Five-year clinical and radiological results of combined anteroposterior stabilization of thoracolumbar fractures

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Despite promising early clinical results, the long-term outcome of the use of expandable titanium cages to reconstruct the anterior column after traumatic burst fractures is still unknown. The purpose of this prospective study was to assess the clinical and radiological outcomes of the use of expandable titanium cages 5 years postoperatively.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Eighty patients with traumatic thoracolumbar burst fractures (T4–L5) underwent posterior stabilization followed by anterior corpectomy and reconstruction using expandable titanium cages with or without additional anterior plating. After 5 years, fusion was evaluated by means of plain radiographs and CT scans, and the patients' scores on the Oswestry Disability Index (ODI), their neurological status, and clinical results were assessed.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Forty-five (56%) of the 80 patients could be examined after 5 years. There was a relatively high rate of complications related to thoracotomy (26%), but there were no complications directly related to the cages. Revision surgery was required in 1 case. The average postoperative loss of correction was only 2.4° due to minimal subsidence of the cages. No cage showed a radiolucent line or instability in flexion-extension views. Bony fusion, as assessed by CT scan, was achieved in 41 patients (91%). On clinical examination, 96% of all patients were ambulatory and showed minimal restriction of spinal range of motion; 71% did not need analgesic medication at all; and 67% were able to work. The average ODI score was 12. Thirty-one percent of patients complained of some kind of anterior approach–related complications.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Combined anteroposterior stabilization of thoracolumbar burst fractures with expandable titanium cages is a relative safe procedure with satisfactory radiological and clinical long-term outcome. High fusion rates can be achieved, with only minor loss of correction, typically occurring in the 1st year. However, open thoracotomy carries the risks of additional complications and development of post-thoracotomy syndrome.</jats:p></jats:sec>

Is there a regional difference in morphology interpretation of A3 and A4 fractures among different cultures?

“…16 Similarly, Schnake and colleagues have described excellent results after treatment of neurologically intact patients with burst fractures using 360° fusion. 19,20 In contrast, Bailey et al performed a multicenter trial in Canada regarding the treatment of burst fractures with and without a brace, reporting excellent clinical outcomes without surgery and only a rare need for delayed surgical intervention.…”

“…Contemporary studies from North and South America report successful results with nonoperative treatment of these fractures with or without a brace, 2-4 while current European publications report excellent outcomes from treating similar fractures with 360° fusion. 16,19 Prior to establishing the SIS and the globally applicable algorithm for the treatment of thoracolumbar trauma, an improved understanding of why this variability exists is desirable.…”

Thoracoscopic anterior stabilization for thoracolumbar fractures in patients without spinal cord injury: quality of life and long-term results

“…A growing number of spine surgeons advocate the reconstruction of the anterior spinal column in cases with insufficient anterior load bearing capacity [1][2][3][4][5][6][7]. Additional anterior stabilization provides stability to the anterior column, thereby preventing loss of correction and posterior implant failure [7,8].…”

“…Compared to bone strut grafts, a distractible titanium cage is nowadays considered a safe and effective treatment option. Advantages are in situ expansion, maximization of endplate contact with vertebral bodies and the possibility of minimally invasive implanting [2][3][4]. With the use of titanium cages, the disadvantages of autologous bone struts are prevented such as operating time, donor site morbidity, non-union and fracture of the strut graft [9].…”

“…With the use of titanium cages, the disadvantages of autologous bone struts are prevented such as operating time, donor site morbidity, non-union and fracture of the strut graft [9]. The traditional anterior approach to treat thoracic and high lumbar fractures is invasive and induces secondary damage with thoracotomy or thoracophrenicolaparotomy-related complications up to 26% [4]. An alternative approach is the mini-open thoracoscopic-assisted technique [7,[10][11][12].…”