Functional outcome in patients with thoracolumbar burst fractures treated with dorsal instrumentation and transpedicular cancellous bone grafting

Leferink, V. J. M.; Keizer, H. J.; Oosterhuis, Jurjen K.; Sluis, Corry K. van der; Duis, H. J. ten

doi:10.1007/s00586-002-0518-3

Cited by 52 publications

(32 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…kyphotic deformation) does not seem to influence QoL after injuries of the thoracolumbar spine and, therefore, not omitted this parameter in our current study [9,10]. These findings are in line with the data published by other investigators [39,41,49].…”

Section: Quality Of Life Assessmentsupporting

confidence: 89%

See 1 more Smart Citation

Pain regulation and health-related quality of life after thoracolumbar fractures of the spine

et al. 2007

View full text Add to dashboard Cite

Fractures of the thoracolumbar spine rank among the severest injuries of the human skeleton. Especially in younger patients they often result from high-energy accidents. Recently, a shift in paradigm towards more aggressive treatment strategies including anterior procedures could be observed. However, so far only few data exist reflecting the quality of life (QoL) after such injuries. The aim of this study was to evaluate medium-term QoL and further to identify factors that influence the clinical outcome in patients with fractures of the thoracolumbar spine. Data of 906 patients who were treated during a 10-year period in our institution were evaluated retrospectively. Only patients with single-level traumatic injuries aged between 18 and 65 years without neurological deficits, concomitant injuries of other locations and internal comorbidities were included into the investigation (n = 204). Three different treatment groups (i.e. non-operative, dorsal and dorsoventral stabilisation) were compared to healthy controls as well as different pain populations. The QoL was assessed using established questionnaires (SF-36, HFAQ, VAS-Spinescore, PRQ, and PTSD). Sixty-five percent of the included patients (n = 133) were studied at an average follow-up of 5.3 +/- 1.7 years after injury. All treatment groups revealed an identical gender and age distribution. More severe and unstable injuries were found in the surgical groups associated with higher treatment costs and a longer inability to work. Compared to healthy controls, QoL was compromised to the same extent in all groups. Furthermore, all patients treated in this study did significantly better than low back pain individuals with regard to QoL and pain regulation parameters. In our study, patients with thoracolumbar spine fractures showed a reduced QoL compared to healthy controls. Thus, patients do not seem to regain their former QoL. However, the level of discomfort was comparably low in all groups, even in patients with more severe injuries requiring extensive surgery. Overall, outcome and QoL after traumatic fractures of the thoracolumbar spine rather seem to be determined by the severity of injury than by pain regulation or other psychosocial factors which is likely the case in low back pain disorders.

show abstract

Section: Quality Of Life Assessmentsupporting

confidence: 89%

“…In line with this observation several other study groups have previously described quite similar results with regard to the SF-36 [7,39,41,49,62].…”

Section: Quality Of Life Assessmentsupporting

confidence: 88%

Pain regulation and health-related quality of life after thoracolumbar fractures of the spine

et al. 2007

View full text Add to dashboard Cite

show abstract

“…Additional transpedicular bone-grafting did not prevent from re-kyphosing and the reported loss of correction after posterior fixation was significant [2,46,49,50,100]. However, with regard to clinical outcome several authors reported good results with posterior stabilisation alone [65,75,84,100]. Therefore, the relevance of achieving an optimal ''technical/radiological result'' with anatomic alignment and definite stability by interbody fusion is still under debate.…”

Section: Discussionmentioning

confidence: 99%

Combined posterior–anterior stabilisation of thoracolumbar injuries utilising a vertebral body replacing implant

et al. 2009

View full text Add to dashboard Cite

The authors report on a prospectively followed series of 35 patients with injuries of the thoracolumbar spine from T7 to L3. The radiological course after combined posterior-anterior surgery with anterior column reconstruction with a distractible vertebral body replacing implant demonstrated a stable reconstruction technique with almost no re-kyphosing. In 18/18 patients with CT follow-up intervertebral fusion was observed as bony bridging lateral to the VBR implant. The functional/clinical outcome of the patients was analysed with a set of eight validated outcome scales. After an average follow-up period of 2(1/2) years encouraging results were noticed. The neurological improvement rate (> or =1 Frankel/ASIA grade) was 8/12 patients (67%) with a complete recovery in 6 cases. 17/29 patients returned to former occupation; 20/29 patients returned to former leisure activities; 24/28 patients rated their general outcome as "unlimited and pain free" or "occasionally and/or mild complaints" with a VAS score of >80 (scale 0-100). The psychometric questionnaires revealed good results with strong correlation comparing the different scoring systems statistically: mean McGill Pain Questionnaire 12.5 (0-40); mean Oswestry Disability Index 20% (0-51). 13/29 patients scored <4 in the Roland and Morris Disability Questionnaire. The German back pain questionnaire (Funktionsfragebogen Hannover Rücken) showed a mean "functional capacity" of 75%, corresponding with moderate restriction. We concluded the presented method as highly effective to completely reduce and maintain an anatomic spinal alignment. The outcome tended to be better in comparison with non-operatively treated patients as well as with norm populations with low back pain.

