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Grin A, Karanadze V, Lvov I, Kordonskiy A, Talypov A, Smirnov V, Zakharov P. Effective method of pedicle screw fixation in patients with neurologically intact thoracolumbar burst fractures: a systematic review of studies published over the last 20 years. NEUROCIRUGIA (ENGLISH EDITION) 2024:S2529-8496(24)00048-0. [PMID: 39089628 DOI: 10.1016/j.neucie.2024.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 07/10/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVE To conduct a systematic review of studies on various posterior pedicle screw fixation (PSF) methods used for treating neurologically intact thoracolumbar burst fractures and to identify the most effective and safe approaches. METHODS We conducted a systematic review adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with the study registered in PROSPERO (CRD42024531093). The inclusion criteria were: (1) publication dates from January 1, 2004, to December 31, 2023; (2) availability of full-text articles in English; (3) thoracolumbar burst fractures without neurological deficits; (4) patients aged over 18; (5) reports on treatment outcomes or complications; (6) a mean follow-up period of at least 12 months. RESULTS A total of 69 articles covering 116 patient groups were included. Our analysis highlighted the advantages of short-segment fixation without fusion over monosegmental, short-segment and long-segment fusion in terms of shorter operation times and reduced intraoperative blood loss (p = 0.001 and p < 0.001, respectively). Extensive fusion was associated with a significantly higher frequency of deep surgical site infections compared to other PSF methods (p = 0.043). Percutaneous pedicle screw fixation, applied to patients with lower body compression rates and kyphotic deformities, led to less potential for correction (p = 0.004), yet significantly decreased blood loss (p = 0.011), operation duration (p < 0.0001), and hospitalization duration (p < 0.0001). No significant benefits were observed with the use of additional intermediate screws in short-segment PSF. CONCLUSIONS Short-segment pedicle screw fixation could be the optimal surgical treatment method for neurologically intact thoracolumbar burst fractures. The use of posterior lateral fusion in this context may increase the deep surgical site infection rate without reducing the frequency of implant-related complications or improving long-term treatment outcomes. The percutaneous approach remains the preferred technique; however, its limited reduction capabilities should be carefully considered during surgical planning for patients with severe kyphotic deformities. The application of intermediate screws in such patients has not demonstrated significant advantages. Removing the fixation system has not led to a significant decrease in implant-related complications or improvement in quality of life. The data obtained from the systematic review may assist surgeons in selecting the most appropriate surgical treatment method for patients with neurologically intact thoracolumbar burst fractures, thereby avoiding ineffective procedures and improving both short-term and long-term outcomes.
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Affiliation(s)
- Andrey Grin
- Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
| | - Vasiliy Karanadze
- Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
| | - Ivan Lvov
- Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia.
| | - Anton Kordonskiy
- Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
| | - Aleksandr Talypov
- Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
| | - Vladimir Smirnov
- Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
| | - Petr Zakharov
- Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
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Marie-Hardy L, Mohsinaly Y, Pietton R, Bonaccorsi R, Vialle R, Pascal-Moussellard H. Defining threshold for sagittal correction in lumbar fractures. 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 2024; 33:1550-1555. [PMID: 38315226 DOI: 10.1007/s00586-024-08138-4] [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: 06/13/2023] [Revised: 12/04/2023] [Accepted: 01/10/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE Surgical indications for thoraco-lumbar fractures are driven both by neurological status, fractures instability and kyphotic deformity. Regarding kyphotic deformity, an angulation superior to 20° is considered by many surgeons as a surgical indication to reduce the disability induced by post-traumatic kyphosis. However, there is a lack of data reporting the ideal or theoretical lordosis that one must have in a particular lumbar segment on CT-scan. The main goal of this study was to determine the mean value for segmental lumbar lordosis according to pelvic incidence (PI) on a cohort of normal subjects. METHODS The consecutive CT-scan of 171 normal adult subjects were retrospectively analyzed. The PI and the segmental lordosis (L4S1, L3L5, L2L4, L3L1, L2T12 and T11-L1) were measured on all CT-scan. The mean values were calculated for the global cohort and a sub-group analysis according to IP ranges (< 45°, 45 < IP < 60° and > 60°) was performed. RESULTS The mean angular values for the whole cohort were IP: 54, 9°; L4S1: - 38, 1°; L3L5: - 30, 6°; L2L4: - 14, 1°; L1L3: - 4, 9°; T12L2: + 1, 9° and T11L1: + 5, 4°. The segmental values vary significatively with PI ranges, as for L3L5: - 26, 8° (PI < 45°); - 30° (45 < PI < 60°) and - 35, 1° (PI > 60°). CONCLUSION These results provide a referential of theoretical values of segmental lordosis according to PI. This abacus may help spinal surgeon in their decision-making process regarding lumbar fractures, to determine the amount of sagittal correction needed, according to the PI range, to be adapted to the sagittal morphology of the patient. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Laura Marie-Hardy
- Spine Surgery Unit, Orthopaedic Department, Pitié-Salpétrière Hospital, 43-87 Bd de l'Hôpital, 75013, Paris, France.
