6-Year follow-up of ventral monosegmental spondylodesis of incomplete burst fractures of the thoracolumbar spine using three cortical iliac crest bone grafts

Spiegl, Ulrich; Hauck, Stefan; Merkel, P.; Bühren, V.; Gonschorek, O.

doi:10.1007/s00402-012-1576-6

Cited by 12 publications

(8 citation statements)

References 28 publications

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“…Three patients complained about pain or hyposensitivity at 12 year follow-up. At 6-year follow-up, 71% of all patients were suffering from donor site pain [21]. These findings are consistent with the findings of Wippermann et al [22] who reported an overall complication rate of 19.6% after iliac crest harvesting.…”

Section: Clinical Outcomesupporting

confidence: 90%

Long-term results after thoracoscopic anterior spondylodesis with or without posterior stabilization of unstable incomplete burst fractures of the thoracolumbar junction: a prospective cohort study

et al. 2020

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Background Minimally invasive, thoracoscopic anterior spondylodesis (MIAS) is an established treatment for burst fractures of the thoracolumbar spine. Good restoration of the local sagittal alignment and good functional results have been reported. The aim of this study was to evaluate long-term results of MIAS in patients with incomplete burst fractures and to analyze the influence on global sagittal alignment, clinical outcomes, and adjacent segment degeneration. Methods From 2002 to 2003, 18 patients were treated with MIAS for incomplete thoracolumbar burst fractures. Mono-segmental spondylodesis was performed with an iliac crest bone graft and bisegmental spondylodesis with a titanium cage. In this single-center prospective cohort study, 15 patients were available for follow-up (FU) after an average of 12.9 years (12.1–14.4). Seven patients were treated with a combined anterior and posterior instrumentation and eight patients with anterior spondylodesis only. The primary clinical outcome parameter was the Oswestry Disability Index (ODI); secondary parameters were the Short Form 36 (SF36) and the visual analog scale (VAS spine). Full spine radiographs were assessed for bisegmental Cobb angle, alignment parameters, and signs of adjacent segment degeneration (ASD). Results ODI evaluation showed a mean impairment of 11.7% with minimal limitations in 13 patients. Neither a significant deterioration over time nor significant differences between both therapy strategies were found in the clinical scores at the latest follow-up. The mean bisegmental increase of regional malalignment of reduction was 8.8° (± 7.3°) with no significant correlation to any clinical outcome scores. The majority of patients had no signs of adjacent segment degeneration. Two patients showed minor radiologic changes. All patients had a balanced sagittal spine profile. Conclusions In conclusion, MIAS leads to good clinical results with—in majority—minimal spine-related impairment at the latest follow-up. No significant deterioration at 12-year FU was detectable compared to the 6-year results for the SF36 and VAS spine scores. There was no association between sagittal alignment, clinical outcome scores, and ASD. Trial registration The study was retrospectively registered in the German Clinical Trials Register (Nr.00015656).

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Section: Clinical Outcomesupporting

confidence: 90%

Long-term results after thoracoscopic anterior spondylodesis with or without posterior stabilization of unstable incomplete burst fractures of the thoracolumbar junction: a prospective cohort study

et al. 2020

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“…In addition to this, the surgical approach to the iliac crest is associated with relevant morbidity including persisting long-term graft donor site pain [25]. The six-year outcomes of our patients, who were treated with an iliac crest bone graft, has been published recently [22]. The proportion of our patients suffering from donor site pain is high (71 %).…”

Section: Discussionmentioning

confidence: 96%

“…The other three patients suffered from minor discomfort. Only four patients (29 %) who were treated ventrally with an iliac crest bone graft did not mention any discomfort related to the donor site [22]. Eight of them (57 %) reported slight intermittent pain without any need of analgesics, whereas two patients (14 %), irregularly taking non-steroidal anti-inflammatory drugs, suffered persistent pain.…”

Section: Resultsmentioning

confidence: 99%

Six-year outcome of thoracoscopic ventral spondylodesis after unstable incomplete cranial burst fractures of the thoracolumbar junction: ventral versus dorso-ventral strategy

Spiegl

Hauck

Merkel

et al. 2013

International Orthopaedics (SICOT)

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Purpose The purpose of this study is to determine the long term-results after thoracoscopic spondylodesis particularly with respect to a ventral versus dorso-ventral treatment strategy. Methods In this prospective cohort study, a follow-up examination was performed in 19 patients (seven men, 12 women, average age: 37.7 years, follow-up rate: 79 %), six years after ventral thoracoscopic spondylodesis of unstable, incomplete burst fractures. Nine patients received a ventral monosegmental spondylodesis with iliac crest bone graft. The other ten cases were treated dorso-ventrally, five undergoing a ventral monosegmental treatment with iliac crest bone graft; the other five a ventral bisegmental treatment with expandable titanium cage. Results The complication rate was 15.7 %, the rate of revision of 10.5 %. No complication was related to the ventral thoracoscopic approach, whereas all of them were related to the iliac crest bone graft. The operative bisegmental kyphotic reduction was higher in the dorso-ventrally treated group. Afterwards, the loss of reduction was similar in both study groups. The mean VAS spine score summed up to more than 80 in both groups. The mean PCS scores were comparable to a normal healthy collective of the same age. Conclusions The ventral thoracoscopic approach to the spine seems to be a safe therapeutic strategy. A dorsoventral treatment concept goes along with a higher operative reduction potential.

