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Najjar E, Meshneb M, Isapure A, Komaitis S, Hassanin MA, Rampersad R, Elnady B, Salem KM, Quraishi NA. Thoracolumbar Fractures: Comparing the Effect of Minimally Invasive Versus Open Schanz Screw Techniques on Sagittal Alignment. Cureus 2024; 16:e63187. [PMID: 38933343 PMCID: PMC11200998 DOI: 10.7759/cureus.63187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2024] [Indexed: 06/28/2024] Open
Abstract
STUDY DESIGN This is a retrospective comparative cohort study. PURPOSE This study aims to compare the effects of minimally invasive surgery (MIS) and open surgery (OS) on global sagittal alignment (GSA) in surgically managed thoracolumbar fractures. OVERVIEW OF LITERATURE The optimal treatment of traumatic thoracolumbar fractures (TLF) remains controversial. Both MIS techniques with polyaxial screws and OS techniques with Schanz screws have gained widespread use. The effect of each technique on the global sagittal alignment has not been reported. METHODS From 2014 to 2021, 22 patients with traumatic TLF underwent open posterior stabilization using an open transpedicular Schanz screw-rod construct and were compared to 15 patients who underwent minimally invasive surgery using a polyaxial percutaneous pedicle screw-rod construct. The reported radiological parameters measured on preoperative supine CT scan and immediate postop standing X-ray and on final follow-up whole spine standing X-rays included pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL), preoperative segmental kyphosis (Preop-K), immediate post-operative segmental kyphosis (postop-Ki), final post-operative segmental kyphosis (postop-Kf), sagittal-vertica-axis (SVA), and spino-sacral angle (SSA). RESULTS The average age of the OS group was 42.5 years; 5 patients had AO type B, and 17 patients had AO type A (A3 and A4) fractures. The average follow-up was 16.8 months. The average radiological parameters were: PI = 54.9°, PI-LL = 3°, PT = 17.6°, preop-K = 16.2°, postop-Ki = 8.7°, final postop-Kf = 14.3°, SVA = 4.58 cm, and SSA = 101.8°. The average age of the MIS group was 43.4 years; 5 patients had AO type B, and 10 patients had AO type A fractures. The average follow-up was 25 months. The average radiological parameters were as follows: PI = 51°, PI-LL = 8°, PT = 18°, preop-K = 18.4°, postop-Ki = 11.6°, postop-Kf = 14.3°, SVA = 6.4 cm, SSA = 106°. CONCLUSION The fixation technique did not significantly affect the final correction of the local kyphosis and global spine alignment parameters.
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Affiliation(s)
- Elie Najjar
- Spinal Unit, The Centre for Spinal Studies and Surgery (CSSS) Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, GBR
| | - Mostafa Meshneb
- Spinal Unit, The Centre for Spinal Studies and Surgery (CSSS) Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, GBR
| | - Anish Isapure
- Spinal Unit, The Centre for Spinal Studies and Surgery (CSSS) Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, GBR
| | - Spyridon Komaitis
- Spinal Unit, The Centre for Spinal Studies and Surgery (CSSS) Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, GBR
| | - Mohamed A Hassanin
- Spinal Unit, The Centre for Spinal Studies and Surgery (CSSS) Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, GBR
| | - Rishi Rampersad
- Spinal Unit, The Centre for Spinal Studies and Surgery (CSSS) Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, GBR
| | - Belal Elnady
- Department of Orthopedics and Trauma Surgery, Assiut University Hospitals, Assiut, EGY
| | - Khalid M Salem
- Spinal Unit, The Centre for Spinal Studies and Surgery (CSSS) Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, GBR
| | - Nasir A Quraishi
- Spinal Unit, The Centre for Spinal Studies and Surgery (CSSS) Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, GBR
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Zhang J, Xu J, Xu C, Xie Y. Posterior endpoint determination of the lumbar pedicle central axis on the anterior-posterior fluoroscopic image for pedicle screw insertion. Sci Rep 2024; 14:9272. [PMID: 38653756 DOI: 10.1038/s41598-024-57349-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/18/2024] [Indexed: 04/25/2024] Open
Abstract
The transpedicular procedure has been widely used in spinal surgery. The determination of the best entry point is the key to perform a successful transpedicular procedure. Various techniques have been used to determine this point, but the results are variable. This study was carried out to determine the posterior endpoint of the lumbar pedicle central axis on the standard anterior-posterior (AP) fluoroscopic images. Computer-aided design technology was used to determine the pedicle central axis and the posterior endpoint of the pedicle central axis on the posterior aspect of the vertebra. The standard AP fluoroscopic image of the lumbar vertebral models by three-dimensional printing was achieved. The endpoint projection on the AP fluoroscopic image was determined in reference to the pedicle cortex projection by the measurements of the angle and distance on the established X-Y coordinate system of the radiologic image. The projection of posterior endpoint of the lumbar pedicle central axis were found to be superior to the X-axis of the established X-Y coordinate system and was located on the pedicle cortex projection on the standard AP fluoroscopic image of the vertebra. The projection point was distributed in different sectors in the coordinate system. It was located superior to the X-axis by 18° to 26° at L1, while they were located superior to the X-axis by 12° to 14° at L2 to L5. The projections of posterior endpoints of the lumbar pedicle central axis were located in different positions on the standard AP fluoroscopic image of the vertebra. The determination method of the projection point was helpful for selecting an entry point for a transpedicular procedure with a fluoroscopic technique.
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Affiliation(s)
- Jun Zhang
- Shanghai Key Laboratory of Orthopaedic Implant, Department of Orthopaedic Surgery, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Department of Orthopaedic Surgery, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Jiawei Xu
- Shanghai Key Laboratory of Orthopaedic Implant, Department of Orthopaedic Surgery, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chenyang Xu
- Shanghai Key Laboratory of Orthopaedic Implant, Department of Orthopaedic Surgery, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Youzhuan Xie
- Shanghai Key Laboratory of Orthopaedic Implant, Department of Orthopaedic Surgery, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
- Department of Orthopaedic Surgery, Quanzhou Taiwanese Investment Zone Hospital, Fujian, China.
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Gomez GI, Li GQ, Valido AA, Stoner AJ, Bromley-Dulfano RA, Sheira D, Gonzalez CA, Khan SI, Choi J, Zygourakis CC, Weiser TG. Thoracic and Lumbar Spine Injury: Evidence-Based Diagnosis, Management, and Outcomes. Am Surg 2024; 90:902-910. [PMID: 37983195 DOI: 10.1177/00031348231216479] [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] [Indexed: 11/22/2023]
Abstract
BACKGROUND Traumatic thoracolumbar spine injuries are associated with significant morbidity and mortality. Targeted for non-spine specialist trauma surgeons, this systematic scoping review aimed to examine literature for up-to-date evidence on presentation, management, and outcomes of thoracolumbar spine injuries in adult trauma patients. METHODS This review was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. We searched four bibliographic databases: PubMed, EMBASE, Web of Science, and the Cochrane Library. Eligible studies included experimental, observational, and evidence-synthesis articles evaluating patients with thoracic, lumbar, or thoracolumbar spine injury, published in English between January 1, 2010 and January 31, 2021. Studies which focused on animals, cadavers, cohorts with N <30, and pediatric cohorts (age <18 years old), as well as case studies, abstracts, and commentaries were excluded. RESULTS A total of 2501 studies were screened, of which 326 unique studies were fully text reviewed and twelve aspects of injury management were identified and discussed: injury patterns, determination of injury status and imaging options, considerations in management, and patient quality of life. We found: (1) imaging is a necessary diagnostic tool, (2) no consensus exists for preferred injury characterization scoring systems, (3) operative management should be considered for unstable fractures, decompression, and deformity, and (4) certain patients experience significant burden following injury. DISCUSSION In this systematic scoping review, we present the most up-to-date information regarding the management of traumatic thoracolumbar spine injuries. This allows non-specialist trauma surgeons to become more familiar with thoracolumbar spine injuries in trauma patients and provides a framework for their management.
