continuous outcomes with the 95% confidence intervals. Heterogeneity was assessed using the χ2 test and I2 statistics. The study was registered with PROSPERO (CRD 42021290078). RESULTS Two randomized controlled trials and six retrospective cohort studies were included in the present analysis. The percutaneous approach was associated with less intraoperative blood loss compared with the mini-open Wiltse approach. No significant differences were found in the total length of the incisions, hospitalization time, postoperative visual analog scale scores, postoperative Oswestry disability index, postoperative Cobb angle, postoperative Cobb angle correction, postoperative Cobb angle correction loss, accuracy rate of pedicle screw placement, and postoperative complications between MWPSF and PPSF. However, the incidence of facet joint violation was significantly higher in the PPSF group. In addition, MWPSF was associated with a shorter operative time, shorter intraoperative fluoroscopy time, lower hospitalization costs, better postoperative vertebral body angle and percentage of vertebral body height compared with PPSF. CONCLUSIONS Both MWPSF and PPSF are safe and effective treatments of neurologically intact thoracolumbar fractures. Nevertheless, our results have indicated that MWPSF might be the better choice, because it has a shorter learning curve and decreased facet joint violation, operative time, hospitalization costs, and radiation exposure. In addition, MWPSF was associated with better improvement of the postoperative vertebral body angle and percentage of vertebral body height.
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Greenberg JK, Burks SS, Dibble CF, Javeed S, Gupta VP, Yahanda AT, Perez-Roman RJ, Govindarajan V, Dailey AT, Dhall S, Hoh DJ, Gelb DE, Kanter AS, Klineberg EO, Lee MJ, Mummaneni PV, Park P, Sansur CA, Than KD, Yoon JJW, Wang MY, Ray WZ. An updated management algorithm for incorporating minimally invasive techniques to treat thoracolumbar trauma. J Neurosurg Spine 2022; 36:558-567. [PMID: 34715673 DOI: 10.3171/2021.7.spine21790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 07/01/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Minimally invasive surgery (MIS) techniques can effectively stabilize and decompress many thoracolumbar injuries with decreased morbidity and tissue destruction compared with open approaches. Nonetheless, there is limited direction regarding the breadth and limitations of MIS techniques for thoracolumbar injuries. Consequently, the objectives of this study were to 1) identify the range of current practice patterns for thoracolumbar trauma and 2) integrate expert opinion and literature review to develop an updated treatment algorithm. METHODS A survey describing 10 clinical cases with a range of thoracolumbar injuries was sent to 12 surgeons with expertise in spine trauma. The survey results were summarized using descriptive statistics, along with the Fleiss kappa statistic of interrater agreement. To develop an updated treatment algorithm, the authors used a modified Delphi technique that incorporated a literature review, the survey results, and iterative feedback from a group of 14 spine trauma experts. The final algorithm represented the consensus opinion of that expert group. RESULTS Eleven of 12 surgeons contacted completed the case survey, including 8 (73%) neurosurgeons and 3 (27%) orthopedic surgeons. For the 4 cases involving patients with neurological deficits, nearly all respondents recommended decompression and fusion, and the proportion recommending open surgery ranged from 55% to 100% by case. Recommendations for the remaining cases were heterogeneous. Among the neurologically intact patients, MIS techniques were typically recommended more often than open techniques. The overall interrater agreement in recommendations was 0.23, indicating fair agreement. Considering both literature review and expert opinion, the updated algorithm indicated that MIS techniques could be used to treat most thoracolumbar injuries. Among neurologically intact patients, percutaneous instrumentation without arthrodesis was recommended for those with AO Spine Thoracolumbar Classification System subtype A3/A4 (Thoracolumbar Injury Classification and Severity Score [TLICS] 4) injuries, but MIS posterior arthrodesis was recommended for most patients with AO Spine subtype B2/B3 (TLICS > 4) injuries. Depending on vertebral body integrity, anterolateral corpectomy or mini-open decompression could be used for patients with neurological deficits. CONCLUSIONS Spine trauma experts endorsed a range of strategies for treating thoracolumbar injuries but felt that MIS techniques were an option for most patients. The updated treatment algorithm may provide a foundation for surgeons interested in safe approaches for using MIS techniques to treat thoracolumbar trauma.
