Midterm outcome after posterior stabilization of unstable Midthoracic spine fractures in the elderly

Abstract

Background The evidence for the treatment of midthoracic fractures in elderly patients is weak. The aim of this study was to evaluate midterm results after posterior stabilization of unstable midthoracic fractures in the elderly. Methods Retrospectively, all patients aged ≥65 suffering from an acute unstable midthoracic fracture treated with posterior stabilization were included. Trauma mechanism, ASA score, concomitant injuries, ODI score and radiographic loss of reduction were evaluated. Posterior stabilization strategy was divided into short-segmental stabilization and long-segmental stabilization. Results Fifty-nine patients (76.9 ± 6.3 years; 51% female) were included. The fracture was caused by a low-energy trauma mechanism in 22 patients (35.6%). Twenty-one patients died during the follow-up period (35.6%). Remaining patients (n = 38) were followed up after a mean of 60 months. Patients who died were significantly older (p = 0.01) and had significantly higher ASA scores (p = 0.02). Adjacent thoracic cage fractures had no effect on mortality or outcome scores. A total of 12 sequential vertebral fractures occurred (35.3%). The mean ODI at the latest follow up was 31.3 ± 24.7, the mean regional sagittal loss of reduction was 5.1° (± 4.0). Patients treated with long segmental stabilization had a significantly lower rate of sequential vertebral fractures during follow-up (p = 0.03). Conclusion Unstable fractures of the midthoracic spine are associated with high rates of thoracic cage injuries. The mortality rate was rather high. The majority of the survivors had minimal to moderate disabilities. Thereby, patients treated with long segmental stabilization had a significantly lower rate of sequential vertebral body fractures during follow-up.

Awake Percutaneous Fixation for Unstable Fractures of the Spine in High-risk Patients: A Retrospective Study

“…Previous studies have reported on the advantages and nuances of this technique; however, despite some similarities of the surgical approach, these studies focused on degenerative diseases or kyphoplasty rather than instrumentation for unstable fractures, and some of them treated under general anesthesia. 10,27,28 The closest related study is the one written by Chopko; in his study, he conducted percutaneous decompression, vertebral fixation, and fusion in 13 patients having spondylopathy and lower back pain under sedation in a neuroangiography room. All the patients presented a very high risk for general anesthesia as determined by related comorbidities and patient age.…”

“…[6][7][8] Other studies disagree with this, and reports of improved clinical and radiologic outcomes after surgery also exist. 9,10 In cases in which an unstable fracture is present, the current literature is inconclusive regarding treatment of elderly patients because of the high risk that this population represents. For instance, Mao et al described an increased risk for medical complications in patients older than 80 years who underwent surgery.…”

“…6-8 Other studies disagree with this, and reports of improved clinical and radiologic outcomes after surgery also exist. 9,10…”

Effect of subsequent vertebral body fractures on the outcome after posterior stabilization of unstable geriatric fractures of the thoracolumbar spine

“…Otherwise, an additional CT was carried out in patients with signs of vertebral fractures after low and moderate energy trauma, which was done in 4% of the patients. The trauma mechanism was analyzed and divided into low energy trauma, moderate energy trauma, and high energy trauma in accordance to Spiegl et al [9]. Additionally, fractures that could not be remembered were defined as insufficiency fractures.…”

“…Relevant kyphotic malalignment leads to an increase rate of subsequent vertebral body fractures due to increased biomechanical stress first of all at the adjacent vertebral bodies and secondly in the midthoracic spine [8]. However, studies have shown unexpected high rates of subsequent vertebral body fractures after posterior stabilization despite low to moderate loss of reduction [6,9]. Additionally, subsequent vertebral fractures were associated with worse clinical outcome after operative stabilization [6].…”