| | - Yann Mohsinaly
- Spine Surgery Unit, Orthopaedic Department, Pitié-Salpétrière Hospital, 43-87 Bd de l'Hôpital, 75013, Paris, France
| | - Raphaël Pietton
- Spine Surgery Unit, Orthopaedic Department, Pitié-Salpétrière Hospital, 43-87 Bd de l'Hôpital, 75013, Paris, France
| | - Raphaël Bonaccorsi
- Spine Surgery Unit, Orthopaedic Department, Pitié-Salpétrière Hospital, 43-87 Bd de l'Hôpital, 75013, Paris, France
| | - Raphaël Vialle
- Pediatric Orthopaedic Department, Trousseau Hospital, 26 Av. du Dr Arnold Netter, 75012, Paris, France
| | - Hugues Pascal-Moussellard
- Spine Surgery Unit, Orthopaedic Department, Pitié-Salpétrière Hospital, 43-87 Bd de l'Hôpital, 75013, Paris, France
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Sural S, Goyal A, Garg R, Singh A, Kashyap A, Arora S. Evaluation of vertebral shortening and interbody fusion with short segment pedicle screw fixation for unstable thoracolumbar fractures. J Orthop 2023; 37:15-21. [PMID: 36974098 PMCID: PMC10039110 DOI: 10.1016/j.jor.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 01/30/2023] Open
Abstract
Background Various operative procedures have been described for the treatment of traumatic paraplegia caused by unstable thoracolumbar fractures. We prospectively evaluated interbody fusion (IBF) with SS-PSF in these cases with regard to clinico-radiological outcome with the objectives: (1) Does IBF and short segment pedicle screw fixation (SS-PSF) prevent progression of kyphotic angle after surgery? (2) Can this procedure be safely performed in the setting of acute trauma?. Methods Sixteen patients suffering from traumatic paraplegia caused by acute unstable thoracolumbar fractures were enrolled prospectively and underwent IBF with SS-PSF. They were evaluated for magnitude of shortening in spine, progression of kyphotic angle, and neurological improvement by American spinal injury association scale (ASIA). Results Out of total sixteen, 14 patients were ASIA grade A and 2 were grade C, at the time of presentation. Thirteen out of these 14 remained grade A and one improved to B. Both the patients who had grade C involvement at the time of presentation improved to grade D at one-year follow-up. The mean blood loss was 750 ml (range; 650 ml-1150 ml). Mean kyphotic angle decreased from 20.6° (range; 13° to 37°) preoperatively to 6.2° (range; 3° to 10°) at postoperative day 2 (p = 0.002). Its mean value after 6 months was 6.5° (range; 3° to 11°). The procedure resulted in mean spinal column shortening of 18 mm (range; 16 mm-22 mm) in the spinal column. All the patients achieved bony union by a mean duration of 3.9 months (range; 3 months-6 months). Conclusions IBF with SS-PSF has the shortest possible instrumented construct for thoracolumbar junction fusion done by posterior approach. The interbody fusion for unstable thoracolumbar junction fractures prevents the progression of kyphotic angle post-operatively. Level of evidence Level 4.
