Radiological Evaluation Does Not Reflect the Clinical Outcome After Surgery in Unstable Thoracolumbar and Lumbar Type A Fractures Without Neurological Symptoms

Abstract

Study design: This is a prospective study of 2 cohorts. Objective: Compare the clinical and radiologic outcome of 2 cohorts of unstable thoracolumbar and lumbar fractures treated by open posterior fixation (OPF) with bone graft or by percutaneous fixation (PCF) without grafting. Summary of Background Data: In recent years, PCF is the most common treatment of thoracolumbar fractures. To date, no studies have analyzed clinical outcomes in terms of return to work. Material and Methods: Two cohorts of patients with unstable thoracolumbar and lumbar fractures fractures (type A2, A3, and A4) without neurological symptoms underwent OPF (n=91) or PCF (n=54) between 2010 and 2015. A conventional radiologic study was performed in the preoperative, immediate postoperative period, 1-year, and 2-year follow-up. Clinical outcomes were evaluated by Visual Analog Scale and Oswestry Disability Index scores at 1-year and 2-year follow-up. The period to return to work and the type of work were also recorded. Results: The percentages of correction were significantly higher in cases operated by OPF: fracture angle (P<0.001), kyphotic deformity (P<0.001), vertebral compression (P<0.001), and displacement (P<0.001). Cases operated by PCF experienced greater loss of correction at 2-year follow-up, especially in fracture displacement (P<0.001), deformity angle (P<0.001), kyphotic deformity (P<0.001), and in the sagittal index (P<0.001). Besides this greater loss of correction, PCF cases showed better Visual Analog Scale (P<0.001) and Oswestry Disability Index scores (P<0.001) at final follow-up. The percentage of patients returning to the same heavy work position was higher in the PCF group (P<0.001) and in a shorter period of time (P<0.001). Conclusions: The greater loss of correction of patients undergoing PCF does not reflect the clinical outcomes that were significantly better as compared to patients undergoing open fixation with grafting. It would be useful to further evaluate if the radiological changes could have a long-term clinical significance.

Effect of postural nursing intervention on preventing pressure injury after thoracolumbar incision and internal fixation in southern China

“…In the clinical treatment of such patients, it is necessary to formulate a reasonable, effective and operable treatment plan based on spinal canal lesions and neurological symptoms (Lorente et al, 2019). Traditional therapy first expands the decompression spinal canal., then the fracture reduction and internal fixation treatment, the operation time is long, the amount of bleeding is large, a small number of elderly patients or patients with severe trauma are not easy to bear, and it is difficult to complete the treatment successfully (De Iure et al, 2018;Franklin et al, 2019).…”

Comparative finite element analysis of posterior short segment fixation constructs with or without intermediate screws in the fractured vertebrae for the treatment of type a thoracolumbar fracture

“…Percutaneous pedicle screw-rod xation has been developed to restore stability, alignment while promoting early mobilization of the patients with thoracolumbar/lumbar fractures (Neeley et al 2022;Pannu et al 2019). As a consequence, more correction loss could be observed in thoracolumbar/lumbar fractures treated by percutaneous four-screw xation technique as compared with conventional open short segment xation with posterolateral fusion (Hirota et al 2022; Lorente et al 2019). Therefore, six-screw short-segment posterior xation, which involves additional augmentation at the fractured vertebrae has been proposed to reduce the rates of kyphosis recurrence and implant failure (Kapoen et al 2020).…”

Evaluation of disc degeneration adjacent to AOspine A fractures: pre- and post-operative MRI analysis

“…Historically, for Magerl, type A fracture was a strictly bony and stable injury [2]. Nonetheless, several studies have highlighted a loss of sagittal correction after fracture treatment, whether it was conservative or surgical [7][8][9]. This loss of correction was evaluated around 10% and was located in the disc for 75% and in the vertebral body for the remaining 25%.…”