Ten-year follow-up results of posterior instrumentation without fusion for traumatic thoracic and lumbar spine fractures

Kocanli, Ozcan; Kömür, Baran; Duymuş, Tahir Mutlu; Güçlü, Bülent; Yılmaz, Barış; Sesli, Erhan

doi:10.1016/j.jor.2016.06.021

Cited by 10 publications

(9 citation statements)

References 30 publications

(28 reference statements)

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“…Initial vertebral body height in all patients and kyphosis in oblique endplates was significantly improved in our study. As reported in other series of traumatic burst fractures, 14,16,19,28 progressive loss of the initial correction of vertebral body height was also noted in our patients, which explained the changes in segmental kyphosis over time; however, similar to these reports, this observation was not associated with symptoms and did not correlate with significant need for reoperation. We believe that the presence of the intact spinal hardware and the adequate load sharing in the reconstructed vertebral body allowed the axial load to be handled; therefore, the small loss of correction was not predictive of poor functional outcome.…”

Section: Discussionsupporting

confidence: 91%

Interbody distraction and vertebral body reconstruction with polymethylmethacrylate for the treatment of pathological fractures

Zuckerman

Rao

Rhines

et al. 2017

Journal of Neurosurgery: Spine

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OBJECTIVETreatment of epidural spinal cord compression (ESCC) caused by tumor includes surgical decompression and stabilization followed by postoperative radiation. In the case of severe axial loading impairment, anterior column reconstruction is indicated. The authors describe the use of interbody distraction to restore vertebral body height and correct kyphotic angulation prior to reconstruction with polymethylmethacrylate (PMMA), and report the long-term durability of such reconstruction.METHODSA single institution, prospective series of patients with ESCC undergoing single-stage decompression, anterior column reconstruction, and posterior instrumentation from 2013 to 2016 was retrospectively analyzed. Several demographic, perioperative, and radiographic measurements were collected. Descriptive statistics were compiled, in addition to postoperative changes in anterior height, posterior height, and kyphosis. Paired Student t-tests were performed for each variable. Overall survival was calculated using the techniques described by Kaplan and Meier.RESULTSTwenty-one patients underwent single-stage posterior decompression with interbody distraction and anterior column reconstruction using PMMA. The median age and Karnofsky Performance Scale score were 61 years and 70, respectively. Primary tumors included renal cell (n = 8), lung (n = 4), multiple myeloma (n = 2), prostate (n = 2), and other (n = 5). Eighteen patients underwent a single-level vertebral body reconstruction and 3 underwent multilevel transpedicular corpectomies. The median survival duration was 13.3 months. In the immediate postoperative setting, statistically significant improvement was noted in anterior body height (p = 0.0017, 95% confidence interval [CI] −4.15 to −1.11) and posterior body height (p = 0.0116, 95% CI −3.14 to −0.45) in all patients, and improved kyphosis was observed in those with oblique endplates (p = 0.0002, 95% CI 11.16–20.27). In the median follow-up duration of 13.9 months, the authors observed 3 cases of asymptomatic PMMA subsidence. One patient required reoperation in the form of extension of fusion.CONCLUSIONSIn situ interbody distraction allows safe and durable reconstruction with PMMA, restores vertebral height, and corrects kyphotic deformities associated with severe pathological fractures caused by tumor. This is accomplished with minimal manipulation of the thecal sac and avoiding an extensive 360° surgical approach in patients who cannot tolerate extensive surgery.

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Section: Discussionsupporting

confidence: 91%

Interbody distraction and vertebral body reconstruction with polymethylmethacrylate for the treatment of pathological fractures

Zuckerman

Rao

Rhines

et al. 2017

Journal of Neurosurgery: Spine

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“…Based on previous reports, progressive kyphosis might be inevitable despite fusion. For our study, the residual deformity did not correlate with the symptoms of the patients at their time of follow-up [1,19]. The result showed that the selective fusion procedures achieved comparable clinical and radiographic outcomes with bi-segment fusion groups, which not only validated the selectively fused schemes but also is appropriate for TLF treatment.…”

Section: Discussionmentioning

confidence: 77%

Treatment of thoracolumbar fractures by temporary posterior instrumentation with selective fusion schemes