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Affiliation(s)
- Sumit Sural
- Department of Orthopaedic Surgery, Maulana Azad Medical College & Associated Lok Nayak Hospital, New Delhi, 110002, India
| | - Arpit Goyal
- SKOP Centre, B-516, Kamla Nagar, Agra, UP, India
| | - Rahul Garg
- Department of Orthopaedic Surgery, Maulana Azad Medical College & Associated Lok Nayak Hospital, New Delhi, 110002, India
| | - Ashwani Singh
- National Heart Institute, East of Kailash, New Delhi, 110065, India
| | - Abhishek Kashyap
- Department of Orthopaedic Surgery, Maulana Azad Medical College & Associated Lok Nayak Hospital, New Delhi, 110002, India
| | - Sumit Arora
- Department of Orthopaedic Surgery, Maulana Azad Medical College & Associated Lok Nayak Hospital, New Delhi, 110002, India
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José LM, Coury P, Meves R. Spinal Cord Alignment in Patients with Thoracolumbar Burst Fracture. Rev Bras Ortop 2023; 58:58-66. [PMID: 36969772 PMCID: PMC10038722 DOI: 10.1055/s-0042-1756322] [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: 03/01/2022] [Accepted: 07/26/2022] [Indexed: 03/26/2023] Open
Abstract
Objective To evaluate the spinopelvic alignment in patients with thoracolumbar burst fracture (TBF) without neurological deficit treated nonsurgically and surgically in a tertiary reference trauma hospital. Method Retrospective cross-sectional study of patients with single level, type A3 and A4 AOSpine TBF only of the thoracolumbar region. Analysis of clinical data, low back pain (visual analogue scale [VAS]), Denis Pain Scale, quality of life (SF-36), sagittal (TC, TLC, LL, SVA) and spinopelvic (IP, PV, SI, PI-LL) radiographic parameters of patients treated surgically and nonsurgically. Results A total of 50 individuals with an average age of 50 years old with a mean follow-up of 109 months (minimum of 19 and maximum of 306 months) were evaluated. There was a significant difference between treatments for the Denis Work Scale ( p = 0.046) in favor of nonsurgical treatment. There was no significant difference between the treatments for lower back pain VAS and Denis Pain Scale ( p = 0.468 and p = 0.623). There was no significant difference between treatments in any of the domains evaluated with the SF-36 ( p > 0.05). Radiographic parameters were not different between the analyzed groups; however, all radiographic parameters showed significant difference between the population considered asymptomatic, except for pelvic incidence ( p < 0.005). Conclusions The spinopelvic alignment was normal in patients with TBF without neurological deficit treated nonsurgically and surgically after a minimum follow-up of 19 months. However, they presented a higher mean pelvic version and discrepancy between lumbar lordosis and pelvic incidence when compared with the reference values of the Brazilian population.
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Affiliation(s)
- Lucas Miotto José
- Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil
| | - Pedro Coury
- Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil
| | - Robert Meves
- Grupo de Coluna, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil
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Marie-Hardy L, Mohsinaly Y, Pietton R, Stencel-Allemand M, Khalifé M, Bonaccorsi R, Barut N, Pascal-Moussellard H. Efficiency of a novel vertebral body augmentation system (Tektona™) in non-osteoporotic spinal fractures. BMC Musculoskelet Disord 2022; 23:356. [PMID: 35418060 PMCID: PMC9008971 DOI: 10.1186/s12891-022-05272-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/25/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The restauration of the local kyphosis is crucial to thoracolumbar fractures outcomes. Recently, the Tektona™ (Spine Art) system, constituted by a flexible lamella for corporeal reduction has emerged as a promising solution for osteoporotic fractures. However, no study has yet focused on its results on traumatic fractures. METHODS A retrospective longitudinal study on prospectively collected data was conducted on 53 patients that had a kyphoplasty by Tektona™, associated or not to percutaneous fixation. The data collected were clinical, surgical and scannographic (measurement of AVH, MVH and PVH (anterior/medium/posterior vertebral height), and RTA (regional traumatic angle) in°), preoperatively, post-operatively and at last follow-up. RESULTS Fractures were mainly located at the upper lumbar spine and were AOSpine A3 type for 74%. The mean RTA was 12° in pre-operative, 4° in post-operative (p = 2e- 9), and 8° at the last follow-up (p = 0,01). The mean correction of RTA for the fixation group was - 10 ± 6° versus - 7 ± 4° for the kyphobroplasty alone group (p = 0,006). The mean correction for fractures located at T10-T12 was - 9 ± 3°, - 9 ± 5° for L1, - 8 ± 3° for L2 and - 5 ± 3° for L3-L5 (p = 0,045). CONCLUSIONS The Tektona® system appears to be efficient for acute thoraco-lumbar fractures, comparable to other available systems, allowing a real intracorporeal reduction work. Its relevance, especially in the long term needs further investigation. The association of a percutaneous fixation allow to obtain a better correction of the RTA but did not seem to prevent the loss of correction at follow-up.
