Impact of Sagittal Balance on Clinical Outcomes in Surgically Treated T12 and L1 Burst Fractures: Analysis of Long-Term Outcomes after Posterior-Only and Combined Posteroanterior Treatment

Abstract

Objective. Long-term radiological and clinical outcome retrospective study of surgical treatment for T12 and L1 burst fractures in perspective of sagittal balance measures. Methods. Patients with age of 16–60 years, complete radiographs, early surgical treatment surgery, and follow-up (F/U) > 18 months were included and strict exclusion criteria applied. Regional and thoracolumbar kyphosis angles (RKA and TLA) were measured preoperatively and at final F/U, as were parameters of the spinopelvic sagittal alignment. Clinical outcomes were assessed using validated measures. Results. 36 patients with age mean age of 39 years and F/U of 69 months were included. 61% of patients were treated with bisegmental posterior instrumentation (POST-I) and 39% with combined posteroanterior instrumented fusion (PA-F). At F/U, several indicators for clinical outcomes showed a significant correlation with radiographic measures in the overall cohort with inferior clinical outcomes corresponding with increasing residual deformity and sagittal malalignment. Statistical analysis failed to reach level of significance for the differences between POST-I and PA-F group at final F/U. Only a strong trend towards better restoration of the thoracolumbar alignment was observed for the PA-F group in terms of the RKA and TLA. Conclusions. Results in a surgically treated cohort of T12 and L1 burst fracture patients indicate that superior clinical outcomes depend on restoration of sagittal alignment.

Percutaneous Vertebral Augmentation Techniques in Osteoporotic and Traumatic Fractures

“…The maintenance of a close-tophysiological sagittal alignment with restoration of the regional kyphosis angle and thoracolumbar junction angle influences the clinical outcome measures. 60,61 This is in agreement with other studies indicating that sagittal imbalance caused by adult degenerative deformity or posttraumatic deformity promote increasing pain, worse clinical outcomes, and a loss of health-related quality of life. 62,63 To summarize, the traumatic fracture probably raises a greater demand for maintenance of correction than the osteoporotic fractures because the patients are younger.…”

Does Combined Anterior-Posterior Approach Improve Outcomes Compared with Posterioronly Approach in Traumatic Thoracolumbar Burst Fractures?: A Systematic Review

“…The systematic literature search yielded 4,015 initial studies whose titles and abstracts were screened. Of these, 40 articles were eligible for full-text review, out of which five studies were suitable for inclusion in this review [5][6][7][8][9]. Fig.…”

“…The duration of follow-up ranged from 3 to 69 months (median, 27 months). One study investigated neurologically intact patients only [8], whereas two studies included neurologically intact and nonintact patients [5,7], and neurological status was not stated in two studies [6,9]. Table 1 summarizes patient demographics, fracture characteristics (including classification), and rationale of the approach of included studies.…”

Möglichkeiten zur Optimierung der Implantatstabilität bei osteoporotischen Frakturen der Wirbelsäule

“…Die Aufrechterhaltung einer physiologischen sagittalen Ausrichtung mit Wiederherstellung der regionalen Kyphosewinkel führt zu besseren klinischen Ergebnissen und geringere Risiken für Anschlussfrakturen. Das Risiko für die Entwicklung einer Anschlusskyphose (fraktur-und nicht frakturbedingt) wächst, je weniger eine sagittale Rekonstruktion erfolgt ist [20]. Dennoch sollte immer eine altersadaptierte Analyse des Risiko-Nutzen-Verhältnisses erfolgen.…”