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Duan Y, Feng D, Chen J, Wu Y, Li T, Jiang L, Huang Y. Anterior, Posterior and Anterior-Posterior Approaches for the Treatment of Thoracolumbar Burst Fractures: A Network Meta-Analysis of Randomized Controlled Trials. J INVEST SURG 2024; 37:2301794. [PMID: 38199978 DOI: 10.1080/08941939.2024.2301794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE To compare the clinical and radiological results of the anterior approach versus the posterior approach versus the anterior-posterior approach for the treatment of thoracolumbar burst fractures. METHODS The network meta-analysis was performed in accordance with the PRISMA Statement. Electronic searches of PubMed and Embase were conducted up to June 22, 2023, for relevant randomized controlled trials. STATA13.0 was used to perform network meta-analysis. p < .05 was considered significant. RESULTS Nine RCTs with a total of 550 patients receiving surgical treatment in at least two of the three approaches, including anterior, posterior and anterior-posterior approaches, were included. The surgical duration and intraoperative bleeding volume in the posterior approach were significantly lower than those in the anterior (SMD, -1.72; 95% CI, -2.82, -0.62) and anterior-posterior approaches (SMD, 3.33; 95% CI, 1.65, 5.00). The surgical duration in the anterior approach was significantly lower than that in the anterior-posterior approach (SMD, 1.61; 95% CI, 0.12, 3.10). The Cobb angle in the anterior-posterior approach was significantly lower than that in the anterior approach (MD, -4.83; 95% CI, -9.60, -0.05). The VAS score in the posterior approach was significantly higher than that in the anterior approach (MD, 0.85; 95% CI, 0.55, 1.16) and anterior-posterior approach (MD, -0.84; 95% CI, -1.12, -0.55). No significant difference was identified among the three surgical approaches in implant failure rate and infection rate. CONCLUSION All three approaches were safe approaches with advantages and disadvantages. The selection of surgical approaches for the treatment of thoracolumbar burst fractures may be individualized.
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Affiliation(s)
- Yuchen Duan
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Dagang Feng
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Jun Chen
- Department of Critical Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Yamei Wu
- Sichuan Academy of Chinese Medicine Sciences, Chengdu, China
| | - Tong Li
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Leiming Jiang
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Yong Huang
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
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Kang KH, Seok SY, Cho JH. Concurrently Occurring Spinal Cord Cross-Section and Aortic Injury After a Chalk-Stick Fracture and Dislocation in Patient with Ankylosing Spondylitis: Clinical Image. World Neurosurg 2024; 184:149-151. [PMID: 38278209 DOI: 10.1016/j.wneu.2024.01.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 01/28/2024]
Abstract
A 74-year-old woman with ankylosing spondylitis presented with back pain and complete paraplegia after a fall. A radiologic finding of a bamboo spine, a characteristic feature of ankylosing spondylitis, was observed on computed tomography, along with a fracture-dislocation involving T10 and T11 (chalk-stick fracture) and compression of the descending thoracic aorta due to the caudal bony column. The patient underwent an open reduction and T8-L3 posterior fusion in the operating room. A complete cross-section of the spinal cord was observed during surgery. Post operation, a decrease in blood pressure led to a thoracotomy and thoracic endovascular aortic repair due to a crack in the descending aorta wall. Thoracolumbar fracture-dislocations, particularly in patients with ankylosing spondylitis, are characterized by instability and can be further complicated by concurrent vascular and spinal cord injuries. It is crucial therefore to recognize the potential for vascular and spinal cord injuries early on in such cases.