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Affiliation(s)
- Laura Marie-Hardy
- Orthopaedic Surgery Department, Spine Unit; Pitié-Salpétrière Hospital, 47-83 bd de l’hôpital, 75013 Paris, France
| | - Yann Mohsinaly
- Orthopaedic Surgery Department, Spine Unit; Pitié-Salpétrière Hospital, 47-83 bd de l’hôpital, 75013 Paris, France
| | - Raphaël Pietton
- Orthopaedic Surgery Department, Spine Unit; Pitié-Salpétrière Hospital, 47-83 bd de l’hôpital, 75013 Paris, France
| | - Marion Stencel-Allemand
- Orthopaedic Surgery Department, Spine Unit; Pitié-Salpétrière Hospital, 47-83 bd de l’hôpital, 75013 Paris, France
| | - Marc Khalifé
- Orthopaedic Surgery Department, Spine Unit; Hopital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France
| | - Raphaël Bonaccorsi
- Orthopaedic Surgery Department, Spine Unit; Pitié-Salpétrière Hospital, 47-83 bd de l’hôpital, 75013 Paris, France
| | - Nicolas Barut
- Orthopaedic Surgery Department, Spine Unit; Pitié-Salpétrière Hospital, 47-83 bd de l’hôpital, 75013 Paris, France
| | - Hugues Pascal-Moussellard
- Orthopaedic Surgery Department, Spine Unit; Pitié-Salpétrière Hospital, 47-83 bd de l’hôpital, 75013 Paris, France
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Outcomes of Anterior Decompression and Anterior Instrumentation in Thoracolumbar Burst Fractures-A Prospective Observational Study With Mid-Term Follow-up. J Orthop Trauma 2022; 36:136-141. [PMID: 34483323 DOI: 10.1097/bot.0000000000002261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To analyze the functional, neurological, and radiological outcomes after anterior surgery in thoracolumbar burst fractures. DESIGN Prospective observational study. SETTING Tertiary care hospital. PATIENTS Thirty-six patients with thoracolumbar burst fractures (T11-L2). INTERVENTION Anterior decompression, anterior column reconstruction with mesh cage, and instrumented stabilization. OUTCOME Functional (Visual Analog Score, Oswestry Disability Index, and Spinal Cord Independence Measure), neurological (ASIA Impairment Scale), and radiological (kyphosis, anterior vertebral height loss, canal encroachment %) parameters. RESULTS Patients were prospectively followed for a mean duration of 5.9 ± 3.2 years (2.4-10 years). Statistically significant improvement was noted in functional outcomes from preop values (P-value < 0.001). 29 patients (80.5%) had improvement in neurology after surgery at the final follow-up with a positive correlation with % change in canal encroachment (r = 0.64, P -0.018). The mean preoperative kyphosis of 29.1 ± 11.9 degrees got corrected to 9.4 ± 3.8 degrees in immediate postop and 15.7 ± 11.8 at the final follow-up(P < 0.001). Preoperative mean canal encroachment of 58.5 ± 15.7% was reduced to 6.5 ± 3.2% postoperatively (P < 0.001). Two patients developed neurological complications (subacute progressive ascending myelopathy), and 5 patients developed pulmonary complications. No pseudarthrosis, implant loosening, or cage migration was noted in any patient. CONCLUSION Anterior surgery performed in 36 patients with thoracolumbar burst fractures in our study showed good outcomes. 80.5% of patients improved in neurology after surgery by at least one ASIA Impairment Scale grade. There was statistically significant improvement noted in radiological outcome (Kyphosis and Canal encroachment %) and functional outcome (Visual Analog Score, Oswestry Disability Index, and Spinal Cord Independence Measure score) after surgery in immediate postop and at the final follow-up. Only 13.8% of patients developed pulmonary complications that were managed successfully with chest drain. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Yaman O, Zileli M, Şentürk S, Paksoy K, Sharif S. Kyphosis After Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations. Neurospine 2022; 18:681-692. [PMID: 35000321 PMCID: PMC8752698 DOI: 10.14245/ns.2142340.170] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/28/2021] [Indexed: 11/25/2022] Open
Abstract
Thoracolumbar fractures change the biomechanics of the spine. Load distribution causes kyphosis by the time. Treatment of posttraumatic kyphosis is still controversial. We reviewed the literature between 2010 and 2020 using a search with keywords “thoracolumbar fracture and kyphosis.” We removed osteoporotic fractures, ankylosing spondylitis fractures, non-English language papers, case reports, and low-quality case series. Up-to-date information on posttraumatic kyphosis management was reviewed to reach an agreement in a consensus meeting of the World Federation of Neurosurgical Societies (WFNS) Spine Committee. The first meeting was conducted in Peshawar in December 2019 with WFNS Spine Committee members’ presence and participation. The second meeting was a virtual meeting via the internet on June 12, 2020. We utilized the Delphi method to administer the questionnaire to preserve a high degree of validity. We summarized 42 papers on posttraumatic kyphosis. Surgical treatment of thoracolumbar kyphosis due to unstable burst fractures can be done via a posterior only approach. Less blood loss and reduced surgery time are the main advantages of posterior surgery. Kyphosis angle for surgical decision and fusion levels are controversial. However, global sagittal balance should be taken into consideration for the segment that has to be included. Adding an intermediate screw at the fractured level strengthens the construct.