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Affiliation(s)
- Jacob K Greenberg
- 1Department of Neurological Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Stephen Shelby Burks
- 2Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Christopher F Dibble
- 1Department of Neurological Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Saad Javeed
- 1Department of Neurological Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Vivek P Gupta
- 1Department of Neurological Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Alexander T Yahanda
- 1Department of Neurological Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Roberto J Perez-Roman
- 2Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Vaidya Govindarajan
- 2Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Andrew T Dailey
- 3Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Sanjay Dhall
- 4Department of Neurological Surgery, University of California, San Francisco, California
| | - Daniel J Hoh
- 5Department of Neurosurgery, University of Florida, Gainesville, Florida
| | | | - Adam S Kanter
- 8Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Eric O Klineberg
- 9Department of Orthopedic Surgery, University of California, Davis, Sacramento, California
| | - Michael J Lee
- 10Department of Orthopedic Surgery, University of Chicago, Chicago, Illinois
| | - Praveen V Mummaneni
- 4Department of Neurological Surgery, University of California, San Francisco, California
| | - Paul Park
- 11Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Charles A Sansur
- 7Neurosurgery, University of Maryland Medical Center, Baltimore, Maryland
| | - Khoi D Than
- 12Department of Neurosurgery, Duke University, Durham, North Carolina; and
| | - Jon J W Yoon
- 13Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Michael Y Wang
- 2Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Wilson Z Ray
- 1Department of Neurological Surgery, Washington University in St. Louis, St. Louis, Missouri
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Couri PHCP, Kim LD, Santos WZ, Mendonça RGMD, Astur N, Gotfryd AO, Avanzi O, Caffaro MFS, Meves R. PERCUTANEOUS INSTRUMENTATION WITHOUT ARTHRODESIS FOR THORACOLUMBAR BURST FRACTURES (A3/A4, B): A RETROSPECTIVE STUDY. COLUNA/COLUMNA 2021. [DOI: 10.1590/s1808-185120212004250462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: There is still no consensus as to the treatment options for thoracolumbar burst fractures, although these fractures are widely described in the literature. The aim of this study was to evaluate the clinical and radiological outcomes of percutaneous instrumentation without arthrodesis as a method of fixation of these lesions. Methods: This retrospective, cross-sectional study evaluated 16 patients by measuring regional kyphosis using the Cobb method and the scores for quality of life and return to work (Oswestry Disability Index, VAS, SF-36 and Denis). Results: Six months after surgical treatment, 62.5% of all patients showed minimal disability according to the Oswestry Disability Index, maintenance of regional kyphosis correction and no synthesis failure. Conclusions: The clinical and radiological outcomes of the study suggest that minimally invasive fixation is indicated for the treatment of thoracolumbar burst fractures. Level of evidence IV; Observational study: retrospective cohort.
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Affiliation(s)
| | | | | | | | - Nelson Astur
- Hospital de Misericórdia Santa Casa de São Paulo, Brazil
| | | | - Osmar Avanzi
- Hospital de Misericórdia Santa Casa de São Paulo, Brazil
| | | | - Robert Meves
- Hospital de Misericórdia Santa Casa de São Paulo, Brazil
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Chung AS, Ballatori A, Ortega B, Min E, Formanek B, Liu J, Hsieh P, Hah R, Wang JC, Buser Z. Is Less Really More? Economic Evaluation of Minimally Invasive Surgery. Global Spine J 2021; 11:30S-36S. [PMID: 32975446 PMCID: PMC8076812 DOI: 10.1177/2192568220958403] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
STUDY DESIGN Review. OBJECTIVE A comparative overview of cost-effectiveness between minimally invasive versus and equivalent open spinal surgeries. METHODS A literature search using PubMed was performed to identify articles of interest. To maximize the capture of studies in our initial search, we combined variants of the terms "cost," "minimally invasive," "spine," "spinal fusion," "decompression" as either keywords or MeSH terms. PearlDiver database was queried for open and minimally invasive surgery (MIS; endoscopic or percutaneous) reimbursements between Q3 2015 and Q2 2018. RESULTS In general, MIS techniques appeared to decrease blood loss, shorten hospital lengths of stay, mitigate complications, decrease perioperative pain, and enable quicker return to daily activities when compared to equivalent open surgical techniques. With regard to cost, primarily as a result of these latter benefits, MIS was associated with lower costs of care when compared to equivalent open techniques. However, cost reporting was sparse, and relevant methodology was inconsistent throughout the spine literature. Within the PearlDiver data sets, MIS approaches had lower reimbursements than open approaches for both lumbar posterior fusion and discectomy. CONCLUSIONS Current data suggests that overall cost-savings may be incurred with use of MIS techniques. However, data reporting on costs lacks in uniformity, making it difficult to formulate any firm conclusions regarding any incremental improvements in cost-effectiveness that may be incurred when utilizing MIS techniques when compared to equivalent open techniques.