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Affiliation(s)
- Kyun Ho Kang
- Departments of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Sang Yun Seok
- Departments of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea.
| | - Jae Hwan Cho
- Departments of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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3
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Moawad CM, Arzi H, Naik A, Bashir R, Arnold PM. Short-Segment Pedicle Fixation of Traumatic Low Lumbar Fractures (L3-L5): Report of 36 Cases. Clin Spine Surg 2022; 35:E590-E595. [PMID: 35383612 DOI: 10.1097/bsd.0000000000001324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 03/01/2022] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN Prospective review. OBJECTIVE The aim was to assess the efficacy and safety of short-segment pedicle fixation of low lumbar fractures (L3-L5). BACKGROUND Low lumbar fractures are relatively uncommon, and limited data exists regarding the management of these injuries. No previous studies have specifically examined the surgical management of L3-L5 fractures exclusively with pedicle fixation. MATERIALS AND METHODS We reviewed prospectively collected data of 36 patients who underwent short-segment pedicle fixation for low lumbar fractures at our institution between 1993 and 2018. RESULTS There was no worsening of neurological status following surgery, and three patients regained motor or sphincter function. Thirty-one (86.1%) patients went on to successful fusion. Three (8%) patients required reoperation. Four (11%) patients had surgical complications. CONCLUSIONS This large series provides information regarding the safety and efficacy of surgical management of low lumbar fractures with pedicle fixation. Following surgery, there was no neurological worsening and some patients regained neurological function. Low complication rates, low reoperation rates, and low pain levels at final follow-up provide evidence that the surgical management of low lumbar fractures utilizing short-segment pedicle fixation is safe and efficacious.
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Affiliation(s)
| | | | | | - Rashid Bashir
- Department of Bioengineering and Basic and Translational Sciences, Grainger College of Engineering, Carle Illinois College of Medicine, University of Illinois, Urbana Champaign, IL
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Hughes H, Carthy AM, Sheridan GA, Donnell JM, Doyle F, Butler J. Thoracolumbar Burst Fractures: A Systematic Review and Meta-Analysis Comparing Posterior-Only Instrumentation Versus Combined Anterior-Posterior Instrumentation. Spine (Phila Pa 1976) 2021; 46:E840-E849. [PMID: 34228696 DOI: 10.1097/brs.0000000000003934] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Meta-analysis. OBJECTIVE To compare the clinical, functional, and radiological outcomes of posterior-only versus combined anterior-posterior instrumentation in order to determine the optimal surgical intervention for thoracolumbar burst fractures. SUMMARY OF BACKGROUND DATA Unstable thoracolumbar burst fractures warrant surgical intervention to prevent neurological deterioration and progressive kyphosis, which can lead to significant pain and functional morbidity. The available literature remains largely inconclusive in determining the optimal instrumentation strategy. METHODS Electronic searches of MEDLINE (1948-May 2020), EMBASE (1947-May 2020), The Cochrane Library (1991-May 2020), and other databases were conducted. Cochrane Collaboration guidelines were used for data extraction and quality assessment. Outcomes of interest were divided into three categories: radiological (degree of postoperative kyphosis correction; loss of kyphosis correction at final follow-up), functional (visual analogue scale [VAS] pain score; Oswestry Disability Index [ODI] score), and clinical (intraoperative blood loss; length of stay [LOS]; operative time; the number and type of postoperative complications). RESULTS Four randomized control trials (RCTs) were retrieved, including 145 randomized participants. Seventy-three patients underwent posterior-only instrumentation and 72 underwent combined instrumentation. No significant difference was found in the degree of postoperative kyphosis correction (P = 0.39), VAS (centimeters) at final follow-up (P = 0.67), ODI at final follow-up (P = 0.89) or the number of postoperative complications between the two approaches (P = 0.49). Posterior-only instrumentation was associated with lower blood loss (P < 0.001), operative time (P < 0.001), and LOS (P = 0.01). Combined instrumentation had a lower degree of kyphosis loss at final follow-up (P = 0.001). There was heterogeneity in the duration of follow-up between the included studies (mean follow-up range 24-121 months). CONCLUSION The available literature remains largely inconclusive. In order to reliably inform practice in this area, there is a need for large, high-quality, multicenter RCTs with standardized reporting of outcomes, with a particular focus on outcomes relating to patient function and severe complications causing long-term morbidity.Level of Evidence: 2.
