Posterior Vertebrectomy via the Unilateral Pedicle or Bilateral Pedicle Approach in the Treatment of Lumber Burst Fracture with Neurological Deficits: A Comparative Retrospective Cohort Study

Abstract

Background: Posterior vertebrectomy with bilateral pedicle approach (BPA) is widely applied in lumber burst fracture (LBF). However, some disadvantages exist, such as a prolonged operation time, extensive soft tissue injury, and excessive blood loss. Posterior vertebrectomy with unilateral pedicle approach (UPA) is a novel technique for decompression of spinal canal. Thus, we explored the potential of UPA to achieve better outcomes than BPA. Material/Methods: Of 47 patients who underwent posterior vertebrectomy for LBF, 23 patients were treated with UPA and 24 patients were treated with BPA. Clinical and radiographical outcomes were assessed with a follow-up of more than 24 months. Patients were evaluated before and after surgery according to the following parameter: duration of operation (DO), blood loss volume (BLV), the kyphotic angle (KA), the ratio of the height of anterior vertebral edge, the ratio of the sagittal injury, visual analog scale (VAS), Oswestry Disability Index (ODI), and Frankel scores. Results: The follow-up time ranged from 24 to 37 months (average 26.4 months). The UPA group had significantly decreased DO and BLV (P<0.05). The 2 cohorts showed similar performance at 6 months (P>0.05), 12 months (P>0.05), and 24 months (P>0.05) post-surgery, in terms of parameters including KA, the ratio of the vertebral anterior, the ratio of sagittal damage, Frankel scores, ODI, and VAS. Conclusions: UPA and BPA had a similar clinical performance for LBF. However, the shorter DO and lower BLV achieved in the UPA cohort suggested UPA is a better alternative for LBF.

Lessons from a lumbar burst fracture patient infected with SARS-CoV-2

“…Fever occasionally develops after surgery as a stress response to the procedure [8][9]. In the present case, the elevated neutrophils and the reduction in lymphocytes indicated the possibility of infection, though the chest CT revealed no obvious abnormity.…”

Posterior Pediculectomy and Vertebral Trough-Cut Technique for Reduction of Retropulsed Bone Fragments in Thoracolumbar Burst Fractures: A Surgical Technique and Treatment Algorithm Plan

“…In our study all patients experienced improvement in Asia score, (mean 2 grades (1-4)) and 11/13 of the patients were able to walk independently at time of last follow-up. Maciejczak et al and Xiong et al have described approaches involving a partial or complete pedicle removal combined with vertebrectomy [25,26]. However our technique avoids the blood loss and surgical time involved with performing a vertebrectomy.…”

Single-Stage Posterior Transpedicular Corpectomy and 360-Degree Reconstruction for Thoracic and Lumbar Burst Fractures: Technical Nuances and Outcomes

“…During the last decade, a purely posterior approach that combines both posterior and anterior column reconstruction and fusion has been described by many authors with good clinical results and lower complication rates with respect to the traditional combined anterior/posterior procedures. 7 8 9 28 30 31 32 33 34 35 36 37 38 39 40 41 42…”

“…[23][24][25][26][27][28][29] During the last decade, a purely posterior approach that combines both posterior and anterior column reconstruction and fusion has been described by many authors with good clinical results and lower complication rates with respect to the traditional combined anterior/posterior procedures. 7-9,28, [30][31][32][33][34][35][36][37][38][39][40][41][42] In this study, we analyzed the technical aspects and surgical outcome of 19 cases of thoracic and lumbar burst fractures who underwent a single-stage posterior transpedicular corpectomy and circumferential arthrodesis with the aid of spinal navigation.…”