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Affiliation(s)
- Onur Yaman
- Memorial Bahcelievler Spine Center, Istanbul, Turkey
| | - Mehmet Zileli
- Department of Neurosurgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Salim Şentürk
- Memorial Bahcelievler Spine Center, Istanbul, Turkey
| | - Kemal Paksoy
- Memorial Bahcelievler Spine Center, Istanbul, Turkey
| | - Salman Sharif
- Liaquat National Hospital, Department of Neurosurgery, Karachi, Pakistan
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Thoracolumbar Burst Fracture: McCormack Load-sharing Classification: Systematic Review and Single-arm Meta-analysis. Spine (Phila Pa 1976) 2021; 46:E542-E550. [PMID: 33273433 DOI: 10.1097/brs.0000000000003826] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A systematic review and single-arm meta-analysis of randomized clinical trials. OBJECTIVE The aim of this study was to evaluate whether the load-sharing classification (LSC) is reliable to predict the best surgical approach for thoracolumbar burst fracture (TBF). SUMMARY OF BACKGROUND DATA There is no previous review evaluating the efficacy of the use of LSC as a guide in the surgical treatment of burst fractures. METHODS On April 19th, 2019, a broad search was performed in the following databases: EMBASE, PubMed, Cochrane, SCOPUS, Web of Science, LILACS, and gray literature. This study was registered on the International Prospective Register of Systematic Reviews. We included clinical trials involving patients with TBF undergoing posterior surgical treatment, classified by load-sharing score, and that enabled the analysis of the outcomes loss of segmental kyphosis and implant failure (IF). We performed random- or fixed-effects models meta-analyses depending on the data homogeneity. Heterogeneity between studies was estimated by I2 and τ2 statistics. RESULTS The search identified 189 references, out of which nine studies were eligible for this review. All articles presenting LSC up to 6 proved to be reliable in indicating that only posterior instrumentation is necessary, without screw failures or loss of kyphosis correction. For cases where the LSC was >6, only 2.5% of the individuals presented IF upon posterior approach alone. For loss of kyphosis correction, only 5% of patients had this outcome where LSC >6. For both outcomes together, we had 6% of postoperative problems (I2 = 77%, τ2 < 0.0015, P < 0.01). CONCLUSION Load-sharing scores up to 6 are 100% reliable, only requiring posterior instrumentation for stabilization. For scores >6, the risk of implant breakage and loss of kyphosis correction in posterior fixation alone is low. Thus, other factors should be considered to define the best surgical approach to be adopted.Level of Evidence: 1.
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Surgical Management of Thoracolumbar Burst Fractures: Surgical Decision-making Using the AOSpine Thoracolumbar Injury Classification Score and Thoracolumbar Injury Classification and Severity Score. Clin Spine Surg 2021; 34:4-13. [PMID: 32657842 DOI: 10.1097/bsd.0000000000001038] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 05/22/2020] [Indexed: 12/13/2022]
Abstract
The management of thoracolumbar burst fractures is controversial with no universally accepted treatment algorithm. Several classification and scoring systems have been developed to assist in surgical decision-making. The most widely accepted are the Thoracolumbar Injury Classification and Severity Score (TLICS) and AOSpine Thoracolumbar Injury Classification Score (TL AOSIS) with both systems designed to provide a simple objective scoring criteria to guide the surgical or nonsurgical management of complex injury patterns. When used in the evaluation and treatment of thoracolumbar burst fractures, both of these systems result in safe and consistent patient care. However, there are important differences between the 2 systems, specifically in the evaluation of the complete burst fractures (AOSIS A4) and patients with transient neurological deficits (AOSIS N1). In these circumstances, the AOSpine system may more accurately capture and characterize injury severity, providing the most refined guidance for optimal treatment. With respect to surgical approach, these systems provide a framework for decision-making based on patient neurology and the status of the posterior tension band. Here we propose an operative treatment algorithm based on these fracture characteristics as well as the level of injury.