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Affiliation(s)
- Giselle I Gomez
- Stanford University School of Medicine, Stanford, CA, USA
- Surgeons Writing About Trauma, Stanford University, Stanford, CA, USA
| | - Guan Q Li
- Stanford University School of Medicine, Stanford, CA, USA
- Surgeons Writing About Trauma, Stanford University, Stanford, CA, USA
| | - Austin A Valido
- Stanford University School of Medicine, Stanford, CA, USA
- Surgeons Writing About Trauma, Stanford University, Stanford, CA, USA
| | | | - Rebecca A Bromley-Dulfano
- Stanford University School of Medicine, Stanford, CA, USA
- Surgeons Writing About Trauma, Stanford University, Stanford, CA, USA
| | - Dina Sheira
- Stanford University School of Medicine, Stanford, CA, USA
- Surgeons Writing About Trauma, Stanford University, Stanford, CA, USA
| | - Cayo A Gonzalez
- Stanford University School of Medicine, Stanford, CA, USA
- Surgeons Writing About Trauma, Stanford University, Stanford, CA, USA
| | - Suleman I Khan
- Stanford University School of Medicine, Stanford, CA, USA
- Surgeons Writing About Trauma, Stanford University, Stanford, CA, USA
| | - Jeff Choi
- Surgeons Writing About Trauma, Stanford University, Stanford, CA, USA
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, CA, USA
| | | | - Thomas G Weiser
- Surgeons Writing About Trauma, Stanford University, Stanford, CA, USA
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, CA, USA
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Murans G, Meska L, Gaurilcikas M, Jespersen SM, Lindberg-Larsen M. Patient-reported outcome from minimal invasive surgery compared with conventional open surgery for thoracolumbar fractures of the spine. BRAIN & SPINE 2024; 4:102782. [PMID: 38510609 PMCID: PMC10951746 DOI: 10.1016/j.bas.2024.102782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 02/12/2024] [Accepted: 03/01/2024] [Indexed: 03/22/2024]
Abstract
Study design retrospective cohort study of prospectively collected data. Objective The treatment guidelines for thoracolumbar spinal fractures are controversial although minimally invasive surgery (MIS) is a popular alternative to the traditional open approach (TOA). Limited data exists about outcomes after MIS fracture treatment. The main aim of our study was to evaluate self-reported disability, health-related quality of life, pain, and satisfaction after MIS compared with TOA. Methods Of 173 patients operated from 2014 to 2018, 64.7% patients completed the Oswestry Disability Index (ODI), the EQ-5D-5L, and a tailored clinical follow-up questionnaire on employment status, pain, activity level, and satisfaction with treatment. Results Of the 112 patients, 34 had MIS and 78 had TOA. Mean follow-up was 56 months. The two groups were comparable on demographic variables apart from mean age - MIS group was 10 years older. The MIS group had better ODI scores (p = 0.046), but the groups were similar regarding return to work and disability retirement. The EQ-5D-5L index for the MIS were very close (mean -0.033, median +0.049) to the Danish population score, while the TOA showed a greater deviation (mean - 0.125, median -0.040). The MIS used less pain medication than the TOA. Both groups were similarly satisfied with treatment results. Conclusion Our data indicates that MIS surgery for thoracolumbar spinal fractures can achieve acceptable self-reported outcomes in terms of disability, health-related quality of life, pain, and satisfaction with treatment. However, a randomized controlled trial is needed to determine whether the MIS approach is superior to TOA.
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Affiliation(s)
- Girts Murans
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital and Svendborg, Odense, Denmark
- Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, Denmark
- University Center for Spine Surgery, Department of Neurosurgery, Odense University Hospital, Denamrk
| | - Laurynas Meska
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital and Svendborg, Odense, Denmark
- University Center for Spine Surgery, Department of Neurosurgery, Odense University Hospital, Denamrk
| | - Marius Gaurilcikas
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital and Svendborg, Odense, Denmark
- University Center for Spine Surgery, Department of Neurosurgery, Odense University Hospital, Denamrk
| | - Stig Mindedahl Jespersen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital and Svendborg, Odense, Denmark
- University Center for Spine Surgery, Department of Neurosurgery, Odense University Hospital, Denamrk
| | - Martin Lindberg-Larsen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital and Svendborg, Odense, Denmark
- Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, Denmark
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Choovongkomol K, Piyapromdee U, Thepjung S, Tanaviriyachai T, Jongkittanakul S, Sudprasert W. Comparative Outcomes of Percutaneous and Conventional Open Pedicle Screw Fixation for Single-level Thoracolumbar Spine Injury: Randomised Controlled Trial. Malays Orthop J 2024; 18:106-115. [PMID: 38638653 PMCID: PMC11023354 DOI: 10.5704/moj.2403.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 10/08/2023] [Indexed: 04/20/2024] Open
Abstract
Introduction To compare post-operative outcomes of percutaneous pedicle screw fixation (PPSF) vs open pedicle screw fixation (OPSF) in patients with thoracolumbar spine fractures with no neurological deficits. Materials and methods In a randomised controlled trial, patients received short-segment fixation with intermediate screws. We assessed post-operative back pain (Visual Analog Scale or VAS), blood loss, operative/fluoroscopy times, radiographic parameters, and oswestry disability index (ODI) scores at 1, 2, 3, 6, 9, and 12 months. Results Between January 2018 and October 2019, 31 patients received PPSF and 30 OPSF. Mean intra-operative blood loss was 66.45 (±44.29) ml for PPSF vs 184.83 (±128.36) ml for OPSF (p<0.001). Fluoroscopy time averaged 2.36 (±0.76) minutes for PPSF vs 0.58 (±0.51) minutes for OPSF (p<0.001). No significant differences existed in operative time or post-operative VAS scores. Radiographic parameters (kyphosis angle and vertebral height ratios) didn't significantly differ post-operatively or at 12 months. However, ODI scores differed significantly at 6 months (p=0.025), with no difference at 12 months. Conclusion In this trial, PPSF was comparable to OPSF in improving ODI scores at 12 months but showed earlier improvement at 6 months and reduced blood loss. Radiographic outcomes remained similar between groups over 12 months.
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Affiliation(s)
- K Choovongkomol
- Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | - U Piyapromdee
- Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | - S Thepjung
- Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | - T Tanaviriyachai
- Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | - S Jongkittanakul
- Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | - W Sudprasert
- Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
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Luo M, Yang Y, Liu Z, Tan J, Luo J, Long Z, Chen M, Liang C, Xiao Z. Percutaneous versus traditional open approaches for the treatment of thoracolumbar fractures in patients without neurologic deficits: a meta-analysis of 35 cohort studies. Neurosurg Rev 2024; 47:62. [PMID: 38263482 DOI: 10.1007/s10143-023-02259-y] [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: 10/23/2023] [Revised: 11/23/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024]
Abstract
At present, percutaneous surgery is widely used to treat thoracolumbar fractures. However, the actual safety, feasibility, and effectiveness of percutaneous surgery are not clear. Through systematic review and meta-analysis, we compared the efficacies of percutaneous pedicle screw fixation and open pedicle screw fixation in the treatment of thoracolumbar fractures without nerve root symptoms. We systematically searched the PubMed, Embase, and Cochrane libraries for articles published on or before June 2023. All results were evaluated by standard methods recommended for meta-analysis, continuous data were expressed by standard mean differences (SMDs), and binary variables were analyzed by odds ratios (ORs) and 95% confidence intervals (95% CIs). We also explored the main sources of heterogeneity and the stability of the results through sensitivity analysis, Begg's funnel plots, and Egger's test. Thirty-five cohort studies with a total of 3039 patients were included. The study found that patients who undergo percutaneous approaches have less intraoperative blood loss (IBL), shorter length of hospital stay (LOS), shorter operation time, and shorter incision. Moreover, percutaneous approaches had more advantages in terms of visual analog scale (VAS) scores, Oswestry Disability Index (ODI) scores, and infection rates. However, there was no significant difference in anterior vertebral body height (AVB), Cobb angle (CA), or screw errors between the two groups. In the long run, the clinical and surgical results of the percutaneous approach are better than those of the open approach, but the radiological results of both operations do not seem to show an advantage for any specific approach. Because of publication bias and heterogeneity, our findings must be interpreted with caution. However, this paper will provide some support for clinicians to choose suitable surgical methods for the treatment of thoracolumbar fractures.
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Affiliation(s)
- Mingjiang Luo
- Department of Spinal Surgery, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421000, Hunan, China
| | - Yuxin Yang
- Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Zhixuan Liu
- Department of Orthopedic Trauma, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Jiayi Tan
- Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Jiahui Luo
- Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Zifan Long
- Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Miaojue Chen
- Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Can Liang
- Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Zhihong Xiao
- Department of Spinal Surgery, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421000, Hunan, China.