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Affiliation(s)
- Hannah Hughes
- Department of Trauma and Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Andrea Mc Carthy
- Department of Trauma and Orthopaedic Surgery, Cork University Hospital, Wilton, Cork, Ireland
| | - Gerard Anthony Sheridan
- Department of Trauma and Orthopaedic Surgery, Cork University Hospital, Wilton, Cork, Ireland
| | - Jake Mc Donnell
- Department of Trauma and Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Frank Doyle
- Faculty of Medicine and Health Sciences, School of Postgraduate Studies, Royal College of Surgeons in Ireland, Ireland
| | - Joseph Butler
- Department of Trauma and Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
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5
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Thiébaut B, Bastard C, Eymard F, Bouthors C, Flouzat Lachaniette CH, Dubory A. Long-Term Results of Anterior-Only Lumbar Interbody Fusions in Rheumatoid Arthritis Patients: Comparative Retrospective Cohort Study. World Neurosurg 2021; 154:e109-e117. [PMID: 34224890 DOI: 10.1016/j.wneu.2021.06.128] [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: 04/07/2021] [Revised: 06/27/2021] [Accepted: 06/28/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Rheumatoid arthritis (RA) is a risk factor of lumbar spine surgical failure. The interest of anterior lumbar fusion in this context remains unknown. This retrospective study aimed to compare the outcome of anterior-only fusions between RA patients and non-RA (NRA) patients to treat lumbar spine degenerative disorders. METHODS NRA and RA groups including anterior-only fusion were compared. Clinical data (Visual Analog Scale score axial back pain scale, the Oswestry Disability Index, and a questionnaire of satisfaction regarding the surgical result); radiologic data (bone fusion, sagittal balance analysis); and adverse events were assessed using repeated measure 1-way analysis of variance. RESULTS The mean follow-up was 9.5 years (95% confidence interval [7.1-12.2]) for the RA group (n = 13) and 9.4 years (95% confidence interval [8.7-10.3]) for the NRA group (n = 36). Anterior fusion improved clinical outcome without any effect of RA (Visual Analog Scale score axial back pain scale; P < 0.001/Oswestry Disability Index; P = 0.01). The presence of RA influenced neither the satisfaction as the regards the surgical result nor spine balance nor bone fusion. Context of RA increased the surgical revision rate (10 patients [76.9%] for RA group vs. 3 patients [8.8%] for the NRA group; P = 0.001) because of the occurrence of an adjacent segment disease needing surgical revision (P = 0.028), especially the occurrence of intervertebral frontal dislocation (P = 0.02). CONCLUSIONS As noticed for posterior-only fusion, the anterior lumbar approach in RA patients does not seem to avoid the occurrence of an adjacent segment disease.
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Affiliation(s)
- Benjamin Thiébaut
- Department of Orthopaedic Surgery, Henri Mondor Hospital, AP-HP, University of Paris, East Créteil, France
| | - Claire Bastard
- Department of Orthopaedic Surgery, Henri Mondor Hospital, AP-HP, University of Paris, East Créteil, France; Cell and Tissue Engineering for Musculoskeletal Disorders (Group 5)/Biology of the NeuroMuscular System (INSERM Team 10)/Mondor Institute for Biomedical Research, Creteil, France
| | - Florent Eymard
- Department of Rheumatology, Henri Mondor Hospital, AP-HP, University of Paris, East Créteil, France
| | - Charlie Bouthors
- Orthopaedic Department, Tumor and Spine Unit, Bicêtre University Hospital, Paris, France
| | - Charles Henri Flouzat Lachaniette
- Department of Orthopaedic Surgery, Henri Mondor Hospital, AP-HP, University of Paris, East Créteil, France; Cell and Tissue Engineering for Musculoskeletal Disorders (Group 5)/Biology of the NeuroMuscular System (INSERM Team 10)/Mondor Institute for Biomedical Research, Creteil, France
| | - Arnaud Dubory
- Department of Orthopaedic Surgery, Henri Mondor Hospital, AP-HP, University of Paris, East Créteil, France; Cell and Tissue Engineering for Musculoskeletal Disorders (Group 5)/Biology of the NeuroMuscular System (INSERM Team 10)/Mondor Institute for Biomedical Research, Creteil, France.