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Pratheep KG, Viswanathan VK. Letter to the Editor: Does Combined Anterior-Posterior Approach Improve Outcomes Compared with Posterior-only Approach in Traumatic Thoracolumbar Burst Fractures?: A Systematic Review. Asian Spine J 2020; 14:760-761. [PMID: 33108839 PMCID: PMC7595818 DOI: 10.31616/asj.2020.0388.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 07/22/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- K Guna Pratheep
- Department of Spine Surgery, Ganga Medical Centre and Hospital Pvt. Ltd., Coimbatore, India
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Tan T, Donohoe TJ, Huang MSJ, Rutges J, Marion T, Mathew J, Fitzgerald M, Tee J. Does Combined Anterior-Posterior Approach Improve Outcomes Compared with Posterioronly Approach in Traumatic Thoracolumbar Burst Fractures?: A Systematic Review. Asian Spine J 2020; 14:388-398. [PMID: 31906611 PMCID: PMC7280926 DOI: 10.31616/asj.2019.0203] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 08/08/2019] [Indexed: 01/11/2023] Open
Abstract
The aim of this systematic review was to evaluate the surgical, radiological, and functional outcomes of posterior-only versus combined anterior-posterior approaches in patients with traumatic thoracolumbar burst fractures. The ideal approach (anterior-only, posterior-only, or combined anterior-posterior) for the surgical management of thoracolumbar burst fracture remains controversial, with each approach having its advantages and disadvantages. A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed (registration no., CRD42018115120). The authors reviewed comparative studies evaluating posterior-only approach compared with combined anterior-posterior approaches with respect to clinical, surgical, radiographic, and functional outcome measures. Five retrospective cohort studies were included. Postoperative neurological deterioration was not reported in either group. Operative time, estimated blood loss, and postoperative length of stay were increased among patients in the combined anterior-posterior group in one study and equivalent between groups in another study. No significant difference was observed between the two approaches with regards to long-term postoperative Cobb angle (mean difference, -0.2; 95% confidence interval, -5.2 to 4.8; p =0.936). Moreover, no significant difference in functional patient outcomes was observed in the 36item Short-Form Health Survey, Visual Analog Scale, and return-to-work rates between the two groups. The available evidence does not indicate improved clinical, radiologic (including kyphotic deformity), and functional outcomes in the combined anterior-posterior and posterior-only approaches in the management of traumatic thoracolumbar burst fractures. Further studies are required to ascertain if a subset of patients will benefit from a combined anterior-posterior approach.
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Affiliation(s)
- Terence Tan
- National Trauma Research Institute, Melbourne, VIC, Australia.,Department of Neurosurgery, The Alfred Hospital, Melbourne, VIC, Australia
| | - Tom J Donohoe
- National Trauma Research Institute, Melbourne, VIC, Australia.,Department of Neurosurgery, St. Vincent's Hospital, Melbourne, VIC, Australia
| | - Milly Shu-Jing Huang
- National Trauma Research Institute, Melbourne, VIC, Australia.,Department of Neurosurgery, The Alfred Hospital, Melbourne, VIC, Australia
| | - Joost Rutges
- Department of Orthopaedics, Erasmus MC, Rotterdam, Netherlands
| | - Travis Marion
- Division of Orthopaedic Surgery, Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Joseph Mathew
- National Trauma Research Institute, Melbourne, VIC, Australia
| | - Mark Fitzgerald
- National Trauma Research Institute, Melbourne, VIC, Australia
| | - Jin Tee
- National Trauma Research Institute, Melbourne, VIC, Australia.,Department of Neurosurgery, The Alfred Hospital, Melbourne, VIC, Australia
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Kerschbaumer G, Gaulin B, Ruatti S, Tonetti J, Boudissa M. Clinical and radiological outcomes in thoracolumbar fractures using the SpineJack device. A prospective study of seventy-four patients with a two point three year mean of follow-up. INTERNATIONAL ORTHOPAEDICS 2019; 43:2773-2779. [DOI: 10.1007/s00264-019-04391-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/07/2019] [Indexed: 12/31/2022]
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Korshunova GA, Shul'ga AE, Zaretskov VV, Smol'kin AA. [Functional state of spinal cord and its radices in patients with thoracic and lumbar spine injuries]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:44-48. [PMID: 30874526 DOI: 10.17116/jnevro201911902144] [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: 11/17/2022]
Abstract
AIM To estimate the character of neurophysiological monitoring in patients with thoracic and lumbar spine injuries at different treatment stages. MATERIAL AND METHODS Thirty-eight patients with non-complicated (22 patients, group 1) and complicated (16 patients, group 2) thoracic and lumbar spine injuries underwent electroneuromyography (ENM) and transcranial magnetic stimulation (TMS). The examination was performed at early (up to 2 weeks) and later (more than 1 month) post-injury periods, before the operation and on the 10th day after decompressing-stabilizing interventions. RESULTS Before the operation, 71.4% patients of group 1 had ENM-signs of suppressed motor neuron activity in L5 segment of the spinal cord with peroneal nerve axonopathy. The most significant changes in ENM-indexes were observed in medullary channel stenosis of more than 30%. TMS parameters in group 1 were normal while in the 2nd group, EMN and TMS results before the operation demonstrated preserved motor neuron activity at the injury level despite gross neurological symptoms and 100% of medullary channel lumen deficit. In the postoperative period, ENM and TMS revealed no definite negative dynamics in patients of both groups. Patients with locomotor disorders, who underwent surgery at late post-injury periods, showed neurophysiological dynamics on the 10th day postoperatively. Low amplitude motor evoked potentials (kMEP), which were not present before, suggested initial signs of conductibility restoration (in 22% of patients) that proved the effectiveness of decompressive interventions in the long-term post-injury period. CONCLUSION ENM- and TMS monitoring in patients with complicated and non-complicated injuries of thoracic and lumbar spine allowed revealing the positive influence of decompressing-stabilizing operations conducted both at early and late post-injury periods on the state of spinal cord conductibility and segmental apparatus.