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Affiliation(s)
| | | | | | - Elliot Min
- University of Southern California, Los Angeles, CA, USA
| | | | - John Liu
- University of Southern California, Los Angeles, CA, USA
| | - Patrick Hsieh
- University of Southern California, Los Angeles, CA, USA
| | - Raymond Hah
- University of Southern California, Los Angeles, CA, USA
| | | | - Zorica Buser
- University of Southern California, Los Angeles, CA, USA,Zorica Buser, Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, 1520 San Pablo St, Suite 2000, Los Angeles, CA 90033, USA.
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Ansar MN, Hashmi SM, Colombo F. Minimally Invasive Spine (MIS) Surgery in Traumatic Thoracolumbar Fractures: A Single-Center Experience. Asian J Neurosurg 2020; 15:76-82. [PMID: 32181177 PMCID: PMC7057865 DOI: 10.4103/ajns.ajns_236_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 12/23/2019] [Indexed: 12/03/2022] Open
Abstract
Objective: Traumatic thoracolumbar fractures are common, and surgical fixation is a well-established treatment option, with the aim to achieve spinal stability and preserve neurological function. Pedicle screw fixation using a minimally invasive spine (MIS) surgical approach has emerged as an alternative approach for the treatment of thoracolumbar fractures. The aim of this study is to collect data regarding epidemiology, management, and outcomes of patients treated with MIS pedicle screw fixation for traumatic thoracolumbar fractures in our neurosurgical department. Materials and Methods: This was a retrospective cohort study including all patients who underwent MIS fixation from March 2013 to March 2017. Results: A total of 125 patients were included, 61 males and 64 females; the mean age was 59 years. The majority of injuries were from falls. In 48 cases, the fracture involved a thoracic vertebra and in 77 cases a lumbar vertebra. More than 10% of the patients presented with a neurological deficit on admission and 75% of those showed postoperative improvement in their neurology. The average length of hospital stay was 14 days. MIS fixation achieved a satisfactory regional sagittal angle (RSA) postoperatively in all patients. The vast majority of patients had no or mild postoperative pain and achieved a good functional outcome. Conclusions: MIS fixation is a safe surgical option with comparable outcomes to open surgery and a potential reduction in perioperative morbidity. MIS surgery achieves a rapid and significant improvement in pain score, functional outcome, Frankel Grade, and RSA. We expect that MIS fixation will become the predominant technique in the management of traumatic thoracolumbar fractures.
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Affiliation(s)
| | - Syed Maroof Hashmi
- Department of Neurosurgery, Royal Preston Hospital, Preston, United Kingdom
| | - Francesca Colombo
- Department of Neurosurgery, Royal Preston Hospital, Preston, United Kingdom
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Elenany SA, Alkosha HA, Ibrahiem MS. Role of minimally invasive percutaneous fixation in thoracolumbar fractures: a prospective study. EGYPTIAN JOURNAL OF NEUROSURGERY 2019. [DOI: 10.1186/s41984-019-0063-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractBackgroundEach year, there are approximately 5 million new vertebral fractures worldwide. Being a mobile flexible segment that is prone to severe stresses and loads, thoracolumbar fractures are considered one of the most controversial and challenging fracture types to manage.ObjectiveThe aim of this study is to explore the technique and to evaluate feasibility, safety, and outcome of percutaneous transpedicular fixation in the management of thoracolumbar fractures.MethodsThis study was carried out in the period between May 2016 and June 2017, where 20 consecutive patients with thoracolumbar fractures, based on TLICS scoring and neurological status, underwent a posterior percutaneous transpedicular fixation. The mean age was 33.85 years, range 20–49 years. Patients were followed up for 12 months. Patients had their clinical outcomes reviewed and evaluated in terms of cosmesis by visual analog scale (VAS) and in terms of Cobb angle correction.ResultsThe length of the procedure varied from 120 to 180 min with mean time of 154.50 min. There was no significant blood loss in all cases. The volume of blood loss ranged from 150 to 200 cc with mean loss of 174.25 cc.No major intraoperative complications happened in our study cases. Six cases had only one laterally malpositioned screw each. All cases returned to their previous activity without limitations (E5). Those who were completely pain free (F5) were 15 patients. Only five patients were suffering from moderate pain (F4). The Prolo scale was either 9 or 10 with mean of 9.60.ConclusionBy comparing our results with other studies, we found more or less equivalence in terms of neurological recovery, functional outcome, fusion rate, and maintenance of correction gain. However, the cosmesis scores for patients in the study were great.
