Radiological Results and Clinical Patient Outcome After Implantation of a Hydraulic Expandable Vertebral Body Replacement following Traumatic Vertebral Fractures in the Thoracic and Lumbar Spine

Kreinest, Michael; Schmahl, Dorothee; Grützner, Paul Alfred; Matschke, Stefan

doi:10.1097/brs.0000000000001862

Cited by 13 publications

(10 citation statements)

References 31 publications

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“…Schnake et al reported an average ODI score of 12 points (=24.0%) at a five-year follow-up after posterior-anterior stabilization of traumatic thoraco-lumbar fractures using expandable titanium cages, which is also consistent with our results, nearly 9 years after surgery in average [ 10 ]. In line with our findings, Kreinest et al reported most patients to be satisfied, 3 years after implantation of a hydraulic expandable VBR following traumatic thoracic and lumbar vertebral fractures [ 11 ]. Different to our methods they chose the VAS Spine score as an outcome parameter and found a mean rating of 65.2 ± 23.1 in their study population, which was found to be comparable to the rating of 58.4 from the German Spine Fracture Registry for operatively treated patients after spine fractures [ 4 ].…”

Section: Discussionsupporting

confidence: 92%

“…Different to our methods they chose the VAS Spine score as an outcome parameter and found a mean rating of 65.2 ± 23.1 in their study population, which was found to be comparable to the rating of 58.4 from the German Spine Fracture Registry for operatively treated patients after spine fractures [ 4 ]. Comparable with our findings, they observed a significant reduction of functional outcome scores in their study cohort when compared to healthy subjects, but most of the patients (85.1%) were “generally/very satisfied” with their outcome [ 11 ]. Other study-groups like Spiegl et al achieved better VAS Scores with a thoracoscopic procedure [ 30 ], but in the current study we could not identify a significant influence of the surgical approach or other surgery-related parameters on the health-related QoL.…”

Section: Discussionsupporting

confidence: 87%

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Radiological and mid- to long-term patient-reported outcome after stabilization of traumatic thoraco-lumbar spinal fractures using an expandable vertebral body replacement implant

Lang

Schwaiger

Voß

et al. 2021

BMC Musculoskelet Disord

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Background For the treatment of unstable thoraco-lumbar burst fractures, a combined posterior and anterior stabilization instead of a posterior-only instrumentation is recommend in the current literature due to the instability of the anterior column. Data on restoring the bi-segmental kyphotic endplate angle (BKA) with expandable vertebral body replacements (VBR) and on the mid- to long-term patient-reported outcome measures (PROM) is sparse. Methods A retrospective cohort study of patients with traumatic thoraco-lumbar spinal fractures treated with an expandable VBR implant (Obelisc™, Ulrich Medical, Germany) between 2001 and 2015 was conducted. Patient and treatment characteristics were evaluated retrospectively. Radiological data acquisition was completed pre- and postoperatively, 6 months and at least 2 years after the VBR surgery. The BKA was measured and fusion-rates were assessed. The SF-36, EQ-5D and ODI questionnaires were evaluated prospectively. Results Ninety-six patients (25 female, 71 male; age: 46.1 ± 12.8 years) were included in the study. An AO Type A4 fracture was seen in 80/96 cases (83.3%). Seventy-three fractures (76.0%) were located at the lumbar spine. Intraoperative reduction of the BKA in n = 96 patients was 10.5 ± 9.4° (p < 0.01). A loss of correction of 1.0 ± 2.8° at the first follow-up (t1) and of 2.4 ± 4.0° at the second follow-up (t2) was measured (each p < 0.05). The bony fusion rate was 97.9%. The total revision rate was 4.2%. Fifty-one patients (53.1% of included patients; age: 48.9 ± 12.4 years) completed the PROM questionnaires after 106.4 ± 44.3 months and therefore were assigned to the respondent group. The mean ODI score was 28.2 ± 18.3%, the mean EQ-5D VAS reached 60.7 ± 4.1 points. Stratified SF-36 results (ISS < and ≥ 16) were lower compared to a reference population. Conclusion The treatment of traumatic thoraco-lumbar fractures with an expandable VBR implant lead to a high rate of bony fusion. A significant correction of the BKA could be achieved and no clinically relevant loss of reduction occurred during the follow-up. Even though health related quality of life did not reach the normative population values, overall satisfactory results were reported.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 87%

Radiological and mid- to long-term patient-reported outcome after stabilization of traumatic thoraco-lumbar spinal fractures using an expandable vertebral body replacement implant