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Thelen S, Oezel L, Hilss L, Grassmann JP, Betsch M, Wild M. Is restoration of vertebral body height after vertebral body fractures and minimally-invasive dorsal stabilization with polyaxial pedicle screws just an illusion? Arch Orthop Trauma Surg 2024; 144:239-250. [PMID: 37838983 PMCID: PMC10774198 DOI: 10.1007/s00402-023-05082-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 09/18/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION Thoracolumbar spine fractures often require surgical treatment as they are associated with spinal instability. Optimal operative techniques and treatment are discussed controversially. Aim of our prospective cohort study was to investigate the sagittal alignment after reduction, the secondary loss of reduction and the subjective outcome as well as the causal correlation of these parameters after minimally invasive stabilization of thoracic and lumbar fractures with polyaxial pedicle screws. MATERIALS AND METHODS In a single-center study, a total of 78 patients with an average age of 61 ± 17 years who suffered a fracture of the thoracic or lumbar spine were included and subjected to a clinical and radiological follow-up examination after 8.5 ± 8 months. The kyphotic deformity was measured by determining the vertebral body angle, the mono- and bi-segmental wedge angle at three time points. The patients' subjective outcome was evaluated by the VAS spine score. RESULTS After surgical therapy, a significant reduction of the traumatic kyphotic deformity was shown with an improvement of all angles (vertebral body angle: 3.2° ± 4.4°, mono- and bi-segmental wedge angle: 3.1° ± 5.6°, 2.0° ± 6.3°). After follow-up, a significant loss of sagittal alignment was observed for all measured parameters with a loss of correction. However, no correlation between the loss of reduction and the subjective outcome regarding the VAS spine scale could be detected. CONCLUSION The minimally invasive dorsal stabilization of thoracic and lumbar spine fractures with polyaxial pedicle screws achieved a satisfactory reduction of the fracture-induced kyphotic deformity immediately postoperatively with a floss of reduction in the further course. However, maybe the main goal of this surgical procedure should be the prevention of a complete collapse of the vertebral body instead of a long-lasting restoration of anatomic sagittal alignment. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Simon Thelen
- Department of Orthopaedics and Trauma Surgery, University Hospital Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Lisa Oezel
- Department of Orthopaedics and Trauma Surgery, University Hospital Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.
| | - Lena Hilss
- Department of Orthopaedics, Trauma- and Hand Surgery, Klinikum Darmstadt, Darmstadt, Germany
| | - Jan-Peter Grassmann
- Department of Orthopaedics and Trauma Surgery, University Hospital Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Marcel Betsch
- Department of Orthopaedics and Trauma Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Michael Wild
- Department of Orthopaedics, Trauma- and Hand Surgery, Klinikum Darmstadt, Darmstadt, Germany
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Mak SYJ, Siu YC, Chau WW, Lo CY, Ma CM. Long segment versus short segment stabilization in thoracolumbar spine fracture: A retrospective clinical and radiological analysis. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2023. [DOI: 10.1177/22104917221128836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: Thoracolumbar spine fracture is one of the commonest spinal fractures. The treatment of choice of surgery is still controversial. This is a retrospective analysis of clinical and radiological outcomes of long and short segment stabilization for patients admitted with thoracolumbar fracture in our hospitals. Material and Method: Inclusion criteria included a single level of thoracolumbar fracture, excluding pre-existing deformity or spinal surgery, osteoporosis, and pathological fracture. Clinical parameters included visual analogue scale (VAS), operative time, intraoperative blood loss, and postoperative length of stay. Radiological parameters included wedge angle and anterior and posterior vertebral height ratio. Results: From June 2007 to May 2020, 56 patients (male = 31, female = 25) were recruited. There were 25 patients in the short segment group (open = 11, minimal invasive surgery (MIS) = 14) and 31 patients in the long segment group. Clinically, significantly better VAS at 6 months (1 vs. 1.96; p = 0.041), shorter post-op length of stay (16 days vs. 25 days; p = 0.01), and less blood loss (178 ml vs. 824 ml; p < 0.01) were found in the short segment group. Radiologically, the short segment group showed significantly better wedge angle at immediate (5° vs. 9.23°; p = 0.002) and long-term follow-up (7.41° vs. 11.43°; p = 0.01). Moreover, the short segment group has significantly better post-op anterior and posterior vertebral height ratios. Within the short segment group, the MIS group showed significantly less blood loss (82 ml vs. 303 ml; p < 0.01). However radiological parameters favour the open group. Discussion and Conclusion: For single-level thoracolumbar fracture, both long and short stabilizations were effective in reducing and stabilizing the fracture. However, the short segment group showed significantly superior results. Moreover, a minimally invasive technique in short segment stabilization showed even less blood loss but less optimal radiological results. Therefore, short segment stabilization could be the treatment of choice for traumatic thoracolumbar spine fractures.
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Affiliation(s)
- Suk-Ying Jodhy Mak
- Department of Orthopedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, New Territories, Hong Kong
| | - Yuk-Cheun Siu
- Department of Orthopaedic and Traumatology, North District Hospital, Hong Kong
| | - Wai-Wang Chau
- Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, New Territories, Hong Kong
| | - Cho-Yau Lo
- Department of Orthopaedic and Traumatology, North District Hospital, Hong Kong
| | - Chun-Man Ma
- Department of Orthopaedic and Traumatology, North District Hospital, Hong Kong
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Ullrich BW, Schenk P, Scheyerer MJ, Bäumlein M, Katscher S, Schnake KJ, Zimmermann V, Schwarz F, Schmeiser G, Scherer M, Müller M, Sprengel K, Osterhoff G, Liepold K, Schramm S, Baron C, Siekmann H, Franck A, Isik N, Klauke F, Spiegl UJA. Georg Schmorl prize of the German spine society (DWG) 2022: current treatment for inpatients with osteoporotic thoracolumbar fractures-results of the EOFTT study. 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 2023; 32:1525-1535. [PMID: 36595136 DOI: 10.1007/s00586-022-07519-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 12/22/2022] [Accepted: 12/26/2022] [Indexed: 01/04/2023]
Abstract
AIM Osteoporotic thoracolumbar fractures are of increasing importance. To identify the optimal treatment strategy this multicentre prospective cohort study was performed. PURPOSE Patients suffering from osteoporotic thoracolumbar fractures were included. Excluded were tumour diseases, infections and limb fractures. Age, sex, trauma mechanism, OF classification, OF-score, treatment strategy, pain condition and mobilization were analysed. METHODS A total of 518 patients' aged 75 ± 10 (41-97) years were included in 17 centre. A total of 174 patients were treated conservatively, and 344 were treated surgically, of whom 310 (90%) received minimally invasive treatment. An increase in the OF classification was associated with an increase in both the likelihood of surgery and the surgical invasiveness. RESULTS Five (3%) complications occurred during conservative treatment, and 46 (13%) occurred in the surgically treated patients. 4 surgical site infections and 2 mechanical failures requested revision surgery. At discharge pain improved significantly from a visual analogue scale score of 7.7 (surgical) and 6.0 (conservative) to a score of 4 in both groups (p < 0.001). Over the course of treatment, mobility improved significantly (p = 0.001), with a significantly stronger (p = 0.007) improvement in the surgically treated patients. CONCLUSION Fracture severity according to the OF classification is significantly correlated with higher surgery rates and higher invasiveness of surgery. The most commonly used surgical strategy was minimally invasive short-segmental hybrid stabilization followed by kyphoplasty/vertebroplasty. Despite the worse clinical conditions of the surgically treated patients both conservative and surgical treatment led to an improved pain situation and mobility during the inpatient stay to nearly the same level for both treatments.
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Affiliation(s)
- Bernhard W Ullrich
- Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle gGmbH, 06112, Halle, Germany.
