Different pedicle osteosynthesis for thoracolumbar vertebral fractures in elderly patients

Girardo, Massimo; Rava, Alessandro; Fusini, Federico; Gargiulo, G.; Coniglio, A.; Cinnella, Pasquale

doi:10.1007/s00586-018-5624-y

Cited by 26 publications

(18 citation statements)

References 23 publications

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“…Surgical treatment for osteoporotic vertebral fracture (OVF) is still challeng-ing for spine surgeons. The literature reports several approaches to treatment, but there is no current consensus on a standard technique [3][4][5][6][7]. Compared with younger population, high rate of complications is associated with pedicle screw fixation because of poor bone quality such as loosening, pullout, or screw migration [8].…”

Section: Introductionmentioning

confidence: 99%

Long versus Short Segment Instrumentation in Osteoporotic Thoracolumbar Vertebral Fracture

et al. 2021

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This study aimed to compare clinical and radiological data and rate of mechanical complications in elderly patients treated with short segment (SSS) or long segment stabilization (LSS) for thoracolumbar junction osteoporotic vertebral fractures (OVFs). Overview of Literature: A fervent debate is now focused on the treatment of OVF using SSS or LSS. High rate of complications is associated with pedicle screw fixation because of poor bone quality. Methods: Patients over 65 years old with a T-score of <−2.5, affected by (T10-L2) vertebral fracture treated with LSS or SSS pedicle screw fixation, with at least 24 months of follow-up were evaluated. All patients were analyzed with conventional X-ray to evaluate bisegmental kyphotic angle (BKA) and clinically with Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and rate of mechanical complications at 2, 6, 12, and 24 months. Data were expressed as mean±standard deviation. Student t-test was used to compare clinical scores between populations. Mann-Whitney U-test was used to analyze clinical and radiological variable, whereas Fisher's exact test was used to identify differences in the rate of complications between groups. Results: A total of 37 patients met the inclusion criteria. Mean follow-up was 33.97±9.26 months. For both groups, ODI and VAS significantly decreased over time with good results (p<0.00001). At the final follow-up, no significant differences were found in terms of ODI and VAS. There was no difference in correction of BKA between groups; however, a significant difference was found in LSS group between pre-and postoperative BKA (p=0.046), whereas no difference was found in SSS group. A significant difference in the rate of mechanical complications was found between groups (p=0.011). Conclusions: Both treatments showed good clinical and radiological results; however, LSS group showed better BKA correction and lower mechanical complications than SSS group.

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Section: Introductionmentioning

confidence: 99%

Long versus Short Segment Instrumentation in Osteoporotic Thoracolumbar Vertebral Fracture

et al. 2021

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“…Complications were extremely rare in both arms of the study with the same rate of other studies that show how the posterior approach is safer for the patient. [24252627282930] Clinical results were also satisfactory [Figures 1 and 2]. The scores obtained with the administration of the SRS 24 questionnaire (which has been used for years in studies published in the literature)[3132] were comparable in the two study-arms.…”

