Thoracolumbar flexion dysfunction and thoracolumbar compression fracture in postmenopausal women: a single-center retrospective study

A Clinical Comparative Study on Percutaneous and Open Approaches for Screw Internal Fixation in Treating Thoracolumbar Fractures

OBJECTIVE

Conventional open internal fixation surgery for thoracolumbar fractures has many complications and long recovery time. There are few clinical studies on the minimally invasive percutaneous injured vertebrae screw internal fixation. The purpose of this paper is to evaluate the application value of minimally invasive percutaneous injured vertebrae screw internal fixation in the treatment of thoracolumbar fractures (TF).

METHODS

A total of 98 patients with TF admitted to our hospital from January 2019 to December 2021 were retrospectively enrolled. According to the surgical method, the patients were divided into the study group (n = 49, treated with minimally invasive percutaneous injured vertebrae screw internal fixation) and the control group (n = 49, treated with traditional open internal fixation surgery). The two groups were compared in the perioperative period, the degree of pain at different periods, the percentage of the height of the anterior edge of the injured vertebra, the Cobb angle of the injured vertebra body and the wedge angle of the injured vertebra body at the first week and the last follow-up, and the postoperative complications and the occurrence of the cone shell after the operation were recorded. Then, statistical analysis such as Student's t test or Chi-Square test was performed.

RESULTS

The operation time (p = 0.002), intraoperative blood loss (p < 0.001), postoperative drainage volume (p = 0.011), and length of hospital stay (p = 0.003) in the study group were significantly lower than that in the control group. The VAS in the study group (3.38 ± 1.02) was significantly lower than that in the control group (4.56 ± 1.04) on the 7th day after the operation, with a significant difference (p < 0.001). The correction values of the percentage of leading edge height (LEH), Cobb angle, wedge angle in the study group were significantly lower than that in the control group at 1 week after surgery (all ps < 0.001). The incidence of postoperative complications in the study group (one case, 2.04%) was significantly lower than that in the control group (seven cases, 14.29%) (p = 0.031). At 1 month, 6 months, 10 months, and the last follow-up, the incidence of "empty shell" on CT scan in the study group were lower than that in the control group with a significant difference (all ps < 0.05).

CONCLUSION

Applying minimally invasive percutaneous injured vertebrae screw internal fixation is more beneficial to shorten the operation time and hospital stay, with fewer postoperative complications.

Dynamic Spine Hyperflexion Is Related to Vertebral Compression Fractures in Postmenopausal Women

OBJECTIVE

Previous studies on osteoporotic vertebral fractures are usually based on the neutral posture of spine; however, the fractures are usually associated with the flexion posture of spine. Therefore, we aimed to ascertain the relationship between vertebral compression fractures and thoracolumbar hyperflexion Cobb angles (TLHCobb) and determine the clinical cut-off of the TLHCobb angle.

METHODS

In this retrospective case-control study, TLHCobbs were collected from 154 postmenopausal women (67.45 ± 6.68 years) with vertebral compression fractures (study group) and 310 postmenopausal women (66.57 ± 8.22 years) without vertebral compression fractures (control group) from June 2017 to July 2019. Demographic data, clinical data, and quantitative computed tomography (QCT) findings were compared between the groups. Chi-squared tests, unpaired t-tests, and Mann Whitney U were used to assess the group characteristics and proportions. Logistic regression was used to examine the association between vertebral compression fractures and TLHCobb. The cut-off of the TLHCobb was determined by ROC curve and Youden's index.

RESULTS

Fracture prevalence was higher in the higher TLHCobb study group than that in the control group [OR = 2.81 (2.15-3.67)] after adjusting for age, BMI, and QCT findings. TLHCobbs at and >20.05° were associated with an increased fracture prevalence and ORs of 2.79 (1.82-4.27) and 4.83 (3.24-7.20), respectively. TLHCobb, disk height (semiquantitative grading score) and QCT values differed between the study and control groups (p < 0.001 for all three). There were no significant differences in body mass index (BMI), or coronal TLCobb between the two groups.

CONCLUSION

There was an association between the prevalence of vertebral compression fractures and TLHCobbs in postmenopausal women, and a TLHCobb > 20.05° can be an indicator of vertebral fracture.

Effect of Core Stability Training on Unstable Support Surfaces in Postoperative Rehabilitation of Thoracolumbar Vertebral Compression Fractures in the Elderly

Objective

Thoracolumbar vertebral compression fractures (TVCF) are caused by anterior flexion or vertical downward violence to the spine (Sezer et al. 2021). This study is aimed at investigating the effect of core stability training (CST) on unstable support surfaces in the postoperative rehabilitation of TVCF in the elderly. Methods. Ninety-eight patients with TVCF who underwent surgical treatment in our hospital from July 2021 to April 2022 were selected as study subjects. Then, they were divided into a research group receiving unstable support surface CST and a control group with conventional rehabilitation training according to the random number table method. Before and after the training, the X-ray machine was positioned and the anterior margin and middle height ratio and the posterior convex Cobb angle of the injured vertebrae were observed, and the balance detector was used to detect patients' eye opening and closing trajectory length, Romberg rate, and to perform gait test. Patients' pain, lumbar spine function, and quality of life were subsequently assessed using the Visual Analogue Scale (VAS), Oswestry Dysfunction Index (ODI), Generic Quality of Life Inventory-74 (GQOL-74), and patient satisfaction with rehabilitation was investigated. Results. After rehabilitation training, there was no statistically marked difference in eye-opening trajectory length between both groups (P > 0.05). The research group had higher scores than the control group in all dimensions of the anterior border of the injured vertebra, middle height ratio, and GQOL-74, while the posterior convex Cobb angle, closed-eye trajectory length, Romberg rate, VAS, and ODI were lower than the control group (P < 0.05). The research group also revealed better gait improvement and higher rehabilitation satisfaction than the control group after training (P < 0.05).

Conclusion

Unstable support surface CST can effectively improve postoperative vertebral body rehabilitation, balance function, gait, pain conditions, and lumbar spine function in elderly TVCF patients, and enhance their quality of life and rehabilitation satisfaction. This trial is registered with ChiCTR2000014547.