Thoracolumbar fractures surgically treated by “in situ contouring”

Abstract

This is a retrospective study on a series of 70 patients with thoracolumbar fractures (TL), surgically treated by the in situ bending technique (ISB). Its purpose is to show the performances and limits of the ISB technique for the early correction of post-traumatic spine deformities as well as to estimate the overall outcome in this series and to discuss the indications for anterior grafting. Although the management of limbs fractures is a cleared issue today, spine fractures management is still a matter of debate. Surgical treatment progresses fast, while indications, the fixation techniques, fracture reduction options, and associated grafting are still blurry. Seventy patients with TL fractures, mean age 40.3 years (20-80) were treated by posterior fusion with a standard construct and deformity reduction by means of the ISB technique. Mean follow-up was 30.7 months (12-78). Pre- and post-operative deformity was evaluated and the relative deformity as defined by Farcy's sagittal index (SIF) was analyzed. Thirty-eight patients underwent anterior interbody grafting. The pre-operative SIF decreased from 16.98 to 1.62 degrees (15.36 degrees decrease). Eighty percent of patients were normo- or hyper-corrected. The loss of correction during the follow-up occurred within the disc (SIF: -2.24 degrees , vertebral kyphosis 0.94 degrees , p<0.001), and was lower in patients who underwent secondary anterior grafting (-5.21 degrees vs.-1.18 degrees , p=0.002). Clinical outcome is good (Oswestry=29.75) and seems to be better in cases of double approach (20.71 vs. 37.,4, p=0.001). Sepsis occurred in ten cases, and two patients experienced construct dismounting. One patient had a retroperitoneal hematoma that required embolization. Seventy-one percent of operated patients went back to their previous work after surgery. Spine fractures deserve an efficient treatment. The ISB technique improves post traumatic kyphosis. This results is maintained at long term if the posterior fusion is associated with anterior grafting in cases where the correction within the disc exceeds 50% of the total correction.

Posterior-only spinal release combined with derotation, translation, segmental correction, and an in situ rod-contouring technique for treatment of severe and rigid scoliosis

“…In contrast, the in situ rod-contouring technique can provide greater strength to directly correct the scoliosis rigid deformity. 17,18 As expected, our results indicated that a good correction ratio was obtained in the scoliosis Cobb angle in the coronal plane, from 85.7° (range 77°-94°) preoperatively to 33.1° (range 21°-52°) postoperatively.The in situ rod-contouring technique is not usually used because it may lead to bone fracture and neurologi- …”

Low thoracic and lumbar burst fractures: radiographic and functional outcomes

“…The parameters used for radiographic evaluation were the sagittal index of the fractured segment (Fracy's sagittal index [5]); the relation between the traumatic vertebra body height and the adjacent vertebrae (compression percentage = 100 -(2 · F/A + B) · 100. F-height of fractured vertebra, A-height of the proximal vertebra, B-height of the distal vertebra) [21]; the height of the intervertebral disk above and below the fractured vertebra; classification of the fracture based on load sharing according to McCormack et al [16]; loosening and rupture of the implants used for fixation.…”

Double approach in thoraco-lumbar malunions

“…The deformity is corrected by in situ contouring [3,4] and we believe that the optimum correction of the regional deformity is achieved by the posterior approach. The spinal stabilization by means of pedicle screws allows for a global approach of Louis's three-column spine [5].…”

“…The spinal stabilization by means of pedicle screws allows for a global approach of Louis's three-column spine [5]. Corporeal screws stabilize only the anterior column and therefore they are less efficient and the construct is less stable [4].…”