Combined Posterior and Delayed Staged Mini-open Anterior Short-segment Fusion for Thoracolumbar Burst Fractures

Tofuku, Katsuhiro; Koga, Hiroaki; Ijiri, Kosei; Ishidou, Yasuhiro; Yamamoto, Takuya; Zenmyo, Michihisa; Yone, Kazunori; Komiya, Setsuro

doi:10.1097/bsd.0b013e31820bb20f

Cited by 13 publications

(7 citation statements)

References 45 publications

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“…failure of the anterior and middle column under compression or disruption of the posterior column) or associated with a neurologic deficit are most often treated surgically (Verlaan et al 2004, Oner et al 2010). Currently, short-segment posterior stabilization is considered to be the first step towards preserving motion segments, preventing adjacent segment disease, shortening operating time, and reducing intraoperative blood loss (Verlaan et al 2004, Dai et al 2007, Zdeblick et al 2009, Gelb et al 2010, Kim et al 2011, Schmid et al 2011, Tofuku et al 2012). Furthermore, short-segment posterior stabilization can be performed in a standard emergency surgery setting.…”

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confidence: 99%

Short-segment posterior instrumentation combined with anterior spondylodesis using an autologous rib graft in thoracolumbar burst fractures

Aebli¹,

Kaiser²,

Moulin³

et al. 2013

Acta Orthopaedica

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Background and purposeThere are very few data concerning the outcome after short-segment posterior stabilization and anterior spondylodesis with rib grafts in patients suffering from unstable thoracolumbar burst fractures. We have therefore investigated the clinical and radiographic outcome after posterior bisegmental instrumentation and monosegmental anterior spondylodesis using an autologous rib graft for unstable thoracolumbar burst fractures.Patients and methodsThis was a retrospective analysis of 32 consecutive patients at a single center. The monosegmental Cobb angle was measured preoperatively, postoperatively, then 6 and 12 months postoperatively, and also after implant removal. Anterior vertebral fusion was graded on conventional radiographs according to the criteria proposed by Molinari.ResultsSegmental kyphosis at the fracture site was corrected from a median of -20° (95% CI: -21.2 to -18.8) to -1.0° (95% CI: -2.7 to 0.7) postoperatively. 1 year after surgery, the segmental angle had decreased by a median of 2.0° (95% CI: 0.2 to 2.8). The spondylodesis fused in all patients, which was evident from incorporation and remodeling of the rib grafts. The median correction loss after implant removal was 0.0° (95% CI: -0.5 to 0.5). 26 of the 32 patients reported having no back complaints at the last follow-up (2 years postoperatively). 1 patient suffered from intercostal neuralgia, and 5 patients reported mild to moderate back pain.InterpretationShort-segment posterior instrumentation and anterior spondylodesis using an autologous rib graft resulted in sufficient correction of posttraumatic segmental kyphosis. There was no clinically relevant correction loss, and the majority of patients had no back complaints at the 2-year follow-up.

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confidence: 99%

Short-segment posterior instrumentation combined with anterior spondylodesis using an autologous rib graft in thoracolumbar burst fractures

Aebli¹,

Kaiser²,

Moulin³

et al. 2013

Acta Orthopaedica

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“…In study by Carl et al [36], an average blood loss of 2300 ml and an average of a 4-day delay until surgery after the accident were reported. However, Tofuku et al [37] reported an average blood loss of 545 ml in combined delayed staged anterior surgery. In the present study, the average blood loss was 516 ml in combined delayed staged anterior surgery, which was more favorable and less invasive than the conventional one-stage combined procedure, and also comparable with that of Tofuku et al [37].…”

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confidence: 99%

Combined posterior percutaneous pedicle screw fixation with delayed anterior monosegmental column reconstruction for unstable thoracolumbar burst fractures

