Long-Term Follow-Up Results of Thoracolumbar Fractures After Posterior Instrumentation

Taşdemiroğlu, Erol; Tibbs, Phillip A.

doi:10.1097/00007632-199508000-00011

Cited by 59 publications

(25 citation statements)

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“…All these parameters affect the decision regarding the surgical approach, with each parameter being an indication for one or the other approach. Therefore, no consensus has been reached about the ideal treatment approach [18,19].…”

Section: Introductionmentioning

confidence: 99%

Anterior versus posterior approach for treatment of thoracolumbar burst fractures: a meta-analysis

Xiong

et al. 2013

Eur Spine J

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Purpose To critically review and summarize the literature comparing the results of surgery via an anterior approach and that via a posterior approach for the treatment of thoracolumbar burst fractures to identify the better approach. Methods In this meta-analysis, we conducted electronic searches of MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and other databases using the search terms ''thoracolumbar fractures'', ''anterior'', ''posterior'', ''controlled clinical trials''. Relevant journals or conference proceedings were also searched manually. Data extraction and quality assessment were in accordance with Cochrane Collaboration guidelines. The analysis was performed on individual patient data from all the trials that met the selection criteria. Sensitivity analysis was performed when there was significant heterogeneity. Results were expressed as risk difference for dichotomous outcomes and mean difference for continuous outcomes with 95 % confidence interval. Results Four randomized clinical trials and three controlled clinical trials comparing the results of the anterior versus posterior approach in the treatment of thoracolumbar burst fractures were retrieved; these studies included 179 and 152 patients in the anterior and posterior approach groups, respectively. There were no differences in terms of neurological recovery, return to work, complications and Cobb angle between the two groups. The anterior approach was associated with longer operative time, greater blood loss and higher cost than the posterior approach. Conclusions The posterior approach may be more effective than the anterior approach. However, more highquality, randomized controlled trials are required to compare these approaches and guide clinical decision-making. Level of Evidence Level II, therapeutic study. See the Guidelines for Authors for a complete description of level of evidence.

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Section: Introductionmentioning

confidence: 99%

Anterior versus posterior approach for treatment of thoracolumbar burst fractures: a meta-analysis

Xiong

et al. 2013

Eur Spine J

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“…Ten authors report persistent neurological deterioration. 11,12,21,23,26,31,33,42,46,60 One found that 17% of patients who were initially neurologically intact suffered deterioration after surgery. 21 Tables V and VI give an overview of the more common complications.…”

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confidence: 99%

Does ‘Canal Clearance’ Affect Neurological Outcome After Thoracolumbar Burst Fractures?

Boerger

Limb

Dickson

2000

The Journal of Bone and Joint Surgery. British volume

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Surgical decompression of the spinal canal is presently accepted worldwide as the method of treatment for thoracolumbar burst fractures with neurological deficit in the belief that neurological recovery may be produced or enhanced. Our clinical and laboratory experience, however, indicates that the paralysis occurs at the moment of injury and is not related to the position of the fragments of the fracture on subsequent imaging. Since the preoperative geometry of the fracture may be of no relevance, our hypothesis, backed by more than two decades of operative experience, is that alteration of the canal by 'surgical clearance' does not affect the neurological outcome.We have reviewed the existing world literature in an attempt to find evidence-based justification for the variety of surgical procedures used in the management of these fractures. We retrieved 275 publications on the management of burst fractures of which 60 met minimal inclusion criteria and were analysed more closely. Only three papers were prospective studies; the remainder were retrospective descriptive analyses. None of the 60 articles included control groups. The design of nine studies was sufficiently similar to allow pooling of their results, which failed to establish a significant advantage of surgical over non-surgical treatment as regards neurological improvement. Significant complications were reported in 75% of papers, including neurological deterioration. Surgical treatment for burst fracture in the belief that neurological improvement can be achieved is not justified, although surgery may still occasionally be indicated for structural reasons. This information should not be withheld from the patients. There are many different classifications of thoracolumbar spinal injuries but the most popular is that of Denis 1 which is based on the three-column theory as considered in the sagittal plane. The three columns are the anterior, which comprises the front half of the bodies and the anterior longitudinal ligament, the middle, namely the back half of the bodies and the posterior longitudinal ligament, and the posterior, which includes the laminae, facet joints and spinous processes plus the ligaments and muscles attached to them. The more columns which are damaged the more unstable is the injury. Four fundamental types of fracture can be distinguished: 1) a simple, stable anterior wedge compression fracture with compression of the anterior column; 2) distraction injuries, referred to as seat-belt injuries; 3) burst fractures with compression of both the anterior and middle columns; and, finally, 4) fracture-dislocations of the spine which are unstable and involve all three columns.Burst fractures are produced by vertical compressive loads, usually with some degree of flexion, since the anterior column is squashed down more than the middle column. Although bone bursts in all directions, one of the compelling images of a burst fracture can be seen on transverse CT which shows bone retropulsed into the spinal canal. Such scans may show a range o...

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“…15,30,40 As an example, the major factors for return to work are associated with education level and absence of compensatory complaints. 5,31,36 Like many authors, we contend that surgical management of unstable spinal fractures can provide satisfactory results, but questions remain as to how best to treat these lesions. Performing short-segment posterior fixation with pedicle screws can allow lordotic distraction for restoration of vertebral body height and kyphosis correction.…”

Section: Surgical Strategymentioning

confidence: 99%

Circumferential management of unstable thoracolumbar fractures using an anterior expandable cage, as an alternative to an iliac crest graft, combined with a posterior screw fixation: results of a series of 85 patients

Graillon

Rakotozanany

Blondel

et al. 2014

FOC

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Object The optimal management of unstable thoracolumbar fractures remains unclear. The objective of the present study was to evaluate the results of using an expandable prosthetic vertebral body cage (EPVBC) in the management of unstable thoracolumbar fractures. Methods Eighty-five patients with unstable T7–L4 thoracolumbar fractures underwent implantation of an EPVBC via an anterior approach combined with posterior fixation. Long-term functional outcomes, including visual analog scale and Oswestry disability index scores, were evaluated. Results In a mean follow-up period of 16 months, anterior fixation led to a significant increase in vertebral body height, with an average gain of 19%. However, the vertebral regional kyphosis angle was not significantly increased by anterior fixation alone. No significant difference was found between early postoperative, 3-month, and 1-year postoperative regional kyphosis angle and vertebral body height. Postoperative impaction of the prosthetic cage in adjacent endplates was observed in 35% of the cases, without worsening at last follow-up. Complete fusion was observed at 1 year postoperatively and no cases of infections or revisions were observed in relation to the anterior approach. Conclusions The use of EPVBCs for unstable thoracolumbar fractures is safe and effective in providing long-term vertebral body height restoration and kyphosis correction, with a moderate surgical and sepsis risk. Anterior cage implantation is an alternative to iliac bone graft fusion and is a viable option in association with a posterior approach, in a single operation without additional risks.

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Long-Term Follow-Up Results of Thoracolumbar Fractures After Posterior Instrumentation

Cited by 59 publications

References 0 publications

Anterior versus posterior approach for treatment of thoracolumbar burst fractures: a meta-analysis

Anterior versus posterior approach for treatment of thoracolumbar burst fractures: a meta-analysis

Does ‘Canal Clearance’ Affect Neurological Outcome After Thoracolumbar Burst Fractures?

Circumferential management of unstable thoracolumbar fractures using an anterior expandable cage, as an alternative to an iliac crest graft, combined with a posterior screw fixation: results of a series of 85 patients

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