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Trungu S, Forcato S, Bruzzaniti P, Fraschetti F, Miscusi M, Cimatti M, Raco A. Minimally Invasive Surgery for the Treatment of Traumatic Monosegmental Thoracolumbar Burst Fractures: Clinical and Radiologic Outcomes of 144 Patients With a 6-year Follow-Up Comparing Two Groups With or Without Intermediate Screw. Clin Spine Surg 2019; 32:E171-E176. [PMID: 31048604 DOI: 10.1097/bsd.0000000000000791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN This was a retrospective study of the clinical and radiologic outcomes of traumatic thoracolumbar (TL) burst fractures. OBJECTIVES We aimed to evaluate the clinical and radiologic outcomes after 6 years of follow-up of 144 patients with monosegmental TL burst fractures treated with percutaneous short-segment pedicle screw fixation, comparing two groups with versus without placement of an intermediate screw at the fractured vertebra. SUMMARY OF BACKGROUND DATA Traumatic TL fractures are the most common vertebral fractures, especially at the TL junction (T10-L2). Minimally invasive surgery (MIS) is a valuable treatment option for traumatic TL burst fractures. MATERIALS AND METHODS The clinical outcomes and radiologic parameters (Cobb angle, midsagittal index, and sagittal index) of 144 patients with traumatic monosegmental TL fractures treated with MIS were evaluated preoperatively, postoperatively, and after 3 and 6 years of follow-up. Patients were categorized into a nonintermediate screw group (nISG) and an intermediate screw group (ISG), and the groups were compared. RESULTS There were 71 patients (49.3%) in the nISG and 73 patients (50.7%) in the ISG. The radiologic parameters improved significantly more from the preoperative evaluation to the 6-year follow-up in the ISG than in the nISG (P<0.025). There were no significant differences in the mean Oswestry Disability Index (ODI) and Visual Analog Scale scores at the 6-year follow-up between the ISG and the nISG: 15.6% (ISG) versus 16.8% (nISG) for ODI (P<0.1) and 2.2 (ISG) versus 2.4 (nISG) for Visual Analog Scale score (P<0.85) (P<0.73). CONCLUSIONS MIS showed good clinical outcomes 6 years after surgery in both the ISG and the nISG. The additional intermediate screw significantly improved radiologic parameters but not clinical outcomes.
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Affiliation(s)
- Sokol Trungu
- N.E.S.M.O.S Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome.,Neurosurgery Unit, Card. G. Panico Hospital, Tricase, Italy
| | - Stefano Forcato
- N.E.S.M.O.S Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome.,Neurosurgery Unit, Card. G. Panico Hospital, Tricase, Italy
| | - Placido Bruzzaniti
- N.E.S.M.O.S Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome
| | - Flavia Fraschetti
- N.E.S.M.O.S Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome
| | - Massimo Miscusi
- N.E.S.M.O.S Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome
| | - Marco Cimatti
- N.E.S.M.O.S Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome
| | - Antonino Raco
- N.E.S.M.O.S Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome
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Sebaaly A, Rizkallah M, Riouallon G, Wang Z, Moreau PE, Bachour F, Maalouf G. Percutaneous fixation of thoracolumbar vertebral fractures. EFORT Open Rev 2019; 3:604-613. [PMID: 30595846 PMCID: PMC6275852 DOI: 10.1302/2058-5241.3.170026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Surgical treatment of patients with thoracolumbar vertebral fracture without neurological deficit is still controversial. Management of vertebral fracture with percutaneous fixation was first reported in 2004. Advantages of percutaneous fixation are: less tissue dissection; decreased post-operative pain; decreased bleeding and operative time (depending on the steep learning curve); better screw positioning with fluoroscopy compared with an open freehand technique; and a decreased infection rate. The limitations of percutaneous fixation of vertebral fractures include increased radiation exposure to the patient and the surgeon, together with the steep learning curve for this technique. Adding a screw at the level of the fractured vertebra has the advantages of incorporating fewer motion segments with less operative time and bleeding. This also increases the axial, sagittal and torsional stiffness of the construct. Percutaneous fixation alone without grafting is sufficient for treating type A and B1 (AO classification) thoracolumbar fractures with satisfactory results concerning kyphosis reduction when compared with open instrumentation and fusion and with open fixation. Type C and B2 fractures (ligamentous injuries) should undergo fusion since the ligamentous healing is mechanically weak, increasing the risk of instability. This review offers a detailed description of percutaneous screw insertion and discusses the advantages and disadvantages.