- Department of Trauma Hand and Reconstructive Surgery, University Hospital Jena, Jena, Germany.
| | - Philipp Schenk
- Department of Science, Research and Education, BG Klinikum Bergmannstrost Halle gGmbH, Halle, Germany
| | - Max J Scheyerer
- Department of Orthopaedic and Traumatology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Joseph-Stelzmann-Straße 24, 50931, Cologne, Germany
| | - Martin Bäumlein
- Center for Orthopaedics and Trauma Surgery, Philipps University of Marburg, University Hospital Giessen and Marburg GmbH, Marburg, Germany
| | - Sebastian Katscher
- Department of Spine Surgery and Neurotraumatology, Sana Klinikum Borna, Borna, Germany
| | - Klaus J Schnake
- Center for Spinal and Scoliosis Surgery, Waldkrankenhaus Erlangen, Erlangen, Germany
- Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany
| | - Volker Zimmermann
- Department of Trauma and Orthopedic Surgery, Klinikum Traunstein, Traunstein, Germany
| | - Falko Schwarz
- Department of Neurosurgery, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Gregor Schmeiser
- Department of Spine Surgery, Schoen-Clinic Hamburg Eilbek, Dehnhaide 120, 22081, Hamburg, Germany
| | - Michael Scherer
- Medical Faculty Technical University of Munich, Munich, Germany
| | - Michael Müller
- Department of Orthopedic and Trauma Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Kai Sprengel
- Hirslanden Clinic St. Anna, University of Lucerne, Lucerne, Switzerland
- Department of Trauma, University Hospital Zurich (USZ), University of Zurich (UZH), Zurich, Switzerland
| | - Georg Osterhoff
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Katja Liepold
- Department of Spine Surgery, Thuringia Clinic "Georgius Agricola" Saalfeld, Teaching Hospital of the University of Jena, Saalfeld, Germany
| | - Simon Schramm
- Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Christopher Baron
- Department for Paraplegia and Spine Surgery, BG Klinikum Tuebingen, Tuebingen, Germany
| | - Holger Siekmann
- Clinic of Trauma, Hand and Reconstruction Surgery, AMEOS-Clinic Halberstadt, Gleimstr. 5, 38820, Halberstadt, Germany
| | - Alexander Franck
- Department of Trauma Surgery and Orthopedics, Regiomed Clinical Center Coburg, Ketschendorfer Str. 33, 96450, Coburg, Germany
| | - N Isik
- Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle gGmbH, 06112, Halle, Germany
| | - Friederike Klauke
- Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle gGmbH, 06112, Halle, Germany
- Department of Trauma Hand and Reconstructive Surgery, University Hospital Jena, Jena, Germany
| | - Ulrich J A Spiegl
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
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Chen D, Jiang X. Pedicle screw fixation combined with posterior decompression and bone grafting for thoracolumbar spinal fractures can enhance curative effect and spinal cord function. Am J Transl Res 2022; 14:8733-8740. [PMID: 36628197 PMCID: PMC9827285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 10/11/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To explore the efficacy of pedicle screw fixation (PSF) combined with posterior decompression and bone grafting for thoracolumbar spinal fractures (TLSFs) and its influence on spinal cord function. METHODS In this retrospective study, 94 patients with TLSFs treated in the China-Japan Friendship Hospital rom June 2015 and September 2020 were selected, including 53 cases in the joint group treated with PSF combined with posterior decompression and bone grafting, and 41 cases in the control group with PSF alone. The two groups were compared in terms of operation time, intra-operational blood loss, length of hospital stay and wound healing as well as the pre- and post-treatment spinal cord function, and patients' clinical outcomes. Pre- and post-operatively, the pain severity was evaluated by the Visual Analogue Scale (VAS), the spinal dysfunction was assessed by Oswestry Disability Index (ODI), and the injured vertebral height and Cobb angles of the thoracolumbar spine (TLS) were compared. The clinical efficacy and postoperative complication rates of the two groups were observed and compared. RESULTS Less operative time, intraoperative bleeding, hospitalization time and wound healing time were determined in the joint group compared with the control group (all P<0.05). The postoperative sensory function and motor function were also better in the joint group (all P<0.05). Postoperatively, the joint group showed lower VAS and ODI scores than in the control group, with lower upper and lower TLS Cobb angles, and higher height of the anterior and posterior margins of the fractured vertebra (all P<0.05). The total effective rate was higher, and the incidence of postoperative complications was significantly lower in the joint group compared with the control group. CONCLUSION PSF combined with posterior decompression and bone grafting is effective in the treatment of TLSFs, which can not only significantly improve the spinal cord function and alleviate spinal dysfunction, but also help to relieve pain and reduce postoperative complications.
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Lee NJ, Buchanan IA, Zuckermann SL, Boddapati V, Mathew J, Geiselmann M, Park PJ, Leung E, Buchholz AL, Khan A, Mullin J, Pollina J, Jazini E, Haines C, Schuler TC, Good CR, Lombardi JM, Lehman RA. What Is the Comparison in Robot Time per Screw, Radiation Exposure, Robot Abandonment, Screw Accuracy, and Clinical Outcomes Between Percutaneous and Open Robot-Assisted Short Lumbar Fusion?: A Multicenter, Propensity-Matched Analysis of 310 Patients. Spine (Phila Pa 1976) 2022; 47:42-48. [PMID: 34091564 PMCID: PMC8654274 DOI: 10.1097/brs.0000000000004132] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/09/2021] [Accepted: 05/03/2021] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Multicenter cohort. OBJECTIVE To compare the robot time/screw, radiation exposure, robot abandonment, screw accuracy, and 90-day outcomes between robot-assisted percutaneous and robot-assisted open approach for short lumbar fusion (1- and 2-level). SUMMARY OF BACKGROUND DATA There is conflicting literature on the superiority of robot-assisted minimally invasive spine surgery to open techniques. A large, multicenter study is needed to further elucidate the outcomes and complications between these two approaches. METHODS We included adult patients (≥18 yrs old) who underwent robot-assisted short lumbar fusion surgery from 2015 to 2019 at four independent institutions. A propensity score matching algorithm was employed to control for the potential selection bias between percutaneous and open surgery. The minimum follow-up was 90 days after the index surgery. RESULTS After propensity score matching, 310 patients remained. The mean (standard deviation) Charlson comorbidity index was 1.6 (1.5) and 53% of patients were female. The most common diagnoses included high-grade spondylolisthesis (grade >2) (48%), degenerative disc disease (22%), and spinal stenosis (25%), and the mean number of instrumented levels was 1.5(0.5). The operative time was longer in the open (198 min) versus the percutaneous group (167 min, P value = 0.007). However, the robot time/screw was similar between cohorts (P value > 0.05). The fluoroscopy time/ screw for percutaneous (14.4 s) was longer than the open group (10.1 s, P value = 0.021). The rates for screw exchange and robot abandonment were similar between groups (P value > 0.05). The estimated blood loss (open: 146 mL vs. percutaneous: 61.3 mL, P value < 0.001) and transfusion rate (open: 3.9% vs. percutaneous: 0%, P value = 0.013) were greater for the open group. The 90-day complication rate and mean length of stay were not different between cohorts (P value > 0.05). CONCLUSION Percutaneous robot-assisted spine surgery may increase radiation exposure, but can achieve a shorter operative time and lower risk for intraoperative blood loss for short-lumbar fusion. Percutaneous approaches do not appear to have an advantage for other short-term postoperative outcomes. Future multicenter studies on longer fusion surgeries and the inclusion of patient-reported outcomes are needed.Level of Evidence: 3.
