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

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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.

Section: Discussionmentioning

confidence: 76%

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

Cinnella

Rava

Mahagna

et al. 2019

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“…Thanks to the good results, we reported that, in this study, associated with other reported in literature, we can suggest surgeons to consider the surgical approach with PMMA CSF to osteoporosis fracture as a safe and reliable treatment. Despite these results is suggestable, for very frail patients, to consider conservative approaches,[ 22 ] and every surgeon that decides to approach this kind of surgery must be aware of the many possible complications; it is strongly recommended to avoid the occasional surgery.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and reliability of cannulated fenestrated screws augmented with polymethylmethacrylate cement in the surgical treatment of osteoporotic vertebral fractures

Coniglio

Rava

Fusini

et al. 2021

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Background: Implants' stability, especially in osteoporosis patients, is a challenging matter. Nowadays, the adoption of cannulated fenestrated screws augmented with polymethylmethacrylate cement (PMMA CSF) is described by some authors. This single-center, retrospective observational study aims to evaluate the long-term effectiveness, reliability, and mechanical performances of this type of screws in osteoporotic fractures. Materials and Methods: All the patients surgically treated from January 2009 to December 2019 with PMMA CSF were evaluated and submitted to the inclusion and exclusion criteria. Clinical and radiological evaluations were performed at pre- and post-surgery time and at the follow-up (FU). Loss of correction in the sagittal plane (bisegmental Cobb angle), kyphosis angle of the fracture (fractured vertebral angle), loosening of pedicle screws (screw's apex vertebral body's anterior cortex mean gap called SAAC gap and screw's apex vertebral body's superior endplate mean gap called SASE gap), visual analog scale, and Oswestry disability index scores were evaluated. Results: One hundred and sixty-three patients (58 males and 105 females) aged over 65 years affected by vertebral osteoporotic fractures were included in the study. At FU, we do not found significant differences in radiological items in respect to the postoperative period. Only one case of loosening and 18 cases of cement leaking (without neurological impairments) were found. Clinical scores improvement was significant in the interval between preoperative and FU. Conclusions: PMMA CSF seems to can guarantee good efficacy and effectiveness in the surgical treatment of vertebral fractures in osteoporosis.

“…A possible alternative treatment is the use of cast on traction bed to reduce and contain TL vertebral fracture; however, a great dislocation of the posterior wall is a contraindication. [ 11 ] On the other hand, surgical stabilization of unstable burst fracture with or without poly methyl methacrylate augmentation could be a valuable choice and suitable to different age of patients according to bone mineral density. [ 12 13 14 15 16 ]…”

Section: Discussionmentioning

confidence: 99%

Back to the future in traumatic fracture shapes of lumbar spine: An analysis of risk of kyphosis after conservative treatment

Fusini

Colò²,

Risitano

et al. 2021

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Introduction: Nonosteoporotic burst vertebral fracture could commonly be treated with conservative or surgical approach. Currently, decision-making process is based on thoracolumbar (TL) AO spine severity injury score. However, some factors could affect posttraumatic kyphosis (PTK) and could be taken into account. The aim of the present study is to identify if axial and sagittal fracture shape and initial kyphosis are the risk factors for PTK. Materials and Methods: All consecutive patients treated between 2016 and 2017 for TL vertebral fracture with conservative treatment were retrospectively evaluated in the study. Only type A3 and A4 vertebral fractures were included in the study. Patients suffering from osteoporosis or other metabolic bone disease, aged above 60 years old were excluded from the study. Initial and 6 months X-ray from injury were analyze to evaluate local kyphosis and region of injury while initial assessment was performed with computed tomography to better identify fracture type and in some cases magnetic resonance imaging to exclude posterior ligament complex injury. Axial and sagittal view of the vertebral plate was analyzed and classified in three shapes according to fragment comminution and dislocation. Statistical analysis was performed trough STATA13 software. Student's t -test was used to evaluate the differences between initial and follow up kyphosis; odds ratio (OR) was used to evaluate the role of initial kyphosis, vertebral sagittal and axial fracture shape as a risk factor for PTK. Kruskal–Wallis test was used to assess the differences among vertebral shape fractures and final kyphosis. Fisher's exact test was used to assess the differences between fracture patterns and final kyphosis. Results: An initial kyphosis >10° (OR 36.75 P = 0.015), shape c vertebral plate (OR 147 P = 0.0015), and sagittal shape 3 (OR 32.25 P = 0.0025) are strongly related with PTK. Kruskal–Wallis test revealed a statistically significant difference among axial fracture shape ( P < 0.0001) and sagittal fracture shape ( P = 0.004) and also for initial kyphosis >10° ( P < 0.0001). Fisher's exact test showed a significant difference for final kyphosis among pattern c3 and other patterns of fracture ( P = 0.0001). Conclusions: A burst type lumbar vertebral fracture affecting a patient with initial local kyphosis >10° and comminution and displacement of vertebral plate and vertebral body is at high risk to develop a local kyphosis >20° in the follow-up if treated conservatively.