Cite this article: EFORT Open Rev 2018;3:604-613. DOI: 10.1302/2058-5241.3.170026.
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Affiliation(s)
- Amer Sebaaly
- Department of Orthopedic Surgery, Bellevue Medical Center University Hospital, Faculty of Medicine, Saint Joseph University, Lebanon.,Department of Orthopedic Surgery, Spine Unit, Centre Hospitalier de l'Université de Montréal (CHUM), Canada
| | - Maroun Rizkallah
- Department of Orthopedic Surgery, Bellevue Medical Center University Hospital, Faculty of Medicine, Saint Joseph University, Lebanon
| | - Guillaume Riouallon
- Department of Orthopedic Surgery, Groupe Hospitalier Paris Saint Joseph, France
| | - Zhi Wang
- Department of Orthopedic Surgery, Spine Unit, Centre Hospitalier de l'Université de Montréal (CHUM), Canada
| | | | - Falah Bachour
- Department of Orthopedic Surgery, Bellevue Medical Center University Hospital, Faculty of Medicine, Saint Joseph University, Lebanon
| | - Ghassan Maalouf
- Department of Orthopedic Surgery, Bellevue Medical Center University Hospital, Faculty of Medicine, Saint Joseph University, Lebanon
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Chi JH, Eichholz KM, Anderson PA, Arnold PM, Dailey AT, Dhall SS, Harrop JS, Hoh DJ, Qureshi S, Rabb CH, Raksin PB, Kaiser MG, O’Toole JE. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Evaluation and Treatment of Patients With Thoracolumbar Spine Trauma: Novel Surgical Strategies. Neurosurgery 2018; 84:E59-E62. [DOI: 10.1093/neuros/nyy364] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 07/16/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- John H Chi
- Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kurt M Eichholz
- St. Louis Minimally Invasive Spine Center, St. Louis, Missouri
| | - Paul A Anderson
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, Wisconsin
| | - Paul M Arnold
- Department of Neurosurgery, University of Kansas School of Medicine, Kansas City, Kansas
| | - Andrew T Dailey
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Sanjay S Dhall
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - James S Harrop
- Departments of Neurological Surgery and Orthopedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Daniel J Hoh
- Lillian S. Wells Department of Neurological Surgery, University of Florida, Gainesville, Florida
| | - Sheeraz Qureshi
- Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, New York
| | - Craig H Rabb
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - P B Raksin
- Division of Neurosurgery, John H. Stroger, Jr Hospital of Cook County and Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois
| | - Michael G Kaiser
- Department of Neurosurgery, Columbia University, New York, New York
| | - John E O’Toole
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois
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Tian F, Tu LY, Gu WF, Zhang EF, Wang ZB, Chu G, Ka H, Zhao J. Percutaneous versus open pedicle screw instrumentation in treatment of thoracic and lumbar spine fractures: A systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e12535. [PMID: 30313040 PMCID: PMC6203502 DOI: 10.1097/md.0000000000012535] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND To assess the safety and efficacy of percutaneous short-segment pedicle instrumentation compared with conventionally open short-segment pedicle instrumentation and provide recommendations for using these procedures to treat thoracolumbar fractures. METHODS The Medline database, Cochrane database of Systematic Reviews, Cochrane Clinical Trial Register, and Embase were searched for articles published. The randomized controlled trials (RCTs) and non-RCTs that compared percutaneous short-segment pedicle instrumentation to open short-segment pedicle instrumentation and provided data on safety and clinical effects were included. Demographic characteristics, clinical outcomes, radiological outcomes, and adverse events were manually extracted from all of the selected studies. Methodological quality of included studies using Methodological Index for Non-Randomized Studies scale and Cochrane collaboration's tool for assessing the risk of bias by 2 reviewers independently. RESULTS Nine studies encompassing 433 patients met the inclusion criteria. Subgroup meta-analyses were performed according to the study design. The pooled results showed there were significant differences between the 2 techniques in short- and long-term visual analog scale, intraoperative blood loss, operative time, postoperative draining loss, hospital stay, and incision size, although there were no significant differences in postoperative radiological outcomes, Oswestry Disability Index, hospitalization cost, intraoperative fluoroscopy time, and adverse events. CONCLUSION Percutaneous short-segment pedicle instrumentation in cases with achieve satisfactory results, could replace in many cases extensive open surgery and not increased related complications. However, further high-quality RCTs are needed to assess the long-term outcome of patients between 2 techniques.