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Affiliation(s)
- Nathan J. Lee
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY
| | - Ian A. Buchanan
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY
| | - Scott L. Zuckermann
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY
| | - Venkat Boddapati
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY
| | - Justin Mathew
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY
| | - Matthew Geiselmann
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY
| | - Paul J. Park
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY
| | - Eric Leung
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY
| | - Avery L. Buchholz
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA
| | - Asham Khan
- Department of Neurosurgery, State University of New York, Buffalo, NY
| | - Jeffrey Mullin
- Department of Neurosurgery, State University of New York, Buffalo, NY
| | - John Pollina
- Department of Neurosurgery, State University of New York, Buffalo, NY
| | - Ehsan Jazini
- Department of Orthopaedics, Virginia Spine Institute, Reston, VA
| | - Colin Haines
- Department of Orthopaedics, Virginia Spine Institute, Reston, VA
| | | | | | - Joseph M. Lombardi
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY
| | - Ronald A. Lehman
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY
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Kumar R, Das S, Gupta P, Manjhi L. Prospective study of posterior open pedicle screw fixation for posttraumatic thoracolumbar and lumbar burst fractures with spinal injury at a tertiary care center: A short-term clinical and radiological follow-up. JOURNAL OF ORTHOPAEDIC DISEASES AND TRAUMATOLOGY 2022. [DOI: 10.4103/jodp.jodp_27_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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A real-time 3D electromagnetic navigation system for percutaneous pedicle screw fixation in traumatic thoraco-lumbar fractures: implications for efficiency, fluoroscopic time, and accuracy compared with those of conventional fluoroscopic guidance. 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 2021; 31:46-55. [PMID: 34333714 DOI: 10.1007/s00586-021-06948-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/14/2021] [Accepted: 07/23/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Navigation is becoming more useful in percutaneous pedicle screw fixation (PPSF). The aim of this study was to compare the efficiency, fluoroscopic time, accuracy, and clinical outcomes of PPSF with a novel electromagnetic navigation (EMN) system for thoraco-lumbar (TL) fractures with those of PPSF with conventional C-arm fluoroscopic (CF) guidance. METHODS A retrospective study was conducted. A total of 162 screws were implanted in 29 patients with the assistance of the EMN system (EMN group), and 220 screws were inserted in 40 patients by using CF guidance (CF group). The duration of surgery, placement time per screw, fluoroscopic time per screw, accuracy of pedicle screw placement, and clinical outcomes were compared between the two groups. RESULTS The duration of surgery and placement time per screw in the EMN group were significantly lower than those in the CF group (P < 0.05). The fluoroscopic time per screw in the CF group was significantly longer than that in the EMN group (P < 0.05). The learning curve of PPSF in the EMN group was steeper than that in the CF group. The accuracy of pedicle screw placement in the EMN group was more precise than that in the CF group (P < 0.05). The VAS scores in the EMN group were significantly lower than those in the CF group at one-week postoperatively (P < 0.05). CONCLUSION Compared with PPSF by using conventional fluoroscopic guidance, PPSF with the aid of the EMN system can increase the efficiency and accuracy of pedicle screw placement and reduce the fluoroscopic time.
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14
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Carazzo CA, Yurac R, Guiroy A, Zamorano JJ, Cabrera JP, Joaquim AF. Minimally Invasive Versus Open Surgery for the Treatment of Types B and C Thoracolumbar Injuries: A PRISMA Systematic Review. Int J Spine Surg 2021; 15:803-810. [PMID: 34266931 DOI: 10.14444/8103] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Thoracic and lumbar spine injuries may require surgical management, particularly AO Spine types B and C injuries. Open reduction and fixation using pedicle screws, with or without fusion and/or decompression, is the gold standard surgical treatment for unstable injuries. Recent advances in instrumentation design have resulted in less-invasive surgeries. However, the literature is sparse about the effectiveness of these procedures for types B and C injuries. The objective is to compare the outcomes of conventional open surgery versus minimally invasive spine surgery (MISS) for the treatment of AO Spine types B and C thoracolumbar injuries. METHODS A systematic review of published literature in PubMed, Web of Science, and Scopus was performed to identify studies comparing outcomes achieved with open versus minimally invasive surgery in AO Spine types B and C thoracolumbar injury patients. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used. RESULTS Five retrospective case-control studies and 3 prospective studies met selection criteria. In general, most of the studies demonstrated that minimally invasive spine surgery is feasible for types B and C injuries, and associated with potential advantages like reduced blood loss, postoperative pain, and muscle injury, and shorter hospital stays. However, no differences were detected in major outcomes, like neurological status or disability. CONCLUSIONS Published literature currently suggests that minimally invasive spine surgery is a valid alternative for treating types B and C thoracolumbar injuries. However, further comparative prospective randomized clinical trials are necessary to establish the superiority of one approach over the other. LEVEL OF EVIDENCE 3.
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Affiliation(s)
| | - Ratko Yurac
- Department of Orthopedics and Traumatology, University del Desarrollo, Santiago, Chile.,Spine Unit, Department of Traumatology, Clínica Alemana, Santiago, Chile
| | - Alfredo Guiroy
- Spine Unit, Orthopedics Department, Hospital Español de Mendoza, Mendoza, Argentina
| | - Juan J Zamorano
- Department of Orthopedics and Traumatology, University del Desarrollo, Santiago, Chile.,Spine Unit, Department of Traumatology, Clínica Alemana, Santiago, Chile
| | - Juan P Cabrera
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Chile
| | - Andrei F Joaquim
- Department of Neurosurgery, University of Campinas, Campinas, SãoPaulo, Brazil
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Aganesov AG, Alexanyan MM, Makarov SA, Mikaelyan KP. [Modern minimally invasive technologies in spine surgery]. Khirurgiia (Mosk) 2021:65-72. [PMID: 34032791 DOI: 10.17116/hirurgia202106265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The number of spine surgeries has been annually increasing all over the world. It is associated with high incidence of spinal degenerative diseases, vertebral traumas and different tumors. Minimally invasive surgical techniques are being developed in spine surgery considering extended surgical procedures, long hospital-stay and disability period. These techniques minimize surgical trauma, shorten hospital-stay and disability period.
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Affiliation(s)
- A G Aganesov
- Petrovsky Russian Scientific Center of Surgery, Moscow, Russia
| | - M M Alexanyan
- Petrovsky Russian Scientific Center of Surgery, Moscow, Russia
| | - S A Makarov
- Petrovsky Russian Scientific Center of Surgery, Moscow, Russia
| | - K P Mikaelyan
- Petrovsky Russian Scientific Center of Surgery, Moscow, Russia
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16
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Zhu C, Wang B, Yin J, Liu XH. A comparison of three different surgery approaches and methods for neurologically intact thoracolumbar fractures: a retrospective study. J Orthop Surg Res 2021; 16:306. [PMID: 33971921 PMCID: PMC8108453 DOI: 10.1186/s13018-021-02459-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/04/2021] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVES The purpose of this study was to evaluate and compare the feasibility, safety, and efficacy of conventional open pedicle screw fixation (COPSF), percutaneous pedicle screw fixation (PPSF), and paraspinal posterior open approach pedicle screw fixation (POPSF) for treating neurologically intact thoracolumbar fractures. METHODS We retrospectively reviewed 108 patients who were posteriorly stabilized without graft fusion. Among them, 36 patients underwent COPSF, 38 patients underwent PPSF, and 34 patients underwent POPSF. The clinical outcomes, relative operation indexes, and radiological findings were assessed and compared among the 3 groups. RESULTS All of the patients were followed up for a mean time of 20 months. The PPSF group and POPSF group had shorter operation times, lower amounts of intraoperative blood loss, and shorter postoperative hospital stays than the COPSF group (P < 0.05). The radiation times and hospitalization costs were highest in the PPSF group (P < 0.05). Every group exhibited significant improvements in the Cobb angle (CA) and the vertebral body angle (VBA) correction (all P < 0.05). The COPSF group and the POPSF group had better improvements than the PPSF group at 3 days postoperation and the POPSF group had the best improvements in the last follow-up (P < 0.05). CONCLUSION Both PPSF and POPSF achieved similar effects as COPSF while also resulting in lower incidences of injury. PPSF is more advantageous in the early rehabilitation time period, compared with COPSF, but POPSF is a better option when considering the long-term effects, the costs of treatment, and the radiation times.
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Affiliation(s)
- Chao Zhu
- Department of Orthopedics, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, People's Republic of China
| | - Bin Wang
- Department of Orthopedics, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, People's Republic of China
| | - Jian Yin
- Department of Orthopedics, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, People's Republic of China
| | - Xin Hui Liu
- Department of Orthopedics, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, People's Republic of China. .,Department of Orthopaedic Surgery, The Affiliated Jiangning Hospital with Nanjing Medical University, No. 169 Hushan Road, Nanjing, 211100, Jiangsu Province, People's Republic of China.
