Circumferential management of unstable thoracolumbar fractures using an anterior expandable cage, as an alternative to an iliac crest graft, combined with a posterior screw fixation: results of a series of 85 patients

Graillon, Thomas; Rakotozanany, P.; Blondel, Benjamin; Adetchessi, T.; Dufour, Henry; Fuentès, S.

doi:10.3171/2014.5.focus1452

Cited by 13 publications

(18 citation statements)

References 43 publications

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“…Using two access routes with intraoperative repositioning of the patient, Lai et al [65] took 230 ± 78 mins. and Graillon et al [66] 185 mins. Blood loss for the posteroanterior procedure for thoracic fractures ranged between 300-2300 ml, for the isolated one-stage procedure 250 ml-3100 ml [5,66].…”

Section: Additive Anterior Proceduresmentioning

confidence: 91%

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Traumatic Fractures of the Thoracic Spine

et al. 2020

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The majority of traumatic vertebral fractures occur at the thoracolumbar junction and the lumbar spine and less commonly at the mid-thoracic and upper thoracic spine. In accordance, a high number of articles are dealing with thoracolumbar fractures focusing on the thoracolumbar junction. Nonetheless, the biomechanics of the thoracic spine differ from the thoracolumbar junction and the lumbar vertebral spine. The aim of this review is to screen the literature dealing with acute traumatic thoracic vertebral fractures in patients with normal bone quality. Thereby, the diagnostic of thoracic vertebral body fractures should include a CT examination. Ideally, the CT should include the whole thoracic cage particularly in patients suffering high energy accidents or in those with clinical suspicion of concomitant thoracic injuries. Generally, concomitant thoracic injuries are frequently seen in patients with thoracic spine fractures. Particularly sternal fractures cause an increase in fracture instability. In case of doubt, long segment stabilization is recommended in patients with unstable mid- und upper thoracic fractures, particularly in those patients with a high grade of instability.

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Section: Additive Anterior Proceduresmentioning

confidence: 91%

“…and Graillon et al [66] 185 mins. Blood loss for the posteroanterior procedure for thoracic fractures ranged between 300-2300 ml, for the isolated one-stage procedure 250 ml-3100 ml [5,66]. As regards the occurrence of perioperative complications, the statistical power is limited in the absence of any control groups.…”

Section: Additive Anterior Proceduresmentioning

confidence: 91%

Traumatic Fractures of the Thoracic Spine

et al. 2020

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“…The indications for cage placement via the anterior route were spine fractures that affected the anterior and middle segments of the vertebra and where there were signs of substance loss due to vertebral body splintering (e.g., documented on CT). [ 5 13 16 ]…”

Section: Methodsmentioning

confidence: 99%

Titanium versus polyetheretherketone implants for vertebral body replacement in the treatment of 77 thoracolumbar spinal fractures

Brandão¹,

Martins²,

Arantes³

et al. 2017

Surg Neurol Int

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Background:Titanium and polyetheretherketone (PEEK) implants have been used in spinal surgery with low rejection rates. Compared to titanium, PEEK has many advantages, including a density more similar to that of bone, radiolucency, and a lack of artifacts in computed tomography (CT) and magnetic resonance imaging (MRI). In this study, we evaluated the effectiveness of PEEK cages as an alternative to titanium for bone fusion after fractures of the thoracolumbar spine. We also propose a classification to the impaction index.Methods:We evaluated 77 patients with fractures of the thoracic or lumbar spine who were treated by anterior fixation with titanium cages (TeCorp®) in 46 (59.7%) patients or PEEK (Verte-stak®) in 31 (40.3%) patients from 2006 to 2012 (Neurological Hospital of Lyon).Results:The titanium group achieved 100% fusion, and the PEEK group achieved 96.3% fusion. The titanium systems correlated with higher impact stress directed toward the lower and upper plateaus of the fused vertebrae; there were no nonunions for those treated with titanium group. Nevertheless, there was only one in the PEEK group. There was no significant difference in the pain scale outcomes for patients with ±10 degrees of the sagittal angle. Statistically, it is not possible to associate the variation of sagittal alignment or the impaction with symptoms of pain. The complication rate related to the implantation of cages was low.Conclusions:Titanium and PEEK are thus equally effective options for the reconstruction of the anterior column. PEEK is advantageous because its radiolucency facilitates the visualization of bone bridges.