Lang

Schwaiger

Voß

et al. 2021

BMC Musculoskelet Disord

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show abstract

“…The mean rating of the VAS Spine score of their study population was 65.2 ± 23.1, which was found to be comparable to the rating of 58.4 from the German Spine Fracture Registry for operatively treated patients after spine fractures (4). Like our ndings, they saw a signi cant reduction of functional outcome scores in their study cohort when compared to healthy subjects (8). Indeed, other study-groups like Spiegl et al achieved better VAS Scores with a thoracoscopic procedure (24), but in the current study we could not identify a signi cant in uence of the surgical approach or other surgeryrelated parameters on the PROM.…”

Section: Discussionsupporting

confidence: 82%

“…Regarding the ODI outcome only one patient reported crippling back pain and no patient suffered exacerbated back pain or was bed-bound. (8). The mean rating of the VAS Spine score of their study population was 65.2 ± 23.1, which was found to be comparable to the rating of 58.4 from the German Spine Fracture Registry for operatively treated patients after spine fractures (4).…”

Section: Discussionsupporting

confidence: 60%

“…Not least because tricortical bone grafts are associated with harvest site donor morbidity (11,12), vertebral body replacement implants (VBR) have been developed over the last decades (13). Expandable implants have been proven to be an alternative to conventional cages and bone blocks (6)(7)(8)(9). Although their effectiveness in providing primary stability has been shown, data on restoring the bi-segmental kyphotic endplate angle (BKA) is sparse.…”

Section: Introductionmentioning

confidence: 99%

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Radiological and Long-Term Patient-Reported Outcome after Stabilization of Traumatic Thoraco-Lumbar Spinal Fractures using an Expandable Vertebral Body Replacement Implant.

Lang

Schwaiger

Voß

et al. 2020

Preprint

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BackgroundA combined posterior and anterior stabilization was found to offer a better restoration of the sagittal profile of thoracolumbar fractures in comparison to posterior-only stabilization. Data on restoring the bisegmental kyphotic endplate angle (BKA) and on patient-reported outcome measures (PROM) is sparse.Patients and Methods136 patients with traumatic thoraco-lumbar spinal fractures were treated with an expandable VBR implant (Obelisc™, Ulrich Medical, Germany). in our trauma department between 2001 and 2015. Radiological data acquisition was completed pre- and postoperatively, after at least six months and approximately two years after surgery. The BKA was measured at each follow-up. The patient related outcome was evaluated prospectively.Results117 (31 female, 86 males; age: 52.7 ± 16.5 years) patients were included in the study. 64 patients (54.7% of included patients; age: 53.2 ± 14.8 years) completed the PROM questionnaires and therefore were assigned to the study group. An A4 fracture was seen in 99 cases (84.6%) and 85 (72.6%) fractures were located at the lumbar spine. Intraoperative reduction of the BKA in 117 patients was 6.6 ± 8.2° (p < 0.01). A significant loss of reduction of 2.6 ± 4.2° at the first follow-up (t1) and of 4.4 ± 6.6° at the second follow-up (t2) was measured (each p < 0.05). The consolidation rate was 95.7%. The total revision rate was 5.1%. 64 patients (54.7% of included patients; age: 53.2 ± 14.8 years) completed the PROM questionnaires and therefore were assigned to the study group. Mean time between index surgery and completion of the PROM questionnaire was 109.4 ± 44.6 months. Mean ODI of was 28.4 ± 17.6, the mean EQ-5D VAS reached 57.9 ± 2.5 points. The cohort showed significantly lower SF-36 values compared to a healthy reference population (each p < 0.05).ConclusionTreatment of traumatic thoraco-lumbar spinal fractures using an expandable VBR implant is an effective and safe procedure. A significant operative correction of the BKA could be achieved. Although the initial reconstruction of the BKA did not consist over time in the study group, satisfactory PROMs were found.

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Vertebral Body Replacement

Nothwang

2023

Manual of Spine Surgery

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Radiological Results and Clinical Patient Outcome After Implantation of a Hydraulic Expandable Vertebral Body Replacement following Traumatic Vertebral Fractures in the Thoracic and Lumbar Spine

Abstract: 2.

Cited by 13 publications

References 31 publications

Radiological and mid- to long-term patient-reported outcome after stabilization of traumatic thoraco-lumbar spinal fractures using an expandable vertebral body replacement implant

Radiological and mid- to long-term patient-reported outcome after stabilization of traumatic thoraco-lumbar spinal fractures using an expandable vertebral body replacement implant

Radiological and Long-Term Patient-Reported Outcome after Stabilization of Traumatic Thoraco-Lumbar Spinal Fractures using an Expandable Vertebral Body Replacement Implant.

Vertebral Body Replacement

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