Study Design. A retrospective study (level of evidence: level 4). Objective. To evaluate the radiographic outcomes after extreme lateral lumbar interbody fusion (XLIF) and oblique lateral lumbar interbody fusion (OLIF) procedures especially the effect of indirect decompression to the ligamentum flavum and to evaluate the effect of facet degeneration to the radiographic outcomes of these procedures. Summary of Background Data. Indirect decompression via lateral lumbar interbody fusion provides spinal canal area expansion. However, the effect to the ligamentum flavum area and thickness at the operated spinal level is unclear. Methods. Thirty-five patients (57 lumbar levels) underwent XLIF or OLIF with percutaneous pedicle screw fixation (PPS) without direct posterior decompression were retrospectively studied. Radiographic parameters including ligamentum flavum area (LFA), ligamentum flavum thickness (LFT), cross-sectional area (CSA) of thecal sac, posterior disc height, foraminal height, cage alignment, and facet degeneration were measured on magnetic resonance image (MRI). Cage position was assessed with plain radiography. Results. All of the radiographic parameters were significantly improved. Comparing pre- and postoperative value, mean LFA decreased from 78.9 ± 24.9 mm2 to 66.9 ± 26.8 mm2 (–14.2%; P-value < 0.00625). Mean right LFT decreased from 2.9 ± 0.9 mm to 2.3 ± 0.7 (–17.0%; P-value < 0.00625). Mean left LFT decreased from 3.3 ± 1.6 mm to 2.6 ± 0.9 mm (–17.6%; P-value < 0.00625). Mean CSA of thecal sac increased from 93.1 ± 43.0 mm2 to 127.3 ± 52.5 mm2 (50.8%; P-value < 0.00625). All radiographic outcomes were not significant difference between lumbar levels that have grade 0–1 and grade 2–3 or between grade 2 and grade 3 facet degeneration. Conclusion. Ligamentum flavum area and thickness were significantly reduced after lateral lumbar interbody fusion through both XLIF and OLIF. Unbuckling of the ligamentum flavum played an important role for improvement of spinal canal area after the indirect decompression. Level of Evidence: 4

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Study DesignProspective, randomized controlled trial.PurposeTo evaluate the effect of topically applied tranexamic acid (TXA) on postoperative blood loss of neurologically intact patients with thoracolumbar spine trauma.Overview of LiteratureFew articles exist regarding the use of topical TXA for postoperative bleeding and blood transfusion in spinal surgery.MethodsA total of 57 patients were operated on with long-segment instrumented fusion without decompression. In 29 patients, a solution containing 1 g of TXA (20 mL) was applied to the site of surgery via a drain tube after the spinal fascia was closed, and then the drain was clamped for 2 hours. The 28 patients in the control group received the same volume of normal saline, and clamping was performed using the same technique. The groups were compared for postoperative packed red cells (PRC) transfusion rate and drainage volume.ResultsThe rate of postoperative PRC transfusion was significantly lower in the topical TXA group than in the control group (13.8% vs. 39.3%; relative risk, 0.35; 95% confidence interval, 0.13 to 0.97; p=0.03). The mean total drainage volume was significantly lower in the topical TXA group than in the control group (246.7±125 mL vs. 445.7±211.1 mL, p<0.01). No adverse events or complications were recorded in any patient during treatment over a mean follow-up period of 27.5 months.ConclusionsThe use of topically administered 1 g TXA in thoracic and lumbar spinal trauma cases effectively decreased postoperative transfusion requirements and minimized postoperative blood loss, as determined by the total drainage volume.

Background: The thoracolumbar spine is the most frequently affected portion of the spine during fractures. In surgical management, short-segment fixation is the treatment of choice because of preserved spine motion and fewer complications. However, this technique causes concerns of kyphosis progression compared with long-segment fixation. The widely used loadsharing classification was of limited value for predicting kyphosis progression in recent literature. The goal of this study was to identify the incidence and explore the factors associated with kyphosis progression in short-segment fixation in thoracolumbar spine fractures.Study Design: Retrospective cohort study. Methods: Patients with thoracolumbar spine fractures and no known neurological deficits treated by short-segment fixation and followed up for at least 12 months during January 2015 to October 2019 were included in this study. Demographic and radiographic data parameters were collected from the hospital database. Incidence of kyphosis progression was collected, and multivariable logistic regression analysis was used to explore associated factors.Results: A total of 91 patients were included in this study. The most common fractures were AO-type A3 in 57.7% of patients, followed by A4 in 31.9%, A2 in 9.9%, and B in 6.6%. Posterior ligamentous complex (PLC) injuries were found in 51.7%. The incidence of kyphosis progression was 35.2%. The PLC was found to be significantly associated with kyphosis progression (OR 3.14, P = 0.040). Intermediate screw insertion was a preventive factor (OR 0.11, P = 0.043). Age, body mass index, and type of fracture were not significant associated factors. Conclusion:The incidence of kyphosis progression was 35.2%. The PLC injury and intermediate screw insertion were significant associated factors. Long-segment fixation in a patient who had PLC injury or intermediate screw insertion should be considered to prevent kyphosis progression.Clinical Relevance: PLC injury was significantly associated with kyphosis progression in short segment thoracolumbar fracture fixation. Therefore, the surgeon should carefully select treatment options for these groups of patients.