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Li P, Huang Y, Liang Z, Gan L, Wei B, Ye Z, Li M, Luo Z. Clinical efficacy and therapeutic value of delayed surgery in patients with symptomatic old thoracolumbar fractures. BMC Surg 2021; 21:290. [PMID: 34116646 PMCID: PMC8194126 DOI: 10.1186/s12893-021-01240-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/06/2021] [Indexed: 11/18/2022] Open
Abstract
Background To investigate the clinical efficacy and therapeutic value of posterior decompression reduction, bone grafting fusion, and internal fixation for treatment of symptomatic old thoracolumbar fractures. Method Retrospective analysis was conducted for 14 patients (9 men, 5 women; average age 40.1 years) with old thoracolumbar fractures who underwent posterior operation. American Spinal Injury Association (ASIA) scores were used to evaluate neurologic function. Vertebral body height, Cobb angle in the sagittal plane, spinal canal volume ratio (%) and bone graft fusion were analyzed by radiography and computed tomography on different follow-up times. Results Mean follow-up was 27.1 months (23–36 months). Of three patients with ASIA grade A, 2 had improved postoperative urination and defecation, although no classification change. Preoperative ASIA score for eight patients with incomplete injury was grade B; four patients recovered to grade C at final follow-up. Preoperative ASIA score was C in three patients, increased to D in two patients and returned to normal E in one patient. Preoperative results showed average injured vertebra height loss rate decreased from 50.4 to 8.9%; average Cobb angle on the sagittal plane recovered from 39.6 to 6.9°; and the average spinal canal volume ratio recovered from 33.8 to 5.9%. Bony fusion was achieved; local lumbago and leg pain were relieved to some extent. No patients exhibited loosening of the fracture treated by internal fixation, pseudoarthrosis, or other related serious complications. Conclusion Treatment of old thoracolumbar fractures by posterior decompression reduction, bone grafting fusion, and internal fixation can relieve spinal cord compression, improve neurologic function of some patients (ASIA grades B–C), effectively relieve pain, correct deformity, restore biomechanical stability, and significantly improve quality of life.
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Affiliation(s)
- Pan Li
- Medical Research Institute, Northwestern Polytechnical University, Xi'an, China.,Department of Orthopaedics, Xijing Hospital, Air Force Medical University, 127 West Changle Road, Xi'an, 710032, China
| | - Yunfei Huang
- Department of Spine Sugery, Xi'an Jiaotong University Affliated Honghui Hospital, Xi'an, China
| | - Zhuowen Liang
- Department of Orthopaedics, Xijing Hospital, Air Force Medical University, 127 West Changle Road, Xi'an, 710032, China
| | - Lu Gan
- Department of Orthopaedics, Xijing Hospital, Air Force Medical University, 127 West Changle Road, Xi'an, 710032, China
| | - Bin Wei
- Department of Orthopaedics, Xijing Hospital, Air Force Medical University, 127 West Changle Road, Xi'an, 710032, China
| | - Zhengxu Ye
- Department of Orthopaedics, Xijing Hospital, Air Force Medical University, 127 West Changle Road, Xi'an, 710032, China
| | - Mo Li
- Department of Orthopaedics, Xijing Hospital, Air Force Medical University, 127 West Changle Road, Xi'an, 710032, China.
| | - Zhuojing Luo
- Department of Orthopaedics, Xijing Hospital, Air Force Medical University, 127 West Changle Road, Xi'an, 710032, China.