Zheng

Liu²,

Jiang³

et al. 2021

British Journal of Neurosurgery

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Objective: This retrospective study investigated the clinical and radiographic outcomes following temporary transpedicular posterior instrumentation between two cohorts of patients with thoracolumbar fractures (TLF) who underwent selective or bi-segments intervertebral articular process fusion.Materials and Methods: Patients with TLF who underwent the temporary posterior xation with selective fusion (Group SF), or bi-segments fusion (Group BF) were studied. Superior intervertebral articular process and interlaminar fusion were performed in Group SF, whereas in Group BF, the patients underwent bi-segments fusion in both superior and inferior articular processes, as well as interlaminar fusion. We measured the distal and proximal intervertebral mobility, regional kyphotic angle, and vertebral height before and after surgery in both groups. Greenough Low-Back Outcome Score was used to assess the clinical outcomes.Results: Sixty-ve patients with TLF from T12 to L2 fractures were enrolled in the study period: 23 patients in the Group SF and 22 patients in the Group BF. All the patients experienced fracture healing (mean follow-up time: 19.7 months). The mean postoperative functional outcomes were 65.0±2.0 points for the Low-Back Outcome Score in the Group SF and 65.2±1.8 for the Group BF. A progressive regional kyphotic angle was observed with time regardless of fusion but was not signi cantly different between the two groups. There was a statistical difference between unfused inferior proximal adjacent and inferior distal adjacent segment regardless of fracture segments. Conclusion:The strategy of selective fusion is reported to be useful for the treatment of patients with TLF. The motion in the un-fused and adjacent segment could be better regained after instrumentation removal in the selectively fusion group.

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“…Based on previous reports, progressive kyphosis might be inevitable despite fusion. For our study, the residual deformity did not correlate with the symptoms of the patients at their time of follow-up [1,19]. The result showed that the selective fusion procedures achieved comparable clinical and radiographic outcomes with bisegment fusion groups, which not only validated the selectively fused schemes but also is appropriate for TLF treatment.…”

Section: Short-segment Open Instrumentation For Surgically Treated Bumentioning

confidence: 76%

Treatment of thoracolumbar fractures by temporary posterior instrumentation with selective fusion schemes

Zheng

Liu

Jiang

et al. 2020

Preprint

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Objective: This retrospective study investigated the clinical and radiographic outcomes following temporary transpedicular posterior instrumentation between two cohorts of patients with thoracolumbar fractures (TLF) who underwent selective or bi-segments intervertebral articular process fusion.Materials and Methods: Patients with TLF who underwent the temporary posterior fixation with selective fusion (Group SF), or bi-segments fusion (Group BF) were studied. Superior intervertebral articular process and interlaminar fusion were performed in Group SF, whereas in Group BF, the patients underwent bi-segments fusion in both superior and inferior articular processes, as well as interlaminar fusion. We measured the distal and proximal intervertebral mobility, regional kyphotic angle, and vertebral height before and after surgery in both groups. Greenough Low-Back Outcome Score was used to assess the clinical outcomes.Results: Sixty-five patients with TLF from T12 to L2 fractures were enrolled in the study period: 23 patients in the Group SF and 22 patients in the Group BF. All the patients experienced fracture healing (mean follow-up time: 19.7 months). The mean postoperative functional outcomes were 65.0±2.0 points for the Low-Back Outcome Score in the Group SF and 65.2±1.8 for the Group BF. A progressive regional kyphotic angle was observed with time regardless of fusion but was not significantly different between the two groups. There was a statistical difference between unfused inferior proximal adjacent and inferior distal adjacent segment regardless of fracture segments.Conclusion: The strategy of selective fusion is reported to be useful for the treatment of patients with TLF. The motion in the un-fused and adjacent segment could be better regained after instrumentation removal in the selectively fusion group.

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Ten-year follow-up results of posterior instrumentation without fusion for traumatic thoracic and lumbar spine fractures

Abstract: Posterior instrumentation without fusion is still among the most useful in treatment of traumatic thoracolumbar fractures.

Cited by 10 publications

References 30 publications

Interbody distraction and vertebral body reconstruction with polymethylmethacrylate for the treatment of pathological fractures

Interbody distraction and vertebral body reconstruction with polymethylmethacrylate for the treatment of pathological fractures

Treatment of thoracolumbar fractures by temporary posterior instrumentation with selective fusion schemes

Treatment of thoracolumbar fractures by temporary posterior instrumentation with selective fusion schemes

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