Short-segment posterior instrumentation combined with anterior spondylodesis using an autologous rib graft in thoracolumbar burst fractures

Abstract

Background and purposeThere are very few data concerning the outcome after short-segment posterior stabilization and anterior spondylodesis with rib grafts in patients suffering from unstable thoracolumbar burst fractures. We have therefore investigated the clinical and radiographic outcome after posterior bisegmental instrumentation and monosegmental anterior spondylodesis using an autologous rib graft for unstable thoracolumbar burst fractures.Patients and methodsThis was a retrospective analysis of 32 consecutive patients at a single center. The monosegmental Cobb angle was measured preoperatively, postoperatively, then 6 and 12 months postoperatively, and also after implant removal. Anterior vertebral fusion was graded on conventional radiographs according to the criteria proposed by Molinari.ResultsSegmental kyphosis at the fracture site was corrected from a median of -20° (95% CI: -21.2 to -18.8) to -1.0° (95% CI: -2.7 to 0.7) postoperatively. 1 year after surgery, the segmental angle had decreased by a median of 2.0° (95% CI: 0.2 to 2.8). The spondylodesis fused in all patients, which was evident from incorporation and remodeling of the rib grafts. The median correction loss after implant removal was 0.0° (95% CI: -0.5 to 0.5). 26 of the 32 patients reported having no back complaints at the last follow-up (2 years postoperatively). 1 patient suffered from intercostal neuralgia, and 5 patients reported mild to moderate back pain.InterpretationShort-segment posterior instrumentation and anterior spondylodesis using an autologous rib graft resulted in sufficient correction of posttraumatic segmental kyphosis. There was no clinically relevant correction loss, and the majority of patients had no back complaints at the 2-year follow-up.

One Stage Anterior Reconstruction and Posterior Instrumentation in Surgical Management of Thoracolumbar Spine Fractures

“…As regard PA surgery the present study coincides with Jain et al [17] and Aebli et al [18] in the following; improvement of the neurological deficit with significant difference between pre and postoperative state (p < 0.001 * ), surgical correction of the kyphotic angle from the preoperative to postoperative measure about 25.64˚ ± 3.82˚ and less loss of correction in the present study than the other study (0.07˚) adequate decompression of the spinal canal postoperatively(57.35% ± 5.01%) with significant difference between pre and postoperative spinal canal compromise, operative time was less in our study than others (179.85 ± 6.35 min) ,longer hospital stay (6.28 ± 1.3 day) EBL was less in the present study than others (689.28 ± 102.15 cc), improvement of the VAS and ODI score from pre to the postoperative state with total loss of score (6.21 points) and 40% ± 6.3% respectively with significant difference. But the present study reported no neurological complication like PLIF surgery but reported two cases had superficial wound infection which treated conservatively and improved after 2 weeks, 2 cases had loose screws and 2 cases had cage subsidence but didn't affect kyphotic angle (<10˚).…”

Efficacy of Titanium Mesh Cages for Anterior Column Reconstruction after Thoracolumbar Corpectomy

“…The anterior approaches in patients with vertebral fractures requires fixation of only one level rostral and caudal to the fractured vertebral body, whereas in the posterior approach instrumentation may span five or more levels with the the anterion column disrupted with secondary deformity [ 17 18 ]. The anterior approach facilitates complete removal of the injured vertebral disc, which may prevent chronic post-traumatic back pressure [ 17 ].…”

“…To optimize fusion, bone grafts are better maintained under compression. This is achieved more effectively using an anterior approach and plating with bicortical screws [ 17 18 ]. There is little evidence in the literature concerning the efficacy of outcome using the cylinderical mesh titanium cage for postcorpectomy reconstruction.…”

“…The primary function of the titanium mesh cage is to provide structural support to the anterior column [ 10 17 ]. The cage can be filled with an autogenous graft, which also enables maintenance of osteoinductivity and osteoconductivity [ 2 ].…”

“…Multiple cages with varying diameters and heights are available. These can be filled with autogenous bone graft, which also enables maintenance of osteoinductivity and osteoconductivity [ 17 19 ]. A titanium mesh cage with cancellous bone after corpectomy provides immediate structural support to the anterior column, while the cancellous bone inside the cage promotes fusion.…”