Surgical Treatment Alternatives for Fixation of Unstable Fractures of the Thoracic and Lumbar Spine

Dickman, Curtis A.; Yahiro, Martin A.; Lü, Hao; Melkerson, Mark N.

doi:10.1097/00007632-199410151-00003

Cited by 88 publications

(47 citation statements)

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“…Meta-analysis is a statistical analysis of data collected from several different researches and surveys on the same problem, pooling outcomes in order to arrive at a more unbiased and scientific conclusion [12,22]. Ideally, each of the studies included in meta-analysis should contain large numbers of cases and have a similar validated design.…”

Section: Discussionmentioning

confidence: 99%

A meta-analysis of artificial total disc replacement versus fusion for lumbar degenerative disc disease

Zhu

Han

et al. 2010

Eur Spine J

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Lumbar fusion has been developed for several decades and became the standard surgical treatment for symptomatic lumbar degenerative disc disease (DDD). Artificial total disc replacement (TDR), as an alternative for spinal arthrodesis, is becoming more commonly employed treating lumbar DDD. It is still uncertain whether TDR is more effective and safer than lumbar fusion. To systematically compare the effectiveness and safety of TDR to that of the fusion for the treatment of lumbar DDD, we performed a meta-analysis. Cochrane review methods were used to analyze all relevant randomized controlled trials published up to July 2009. Five relevant randomized controlled trials involving 837 patients were identified. Patients in TDR group have sightly better functioning and less back or leg pain without clinical significance, and significantly higher satisfaction status in TDR group compared with lumbar fusion group at the 2-year followup. But these outcomes are highly influenced by the study with BAK cage interbody fusion, the function/pain and patient satisfaction status are no longer significantly different between two groups after excluding this study. At 5 years, these outcomes are not significantly different between comparing groups. The complication and reoperation rate of two groups are similar both at 2 and at 5 years. In conclusion, TDR does not show significant superiority for the treatment of lumbar DDD compared with fusion. The benefits of motion preservation and the long-term complications are still unable to be concluded. More highquality RCTs with long-term follow-up are needed.

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Section: Discussionmentioning

confidence: 99%

A meta-analysis of artificial total disc replacement versus fusion for lumbar degenerative disc disease

Zhu

Han

et al. 2010

Eur Spine J

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“…Considerable controversy exists regarding the clinical outcome with these different instrumentation systems [4]. Thus Dickman et al [13], who performed a meta-analysis of surgical treatment alternatives comparing the results from the use of four instrumentation systems, were unable to find convincing evidence as to the best method of treatment of unstable fractures of the thoracolumbar spine. They studied 308 reports published between 1975 and 1994.…”

Section: Discussionmentioning

confidence: 99%

Thoracolumbar spinal fractures: radiological results of transpedicular fixation combined with transpedicular cancellous bone graft and posterior fusion in 183 patients

et al. 2001

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“…This theoretical advantage has been translated to superior clinical results in fracture fixation as well as in deformity correction [6,7,10,14,24]. However, earlier studies demonstrated high perforation rates leading to questions regarding the safety of its use in the thoracic spine [4,21].…”

Section: Discussionmentioning

confidence: 99%

Safety of thoracic pedicle screw application using the funnel technique in Asians: a cadaveric evaluation

2009

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The objective of this cadaveric study is to determine the safety and outcome of thoracic pedicle screw placement in Asians using the funnel technique. Pedicle screws have superior biomechanical as well as clinical data when compared to other methods of instrumentation. However, misplacement in the thoracic spine can result in major neurological implications. There is great variability of the thoracic pedicle morphometry between the Western and the Asian population. The feasibility of thoracic pedicle screw insertion in Asians has not been fully elucidated yet. A pre-insertion radiograph was performed and surgeons were blinded to the morphometry of the thoracic pedicles. 240 pedicle screws were inserted in ten Asian cadavers from T1 to T12 using the funnel technique. 5.0 mm screws were used from T1 to T6 while 6.0 mm screws were used from T7 to T12. Perforations were detected by direct visualization via a wide laminectomy. The narrowest pedicles are found between T3 and T6. T5 pedicle width is smallest measuring 4.1 ± 1.3 mm. There were 24 (10.0%) Grade 1 perforations and only 1 (0.4%) Grade 2 perforation. Grade 2 or worse perforation is considered significant perforation which would threaten the neural structures. There were twice as many lateral and inferior perforations compared to medial perforations. 48.0% of the perforations occurred at T1, T2 and T3 pedicles. Pedicle fracture occurred in 10.4% of pedicles. Intra-operatively, the absence of funnel was found in 24.5% of pedicles. In conclusion, thoracic pedicle screws using 5.0 mm at T1-T6 and 6.0 mm at T7-T12 can be inserted safely in Asian cadavers using the funnel technique despite having smaller thoracic pedicle morphometry.

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Surgical Treatment Alternatives for Fixation of Unstable Fractures of the Thoracic and Lumbar Spine

Cited by 88 publications

References 0 publications

A meta-analysis of artificial total disc replacement versus fusion for lumbar degenerative disc disease

A meta-analysis of artificial total disc replacement versus fusion for lumbar degenerative disc disease

Thoracolumbar spinal fractures: radiological results of transpedicular fixation combined with transpedicular cancellous bone graft and posterior fusion in 183 patients

Safety of thoracic pedicle screw application using the funnel technique in Asians: a cadaveric evaluation

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