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Affiliation(s)
- G A Korshunova
- Research Institute of Traumatology, Orthopedics and Neurosurgery 'Razumovsky Saratov State Medical University' of Ministry Health of the Russian Federation, Saratov, Russia
| | - A E Shul'ga
- Research Institute of Traumatology, Orthopedics and Neurosurgery 'Razumovsky Saratov State Medical University' of Ministry Health of the Russian Federation, Saratov, Russia
| | - V V Zaretskov
- Research Institute of Traumatology, Orthopedics and Neurosurgery 'Razumovsky Saratov State Medical University' of Ministry Health of the Russian Federation, Saratov, Russia
| | - A A Smol'kin
- Research Institute of Traumatology, Orthopedics and Neurosurgery 'Razumovsky Saratov State Medical University' of Ministry Health of the Russian Federation, Saratov, Russia
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Bousson V, Hamze B, Odri G, Funck-Brentano T, Orcel P, Laredo JD. Percutaneous Vertebral Augmentation Techniques in Osteoporotic and Traumatic Fractures. Semin Intervent Radiol 2018; 35:309-323. [PMID: 30402014 DOI: 10.1055/s-0038-1673639] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Percutaneous vertebral augmentation/consolidation techniques are varied. These are vertebroplasty, kyphoplasty, and several methods with percutaneous introduction of an implant (associated or not with cement injection). They are proposed in painful osteoporotic vertebral fractures and traumatic fractures. The objectives are to consolidate the fracture and, if possible, to restore the height of the vertebral body to reduce vertebral and regional kyphosis. Stabilization of the fracture leads to a reduction in pain and thus restores the spinal support function as quickly as possible, which is particularly important in the elderly. The effectiveness of these interventions on fracture pain was challenged once by two randomized trials comparing vertebroplasty to a sham intervention. Since then, many other randomized studies in support of vertebroplasty efficacy have been published. International recommendations reserve vertebroplasty for medical treatment failures on pain, but earlier positioning may be debatable if the objective is to limit kyphotic deformity or even reexpand the vertebral body. Recent data suggest that in osteoporotic fracture, the degree of kyphosis reduction achieved by kyphoplasty and percutaneous implant techniques, compared with vertebroplasty, is not sufficient to justify the additional cost and the use of a somewhat longer and traumatic procedure. In young patients with acute traumatic fractures and a significant kyphotic angle, kyphoplasty and percutaneous implant techniques are preferred to vertebroplasty, as in these cases a deformity reduction has a significant positive impact on the clinical outcome.
