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
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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