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Kitzen J, Bakker WM, Jacobs E, Kuijper MT, Öner FC. Surgeon reported treatment choices for AO type B and C thoracolumbar fractures without neurological deficits: An expert survey. Injury 2024; 55:111389. [PMID: 38341996 DOI: 10.1016/j.injury.2024.111389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/27/2023] [Accepted: 01/26/2024] [Indexed: 02/13/2024]
Abstract
INTRODUCTION Less invasive spine surgery (LISS) has become well-established for thoracolumbar burst fractures without neurological deficits. However, notable controversy persists regarding the adequacy of LISS for more unstable AO type B and C injuries, as it does not allow for formal open fusion. MATERIALS AND METHODS In this cross-sectional survey experienced spine surgeons of the Dutch Spine Society were invited to participate (56 participants). They were asked to indicate the most appropriate treatment for AO type B1, B2 (L1: A1 and L1: A3), B3 and C (L1: A4) injuries at level Th12-L1. Taking into account: age, AO N0-N1, or polytrauma. Specific agreement between participants was obtained applying Variation Ratio (VR). RESULTS A significant level of overall agreement was observed for AO type-B1 injuries with 73.8% of participants opting for percutaneous short-segment fixation (VR 0.775). For AO type-B3 injuries, 79.4% of participants favored percutaneous long-segment fixation (VR 0.794). for AO type-B2 injuries, there was less overall agreement (VR 0.571-0.657). Nonetheless, when considering all AO type-B injuries combined, percutaneous fixation emerged as the most preferred treatment option with substantial agreement (VR 0.871-0.923). Conversely, for AO type-C injuries, there was less agreement among the participants (VI 0.411), 26.5% of them chose additional open spinal fusion. CONCLUSION For all AO type-B injuries there was substantial agreement to treat these fractures with percutaneous techniques. For AO type-C injuries, the survey results do not support a consensus. Nevertheless, the responses raise important questions about the necessity of spinal fusion for such injuries.
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Affiliation(s)
- J Kitzen
- Department of Orthopedic Surgery, Maasstad Medical Centre, P.O. Box 9100, Rotterdam 3007 AC, the Netherlands.
| | - W M Bakker
- Department of Orthopedic Surgery, Maasstad Medical Centre, P.O. Box 9100, Rotterdam 3007 AC, the Netherlands
| | - E Jacobs
- Department of Orthopedic Surgery, Maastricht University Medical Centre, P.O. Box 5800, Maastricht 6202 AZ, the Netherlands
| | - M T Kuijper
- Department of Clinical Epidemiology, Maasstad Medical Centre, P.O. Box 9100, Rotterdam 3007 AC, the Netherlands
| | - F C Öner
- Department Orthopedic Surgery, University Medical Centre Utrecht, P.O. Box 88500, Utrecht 3508 GA, the Netherlands
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Hou J, Ren D, Chen Y, Geng L, Yao S, Wu H, Wang P. Effectiveness of the Endplate Reduction Technique Combined With Bone Grafting for the Treatment of Thoracolumbar Fractures by Using Posterior Short-Segment Fixation. Neurospine 2023; 20:353-364. [PMID: 37016884 PMCID: PMC10080432 DOI: 10.14245/ns.2244980.490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/09/2023] [Indexed: 04/03/2023] Open
Abstract
Objective: This study aimed to examine the effect of the endplate reduction (EPR) technique combined with bone grafting for treating thoracolumbar burst fractures using posterior short-segmental fixation.Methods: Patients with thoracolumbar fractures admitted between January 2018 and October 2021 were retrospectively analyzed, and those meeting the criteria were assigned to the EPR group and the intermediate screws (IS) group. The vertebral wedge angle (VWA), Cobb angle (CA), anterior vertebral body height (AVBH), middle vertebral body height (MVBH), upper endplate line (UEPL), upper intervertebral angle (UIVA), and upper intervertebral disc height (UIDH) indices were examined and compared preoperatively, first day postoperatively, as well as at 12 months postoperatively.Results: The result indicated that the EPR group achieved better MVBH reduction (p < 0.001), UEPL reduction (p < 0.001), vertebral body fracture healing (p = 0.006), as well as implant breakage (p = 0.04) than the IS group; VWA (p < 0.001), CA (p = 0.005), AVBH (p < 0.001), MVBH (p < 0.001), UEPL (p < 0.001), and UIDH (p < 0.001) were lost after reduction less than those in the IS group. There was no significant difference in operative time (p = 0.315) and intraoperative bleeding (p = 0.274) between the 2 groups.Conclusion: The EPR group achieved better results in repositioning and maintaining MVBH and endplate morphology, with less correction loss after the reduction of the VWA, CA, AVBH, and endplate morphology. The EPR group exhibited a better healing pattern after vertebral fracture and disc degeneration was better relieved.
