Anterior Decompression and Shortening Reconstruction with a Titanium Mesh Cage through a Posterior Approach Alone for the Treatment of Lumbar Burst Fractures

Abstract

Study DesignA retrospective study.PurposeTo examine the efficacy and safety for a posterior-approach circumferential decompression and shortening reconstruction with a titanium mesh cage for lumbar burst fractures.Overview of LiteratureSurgical decompression and reconstruction for severely unstable lumbar burst fractures requires an anterior or combined anteroposterior approach. Furthermore, anterior instrumentation for the lower lumbar is restricted through the presence of major vessels.MethodsThree patients with an L1 burst fracture, one with an L3 and three with an L4 (5 men, 2 women; mean age, 65.0 years) who underwent circumferential decompression and shortening reconstruction with a titanium mesh cage through a posterior approach alone and a 4-year follow-up were evaluated regarding the clinical and radiological course.ResultsMean operative time was 277 minutes. Mean blood loss was 471 ml. In 6 patients, the Frankel score improved more than one grade after surgery, and the remaining patient was at Frankel E both before and after surgery. Mean preoperative visual analogue scale was 7.0, improving to 0.7 postoperatively. Local kyphosis improved from 15.7° before surgery to -11.0° after surgery. In 3 cases regarding the mid to lower lumbar patients, local kyphosis increased more than 10° by 3 months following surgery, due to subsidence of the cages. One patient developed severe tilting and subsidence of the cage, requiring additional surgery.ConclusionsThe results concerning this small series suggest the feasibility, efficacy, and safety of this treatment for unstable lumbar burst fractures. This technique from a posterior approach alone offers several advantages over traditional anterior or combined anteroposterior approaches.

Posterior-approach Vertebral Replacement With Rectangular Parallelepiped Cages (PAVREC) for the Treatment of Osteoporotic Vertebral Collapse With Neurological Deficits

“…Before surgery, 9 patients were graded as Frankel C and 10 were graded as Frankel D. All patients recovered >1 grade after surgery and all of them could walk with or without a cane at the time of discharge. Mean preoperative pain VAS score was 7.2 (range, [6][7][8][9]. Pain in the low back or legs was relieved in the early postoperative period for all patients, and the VAS score of each remained at a mean of 1.4 until final follow-up (range, 0-2).…”

“…5,6 We began performing posterior-approach vertebral replacement with a cylindrical cage for the treatment of thoracolumbar burst fracture and osteoporotic late vertebral collapse in 2004. 7 The clinical results were satisfactory; however, subsidence of the cage into the vertebrae was seen in several cases. Therefore, since 2005, we have been using a modified technique with large-sized rectangular parallelepiped cages (REC cages) to prevent subsidence.…”

Anterior decompression with single segmental spinal interbody fusion for Denis type B thoracolumbar burst fracture: a midterm follow-up study

“…The question as to how these fractures should be approached and stabilised (anteriorly or posteriorly) has been the subject of debate. Some authors have confirmed that direct decompression of the middle column can be done through the posterior approach [13]. However, It is generally believed that canal decompression is limited by and often incomplete with the posterior approach when treating thoracolumbar fractures associated with neurologic deficit.…”

“…Neurologic deficit was caused by impact and compression to the ventral surface of the spinal cord in most patients with thoracolumbar fractures, and the anterior approach provided optimal direct exposure for visualisation of the ventral aspect of the dura mater during surgical decompression [1,14]. Such a procedure would offer patients with neurologic deficit a better chance of improving than when using other procedures, even though this technique is surgically more challenging and has a greater potential for complications [13].…”

The Loss of Correction in Thoracolumbar Burst Fracture Treated by Surgery. Can We Predict It?

“…Th e 10 articles -out of 33 -that met the criteria and were included in the fi nal database, discuss the most frequently employed surgical treatment methods for the thoracal and lumbar fractures: posterior short segment fi xation [10][11][12][13][14][15], on one hand, and anterior approach only, as well as posterior-anterior approach [16][17][18][19], on the other.…”