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“…Stryker distractible vertebral body replacement implant is an expandable titanium cage, which can adapt to the patient`s anatomy, enabling the neurosurgeons to treat severe burst fractures. Selfexpandable cages and posterior transpedicular stabilization allow decompression, stabilization and circumferential fusion in one stage without cavity involvement [2], [8], [9], [10]. [11].…”

Section: Case Reportmentioning

confidence: 99%

“…Anterior corpectomy and fixation with an expandable cage, lateral (posterolateral) rod and screws arthrodesis allows vertebral fusion through the same single exposure. It is a safe and effective surgical procedure, with minimal complications [8], [9], [10], [11].…”

Section: Case Reportmentioning

confidence: 99%

From “cage to independence”: good outcomes of an unstable (burst) lumbar fracture, surgically managed with an expandable titanium vertebral cage implant, with posterior transpedicular instrumentation, and rehabilitation program – case presentation

Anghelescu¹,

Cimpeanu²,

Bajenaru³

et al. 2018

Balneo

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Introduction: The thoracolumbar junction (T11-L2) is biomechanically prone to spinal cord injuries (SCI), as it marks the transition from the rigid thoracic segment to the flexible lumbar spine. The damage of the spinal cord is due to a high-energy trauma (mainly motor vehicle accidents, falls from height, etc), in most cases resulting burst fractures of the lumbar region. The vertebral body is crushed in all directions, retro pulsed bony fragments are spread out towards the spinal canal, damaging the spinal cord, and causing neurologic injuries. Case report: This is a retrospective case study of a slim 43-year-old woman who suffered on 23.06.2018 a polytrauma (accidental fall from 3m height, from tree), associating thoraco-abdominal contusions, without cranial trauma and a severe L1 vertebral comminuted / burst fracture, followed by flaccid T12 AIS-A (complete) paraplegia. She underwent a complex neurosurgical approach, with a self-expandable metallic cage (Stryker) and posterior transpedicular stabilization for decompression and circumferential fusion in one stage, without cavity involvement. In an early post-acute stage she was admitted to the Rehabilitation Clinic (from 10.07.2018 until 31.08.2018) as a T12 AIS-C paraplegia (incomplete neurological lesion, with a global motor score 59/100; lower legs motor score 9/50 [4/25 R+5/25 L], with neurogenic bowel and bladder. The evolution was favorable and she was discharged as L2 AIS-D paraplegia (global motor score 70/100; lower legs motor score 20/50 [10/25 R+10/25 L]. Discussion: This case report emphasizes the benefits and functional outcomes after a comprehensive therapeutic approach, of a patient with unstable (burst) lumbar fracture, surgically managed with an expandable titanium vertebral cage implant with posterior transpedicular instrumentation, followed by a complex rehabilitation program, Stryker distractible vertebral body replacement implant is an expandable device, which can adapt to the patient`s anatomy, enabling the neurosurgeons to treat severe burst fractures. Rehabilitation objectives were focused on B-ADL independence (activity, component of the ICF-DH framework)-transfers, orthostatic posture, restore walking, bladder control. The vital prognosis and functional outcome were favorable. Although she was able to use a walking frame at discharge, there were a few drawbacks in what concerns the professional reintegration, due to specific external barriers (she was a military personnel, had neither driving licensee, nor an adapted car). Conclusions: This clinical case underlines the importance of a complex and multidisciplinary approach, prompt surgical intervention and rehabilitation during the early post-acute phase.

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Circumferential management of unstable thoracolumbar fractures using an anterior expandable cage, as an alternative to an iliac crest graft, combined with a posterior screw fixation: results of a series of 85 patients

Cited by 13 publications

References 43 publications

Traumatic Fractures of the Thoracic Spine

Traumatic Fractures of the Thoracic Spine

Titanium versus polyetheretherketone implants for vertebral body replacement in the treatment of 77 thoracolumbar spinal fractures

From “cage to independence”: good outcomes of an unstable (burst) lumbar fracture, surgically managed with an expandable titanium vertebral cage implant, with posterior transpedicular instrumentation, and rehabilitation program – case presentation

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