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Zhao Q, Hao D, Wang B. A novel, percutaneous, self-expanding, forceful reduction screw system for the treatment of thoracolumbar fracture with severe vertebral height loss. J Orthop Surg Res 2018; 13:174. [PMID: 29996932 PMCID: PMC6042226 DOI: 10.1186/s13018-018-0880-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 07/03/2018] [Indexed: 11/13/2022] Open
Abstract
Background Over the past decade, the techniques for minimally invasive spinal stabilization have improved significantly. The multiaxial screw utilized in minimally invasive operations is limited in restoring fracture height, reconstructing the anterior vertebral column, and improving kyphosis. Therefore, the percutaneous, minimally invasive approach is not recommended for a thoracolumbar fracture with severe vertebral height loss. We report our novel, percutaneous, self-expanding, forceful reduction screw system to address this problem. Methods Thirty-eight patients experiencing thoracolumbar fracture, with a vertebral height loss more than 50%, were treated with the novel, percutaneous, self-expanding, forceful reduction screw between March 2014 and June 2015. The patients’ charts and radiographs were reviewed. The vertebral body index (VBI), height of the anterior margin of fractured vertebra (HAMFV), vertebral body angle (VBA), bisegmental Cobb angle (BCA), and Oswestry disability index (ODI) scores were obtained before and after the operation, as well as during the 2-year follow-up. The scoring results were compared using t tests. Results The operation was completed successfully in 38 patients. A total of 152 screws were placed. The average operation time was 90.7 ± 21.9 min, and the average intraoperative bleeding amount was 89.2 ± 31.9 ml. The patients were discharged at a mean of 3.2 ± 0.9 postoperative days, with a mean hospital stay of 4.8 ± 1.0 days. The VBI, HAMFV, VBA, and BCA scores were significantly improved after treatment with the novel screw system; there was a significant difference between pre- and postoperative parameters (p < 0.05). Although the decreases in all of the parameters were variable during the 2-year follow-up, there were no statistical differences between the postoperative imaging parameters and the last follow-up imaging parameters (p > 0.05). The ODI score at the last follow-up examination was 5.9 ± 2.7, which was significantly improved compared with the preoperative score of 44.6 ± 2.3 (p < 0.05). Conclusions We believe that the novel, percutaneous, self-expanding, forceful reduction screw system developed by us not only successfully expands the minimally invasive percutaneous surgery to the thoracolumbar fracture with severe vertebral height loss but also achieves significant vertebral height restoration and kyphosis correction.
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Affiliation(s)
- Qinpeng Zhao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, Xi'an, 710054, Shaanxi, China
| | - Dingjun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, Xi'an, 710054, Shaanxi, China.
| | - Biao Wang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, Xi'an, 710054, Shaanxi, China.