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Affiliation(s)
- Valérie Bousson
- Service de Radiologie Ostéoarticulaire, Viscérale et Vasculaire, Hôpital Lariboisière, APHP, Université Paris-Diderot, Paris, France
| | - Bassam Hamze
- Service de Radiologie Ostéoarticulaire, Viscérale et Vasculaire, Hôpital Lariboisière, APHP, Université Paris-Diderot, Paris, France
| | - Guillaume Odri
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Lariboisière, APHP, Université Paris-Diderot, Paris, France
| | - Thomas Funck-Brentano
- Service de Rhumatologie, Hôpital Lariboisière, APHP, Université Paris-Diderot, Paris, France
| | - Philippe Orcel
- Service de Rhumatologie, Hôpital Lariboisière, APHP, Université Paris-Diderot, Paris, France
| | - Jean-Denis Laredo
- Service de Radiologie Ostéoarticulaire, Viscérale et Vasculaire, Hôpital Lariboisière, APHP, Université Paris-Diderot, Paris, France
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Abstract
RATIONALE Lumbar burst fractures are frequent injury resulting from high-energy trauma, and the patients suffer from pain and the neurologic dysfunction. Although minimally invasive techniques have advanced rapidly, it was the first time to apply transforaminal endoscopic combined with percutaneous pedicle screw fixation to treatment of lumbar burst fractures. PATIENT CONCERNS A 33-year-old man underwent Magerl type A3.1 burst fracture at L2 and compression fractures at L3 due to falling from a height with severe lower back pain, sensory loss, and atony of the right leg. DIAGNOSES Burst fracture at L2, compression fractures at L3. INTERVENTIONS The patient was presented to 1-stage operation of percutaneous pedicle screw fixation at L1, L2, L3, and L4 instead of delayed posterior open surgery. At 1 week after injury, the 2-stage operation with a percutaneous transforaminal endoscopic was undertaken for decompression. OUTCOMES No matter the function of nerve and imaging findings, all got ideal recoveries in just 3 days after 2-stage operation. At the 3-month follow-up, there was no loss of sagittal plane alignment, and spinal cord compression was completely relieved. The patient regained near-full neurologic function postoperatively. LESSONS A minimally invasive surgery (ie, transforaminal endoscopic combined with percutaneous pedicle screw fixation) for the treatment of Magerl type A3.1 burst fracture at lumbar was feasible. In addition, the key to the recovery of neurological function is the complete and effective decompression of spinal.
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Affiliation(s)
- Yuanyi Wang
- The First Hospital of Jilin University, Jilin
| | - Cong Ning
- The First Hospital of Jilin University, Jilin
| | - Liyu Yao
- The First Hospital of Jilin University, Jilin
| | | | | | - Bin Chen
- The Hospital of Chengde Medical College, Hebei, China
| | - Nan Zhang
- The First Hospital of Jilin University, Jilin
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Boehm H, Shousha M, Bahrami R. Korrekturosteotomie für posttraumatische Fehlstellungen. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/s10039-017-0263-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Farrokhi MR, Jamali M, Gholami M, Farrokhi F, Hosseini K. Clinical and radiological outcomes after decompression and posterior fusion in patients with degenerative scoliosis. Br J Neurosurg 2017; 31:514-525. [PMID: 28420247 DOI: 10.1080/02688697.2017.1317717] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The prevalence of degenerative scoliosis (DS) increases with age and an overall increase is seen due to the aging population. This study aims to evaluate the clinical and radiological outcomes after decompression and posterior fusion in patients with DS. METHODS In this is prospective study, 43 patients with DS, aged 37 to 70 years, were eligible to undergo decompression and posterior fusion. Primary outcomes were low back pain (LBP) with or without radicular pain, which was evaluated preoperatively and at 12 and 24 months after surgery with the use of a visual analog scale (VAS), and the quality of life (QOL), which was assessed at the same time periods by the Oswestry Disability Index (ODI) questionnaire. The Cobb's method was used to measure the degree of scoliosis in each patient preoperatively and at 24 hours, 12 and 24 months after the surgery. RESULTS VAS scores improved significantly from a mean of 8.18 preoperatively to 4.48 at 12 months and 3.07 at 24 months postoperatively (P < .001). The mean radicular pain scores also decreased significantly (P < .001). At postoperative 12 months, the mean ODI score was significantly lower than the mean preoperative ODI score (47.81 ± 16.06 vs. 72.18 ± 12.28; P = .001). ODI score at 24 months postoperatively was significantly better than the preoperative ODI (15.53 ± 7.21 vs. 72.18 ± 12.28; P = .016). The mean Cobb angle changed significantly from 31.4° ± 4.88 preoperatively to 3.28° ± 2.10 at 24 months postoperatively (P < .001). CONCLUSIONS Our findings suggest that decompression and posterior fusion in the patients with DS is an effective surgical method which is associated with satisfying clinical results in terms of improvement of postoperative LBP, radicular pain, and QOL, and correction of Cobb angle at 12 and 24 months after the surgery and restoration of sagittal alignment at 2 months postoperatively.
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Affiliation(s)
- Majid Reza Farrokhi
- a Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences , Shiraz , Iran.,b Department of Neurosurgery , Shiraz University of Medical Sciences , Shiraz , Iran
| | - Mohammad Jamali
- a Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences , Shiraz , Iran.,b Department of Neurosurgery , Shiraz University of Medical Sciences , Shiraz , Iran
| | - Mehrnaz Gholami
- a Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences , Shiraz , Iran
| | - Farnaz Farrokhi
- c Student Research Committee , Shiraz University of Medical Sciences , Shiraz , Iran.,d School of Dentistry, Shiraz University of Medical Sciences , Shiraz , Iran
| | - Khadijeh Hosseini
- a Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences , Shiraz , Iran
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