Section: Discussionmentioning

confidence: 77%

Over 70° thoracic idiopathic scoliosis: Results with screws or hybrid constructs

Cinnella

Rava

Mahagna

et al. 2019

J Craniovert Jun Spine

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Background: Adolescent idiopathic scoliosis is the most common type of scoliosis. High degrees curve can be treated with the anterior, posterior, or combined anterior–posterior approach. Contrarily to the anterior approach, the posterior one is widely used nowadays for its good correction outcomes and relatively low-complication rate. Materials and Methods: We evaluated retrospectively 27 patients, treated with posterior approach. Patients were divided into two groups, namely pedicle screws group (PSG) and hybrid group (pedicle screws + sublaminar bands). Radiographic measurements, including thoracic and lumbar Cobb° measurements of primary and secondary curves, coronal balance and sagittal balance, kyphosis and lordosis, curve flexibility, first and last vertebra included in the arthrodesis, and implant density were evaluated. Clinical patients' satisfaction was also evaluated with Scoliosis Research Society (SRS) 24 questionnaire. Results: Considering both groups, on preoperative X-rays, the average primary scoliotic curve angle was 83.56° ± 10.96° (range 70°–112°), whereas the global flexibility was 64° ± 7.63 (range 46°–72°). The curves were classified following the Lenke classification: 17 Type 1, 2 Type 2, and 8 Type 3. The primary curve resulted to be well corrected in both groups. In T0, the groups were homogeneous, but in T1 and follow-up, PSG stated a better mean value. No other significative differences can be found between groups for all other items ( P > 0.05). Clinical results of SRS 24 were excellent in both groups. Conclusions: The posterior approach proved to be an excellent technique for obtaining good clinical and radiographic results if the surgeon adopts the third-generation high-density implants. Level of Evidence: III.

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“…A lot of treatments were proposed for thoracolumbar fractures[567812181920] and the best treatment must be chosen taking in consideration: AO fractures classification, fracture dislocation, neurological status, patients' comorbidities, and compliance. There are several authors supporting conservative treatment with reduction, as well as those reporting excellent results with fracture reduction and stabilization.…”

Section: Discussionmentioning

confidence: 99%

“…Both surgical and conservative treatments are described in literature with good results. [567] Conservative treatments comprehend bed rest, physiotherapy, spinal braces, and closed reduction associated to casting (CRC); however, in literature, there is no evidence about a better conservative treatment. [8]…”

Section: Introductionmentioning

confidence: 99%

Is cast an option in the treatment of thoracolumbar vertebral fractures?

Rava

Fusini

Cinnella

et al. 2019

J Craniovert Jun Spine

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Background: Thoracolumbar vertebral fractures are common in high-energy trauma and often are associated to other concomitant injuries. Currently, brace and Closed Reduction and Casting (CRC) are the two conservative treatments proposed by literature. Despite CRC was widely used in the past, today brace is preferred. The aim of our study is to evaluate clinical and radiographic outcomes of thoracolumbar type A fractures, not associated with other injuries, treated with CRC. Materials and Methods: We retrospectively evaluated all patients treated from 2008 to 2015, with a mean age of 26.69 years (range 15–45). All patients were affected by AO type A fracture: 26 type A1, 17 type A2, and 21 type A3. All patients were evaluated by X-ray, computed tomography, and magnetic resonance imaging. Radiological evaluations included vertebral kyphosis (VK), segmental kyphosis (SK), regional kyphosis (RK) angle, and vertebral ratio (VR) measures. Patients were clinically assessed through visual analog scale, Oswestry Disability Index, Roland–Morris Disability Questionnaire, and Short Form 36 Health Survey. Results: Seventy-four patients (41 males and 33 females) were included in the study. At follow-up (mean 28.48 months ± 5.16), we found significant improvements in VK ( P = 0.000013), SK ( P = 0.000455), and RK ( P = 0.000016). No significant differences were observed in VR ( P = 0.26). Good clinical results were reported in patients in all scores and 90.7% of patients returned to work. Conclusions: Closed reduction and casting is still a reliable treatment option in selected thoracolumbar fractures without spinal cord involvement. A correct fracture evaluation, patient compliance, and motivation are essentials. Level of evidence: IV.

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Different pedicle osteosynthesis for thoracolumbar vertebral fractures in elderly patients

Abstract: All stabilization methods showed good clinical results, but cannulated screws augmented with PMMA seem to provide better implant stability with the lowest rate of loosening. These slides can be retrieved under Electronic Supplementary Material.

Cited by 26 publications

References 23 publications

Long versus Short Segment Instrumentation in Osteoporotic Thoracolumbar Vertebral Fracture

Long versus Short Segment Instrumentation in Osteoporotic Thoracolumbar Vertebral Fracture

Over 70° thoracic idiopathic scoliosis: Results with screws or hybrid constructs

Is cast an option in the treatment of thoracolumbar vertebral fractures?

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