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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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Sun XY, Zhang XN, Hai Y. Answer to the Letter to the Editor of Y. Zhao et al. concerning "Percutaneous versus traditional and paraspinal posterior open approaches for treatment of thoracolumbar fractures without neurologic deficit: a meta-analysis'' by Sun XY, Zhang XN, Hai Y: Eur Spine J (2016); doi:10.1007/s00586-016-4818-4. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:1418-1431. [PMID: 27896532 DOI: 10.1007/s00586-016-4818-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 10/07/2016] [Accepted: 10/09/2016] [Indexed: 12/13/2022]
Abstract
PURPOSE This study evaluated differences in outcome variables between percutaneous, traditional, and paraspinal posterior open approaches for traumatic thoracolumbar fractures without neurologic deficit. METHODS A systematic review of PubMed, Cochrane, and Embase was performed. In this meta-analysis, we conducted online searches of PubMed, Cochrane, Embase using the search terms "thoracolumbar fractures", "lumbar fractures", ''percutaneous'', "minimally invasive", ''open", "traditional", "posterior", "conventional", "pedicle screw", "sextant", and "clinical trial". The analysis was performed on individual patient data from all the studies that met the selection criteria. Clinical outcomes were expressed as risk difference for dichotomous outcomes and mean difference for continuous outcomes with 95 % confidence interval. Heterogeneity was assessed using the χ 2 test and I 2 statistics. RESULTS There were 4 randomized controlled trials and 14 observational articles included in this analysis. Percutaneous approach was associated with better ODI score, less Cobb angle correction, less Cobb angle correction loss, less postoperative VBA correction, and lower infection rate compared with open approach. Percutaneous approach was also associated with shorter operative duration, longer intraoperative fluoroscopy, less postoperative VAS, and postoperative VBH% in comparison with traditional open approach. No significant difference was found in Cobb angle correction, postoperative VBA, VBA correction loss, Postoperative VBH%, VBH correction loss, and pedicle screw misplacement between percutaneous approach and open approach. There was no significant difference in operative duration, intraoperative fluoroscopy, postoperative VAS, and postoperative VBH% between percutaneous approach and paraspianl approach. CONCLUSIONS The functional and the radiological outcome of percutaneous approach would be better than open approach in the long term. Although trans-muscular spatium approach belonged to open fixation methods, it was strictly defined as less invasive approach, which provided less injury to the paraspinal muscles and better reposition effect.
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Affiliation(s)
- Xiang-Yao Sun
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Xi-Nuo Zhang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Yong Hai
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China.
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McAnany SJ, Overley SC, Kim JS, Baird EO, Qureshi SA, Anderson PA. Open Versus Minimally Invasive Fixation Techniques for Thoracolumbar Trauma: A Meta-Analysis. Global Spine J 2016; 6:186-94. [PMID: 26933621 PMCID: PMC4771513 DOI: 10.1055/s-0035-1554777] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 03/30/2015] [Indexed: 11/17/2022] Open
Abstract
Study Design Systematic literature review and meta-analysis of studies published in English. Objective This study evaluated differences in outcome variables between percutaneous and open pedicle screws for traumatic thoracolumbar fractures. Methods A systematic review of PubMed, Cochrane, and Embase was performed. The variables of interest included postoperative visual analog scale (VAS) pain score, kyphosis angle, and vertebral body height, as well as intraoperative blood loss and operative time. The results were pooled by calculating the effect size based on the standardized difference in means. The studies were weighted by the inverse of the variance, which included both within- and between-study error. Confidence intervals were reported at 95%. Heterogeneity was assessed using the Q statistic and I (2). Results After two-reviewer assessment, 38 studies were eliminated. Six studies were found to meet inclusion criteria and were included in the meta-analysis. The combined effect size was found to be in favor of percutaneous fixation for blood loss and operative time (p < 0.05); however, there were no differences in vertebral body height (VBH), kyphosis angle, or VAS scores between open and percutaneous fixation. All of the studies demonstrated relative homogeneity, with I (2) < 25. Conclusions Patients with thoracolumbar fractures can be effectively managed with percutaneous or open pedicle screw placement. There are no differences in VBH, kyphosis angle, or VAS between the two groups. Blood loss and operative time were decreased in the percutaneous group, which may represent a potential benefit, particularly in the polytraumatized patient. All variables in this study demonstrated near-perfect homogeneity, and the effect is likely close to the true effect.