show abstract

“…Uþpakalinës, transpedikulinës stuburo fiksacijos metodo populiarumas iðlieka, nors esama praneðimø apie daþnas metalo konstrukcijø nuovargio lûþiø komplikacijas [20][21][22][23] bei didesnius korekcijos praradimus, palyginti su priekinës fiksacijos metodu [6,24]. Paaiðkinimas toks: daugelis ðio metodo ðalininkø teigia, jog trauminës deformacijos progresavimas, palyginti su pradine deformacija, yra nedidelis ir neturi átakos pacientø skundams [5,25,26], o metalo konstrukcijø lûþiø komplikacijø skaièiø galima sumaþinti ðalinant jas po 10-12 mën. Ðie argumentai nëra átikinami, todël pasirodo vis daugiau straipsniø, rekomenduojanèiø uþpakalinës fiksacijos metodà taikyti kartu su priekinës stuburo kolonos rekonstrukcija ir spondilodeze, ypaè tais atvejais, kai lûþusio slankstelio kûno suspaudimo laipsnis yra labai didelis [23, 24,27,28].…”

Section: Discussionunclassified

“…Mûsø tyrimo pagal NASS klausimynà rezultatai geresni uþ lëtiniais nugaros skausmais besiskundþianèiø ligoniø duomenis, bet nesiekia JAV gyventojø norminiø rodikliø. Roland-Morriso klausimyno vidurkis 5,9 atitinka literatûroje skelbiamus rezultatus, kurie svyruoja nuo 4,5 iki 8,4 [25,41,42]. Dël kultûriniø ir kalbiniø skirtumø tiesioginiø iðvadø ið ðiø palyginimø daryti negalime, taèiau galime teigti, kad metus po stuburo traumos 25,0% pacientø vargina nuolatiniai nugaros skausmai, ribojantys kasdienae veiklà.…”