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Affiliation(s)
- Jiguang Hou
- Orthopaedic Trauma Service Center, The Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, China
- Department of Orthopaedics, First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Dong Ren
- Orthopaedic Trauma Service Center, The Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, China
| | - Yufeng Chen
- Orthopaedic Trauma Service Center, The Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, China
| | - Lindan Geng
- Orthopaedic Trauma Service Center, The Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, China
| | - Shuangquan Yao
- Orthopaedic Trauma Service Center, The Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, China
| | - Haotian Wu
- Orthopaedic Trauma Service Center, The Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, China
| | - Pengcheng Wang
- Orthopaedic Trauma Service Center, The Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, China
- Corresponding Author Pengcheng Wang Orthopaedic Trauma Service Center, The Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, Hebei Province 050051, China
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Su Y, Ren D, Chen Y, Geng L, Yao S, Wu H, Wang P. Effect of endplate reduction on endplate healing morphology and intervertebral disc degeneration in patients with thoracolumbar vertebral fracture. 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; 32:55-67. [PMID: 35435517 DOI: 10.1007/s00586-022-07215-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 02/25/2022] [Accepted: 04/06/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine the effect of endplate reduction on the final healing morphology and degenerative changes in intervertebral discs. METHODS Forty-eight patients with single-level thoracolumbar fractures with endplate injury were included. All patients underwent posterior reduction and pedicle screw fixation, and postoperative imaging was used to determine whether endplate reduction was successful. The healing morphology of the endplate was divided into three types: increased endplate curvature, irregular healing and traumatic Schmorl node. MRI was performed at baseline and at the last follow-up evaluation to observe changes in disc degeneration (disc height and nucleus pulposus signal) and Modic changes. RESULTS The reduction rate in the central area was significantly lower than that in the peripheral area (P = 0.017). In patients with successful reduction, 90.9% (20/22) of the endplates healed with increased curvature. In patients with an unsuccessful endplate reduction, 63.4% (26/41) of the endplates healed irregularly, and 34.1% (14/41) of the endplates formed traumatic Schmorl nodes. Endplate reduction was closely related to the final healing morphology of the endplate (P < 0.001), which had a significant protective effect on the degeneration of the intervertebral disc. At the last follow-up evaluation, there was no statistically significant correlation between different endplate healing morphologies and new Modic changes. CONCLUSIONS The reduction rate in the central area is significantly lower than that in the peripheral area. Although all of the intervertebral discs corresponding to fractured endplates had degenerated to different degrees, successful endplate fracture reduction can obviously delay the degeneration of intervertebral discs.
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Affiliation(s)
- Yunshan Su
- Orthopaedic Trauma Service Center, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei Province, China
| | - Dong Ren
- Orthopaedic Trauma Service Center, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei Province, China
| | - Yufeng Chen
- Orthopaedic Trauma Service Center, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei Province, China
| | - Lindan Geng
- Orthopaedic Trauma Service Center, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei Province, China
| | - Shuangquan Yao
- Orthopaedic Trauma Service Center, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei Province, China
| | - Haotian Wu
- Orthopaedic Trauma Service Center, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei Province, China
| | - Pengcheng Wang
- Orthopaedic Trauma Service Center, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei Province, China.
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Tschauner S, Singer G, Weitzer CU, Castellani C, Till H, Sorantin E, Wegmann H. Does Calcium Phosphate Cement Kyphoplasty Cause Intervertebral Disk Degeneration in Adolescents? Cartilage 2022; 13:77-86. [PMID: 36254621 PMCID: PMC9924988 DOI: 10.1177/19476035221126354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE Balloon kyphoplasty with polymethylmethacrylate (PMMA) represents the standard procedure for the treatment of thoracic and lumbar type A compression fractures. However, an increased degeneration in adjacent intervertebral disks following PMMA kyphoplasty has been demonstrated in elderly patients. Calcium phosphate cement (CPC) appears to be superior to PMMA for the intravertebral stabilization in younger patients. It remains unkown whether CPC kyphoplasty causes degeneration of adjacent disks in adolescents. DESIGN Seven adolescents with thoracolumbar spine fractures underwent kyphoplasty at a mean age of 14.5 years (range 10-18). At a mean follow-up of 3.7 years (range 1 to 4.8) postoperatively, 3.0 Tesla magnetic resonance imaging (MRI) of the spine was performed to assess intervertebral disk degeneration by quantitative T2 relaxation maps and subjective ratings using modified Pfirrmann scores. A total of 56 intervertebral disks was analyzed. Initial computed tomography (CT) examinations served as basis to assess the severity of adjacent endplate injuries in terms of articular step-offs. RESULTS Initial imaging detected 18 thoracolumbar vertebral body fractures of which 9 were treated with CPC kyphoplasty. Quantitative follow-up MRI revealed signs of degeneration in 10 (17.9%) of the examined 56 intervertebral disks, 7 of them adjacent to a previously fractured vertebral body. Signs of disk degeneration were significantly higher in caudal endplates with articular step-offs larger than 5 mm compared to fractured vertebral bodies without endplate step-offs. CONCLUSIONS Quantitative MRI follow-ups did not suggest CPC-related intervertebral disk degradations following thoracolumbar kyphoplasty in adolescents, but indicated disk alterations correlating to adjacent endplate fracture severity.