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Ding S, Lu X, Liu Z, Wang Y. Reduce the fractured central endplate in thoracolumbar fractures using percutaneous pedicle screws and instrumentational maneuvers: Technical strategy and radiological outcomes. Injury 2021; 52:1060-1064. [PMID: 33066988 DOI: 10.1016/j.injury.2020.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/10/2020] [Accepted: 10/03/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Traumatic thoracolumbar burst fracture is a common condition without a clear consensus on the best treatment approach. Percutaneous pedicle screw fixation (PPSF) techniques are widely used in practice, while its ability to correct fracture deformity is relatively weak, especially for the central area of the endplate. In this study, we reported a novel technique to reduce the fractured central endplate in thoracolumbar burst fractures. METHODS The new reduction technique uses six percutaneous pedicle screws for the fractured vertebra and its adjacent vertebrae. Pedicle screws implanted in the two adjacent vertebrae were parallel to the superior vertebral endplate, as routinely required. Two monoaxial pedicle screws implanted in the fractured vertebra were placed toward the anteroinferior portion of the fractured vertebral body. After routine instrumentation and ligamentotaxis reduction, the bolt heads of the four screws implanted in the adjacent vertebrae were first tightened, and then the bolt heads of the screws implanted in the fractured vertebra were gradually tighten to elevate the collapsed endplate. A fundamental principle of this technique is to implant the pedicle screw in the fractured vertebra towards the anteroinferior portion of the vertebra in such a way that the angle between the pedicle screw and the rod is oblique on lateral fluoroscopy. As such, when the bolt heads were tightened, the pedicle screws can be swung up to reduce the endplate fragments. RESULTS The novel technique was performed in 24 patients with neurologically intact thoracolumbar AO type A3 fractures. The middle vertebral height ratio was significantly improved from 69.7%±7.6% after routine reduction to 85.1%±4.5% postoperatively (p<0.01). No complication was noticed for this new reduction technique. At 6-month follow-up, no significant correction loss of the middle and posterior vertebral height ratios, Cobb angle, and vertebral wedge angle was observed, while 5.8% of correction loss was observed for the anterior vertebral height ratio. CONCLUSION The described reduction technique is simple, safe, and effective in reducing the collapsed central endplate in thoracolumbar burst fractures. Such a practical reduction strategy does not need additional medical costs.
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Affiliation(s)
- Shuchen Ding
- The Center of Orthopedics, The 903rd Hospital of People's Liberation Army, Hangzhou, Zhejiang, China
| | - Xuan Lu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang, China
| | - Zhirong Liu
- The Center of Orthopedics, The 903rd Hospital of People's Liberation Army, Hangzhou, Zhejiang, China.
| | - Yue Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang, China.
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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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Alkosha HM, Omar SA, Albayar A, Awad BI. Candidates for Percutaneous Screw Fixation Without Fusion in Thoracolumbar Fractures: A Retrospective Matched Cohort Study. Global Spine J 2020; 10:982-991. [PMID: 32875856 PMCID: PMC7645079 DOI: 10.1177/2192568219886320] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
STUDY DESIGN Retrospective matched cohort study. OBJECTIVES Identifying candidates for isolated percutaneous screw fixation (PSF) in thoracolumbar fractures based on Thoracolumbar Injury Classification and Severity (TLICS) score. METHODS Patients underwent PSF were split into 3 TLICS-score categories, then matched with groups having similar scores managed either non-operatively or via open screw fixation (OSF). Each category was assessed for corrective power and loss of correction by comparing initial and 1-year Cobb angles as well as Oswestry Disability Index and rates of fracture healing at 1 year. RESULTS A total of 102 patients (40 females) with age range 19 to 51 years, were admitted 1 to 25 hours following trauma. Each of TLISC categories consisted of matched treatment groups for comparison. In TLICS-3 fractures (2 treatment groups, n = 12 each), PSF showed similar outcomes but longer time to ambulation and length of stay (LOS) compared with nonoperative management. In TLICS-4 fractures (3 treatment groups, n = 18 each), PSF showed comparable corrective power and outcomes as OSF but was better in terms of operative time, blood loss, time to ambulation, LOS, and cosmesis. Despite higher LOS when compared with nonoperative cases, PSF showed superior radiologic and functional outcomes. In TLICS-5 fractures (2 treatment groups, n = 12 each), PSF showed shorter admissions and time to ambulation but lower corrective power, functional recovery, and tendency to lower healing rates. CONCLUSIONS Isolated PSF is a valid choice in managing TLICS-4 thoracolumbar fractures; however, it did not surpass conventional methods in TLICS-3 or TLICS-5 fracture types. Further studies are needed before the generalization of findings.
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Affiliation(s)
- Hazem M. Alkosha
- Department of Neurosurgery, Mansoura University, Mansoura city, Ad-Dakahlia, Egypt
| | - Sherif A. Omar
- Department of Neurosurgery, Mansoura University, Mansoura city, Ad-Dakahlia, Egypt
| | - Ahmed Albayar
- Department of Neurosurgery, Pereman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Basem I. Awad
- Department of Neurosurgery, Mansoura University, Mansoura city, Ad-Dakahlia, Egypt
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Younus A, Kelly A, Lekgwara P. An institutional review of percutaneous stabilization versus open stabilization of unstable thoracolumbar fractures. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Wu C, Deng J, Li T, Tan L, Yuan D. Percutaneous Pedicle Screw Placement Aided by a New Drill Guide Template Combined with Fluoroscopy: An Accuracy Study. Orthop Surg 2020; 12:471-479. [PMID: 32133781 PMCID: PMC7189065 DOI: 10.1111/os.12642] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/22/2020] [Accepted: 02/04/2020] [Indexed: 12/12/2022] Open
Abstract
Objective To evaluate the accuracy of percutaneous pedicle screw (PPS) placement aided by a new drill guide template. Methods The patients were divided into guide template group and conventional perspective group. In the conventional perspective group, the screws were placed by hand under fluoroscopy. In the guide template group, the screw placement was aided by a new drill guide template, and the drill guide template is designed according to the patient's ideal pedicle screw, but not based on skin morphology. The accuracy was evaluated by comparing the following parameters between the two groups: pedicle breach level, inclination angle deviation between the left and right screws, sagittal angle deviation between the left and right screws, and position deviation of the left and right screw entry points. The consistency of the postoperative screw angle and the corresponding guide template inclination angle was compared in the guide template group. The operative time, blood loss, and radiation times were compared between the groups. Results A total of 146 patients (876 screws) were enrolled in our study including 79 (474 screws) in the guide template group and 67 (402 screws) in the conventional perspective group. The pedicle breach level in the guide template group (22/474) was significantly lower than that in the conventional perspective group (47/402) (P < 0.05). The position and direction deviations of the left and right screws in the guide template group (2.06 ± 1.02 mm, 1.23 ± 1.25 mm, 1.83° ± 1.49°) were significantly less than those in the conventional perspective group (5.33 ± 2.99 mm, 4.32 ± 3.25 mm, 2.87° ± 1.56°). The operation time, blood loss, and radiation times were significantly lower in the guide template group (80.49 ± 9.14 min, 50.42 ± 8.9 mL, 11.02 ± 2.44) than those in the conventional perspective group (108.1 ± 21.18 min, 71.7 ± 17.09 mL, 23.53 ± 4.54). There were no significant differences between the postoperative screw angle and the corresponding guide template angle in the guide template group. Conclusion PPS placement aided by a new drill guide template yielded higher screw accuracy and less operative time, blood loss, and radiation exposure than traditional screw placement.
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Affiliation(s)
- Chao Wu
- Represent Orthopedics Center of Zigong Fourth People's Hospital, Zigong, Sichuan as province, China.,Represent Digital Medical Center of Zigong Fourth People's Hospital, Zigong, Sichuan as province, China
| | - Jiayan Deng
- Represent Digital Medical Center of Zigong Fourth People's Hospital, Zigong, Sichuan as province, China
| | - Tao Li
- Represent Orthopedics Center of Zigong Fourth People's Hospital, Zigong, Sichuan as province, China
| | - Lun Tan
- Represent Orthopedics Center of Zigong Fourth People's Hospital, Zigong, Sichuan as province, China
| | - Dechao Yuan
- Represent Orthopedics Center of Zigong Fourth People's Hospital, Zigong, Sichuan as province, China
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22
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Erichsen CJ, Heyde CE, Josten C, Gonschorek O, Panzer S, von Rüden C, Spiegl UJ. Percutaneous versus open posterior stabilization in AOSpine type A3 thoracolumbar fractures. BMC Musculoskelet Disord 2020; 21:74. [PMID: 32024494 PMCID: PMC7003397 DOI: 10.1186/s12891-020-3099-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 01/29/2020] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of this retrospective cohort study was to compare treatment strategies of two level-one trauma centers regarding clinical and radiological outcomes focusing on non-osteoporotic AOSpine type A3 fractures of the thoracolumbar spine at levels T11 to L2. Methods Eighty-seven patients between 18 and 65 years of age that were treated operatively in either of two trauma centers were included. One treatment strategy includes open posterior stabilization whereas the other uses percutaneous posterior stabilization. Both included additional anterior fusion if necessary. Demographic data, McCormack classification, duration of surgery, hospital stay and further parameters were assessed. Owestry Disability Index (ODI), Visual Analog Scale (VAS) and SF-36 were measured for functional outcome. Bisegmental kyphosis angle, reduction loss and sagittal alignment parameters were assessed for radiological outcome. Follow up was at least 24 months. Results There was no significant difference regarding our primary functional outcome parameter (ODI) between both groups. Regarding radiological outcome kyphosis angle at time of follow up did not show a significant difference. Reduction loss at time of follow up was moderate in both groups with a significantly lower rate in the percutaneously stabilized group. Surgery time was significantly shorter for posterior stabilization and anterior fusion in the percutaneous group. Time of hospital stay was equal for posterior stabilization but shorter for anterior fusion in the open stabilized group. Conclusion Both treatment strategies are safe and effective showing only minor loss of reduction. Clinical relevant differences in functional and radiographic outcome between the two surgical groups could not be demonstrated. Trial registration It was conducted according to ICMJE guidelines and has been retrospectively registered with the German Clinical Trials Registry (identification number: DRKS00015693, 07.11.2018).