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Introduction: Patients who sustained thoracolumbar spine fracture without neurological deficit often require surgical treatment. The conventional open posterior approach had some disadvantages including post-operative pain, blood loss, and duration of the operation. The minimally invasive approach, open muscle-preserving pedicle screw fixation, was proposed to have more benefit than the conventional approach. This study evaluated the clinical and perioperative outcomes of thoracolumbar burst fracture fixation using the open muscle-preserving approach and the conventional open posterior approach. Methods: A prospective cohort study from June 2016 to June 2017 of the open muscle-preserving pedicle screw fixation approach was done compared to the historical control of the conventional open posterior approach from May 2015 to May 2016. The post-operative pain score, blood loss, duration of operation and clinical outcome were analyzed. Results: Twenty-three patients were enrolled in the muscle-preserving approach group, and 27 patients treated with the conventional open posterior approach were the control group. Post-operative VAS was significantly better in the muscle-preserving group (P<0.001). The mean operating time was significantly shorter in the muscle-preserving group (60.4±17.3 min. vs. 90.9±18.9 min., p<0.001). Moreover, the mean intra-operative blood loss of the muscle-preserving group was also significantly lower (156.96±96.3ml. vs. 269.26±147.6ml., p=0.003). Conclusion: Our study results indicate a superiority of the open muscle-preserving approach over the conventional open posterior approach for a thoracolumbar burst fracture without neurologic injury in terms of post-operative pain score, blood loss and duration of operation. The open muscle-preserving approach is an alternative treatment for thoracolumbar burst fractures.

Background: Thoracic spinal tuberculosis (TB) causes destruction of the spine and compression of the adjacent spinal cord. This study aimed to identify the risk factors for neurological deterioration in patients with thoracic spinal TB to guide decision-making regarding immediate surgery before the onset of weakness.Methods: Demographic, clinical, laboratory, and radiologic (x-ray and magnetic resonance imaging) data of 115 patients with active thoracic spinal TB were retrospectively analyzed. Patients with neurological status categorized as Frankel grades A, B, or C (n = 71) were classified as the neurological deficit group, while those with neurological status categorized as Frankel grades D and E (n = 44) constituted the control group. Univariate and multivariate logistic regression analyses were used to predict the risk factors for neurological deficits.Results: The mean patient age was 57.2 years. The most common lesion location was the distal thoracic region (T9-L1; 62.6%). Paradiscal involvement was the most common form of involvement (73%). In the univariate analysis, the significant risk factors associated with neurological worsening were overweight (body mass index [BMI] >25), C-reactive protein level > 20 mg/L, panvertebral involvement, loss of cerebrospinal fluid posterior to the cord, cord signal changes, and canal compromise. The multivariate analysis revealed that only BMI >25 (adjusted OR = 16.18; 95% CI 1.60-163.64; P = 0.018), cord signal changes (adjusted OR = 7.42; 95% CI 1.85-29.74; P = 0.005), and canal encroachment >50% ( adjusted OR = 51.86; 95% CI 5.53-486.24; P = 0.001) were independent risk factors for predicting the risk of neurological deficits.Conclusions: Overweight (BMI >25), cord signal changes, and canal compromise >50% significantly predicted neurological deficits in patients with thoracic spinal TB. Prompt spinal surgery should be considered before progressive worsening of the neurological condition in patients with all of these risk factors.Clinical Relevance: Predictive factors for neurological deficits in thoracic spinal TB were determined. Overweight, cord signal changes, and canal compromise >50% showed predictive value. These factors can help identify patients who require early surgical intervention.