Long-term follow-up results in patients with thoracolumbar unstable burst fracture treated with temporary posterior instrumentation without fusion and implant removal surgery

Abstract

Segmental fusion is not necessarily needed in treatment of thoracolumbar unstable burst fracture requiring surgery. Our objective was to report the results of follow-up for at least 10 years in patients with thoracolumbar unstable burst fracture requiring surgery in which fractured segment was healed following temporary posterior instrumentation without fusion, and in whom implants were subsequently removed. Retrospective Cohort Study. Nineteen patients in whom union of fractured vertebra was observed following surgery and in whom implants were removed within an average 12.2 months, and who could be followed up for at least 10 years, were enrolled. At the last follow-up, we evaluated the segmental motions, anterior body height ratio, progress of further kyphotic deformity, Oswestry Disability Index, Rolland Morris Disability Questionnaire and Short Form 36. Results: The follow-up period after implant removal surgery was 151 months on average. The local kyphotic angle was 26.89 ± 6.08 degrees at the time of injury and 10.11 ± 2.22 degrees at the last follow-up. The anterior body height ratio was 0.54 ± 0.16 at the time of injury and 0.89 ± 0.05 at the last follow-up. Thus, the fractured vertebra was significantly reduced after surgery and maintained till last follow-up. The segmental motion was 9.84 ± 3.03, Oswestry Disability Index was 7.95 ± 7.38, Rolland Morris Disability Questionnaire was 2.17 ± 2.67, short form 36 Physical Component Score was 77.50 ± 16.61, and short form 36 Mental Component Score was 79.21 ± 13.32 at last follow-up. We conducted at least 10-year follow-up and found that temporary posterior instrumentation without fusion should be considered one of the useful alternative treatments for thoracolumbar unstable burst fracture in place of the traditional posterior instrumentation and fusion.

Implant Removal Versus Implant Retention Following Posterior Surgical Stabilization of Thoracolumbar Burst Fractures: A Systematic Review and Meta-Analysis

“…Two studies by Ko et al both state that there is no significant difference in average anterior body height ratio (ABHR) after removal surgery and correction is maintained. 29,36 This is supported by the stable AVH that Chen et al observed with minimal loss from surgery (97.6% + 6.5%) to final follow-up 94.3% + 5.9%. 28 However, Kim et al found evidence of vertebral height loss of 15.3% after implant removal rising to 17.4% at final follow-up (p < 0.01).…”

“…34,38,40 In a similar manner, Ko et al reported statistically significant improvement in Oswestry Disability Index (ODI) scores from 15.86 + 7.93 to 7.96 + 7.38 at last follow-up (p < 0.001). 29 Jeon et al concurred with this finding when they noted that mean ODI at implant removal was 26.6 + 10.4 improving to 16.3 + 11.5 at 1-year follow-up (p ¼ 0.000), which was further reduced to 12.7 + 8.1 (p ¼ 0.000) at 2 years. In patients with neurological deficit who registered exceptionally high disability indices, Chen et al witnessed a remarkable fall in disability from 86.1 + 8.8 preoperatively to 15.9 + 6.4 (p < 0.05) at 1 year, and a further improvement to 8.4 + 4.6 at final follow-up.…”

“…30,31,34 Given its invaluable use as a surrogate of deformity correction after thoracolumbar burst fracture fixation, 12 of the 13 included studies in this systematic review reported the Cobb Angle as an outcome measure. [29][30][31][32][33][34][35][36][37][38][39][40] Seven of these studies demonstrated that there was statistically significant loss of CA correction after implant removal. In their 2016 study, Aono et al found that just before implant removal at 12 months there was surgical reduction loss by 2.38 degrees, which deteriorated by another 7.58 degrees after removal.…”

The Radiological Complications of Short-Segment Pedicle Screw Fixation Combined with Transforaminal Interbody Fusion in the Treatment of Unstable Thoracolumbar Burst Fracture: A Retrospective Case Series Study in Vietnam

“…However, it was reported that this procedure was an effective treatment in patients with thoracolumbar unstable burst fracture who had a McCormack load-sharing score of less than 7 points. 27 Percutaneous fixation alone 28 without grafting or with thoracoscopically assisted corpectomy 29 is sufficient for treating thoracolumbar burst fractures with satisfactory results. Minimally invasive techniques provide more advantages than traditional open approaches in the treatment of thoracolumbar burst fractures.…”

Posterior Ligamentous Complex Injuries of the Thoracolumbar Spine: Importance and Surgical Implications

“…As these ligamentous injuries may not heal effectively, the safety of hardware removal after bony healing may be questioned. However, there is increasing evidence that thoracolumbar injuries with a ruptured PLC may be effectively treated by temporary spinal fixation without fusion, with little to no progressive kyphosis or sagittal imbalance being reported up to 10 years after hardware removal (Figures 8a, 8b) [38,46,53,66,74]. showing no increased kyphosis.…”