Fate of the transpedicular intervertebral bone graft after posterior stabilisation of thoracolumbar fractures

Abstract

The authors present a retrospective clinical and radiological study addressing the outcome after posterior stabilisation of thoracolumbar fractures with intervertebral fusion via transpedicular bone grafting. The study included computed tomographic (CT) scan after implant removal for analysis of the intervertebral fusion and incorporation of the intervertebral bone graft and its influence on postoperative re-kyphosing. Twenty-nine patients with acute fractures of the thoracolumbar spine, treated between 1988 and 1995 at the Department of Trauma Surgery, Hannover Medical School, underwent posterior stabilisation and interbody fusion with transpedicular cancellous bone grafting. This study group was followed clinically and radiologically for a mean of 3.5 years. All patients underwent spiral CT scan with sagittal reconstruction after implant removal. Twenty-four type A, four type B, and one type C lesion were posteriorly stabilised and transpedicular intervertebral bone grafting was performed. The operative time averaged 2 h 50 min, the intraoperative fluoroscopy time 4 min 7 s, and the mean intraoperative blood loss was 376 ml. Four patients out of six with an incomplete neurologic lesion (Frankel/ASIA D) improved to Frankel/ASIA grade E. Two complications were observed: one delayed wound healing and one venous thrombosis with secondary pulmonary embolism. Compared to the preoperative status, our follow-up examinations demonstrated permanent social sequelae: the percentage of individuals able to do physical labor was reduced, whereas the proportion of unemployed or retired patients increased. The assessment of complaints and functional outcome with the Hannover Spine Score reflected a significant difference ( P<0.001) between the status before injury (96.6/100 points) and at follow-up (64.4/100 points). The radiographic follow-up revealed a mean loss of correction of 7.8 degrees ( P<0.005). CT scans after implant removal showed an interbody fusion and incorporation of the transpedicular bone graft in ten patients (34%). In another ten patients (34%), the CT scans demonstrated the interbody fusion at the anterior and posterior walls of the vertebral body via direct contact due to collapse of the disc space. In these patients, the bone graft was not incorporated and no central interbody fusion could be found. In nine patients (31%) neither interbody fusion nor incorporation of the transpedicular graft was achieved. A frequent and reliable intervertebral fusion could not be achieved with the described technique of transpedicular bone grafting. The ineffectiveness of the intervertebral graft was found to be a reason for postoperative re-kyphosing.

Anterior vertebral body replacement with a titanium implant of adjustable height: a prospective clinical study

“…The average age (43.1 years) and the distribution of gender (58% men) are well in agreement with the descriptions in other studies [6,10,[36][37][38]. Falls from a great height are the most frequent cause of injury, followed by road accidents [10,[36][37][38][39].…”

“…This value is just little lower than the score reduction of 24.1 reported by Knop et al [34] for patients treated with an internal fixator and bone chips. The score reduction obtained is similar to those found by previous [10,17,38] studies using other questionnaires. Briem et al [44] reported about a relevant long-term impairment in patients' quality of life after dorso ventral stabilization of thoracolumbar fractures and concluded pain as the most compromising factor being related as well to the severity of the injury and as to the operation itself.…”

“…In all the studies most injuries occurred around the thoracolumbar junction with L1 fractured most frequently [10,36,40]. The frequency of neurological deficits increased considerably with increasing severity of injury [31,38]. In 10/13 of our patients with initial incomplete paraplegia the neurological status improved within the first year by at least one Frankel/ASIA grade.…”

“…Falls from a great height are the most frequent cause of injury, followed by road accidents [10,[36][37][38][39]. The patient group of the present study includes post-traumatic malalignments and spinal tumours as well as fresh fractures, in contrast to most other studies.…”

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.…”