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Affiliation(s)
- Christoph J Erichsen
- Department of Trauma Surgery, BG Trauma Center Murnau, Professor-Küntscher Str. 8, 82418 Murnau, Murnau am Staffelsee, Germany.
| | - Christoph-Eckhard Heyde
- Department of Orthopaedics, Trauma Surgery and Reconstructive Surgery, University of Leipzig, Leipzig, Germany
| | - Christoph Josten
- Department of Orthopaedics, Trauma Surgery and Reconstructive Surgery, University of Leipzig, Leipzig, Germany
| | - Oliver Gonschorek
- Department of Trauma Surgery, BG Trauma Center Murnau, Professor-Küntscher Str. 8, 82418 Murnau, Murnau am Staffelsee, Germany
| | - Stephanie Panzer
- Department of Radiology, BG Trauma Center Murnau, Murnau am Staffelsee, Germany.,Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
| | - Christian von Rüden
- Department of Trauma Surgery, BG Trauma Center Murnau, Professor-Küntscher Str. 8, 82418 Murnau, Murnau am Staffelsee, Germany.,Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
| | - Ulrich J Spiegl
- Department of Orthopaedics, Trauma Surgery and Reconstructive Surgery, University of Leipzig, Leipzig, Germany
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23
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Yang P, Chen K, Zhang K, Sun J, Yang H, Mao H. Percutaneous short-segment pedicle instrumentation assisted with O-arm navigation in the treatment of thoracolumbar burst fractures. J Orthop Translat 2019; 21:1-7. [PMID: 32042590 PMCID: PMC6997617 DOI: 10.1016/j.jot.2019.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 10/19/2019] [Accepted: 11/12/2019] [Indexed: 11/12/2022] Open
Abstract
Object To compare the clinical and radiological outcomes of O-arm navigation assisted percutaneous pedicle fixation and open freehand pedicle fixation in treatment of AO type A3 thoracolumbar burst fractures (TBFs) without neurological deficit. Methods This retrospective study involved 72 patients with type A3 TBFs who underwent O-arm navigation assisted percutaneous pedicle fixation (MIS group) or open freehand posterior pedicle fixation (OPPF group) from September 2015 to December 2017. Demographic data and clinical characteristics were comparable between these two groups before surgery. Operating time, intraoperative blood loss, and the time of hospitalisation stay were analysed. Visual analog scale (VAS) scoring and Oswestry disability index (ODI) was assessed for each patient pre- and postoperatively. Radiographic follow-up was assessed by the Local kyphosis angle (LKA), Vertebral wedge angle (VWA), and Anterior body height (ABH). The accuracy of screw placement was examined by computed tomography. Results The two groups were matched in terms of demographic and clinical features. Intraoperative blood loss was significantly less in the MIS group compared to the OPPF group (p < 0.05). The average time for hospitalisation stay in the MIS group was significantly shorter than OPPF group (p < 0.05). However, the operative time revealed no significant difference between two groups (p > 0.05). Meanwhile, the VAS score and ODI score in the MIS group were significantly lower than that in the OPPF group after surgery (p < 0.05). Radiographic assessments revealed no obvious difference between the 2 groups immediately after surgery or at the final follow-up (p > 0.05); The accuracy rate of pedicle screw position in the MIS group was higher than OPPF group (97.8% vs 78.5%, respectively; p < 0.001). No deep wound infection, additional surgery, implant failure, or neurological complications were recorded in either group. Conclusions Percutaneous short-segment pedicle instrumentation assisted with O-arm navigation represents an effective and safe alternative for type A3 TBFs. It has several advantages compared with open approach, including less blood loss, shorter hospitalisation, less postoperative pain, higher accuracy of pedicle screw placement, and faster recovery period in treating TBFs. However, it requires a longer learning curve and long-term results have to be studied in other well-designed studies. The translational potential of this article Percutaneous short-segment pedicle instrumentation assisted with O-arm navigation represents an effective and safe alternative for type A3 TBFs. The utilization of O-arm navigation and percutaneous pedicle screw fixation guaranteed the high accuracy of screw placement, protected staff from radiation exposure and offered benefits of minimal invasive technique.
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Affiliation(s)
- Peng Yang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, PR China
| | - Kangwu Chen
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, PR China
| | - Kai Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, PR China
| | - Jiajia Sun
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, PR China
| | - Huilin Yang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, PR China
| | - Haiqing Mao
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, PR China
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24
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Open versus minimally invasive percutaneous surgery for surgical treatment of thoracolumbar spine fractures- a multicenter randomized controlled trial: study protocol. BMC Musculoskelet Disord 2019; 20:397. [PMID: 31472691 PMCID: PMC6717640 DOI: 10.1186/s12891-019-2763-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 08/14/2019] [Indexed: 01/29/2023] Open
Abstract
Background Thoracolumbar fractures are most frequent along the spine, and surgical treatment is indicated for unstable fractures. Percutaneous minimally invasive surgery was introduced to reduce the pain associated with the open posterior approach and reduce the morbidity of the procedure by avoiding damage and dissection of the paravertebral muscles. The goal of this study is to compare the surgical treatment of fractures of the thoracolumbar spine treated by the conventional open approach and the percutaneous minimally invasive approach using similar types of pedicle spine fixation systems. Methods/designs This study is designed as a multi-center, randomized controlled trial of patients aged 18–65 years who are scheduled to undergo surgical posterior fixation. Treatment by the conventional open approach or percutaneous minimally invasive approach will be randomly assigned. The primary outcome measure is postoperative pain, which will be measured using the visual analogue scale (VAS). The secondary outcome parameters are intraoperative bleeding, postoperative drainage, surgery time, length of hospital stay, SF-36, EQ-5D-5 l, HADS, pain medication, deambulation after surgery, intraoperative fluoroscopy time, vertebral segment kyphosis, fracture vertebral body height, compression of the vertebral canal, accuracy of the pedicle screws, and breakage or release of the implants. Patient will be followed up for 1, 2, 3, 6, 12 and 24 months postoperatively and evaluated according to the outcomes using clinical and radiological examinations, plain radiographs and computed tomografy (CT). Discussion Surgical treatment of thoracolumbar fractures by the open or percutaneous minimally invasive approach will be compared in a multicenter randomized study using similar types of fixation systems, and the results will be evaluated according to clinical and radiological parameters at 1, 2, 3, 6, 12 and 24 months of follow-up. Trial registration ClinicalTrial.gov approval number: 1.933.631, code: NCT03316703 in may 2017.
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25
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Weiss H, Garcia RM, Hopkins B, Shlobin N, Dahdaleh NS. A Systematic Review of Complications Following Minimally Invasive Spine Surgery Including Transforaminal Lumbar Interbody Fusion. Curr Rev Musculoskelet Med 2019; 12:328-339. [PMID: 31302861 PMCID: PMC6684700 DOI: 10.1007/s12178-019-09574-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW To assess complications after minimally invasive spinal surgeries including transforaminal lumbar interbody fusion (MI-TLIF) by reviewing the most recent literature. RECENT FINDINGS Current literature demonstrates that minimally invasive surgery (MIS) in spine has improved clinical outcomes and reduced complications when compared with open spinal procedures. Recent studies describing MI-TLIF primarily for degenerative disk disease, spondylolisthesis, and vertebral canal stenosis cite over 89 discrete complications, with the most common being radiculitis (ranging from 2.8 to 57.1%), screw malposition (0.3-12.7%), and incidental durotomy (0.3-8.6%). Minimally invasive spine surgery has a distinct set of complications in comparison with other spinal procedures. These complications vary based on the exact MIS procedure and indication. The most frequently documented MI-TLIF complications in current published literature were radiculitis, screw malposition, and incidental durotomy.
