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

Transpedicular Approach for Corpectomy and Circumferential Arthrodesis in Traumatic Lumbar Vertebral Body Burst Fractures: A Retrospective Analysis of Outcome in 35 Patients

Background

Traumatic vertebral burst fractures can be surgically approached via different approaches (anterior/posterior, or combined). Transpedicular approach (TA) is a posterior approach that has the advantage of achieving circumferential arthrodesis via single posterior only approach. The purpose of this study was to analyze our experience with TA in management of traumatic lumbar burst fractures (TLBFs).

Materials and Methods

All consecutive patients with TLBFs managed with TA over 5 years duration were included in this retrospective study. Correction of kyphotic deformity and change in neurological status were analyzed to assess outcome. Cobb's angle and ASIA grade were used for this purpose.

Results

There were 21 males and 14 females. Eight patients had complete (ASIA-A) while 22 had incomplete injury. All patients had a TLICS score >=4. The mean preoperative Cobb's angle was 13.97° that improved to -3.57° postoperatively (mean kyphosis correction-17.54°). None of the patients developed iatrogenic nerve root injury. There was no perioperative mortality. The mean cobb's angle was 1.23° at 39.1 months follow-up. Eight patients developed cage subsidence but none required revision surgery. Postoperatively, 27 (77.1%) patients showed neurological improvement and none deteriorated. The median ASIA score improved from 3 to 5. A fusion rate of 91.4% was observed at last follow-up.

Conclusions

The advantages of TA including sense of familiarity with posterior approach amongst spine surgeons, lesser approach-related morbidity, and results comparable to anterior/combined approaches, make TA an attractive option for managing TLBFs. Although technically difficult, it can be successfully used for circumferential arthrodesis in lumbar region without sacrificing nerve roots.

Comparison anterior minimally invasive oblique retroperitoneal approach and posterior transpedicular approach for debridement fusion in patients with lumbar vertebral osteomyelitis: A randomized controlled trial protocol

BACKGROUND

Pyogenic osteomyelitis of the spine usually occurs in patients over 55 years old with acute osteomyelitis. Surgical treatment and fixation can relieve pain, enhance spinal balance and nerve function, so that patients can walk as soon as possible. Different outcomes of surgical methods include anterior minimally invasive oblique retroperitoneal approach (ORA) and posterior transpedicular approach (PTA). While, there is no consensus on the best treatment for PVO. The goal of the protocol is to compare the clinical consequences between PTA and ORA for treating PVO.

METHOD

The experiment is a single-center randomized clinical research. This experiment was admitted by the Ethics Committee of the People's Hospital of Dayi County (Approval number: 1002-084). In all, 50 patients with lumbar vertebral osteomyelitis (LVO) who prepares surgical treatment will be included in the study. We contain adult patients (aged over 18 years) who accept debridement and spinal stabilization with LVO. Cases are removed if there is previous hardware placement, cases who are not confirmed by microbiology, or severe renal and liver dysfunction. The primary outcomes are intraoperative blood loss, operative time, hospital stay, primary failure and recurrence, and bone fusion. The secondary outcomes are postoperative pain score and physical recovery. SPSS Sample Power version 3.0 (IBM, Armonk, NY, USA) is used for data analysis.

RESULTS

Table 1 will show the outcomes in both groups.

CONCLUSION

This protocol may offer a reliable basis for the effectiveness of the two approaches in the treatment of PVO.

TRIAL REGISTRATION NUMBER

researchregistry6046.

Transforaminal Interbody Impaction of Bone Graft to Treat Collapsed Nonhealed Vertebral Fractures with Endplate Destruction: A Report of Two Cases

Background

A collapsed nonhealed vertebral fracture with endplate destruction is a challenging injury to address, as there is no single definitive treatment. We present two cases using an innovative transforaminal grafting technique to treat these patients. Case Presentation. Case 1: a 72-year-old woman had nonunion of an L1 compression fracture with destruction of both endplates. T12/L1 and L1/L2 transforaminal debridement and impaction of bone graft were performed followed by posterior instrumentation. At three years follow-up, the fusion mass between T12/L1 and L1/L2 was solid and the patient had minimal pain. Case 2: a 62-year-old woman had nonunion of an L1 burst fracture with destruction of the lower endplate. Hemilaminectomy and transforaminal interbody impaction of bone graft was performed. At three years follow-up, the patient had no back pain and a solid fusion. In both cases, local kyphosis was corrected and fusion obtained.

Conclusions

Collapsed nonhealed vertebral body fractures combined with endplate destruction can be successfully treated with a one-step posterior surgery consisting of transforaminal debridement and impaction of bone graft in combination with posterior pedicle instrumentation.