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“…However, studies on monosegmental anterior column reconstruction are scarce. Spiegl et al [27] assessed the clinical and radiological outcome of 14 patients with incomplete burst fractures after a mean of 74 months (range 66–84 months) after thoracoscopic monosegmental ACR using a tricortical iliac crest bone autograft and an additional ventral plate. Nine patients were treated by an anterior only approach and five patients were treated by a combined posterior–anterior approach.…”

Section: Discussionmentioning

confidence: 99%

Monosegmental anterior column reconstruction using an expandable vertebral body replacement device in combined posterior–anterior stabilization of thoracolumbar burst fractures

Lindtner

Mueller

Schmid

et al. 2018

Arch Orthop Trauma Surg

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IntroductionIn combined posterior–anterior stabilization of thoracolumbar burst fractures, the expandable vertebral body replacement device (VBRD) is typically placed bisegmentally for anterior column reconstruction (ACR). The aim of this study, however, was to assess feasibility, outcome and potential pitfalls of monosegmental ACR using a VBRD. In addition, clinical and radiological outcome of monosegmental ACR was related to that of bisegmental ACR using the same thoracoscopic technique.MethodsThirty-seven consecutive neurologically intact patients with burst fractures of the thoracolumbar junction (T11–L2) treated by combined posterior–anterior stabilization were included. Monosegmental ACR was performed in 18 and bisegmental ACR in 19 patients. Fracture type and extent of vertebral body comminution were determined on preoperative CT scans. Monosegmental and bisegmental kyphosis angles were analyzed preoperatively, postoperatively and at final radiological follow-up. Clinical outcome was assessed after a minimum of 2 years (74 ± 45 months; range 24–154; follow-up rate 89.2%) using VAS Spine Score, RMDQ, ODI and WHOQOL-BREF.ResultsMonosegmental ACR resulted in a mean monosegmental and bisegmental surgical correction of − 15.6 ± 7.7° and − 14.7 ± 8.1°, respectively. Postoperative monosegmental and bisegmental loss of correction averaged 2.7 ± 2.7° and 5.2 ± 3.7°, respectively. Two surgical pitfalls of monosegmental ACR were identified: VBRD positioning (1) onto the weak cancellous bone (too far cranially to the inferior endplate of the fractured vertebra) and (2) onto a significantly compromised inferior endplate with at least two (even subtle) fracture lines. Ignoring these pitfalls resulted in VBRD subsidence in five cases. When relating the clinical and radiological outcome of monosegmental ACR to that of bisegmental ACR, no significant differences were found, except for frequency of VBRD subsidence (5 vs. 0, P = 0.02) and bisegmental loss of correction (5.2 ± 3.7° vs. 2.6 ± 2.5°, P = 0.022). After exclusion of cases with VBRD subsidence, the latter did not reach significance anymore (4.9 ± 4.0° vs. 2.6 ± 2.5°, P = 0.084).ConclusionsThis study indicates that monosegmental ACR using a VBRD is feasible in thoracolumbar burst fractures if the inferior endplate is intact (incomplete burst fractures) or features only a single simple split fracture line (burst-split fractures). If the two identified pitfalls are avoided, monosegmental ACR may be a viable alternative to bisegmental ACR in selected thoracolumbar burst fractures to spare a motion segment and to reduce the distance for bony fusion.

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6-Year follow-up of ventral monosegmental spondylodesis of incomplete burst fractures of the thoracolumbar spine using three cortical iliac crest bone grafts

Cited by 12 publications

References 28 publications

Long-term results after thoracoscopic anterior spondylodesis with or without posterior stabilization of unstable incomplete burst fractures of the thoracolumbar junction: a prospective cohort study

Long-term results after thoracoscopic anterior spondylodesis with or without posterior stabilization of unstable incomplete burst fractures of the thoracolumbar junction: a prospective cohort study

Six-year outcome of thoracoscopic ventral spondylodesis after unstable incomplete cranial burst fractures of the thoracolumbar junction: ventral versus dorso-ventral strategy

Monosegmental anterior column reconstruction using an expandable vertebral body replacement device in combined posterior–anterior stabilization of thoracolumbar burst fractures

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