Lou

Chen

et al. 2020

Preprint

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Objective: This study aimed to assess the feasibility as well as the clinical and radiological outcomes of posterior percutaneous pedicle screw fixation (PPSF) combined with anterior monosegmental column reconstruction in unstable thoracolumbar burst fractures. Methods: From January 2011 to August 2017, thirty-five patients with unstable thoracolumbar burst fractures were enrolled in this study. The patients underwent posterior PPSF combined surgery with delayed anterior monosegmental reconstruction utilizing titanium mesh cages. Clinical outcomes, radiological parameters, and treatment-related complications were assessed. Results: The mean age of the patients was 44.8 years. The mean operative time and blood loss were 205 min and 560 ml, respectively. The mean follow-up period was 25.2 months. The Visual analog scale (VAS) pain score was significantly improved postoperatively, and the improvement was maintained until the final follow-up. The mean sagittal kyphosis was corrected from 16.3 preoperatively to 1.5 postoperatively, which increased slightly to 2.6 at the final follow-up. In 24 patients with neurologic dysfunction, 21 (87.5 %) patients had improvement after surgery. None obvious subsidence of the titanium mesh cage and none dislodgement, loosening or breakage of the instrumentation was observed in any patient during the follow-up period. Solid bony fusion was achieved in all patients. Conclusions: Combined posterior PPSF with delayed anterior monosegmental column reconstruction for unstable thoracolumbar burst fractures can produce good clinical and radiological outcomes.

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“…Thus, we used single-stage posterior corpectomy, interbody fusion with titanium mesh and transpedicle screw fixation for this type of injury. This approach combines the advantages of the anterior only approach and the posterior only approach and reduces the trauma and complications that may arise with the combined approach ( 13 , 14 ); however, this approach is not suitable for patients with severe osteoporosis or those in poor physical condition. Nonetheless, this method allows for the completion of decompression, reduction, fusion and fixation in one stage and has the following advantages: less trauma, shorter operative time, less blood loss and total decompression.…”

Section: Discussionmentioning

confidence: 99%

One-stage partial vertebrectomy, titanium mesh implantation and pedicle screw fixation in the treatment of thoracolumbar burst fractures through a posterior approach

Liu¹,

Li²,

Dong³

et al. 2014

Clinics

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OBJECTIVE:To analyze the clinical results of a partial vertebrectomy with titanium mesh implantation and pedicle screw fixation using a posterior approach to reconstruct the spine in the treatment of thoracolumbar burst fractures.METHOD:From January 2006 to August 2008, 20 patients with severe thoracolumbar fractures were treated.For vertebral bodies associated with one injured intervertebral disk, subtotal vertebrectomy surgery and single-segment fusion were performed. For vertebral bodies with two injured adjacent intervertebral disks, partial vertebrectomy surgery and two-segment fusion were performed.RESULTS:All 20 patients were followed up for 12 to 24 months (average of 18 months). There were no complications such as wound infections, hemopneumothorax or abdominal infections in any of the patients. The neurological status of all of the patients was improved by at least one American Spinal Injury Association grade by the last follow-up. The anterior vertebral body height was an average of 50.77% before surgery, 88.51% after surgery and 87.86% at the last follow up; the sagittal Cobb angle was improved, on average, from 26.15° to 5.39° and was 5.90° at the last follow up. The percentage of spinal stenosis was improved, on average, from 26.07% to 4.93%° and was 6.15% at the last follow up. There were significant differences in the anterior vertebral body height pre- and post-surgery and in the sagittal Cobb angle and the percentage of spinal stenosis (p<0) in all patients.CONCLUSIONS:This surgical procedure is simple and can accomplish decompression, reduction, fixation and fusion of the spine in one stage. This approach could be widely used in orthopedics.

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Combined Posterior and Delayed Staged Mini-open Anterior Short-segment Fusion for Thoracolumbar Burst Fractures

Abstract: This combined procedure is less invasive than the conventional combined one, and finally achieves shorter stabilization, resulting in preservation of motion segments. It thus seems to be a reasonable treatment option for thoracolumbar burst fractures.

Cited by 13 publications

References 45 publications

Short-segment posterior instrumentation combined with anterior spondylodesis using an autologous rib graft in thoracolumbar burst fractures

Short-segment posterior instrumentation combined with anterior spondylodesis using an autologous rib graft in thoracolumbar burst fractures

Combined posterior percutaneous pedicle screw fixation with delayed anterior monosegmental column reconstruction for unstable thoracolumbar burst fractures

One-stage partial vertebrectomy, titanium mesh implantation and pedicle screw fixation in the treatment of thoracolumbar burst fractures through a posterior approach

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