Section: Diskusijaunclassified

Stuburo krūtininės ir juosmeninės dalies lūžių operacinio gydymo rezultatai

Šatkauskas¹,

Uvarovas²,

Kocius³

2005

View full text Add to dashboard Cite

Igoris Šatkauskas1, Valentinas Uvarovas2, Manvilius Kocius21 Vilniaus greitosios pagalbos universitetinės ligoninės2-asis ortopedijos ir traumatologijos skyrius,Šiltnamių g. 29, LT-04130 Vilnius2 Vilniaus universiteto Bendrosios, plastinės chirurgijos,ortopedijos ir traumatologijos klinika,Šiltnamių str. 29, LT-04130 VilniusEl paštas: igoris_satkauskas@hotmail.com; igoris.satkauskas@maxi.lt Tikslas Įvertinti stuburo krūtininės ir juosmeninės dalių nestabilių lūžių operacinio gydymo rezultatus. Nustatyti komplikacijų ir rentgenologinių deformacijos kriterijų įtaką ligonių skundams. Ligoniai ir metodai Ištirti 48 ligoniai, operuoti nuo nestabilių stuburo krūtininės ir juosmeninės dalių lūžių be neurologinių komplikacijų. Stuburo slankstelių ir judesio segmento kifozė, Cobbo kampas ir kūno kompresija nustatyta rentgenologiškai prieš operaciją, po operacijos ir vėlesnio ištyrimo metu. Ligonių skausminiai skundai ir negalia įvertinti Šiaurės Amerikos stuburo draugijos (NASS) ir Roland-Morriso klausimynais. Atlikta ligonių asmeninio gydymo rezultatų vertinimo ir nedarbingumo analizė. Įvertintas ryšys tarp stuburo trauminės deformacijos rentgenologinių kriterijų ir klausimynų duomenų. Rezultatai Vidutiniškai po 16,8 mėnesio nuo traumos ištirto 48 ligonio amžiaus vidurkis buvo 38,4 metų (nuo 19 iki 71 metų). Operacijos metu koreguota kifozinė deformacija statistiškai reikšmingai progresavo, tačiau išliko daug mažesnė už pradinę. Iš 38 pacientų, kuriems buvo atlikta tik traspedikulinė fiksacija ir užpakalinė spondilodezė, 10 (26,3%) įvyko metalo konstrukcijų nuovargio lūžiai, o grupėje, kurioje, be transpedikulinės fikacijos, atlikta papildoma priekinė spondilodezė, šių komplikacijų nebuvo. Su metalo konstrukcijomis susijusių komplikacijų grupėje segmento kifozė ir Cobbo kampas progresavo labiau nei grupėje be komplikacijų, bet tai neturėjo jokios įtakos klausimynų rezultatams. NASS skausmo / negalios skalės taškų vidurkis buvo 76,8 ± 20,0, o Roland-Morriso klausimyno – 5,9 ± 6,4. Koreliacijos tarp rentgeninių deformacijos kriterijų ir klausimynų duomenų nerasta. Išvados Nestabiliems sprogstamiesiems lūžiams gydyti trumpos transpedikulinės fiksacijos ir užpakalinės spondilodezės nepakanka. Jei slankstelio kūno kompresija didelio laipsnio, indikuojama papildoma priekinės stuburo kolonos rekonstrukcija ir spondilodezė. Reikšminiai žodžiai: stuburas, lūžiai, operacinis gydymas, komplikacijos Outcome of surgical treatment of thoracic and lumbar spine fractures Igoris Šatkauskas1, Valentinas Uvarovas2, Manvilius Kocius21 Vilnius University Emergency Hospital,2nd Department of Orthopaedics and Traumatology,Šiltnamių str. 29, LT-04130 Vilnius, Lithuania2 Vilnius University Clinic of General, Plastic Surgery,Orthopaedics and Traumatology,Šiltnamių str. 29, LT-04130 Vilnius, LithuaniaE-mail: igoris_satkauskas@hotmail.com; igoris.satkauskas@maxi.lt Objective To evaluate functional and radiological outcomes of thoracic and lumbar spine fractures stabilized surgically and to identify any radiographic findings that may adversely influence posterior fixation failure and final functional outcome. Patients and methods A retrospective review of 48 neurologically intact patients who had undergone surgical stabilization and fusion of unstable thoracic and lumbar spine fractures was performed. Vertebral and regional kyphosis angles, anterior ant posterior vertebral body compression were measured on injury, postoperative and final follow-up radiographs. Functional, pain status and disability were evaluated using the North American Spine Society (NASS) lumbar spine and Roland-Morris Disability (RMDQ) questionnaires. Relationships were sought between radiographic findings, complications and self-reported outcome measurement scores. Results The mean follow-up time for the 48 patients (mean age 38.4, range 19 to 71 years) was 16.8 months. Despite a significant loss of correction, the degree of residual deformity was significantly less than at the time of injury. Of 38 patients treated with posterior short-segment pedicle-screw instrumentation ant posterior fusion, 10 (26.3%) had a fixation failure. In the fixation failure group, the loss of correction of regional kyphosis was significantly greater than in the non-failure group, but it had no influence on the final functional outcome. The mean NASS pain/disability subscale and RMDQ scores were 76.8 ± 20.0 and 5.9 ± 6.4, respectively. No correlation was found between the radiographic findings and questionnaire scores. Conclusions The short-segment pedicle fixation and posterior fusion of unstable burst spine fractures is not sufficient and related with a high rate of the hardware failure. In the presence of a substantial anterior column compromise, a combined procedure of posterior fixation and anterior reconstruction should be considered. Keywords: thoracolumbar spine, fracture, surgical treatment, outcome

show abstract

Functional outcome in patients with thoracolumbar burst fractures treated with dorsal instrumentation and transpedicular cancellous bone grafting

Cited by 52 publications

References 38 publications

Pain regulation and health-related quality of life after thoracolumbar fractures of the spine

Pain regulation and health-related quality of life after thoracolumbar fractures of the spine

Combined posterior–anterior stabilisation of thoracolumbar injuries utilising a vertebral body replacing implant

Stuburo krūtininės ir juosmeninės dalies lūžių operacinio gydymo rezultatai

Contact Info

Product

Resources

About