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7
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Mata-Gómez J, Gilete-Tejero IJ, Rico-Cotelo M, Royano-Sánchez M, Moreno-Flores A, Ortega-Martínez M. Neurologically Asymptomatic Lumbar Traumatic Dislocation With Vascular Compression in a Patient With Ankylosing Spondylitis: Case Report. Int J Spine Surg 2020; 14:S16-S20. [PMID: 33900939 DOI: 10.14444/7159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Ankylosing spondylitis (AS) is associated with high rates of severe thoracolumbar fractures, in many cases with neurological deficits. It is currently a point of debate as to whether the optimal surgical treatment is posterior fixation and fusion or combined approaches. Vascular injuries in this kind of fracture are a challenging issue to solve in the management of these patients. METHODS We are reporting the case of a 65-year-old man who presented an L4 traumatic fracture-dislocation. He had a long history of symptomatic AS. No neurological deficits were detected during the initial exploration. During the preoperative work-up, a lumbar spine computed tomography (CT) scan was taken with vascular reconstruction of the abdominal vessels. It confirmed the compression of the abdominal aorta, which had caused more than 90% stenosis. A posterior approach, an open reduction, and fixation with pedicle screws were performed, without hemodynamic or neurological changes. A postoperative angiography demonstrated a complete recovery of the vessel caliber, without contrast leaks. RESULTS After a 2-year follow-up, the patient was pain free and the CT scan revealed bone fusion. CONCLUSIONS The vascular structures involved in severe thoracolumbar fractures present a dangerous situation that should be considered in the choice of the surgical approach. The posterior approach alone may be a good option in the absence of vascular damage. However, due to risk of vessel rupture during the fracture reduction, vascular surgeons must take part in the surgery. LEVEL OF EVIDENCE 5. CLINICAL RELEVANCE The article provides help for surgeons who have to treat severe fractures in the context of ankylosing spondylitis.
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Affiliation(s)
- Jacinto Mata-Gómez
- Neurosurgery Department, Complejo Hospitalario Universitario de Badajoz, Spain
| | | | - María Rico-Cotelo
- Neurosurgery Department, Complejo Hospitalario Universitario de Cáceres, Spain
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8
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Anderson PA, Raksin PB, Arnold PM, Chi JH, Dailey AT, Dhall SS, Eichholz KM, Harrop JS, Hoh DJ, Qureshi S, Rabb CH, 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: Surgical Approaches. Neurosurgery 2019; 84:E56-E58. [PMID: 30203100 DOI: 10.1093/neuros/nyy363] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 07/16/2018] [Indexed: 11/13/2022] Open
Abstract
QUESTION Does the choice of surgical approach (anterior, posterior, or combined anterior-posterior) improve clinical outcomes in patients with thoracic and lumbar fractures? RECOMMENDATIONS In the surgical treatment of patients with thoracolumbar burst fractures, physicians may use an anterior, posterior, or a combined approach as the selection of approach does not appear to impact clinical or neurological outcomes. Strength of Recommendation: Grade B With regard to radiologic outcomes in the surgical treatment of patients with thoracolumbar fractures, physicians may utilize an anterior, posterior, or combined approach because there is conflicting evidence in the comparison among approaches. Strength of Recommendation: Grade Insufficient With regard to complications in the surgical treatment of patients with thoracolumbar fractures, physicians may use an anterior, posterior, or combined approach because there is conflicting evidence in the comparison among approaches. Strength of Recommendation: Grade Insufficient The full version of the guideline can be reviewed at: https://www.cns.org/guideline-chapters/congress-neurological-surgeons-systematic-review-evidence-based-guidelines/chapter_11.