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Affiliation(s)
- Steven J. McAnany
- Department of Orthopaedic Surgery, Mount Sinai Medical Center, New York, New York, United States
| | - Samuel C. Overley
- Department of Orthopaedic Surgery, Mount Sinai Medical Center, New York, New York, United States
| | - Jun S. Kim
- Department of Orthopaedic Surgery, Mount Sinai Medical Center, New York, New York, United States
| | - Evan O. Baird
- Department of Orthopaedic Surgery, Mount Sinai Medical Center, New York, New York, United States
| | - Sheeraz A. Qureshi
- Department of Orthopaedic Surgery, Mount Sinai Medical Center, New York, New York, United States,Address for correspondence Sheeraz A. Qureshi, MD Department of Orthopaedic Surgery, Mount Sinai Medical Center5 East 98th Street, 9th Floor, New York, NY 10029United States
| | - Paul A. Anderson
- Department of Orthopedic Surgery and Rehabilitation, University of Wisconsin, Madison, Wisconsin, United States
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Bu BX, Wang MJ, Liu WF, Wang YS, Tan HL. Short-segment posterior instrumentation combined with calcium sulfate cement vertebroplasty for thoracolumbar compression fractures: radiographic outcomes including nonunion and other complications. Orthop Traumatol Surg Res 2015; 101:227-33. [PMID: 25703775 DOI: 10.1016/j.otsr.2014.11.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 11/21/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the radiographic outcomes of short-segment posterior instrumentation plus vertebroplasty using injectable calcium sulfate cement (CSC) for thoracolumbar compression fractures. MATERIALS AND METHODS Twenty-eight patients with a single-level thoracolumbar compression fracture, who underwent short-segment pedicle screw fixation and CSC vertebroplasty, were included in the study. The anterior vertebral body height ratio, local kyphosis angle, and the height of the intervertebral disc adjacent to the fractured vertebra were used to evaluate the radiographic results. Complications including bone nonunion, instrument failure, cement leakage, and disc vacuum formation were also assessed. RESULTS The patients were followed up for an average of 24.20±5.40 months. The relative preoperative anterior body height was 55.71±15.29%, which improved to 94.93±5.39% immediately after surgery (P<0.001), and at final follow-up showed a 6.50±3.89% loss of height correction (P<0.001). The mean preoperative local kyphosis angle was 22.23±5.65°, which corrected to 2.67±4.43° immediately after surgery (P<0.001), but reverted to 6.71±4.95° at final follow-up, showing a 4.04±1.91° loss of correction (P<0.001). The mean height of the intervertebral disc proximal to the fractured vertebra was 9.87±0.91 mm before surgery, 12.53±0.98 mm after operation (P<0.001), and the loss of correction at final follow-up was 2.35±1.15 mm with a significant difference compared to immediate postoperative values (P<0.001). Bone nonunion occurred in 7 patients, 2 patients had hardware failure, 9 patients had cement leakage, and 10 patients had disc vacuum phenomenon adjacent to the fractured vertebra. CONCLUSIONS The patients who underwent this procedure had a loss of correction of vertebral height and local kyphosis. Complications such as bone nonunion, instrument failure, cement leakage, and disc vacuum may occur. Rapid CSC resorption accounts for these radiographic outcomes and complications. LEVEL OF EVIDENCE Level IV, retrospective study.
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Affiliation(s)
- B X Bu
- Department of Orthopedic, The First Affiliated Hospital, Zhengzhou University, No. 58 Jianshe Road, 450052 Zhengzhou, China; Luoyang Orthopedics and Traumatology Institution, Luoyang Orthopedic-Traumatological Hospital, No. 82 Qiming South Road, 471002 Luoyang, China
| | - M J Wang
- Luoyang Orthopedics and Traumatology Institution, Luoyang Orthopedic-Traumatological Hospital, No. 82 Qiming South Road, 471002 Luoyang, China
| | - W F Liu
- Department of Orthopedic, Changzhou Wujin Hospital, Jiangsu University, No. 2 Yongning North Road, 213002 Changzhou, China
| | - Y S Wang
- Department of Orthopedic, The First Affiliated Hospital, Zhengzhou University, No. 58 Jianshe Road, 450052 Zhengzhou, China
| | - H L Tan
- Luoyang Orthopedics and Traumatology Institution, Luoyang Orthopedic-Traumatological Hospital, No. 82 Qiming South Road, 471002 Luoyang, China; Department of Orthopedic, Changzhou Wujin Hospital, Jiangsu University, No. 2 Yongning North Road, 213002 Changzhou, China.
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