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Affiliation(s)
- Hannah Weiss
- Department of Neurosurgery, Northwestern University, 676 N Saint Clair, NMH/Arkes Family Pavilion Suite 2210, Chicago, IL, 60611, USA
| | - Roxanna M Garcia
- Department of Neurosurgery, Northwestern University, 676 N Saint Clair, NMH/Arkes Family Pavilion Suite 2210, Chicago, IL, 60611, USA
- Institute for Public Health and Medicine (IPHAM), Center for Healthcare Studies, Northwestern University, Chicago, IL, USA
| | - Ben Hopkins
- Department of Neurosurgery, Northwestern University, 676 N Saint Clair, NMH/Arkes Family Pavilion Suite 2210, Chicago, IL, 60611, USA
| | | | - Nader S Dahdaleh
- Department of Neurosurgery, Northwestern University, 676 N Saint Clair, NMH/Arkes Family Pavilion Suite 2210, Chicago, IL, 60611, USA.
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26
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Verheyden AP, Spiegl UJ, Ekkerlein H, Gercek E, Hauck S, Josten C, Kandziora F, Katscher S, Kobbe P, Knop C, Lehmann W, Meffert RH, Müller CW, Partenheimer A, Schinkel C, Schleicher P, Scholz M, Ulrich C, Hoelzl A. Treatment of Fractures of the Thoracolumbar Spine: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU). Global Spine J 2018; 8:34S-45S. [PMID: 30210959 PMCID: PMC6130107 DOI: 10.1177/2192568218771668] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
STUDY DESIGN consensus paper with systematic literature review. OBJECTIVE The aim of this study was to establish recommendations for treatment of thoracolumbar spine fractures based on systematic review of current literature and consensus of several spine surgery experts. METHODS The project was initiated in September 2008 and published in Germany in 2011. It was redone in 2017 based on systematic literature review, including new AOSpine classification. Members of the expert group were recruited from all over Germany working in hospitals of all levels of care. In total, the consensus process included 9 meetings and 20 hours of video conferences. RESULTS As regards existing studies with highest level of evidence, a clear recommendation regarding treatment (operative vs conservative) or regarding type of surgery (posterior vs anterior vs combined anterior-posterior) cannot be given. Treatment has to be indicated individually based on clinical presentation, general condition of the patient, and radiological parameters. The following specific parameters have to be regarded and are proposed as morphological modifiers in addition to AOSpine classification: sagittal and coronal alignment of spine, degree of vertebral body destruction, stenosis of spinal canal, and intervertebral disc lesion. Meanwhile, the recommendations are used as standard algorithm in many German spine clinics and trauma centers. CONCLUSION Clinical presentation and general condition of the patient are basic requirements for decision making. Additionally, treatment recommendations offer the physician a standardized, reproducible, and in Germany commonly accepted algorithm based on AOSpine classification and 4 morphological modifiers.
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Affiliation(s)
- Akhil P. Verheyden
- Clinic for Trauma, Orthopaedic and Spine Surgery, Lahr, Germany,These authors contributed equally to this article.,Akhil P. Verheyden, Clinic for Trauma, Orthopaedic and Spine Surgery, Lahr, 77933, Germany.
| | - Ulrich J. Spiegl
- Klinik für Orthopädie, Unfallchirurgie und plastische Chirurgie, Leipzig, Germany,These authors contributed equally to this article
| | | | - Erol Gercek
- Zentrum für Unfallchirurgie und Orthopädie, Koblenz, Germany
| | - Stefan Hauck
- Clinic for Trauma, Orthopaedic and Spine Surgery, Lahr, Germany
| | - Christoph Josten
- Klinik für Orthopädie, Unfallchirurgie und plastische Chirurgie, Leipzig, Germany
| | - Frank Kandziora
- Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, Frankfurt am Main, Germany
| | - Sebastian Katscher
- Leitender Arzt Orthopädie / Unfallchirurgie, Sana Klinikum Borna, Borna, Germany
| | - Philipp Kobbe
- Sektion Becken- und Wirbelsäulenchirurgie, Uniklinik RWTH Aachen, Aachen, Germany
| | - Christian Knop
- Klinik für Unfallchirurgie und Orthopädie, Klinikum Stuttgart, Katharinenhospital, Stuttgart, Germany
| | - Wolfgang Lehmann
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Goettingen, Göttingen, Germany
| | - Rainer H. Meffert
- Klinik und Poliklinik für Unfall-, Hand-, Plastische- und Wiederherstellungschirurgie, Universitätsklinik Würzburg, Würzburg, Germany
| | - Christian W. Müller
- Unfallchirurgische Klinik, Medizinische Hochschule Hannover, Hannover, Germany
| | | | - Christian Schinkel
- Klinik für Unfallchirurgie, Handchirurgie und Orthopädie, Klinikum Memmingen, Memmingen, Germany
| | - Philipp Schleicher
- Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, Frankfurt am Main, Germany
| | - Matti Scholz
- Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, Frankfurt am Main, Germany
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27
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Incidence and Risk Factors for Facet Joint Violation in Open Versus Minimally Invasive Procedures During Pedicle Screw Placement in Patients with Trauma. World Neurosurg 2018; 112:e711-e718. [DOI: 10.1016/j.wneu.2018.01.138] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/16/2018] [Accepted: 01/17/2018] [Indexed: 11/20/2022]
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28
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Ti-24Nb-4Zr-8Sn Alloy Pedicle Screw Improves Internal Vertebral Fixation by Reducing Stress-Shielding Effects in a Porcine Model. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8639648. [PMID: 29581988 PMCID: PMC5822754 DOI: 10.1155/2018/8639648] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 01/09/2018] [Accepted: 01/11/2018] [Indexed: 12/29/2022]
Abstract
To ensure the biomechanical properties of Ti-24Nb-4Zr-8Sn, stress-shielding effects were compared between Ti-24Nb-4Zr-8Sn and Ti-6Al-4V fixation by using a porcine model. Twelve thoracolumbar spines (T12–L5) of 12-month-old male pigs were randomly divided into two groups: Ti-24Nb-4Zr-8Sn (EG, n = 6) and Ti-6Al-4V (RG, n = 6) fixation. Pedicle screw was fixed at the outer edge of L4-5 vertebral holes. Fourteen measuring points were selected on the front of transverse process and middle and posterior of L4-5 vertebra. Electronic universal testing machine was used to measure the strain resistance of measuring points after forward and backward flexion loading of 150 N. Meanwhile, stress resistance was compared between both groups. The strain and stress resistance of measurement points 1, 2, 5, 6, 9, and 10–14 in Ti-24Nb-4Zr-8Sn fixation was lower than that of Ti-6Al-4V fixation after forward and backward flexion loading (P < 0.05). The strain and stress resistance of measurement points 3, 4, 7, and 8 was higher in Ti-24Nb-4Zr-8Sn fixation than that of Ti-6Al-4V fixation (P < 0.05). Stress-shielding effects of Ti-24Nb-4Zr-8Sn internal fixation were less than that of Ti-6Al-4V internal fixation. These results suggest that Ti-24Nb-4Zr-8Sn elastic fixation has more biomechanical goals than conventional Ti-6Al-4V internal fixation by reducing stress-shielding effects.
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29
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Aganesov AG, Kheilo AL, Aleksanyan MM, Makarov SA. [Surgical treatment of spine injuries]. Khirurgiia (Mosk) 2018:37-40. [PMID: 29992924 DOI: 10.17116/hirurgia2018737] [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] [Indexed: 06/08/2023]
Abstract
The history of spinal fixation started in the 19th century and had an intensive development in subsequent years. Special progress in surgery for spinal traumatic injuries was noted in the Second World War. Last decades minimally invasive spinal surgical techniques are developed and introduced in everyday practice.
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Affiliation(s)
- A G Aganesov
- Petrovsky Russian Research Center for Surgery, Moscow, Russia
| | - A L Kheilo
- Petrovsky Russian Research Center for Surgery, Moscow, Russia
| | - M M Aleksanyan
- Petrovsky Russian Research Center for Surgery, Moscow, Russia
| | - S A Makarov
- Petrovsky Russian Research Center for Surgery, Moscow, Russia
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