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Affiliation(s)
- Paul A Anderson
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, Wisconsin
| | - 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
| | - Paul M Arnold
- Department of Neurosurgery, University of Kansas School of Medicine, Kansas City, Kansas
| | - John H Chi
- Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - 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
| | - Kurt M Eichholz
- St. Louis Minimally Invasive Spine Center, St. Louis, Missouri
| | - 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, Columbia University, New York, New York
| | - 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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9
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Tranexamic Acid Decreases Visible and Hidden Blood Loss Without Affecting Prethrombotic State Molecular Markers in Transforaminal Thoracic Interbody Fusion for Treatment of Thoracolumbar Fracture-Dislocation. Spine (Phila Pa 1976) 2018; 43:E734-E739. [PMID: 29189568 DOI: 10.1097/brs.0000000000002491] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A randomized, double-blind, placebo-controlled clinical trial. OBJECTIVE To evaluate the efficacy and safety of tranexamic acid (TXA) administered during the surgical correction of thoracolumbar fracture-dislocation. SUMMARY OF BACKGROUND DATA Thoracolumbar fracture-dislocation surgery is generally associated with substantial blood loss and a high risk of deep vein thrombosis. TXA has been shown to improve hemostasis in surgical procedures. METHODS We investigated 80 patients with thoracolumbar fracture-dislocation who underwent transforaminal thoracic interbody fusion between March 2014 and December 2016. The patients were randomized into the TXA (n = 39) and Placebo (n = 41) groups, according to whether they did or did not receive pre- and intraoperative TXA treatment. The two groups were compared for demographic characteristics as well as pre- and postoperative levels of prethrombosis-state molecular markers and visible and hidden blood loss volumes. Additionally, the prevalence of TXA-related complications was determined. RESULTS The two groups did not differ significantly in demographic characteristics. The visible blood loss (intra- and postoperative bleeding during the first 24 h), hidden blood loss, and true total blood loss during surgery in the TXA group were significantly lower than those in the Placebo group (835 ± 180.3 mL, 351 ± 82.3 mL, 1385 ± 102.3 mL vs. 1155 ± 175.3 mL, 564 ± 170.5 mL, 1683 ± 121.0 mL, respectively; P < 0.01). Furthermore, the levels of the prethrombosis-state molecular markers GMP-140, fibrinogen, fibrin degradation products, and D-dimer were higher in the TXA group than in the Placebo group, although the differences were not significant (P > 0.05). No significant intergroup differences were noted in the prevalence of deep venous thrombosis and pulmonary embolus during the study period. CONCLUSION TXA significantly reduced visible and hidden blood loss without affecting the prethrombosis-state molecular markers in transforaminal thoracic interbody fusion or causing any notable adverse effects. LEVEL OF EVIDENCE 3.
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10
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Joaquim AF, Schroeder GD, Patel AA, Vaccaro AR. Clinical and radiological outcome of non-surgical management of thoracic and lumbar spinal fracture-dislocations - a historical analysis in the era of modern spinal surgery. J Spinal Cord Med 2018; 43:3-9. [PMID: 29781783 PMCID: PMC7006754 DOI: 10.1080/10790268.2018.1474692] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
Context: It is well established that traumatic spinal dislocations (AO Type C injuries) should be surgically treated. However, no recent comparative study of surgical versus non-surgical management of type C injuries was found attesting the superiority of surgical treatment.Objective: Due to the lack of information about the natural history of non-surgical management of type C injuries, we evaluated the outcome of historical conservative treatment of type C injuries.Methods: An extensive manual search of articles was performed in the Pubmed Database. We included articles that reported the clinical and/ or the radiological outcome of non-surgical management of thoracic and/ or lumbar spinal fracture-dislocations.Results: Three well described retrospective studies where fracture-dislocations of the thoracolumbar spine were managed non-surgically were included. Non-surgical management typically consisted in postural reduction and prolonged bed rest (about 10-13 weeks on average). Residual deformity was common, and some studies reported a high rate of post treatment pain syndromes. Some studies reported surgery for gibbus deformity after conservative treatment or persistent instability requiring further bed rest. Neurological deterioration was rare, and some patients had some improvement, although the vast majority of the patients had persistent, severe neurological deficits.Conclusions: Compared with historical non-surgical care, surgery for type C injuries decreases the chances of post-operative pain, late spinal deformity and also allowed early rehabilitation, once no bed restriction is necessary. Ethical issues based on this historical analysis may preclude performing a comparative study of non-surgical versus surgical management of these injuries in the modern spine era.