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Affiliation(s)
- Sebastian Tschauner
- Division of Pediatric Radiology,
Department of Radiology, Medical University of Graz, Graz, Austria
| | - Georg Singer
- Department of Pediatric and Adolescent
Surgery, Medical University of Graz, Graz, Austria,Georg Singer, Department of Pediatric and
Adolescent Surgery, Medical University of Graz, Auenbruggerplatz 34, 8036 Graz,
Austria.
| | - Claus-Uwe Weitzer
- Department of Pediatric and Adolescent
Surgery, Medical University of Graz, Graz, Austria
| | - Christoph Castellani
- Department of Pediatric and Adolescent
Surgery, Medical University of Graz, Graz, Austria
| | - Holger Till
- Department of Pediatric and Adolescent
Surgery, Medical University of Graz, Graz, Austria
| | - Erich Sorantin
- Division of Pediatric Radiology,
Department of Radiology, Medical University of Graz, Graz, Austria
| | - Helmut Wegmann
- Department of Pediatric and Adolescent
Surgery, Medical University of Graz, Graz, Austria,Department of Trauma Surgery, Klinikum
Rechts Der Isar, School of Medicine, Technical University of Munich, Munich,
Germany
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Liao JC, Chen WJ. Short-Segment Instrumentation with Fractured Vertebrae Augmentation by Screws and Bone Substitute for Thoracolumbar Unstable Burst Fractures. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4780426. [PMID: 31950038 PMCID: PMC6948339 DOI: 10.1155/2019/4780426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/08/2019] [Accepted: 11/28/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND For thoracolumbar burst fractures, traditional four-screw (one above and one below) short-segment instrumentation is popular and has a high failure rate. Additional augmentation at the fractured vertebrae is believed to reduce surgical failure. The purpose of this study was to examine the clinical and radiographic results of patients who underwent short-segment posterior instrumentation with augmentation by screws and bone substitutes at the fractured vertebrae and to compare these data to those of patients who underwent long-segment instrumentation for thoracolumbar burst fractures. METHODS The study group had twenty patients who underwent short-segment instrumentation with additional augmentation by two screws and bone substitutes at the fractured vertebrae. The control group contained twenty-two patients who underwent eight-screw long instrumentation without vertebra augmentation. Local kyphosis and the anterior body height of the fractured vertebrae were measured. The severity of the fractured vertebrae was evaluated with the load sharing classification (LSC). Any implant failure or loss of correction >10° at the final follow-up was defined as surgical failure. RESULTS Both groups had similar distributions in terms of age, sex, the injured level, and the mechanism of injury before operation. During the operation, the study group had significantly less blood loss (136.0 vs. 363.6 ml, p=0.001) and required shorter operating times (146.8 vs. 157.5 minutes, p=0.112) than the control group. Immediately after surgery, the study group had better correction of the local kyphosis angle (13.4° vs. 11.9°, p=0.212) and restoration of the anterior height (34.7% vs. 31.0%, p=0.326) than the control group. At the final follow-up, no patients in the study group and only one patient in the control group experienced surgical failure. CONCLUSIONS Patients with thoracolumbar burst fractures who received six-screw short-segment posterior fixators with augmentation at the level of the fractured vertebrae via injectable artificial bone substitute achieved satisfactory clinical and radiographic results, and this method could replace long-segment instrumentation methods used in unstable thoracolumbar burst fractures.
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Affiliation(s)
- Jen-Chung Liao
- Department of Orthopedics Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Jer Chen
- Department of Orthopedics Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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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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