Clinical outcome and radiographic results after surgical treatment of post-traumatic thoracolumbar kyphosis following simple type A fractures

Abstract

The surgical management of post-traumatic thoracolumbar kyphosis remains controversial. The need for combined procedures is subject to debate, especially for post-traumatic kyphosis after simple type A fractures. The aim of this retrospective study was to evaluate radiographic findings, patient satisfaction and clinical outcome after mono-segmental surgical treatment using an anterior procedure alone (group 1, n = 10 patients) and using a one-stage combined anterior and posterior procedure (group 2, n = 15 patients) for post-traumatic thoracolumbar kyphosis after simple type A fractures. The main indication for surgery was pain. There were no statistically significant differences between the patients in the two groups concerning age, cause of injury, time interval between trauma and surgery, preoperative kyphosis and preoperative back pain score. For all these 25 patients, complete follow-up data were available for retrospective evaluation. The median follow-up was 17 years in group 1 and 8 years in group 2. Radiographic documentation and classification was made on the basis of standing antero-posterior and lateral views and computed tomographic scans. Fractures were categorized according to the Magerl classification. Kyphotic deformity was assessed on lateral radiographs using the Cobb method. Kyphosis angles were measured preoperatively, directly postoperatively, and at final follow-up. For clinical evaluation, the back pain scoring system of Greenough and Fraser was used. Patients were requested to score their status prior to trauma, preoperatively and at follow-up. The Wilcoxon test was used for statistical analysis ( P < 0.05 is significant). In all cases radiographic union was achieved. Median kyphosis in group 1 was corrected from 23 degrees preoperatively to 12 degrees postoperatively ( P < 0.01) and was 11 degrees at follow-up. Median kyphosis in group 2 was corrected from 21 degrees pre-operatively to 12 degrees postoperatively ( P < 0.01) and was 12 degrees at follow-up. The median back score in group 1 changed from 66 points before the trauma to 23 points ( P < 0.01) preoperatively and 35 points at follow-up ( P < 0.01). The median back score in group 2 changed from 67 points before the trauma to 20 points ( P < 0.01) preoperatively and 38 points at follow-up ( P < 0.01). In group 2, four patients had complaints due to annoying prominence of the dorsal instrumentation. In all these cases the dorsal instrumentation was removed. Statistical analysis in this series of ten patients with anterior spondylodesis compared with 15 patients with combined one-stage spondylodesis did not reveal objective advantages of the combined procedure as far as the outcome of radiographic correction of kyphosis or patient outcome is concerned. It is therefore concluded that in cases of post-traumatic thoracolumbar kyphosis after simple type A fractures, mono-segmental correction using an anterior procedure alone, with spondylodesis, is the surgical procedure of choice.

Complications in minimally invasive percutaneous fixation of thoracic and lumbar spine fractures and tumors

“…Radiographic evaluation was performed through the measurement of segmental kyphosis and the wedging deformity of the involved vertebral body [7]. Back pain, evaluated by VAS scale, was 1.9 points at FU.…”

“…Conservative treatment of stable vertebral fractures has been successfully proposed by many authors [7][8][9][10][11], with bed rest followed by external orthoses, extension gymnastic, plaster jacket in bed or stand reduction [12]. These treatments should be continued for a period of at least 3-4 months during which patient care and cooperation are essential.…”

Association of clinical parameters of operatively treated thoracolumbar fractures with quality of life parameters

“…Fractures of the thoracolumbar spine are major injuries that often require surgical intervention and are known to have an important impact on the long-term outcome after trauma [1]. Most of the studies on the outcome after fractures of the thoracolumbar spine focused on radiological parameters, return to work, activity, and pain [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] without consideration of specific HRQoL outcome measures. Assessment of HRQoL after thoracolumbar fractures with generic instruments such as Short Form-36 health survey (SF-36) has only been reported in a few works [1,[17][18][19][20], which are all limited by the low number of the used HRQoL instruments.…”

The Michel Benoist and Robert Mulholland yearly European Spine Journal Review

“…Is the pain related to an associated degenerate disc, or is it related to deformity? The paper by Been et al [3] was of great value, as it deals with a reasonably ''pure'' group, with no associated spinal cord injury; indeed spinal cord decompression was not present in any of the patients. The study deals with the results in 25 patients of corrective surgery, in terms of degree of correction achieved, pain relief, and what surgical approach was to be preferred: combined posterior and anterior, or anterior alone.…”