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Affiliation(s)
- Andrei Fernandes Joaquim
- Neurosurgery Division, State University of Campinas, Campinas-SP, Brazil,Correspondence to: Andrei Fernandes Joaquim, Neurosurgeon. Department of Neurology. University of Campinas – UNICAMP, Campinas-SP, Brazil; Ph/Fax: +55 1935217489.
| | - Gregory D. Schroeder
- Department of Orthopaedic Surgery and Neurosurgery at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alpesh A. Patel
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alexander R. Vaccaro
- Department of Orthopaedic Surgery and Neurosurgery at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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11
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Vilà-Canet G, García de Frutos A, Covaro A, Ubierna MT, Caceres E. Thoracolumbar fractures without neurological impairment: A review of diagnosis and treatment. EFORT Open Rev 2017; 1:332-338. [PMID: 28507775 PMCID: PMC5414848 DOI: 10.1302/2058-5241.1.000029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
An appropriate protocol and unified management of thoracolumbar fractures without neurological impairment has not been well defined. This review attempts to elucidate some controversies regarding diagnostic tools, the ability to define the most appropriate treatment of classification systems and the evidence for conservative and surgical methods based on the recent literature.
Cite this article: Vilà-Canet G, García de Frutos A, Covaro A, Ubierna MT, Caceres E. Thoracolumbar fractures without neurological impairment: a review of diagnosis and treatment. EFORT Open Rev 2016;1:332-338. DOI: 10.1302/2058-5241.1.000029
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Affiliation(s)
- G Vilà-Canet
- ICATME, Institut Universitari Quirón-Dexeus, Barcelona, Spain
| | | | - A Covaro
- ICATME, Institut Universitari Quirón-Dexeus, Barcelona, Spain
| | - M T Ubierna
- ICATME, Institut Universitari Quirón-Dexeus, Barcelona, Spain
| | - E Caceres
- ICATME, Institut Universitari Quirón-Dexeus, Barcelona, Spain.,Universitat Autónoma de Barcelona, Spain
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12
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Waqar M, Van-Popta D, Barone DG, Bhojak M, Pillay R, Sarsam Z. Short versus long-segment posterior fixation in the treatment of thoracolumbar junction fractures: a comparison of outcomes. Br J Neurosurg 2016; 31:54-57. [DOI: 10.1080/02688697.2016.1206185] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Mueez Waqar
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Dmitri Van-Popta
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Manchester, UK
| | | | - Maneesh Bhojak
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Robin Pillay
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Zaid Sarsam
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
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Li C, Ye Y, Gu Y, Dong J. Minimally invasive resection of extradural dumbbell tumors of thoracic spine: surgical techniques and literature review. 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; 25:4108-4115. [DOI: 10.1007/s00586-016-4677-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/03/2016] [Accepted: 06/21/2016] [Indexed: 12/13/2022]
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Abstract
The most common fractures of the spine are associated with the thoracolumbar junction. The goals of treatment of thoracolumbar fracture are leading to early mobilization and rehabilitation by restoring mechanical stability of fracture and inducing neurologic recovery, thereby enabling patients to return to the workplace. However, it is still debatable about the treatment methods. Neurologic injury should be identified by thorough physical examination for motor and sensory nerve system in order to determine the appropriate treatment. The mechanical stability of fracture also should be evaluated by plain radiographs and computed tomography. In some cases, magnetic resonance imaging is required to evaluate soft tissue injury involving neurologic structure or posterior ligament complex. Based on these physical examinations and imaging studies, fracture stability is evaluated and it is determined whether to use the conservative or operative treatment. The development of instruments have led to more interests on the operative treatment which saves mobile segments without fusion and on instrumentation through minimal invasive approach in recent years. It is still controversial for the use of these treatments because there have not been verified evidences yet. However, the morbidity of patients can be decreased and good clinical and radiologic outcomes can be achieved if the recent operative treatments are used carefully considering the fracture pattern and the injury severity.
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