Percutaneous fixation of thoracolumbar vertebral fractures

Sebaaly, Amer; Rizkallah, Maroun; Riouallon, Guillaume; Wang, Zhi; Moreau, Pierre Emmanuel; Bachour, Falah; Maalouf, Ghassan

doi:10.1302/2058-5241.3.170026

Cited by 9 publications

(10 citation statements)

References 62 publications

(88 reference statements)

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“…In this study, an LSS score ≥7 was also an independent risk factor for correction loss. Some studies have reported that ligamentous healing was mechanically weak, thus increasing the risk of instability (e.g., AO classifications B2 and C) [ 10 ]. In this study, this surgical procedure was performed in cases where it was judged possible to maintain a good repositioning position even with an LSS score of 7 or 8 points, taking bone quality and other factors into consideration.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Postoperative Loss of Correction in Thoracolumbar Injuries Caused by High-Energy Trauma Treated via Percutaneous Posterior Stabilization without Bone Fusion

et al. 2022

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Background and Objectives: Percutaneous pedicle screws were first introduced in 2001, soon becoming the cornerstone of minimally invasive spinal stabilization. Use of the procedure allowed adequate reduction and stabilization of spinal injuries, even in severely injured patients. This decreased bleeding and shortened surgical time, thereby optimizing outcomes; however, postoperative correction loss and kyphosis still occurred in some cases. Thus, we investigated cases of percutaneous posterior fixation for thoracolumbar injury and examined the factors affecting the loss of correction. Materials and Methods: Sixty-seven patients who had undergone percutaneous posterior fixation for thoracolumbar injury (AO classifications A3, A4, B, and C) between 2009 and 2016 were included. Patients with a local kyphosis angle difference ≥10° on computed tomography at the postoperative follow-up (over 12 months after surgery) or those requiring additional surgery for interbody fusion were included in the correction loss group (n = 23); the no-loss group (n = 44) served as the control. The degree of injury (injury level, AO classification, load-sharing score, local kyphosis angle, cuneiform deformity angle, and cranial and caudal disc injury) and surgical content (number of fixed intervertebral vertebrae, type of screw used, presence/absence of screw insertion into the injured vertebrae, and presence/absence of vertebral formation) were evaluated as factors of correctional loss and compared between the two groups. Results: Comparison between each group revealed that differences in the wedge-shaped deformation angle, load-sharing score, degree of cranial disc damage, AO classification at the time of injury, and use of polyaxial screws were statistically significant. Logistic regression analysis showed that the differences in wedge-shaped deformation angle, AO classification, and cranial disc injury were statistically significant; no other factors with statistically significant differences were found. Conclusion: Correction loss was seen in cases with damage to the cranial intervertebral disc as well as the vertebral body.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Postoperative Loss of Correction in Thoracolumbar Injuries Caused by High-Energy Trauma Treated via Percutaneous Posterior Stabilization without Bone Fusion

et al. 2022

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“… 30 However, these techniques also have drawbacks, such as increasing the radiation exposure to the patient and the surgeon because of fluoroscopy and a long learning curve. 28 In addition, our technique may be changed to minimally invasive surgery by applying percutaneous pedicle screw fixation.…”

Section: Discussionmentioning

confidence: 99%

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

Nguyen

Phan

2022

ORR

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Background The radiological complications including correction loss and hardware failure of short segment posterior pedicle screw fixation in the treatment of unstable thoracolumbar burst fractures remain a main concern. Several procedures aiming to reinforce the anterior column have been introduced to solve these limitations, including transforaminal interbody fusion (TIF). The purposes of this study were to evaluate the radiological complications of short-segment pedicle screw fixation in combination with transforaminal interbody fusion in the treatment of unstable thoracolumbar burst fractures. Methods This retrospective case series study enrolled patients with isolated unstable thoracolumbar burst fractures, who were treated by posterior short fixation with TIF between January 2013 and January 2017. Patients were followed up for a minimum of one and half years. For evaluation of correction loss, % loss of anterior vertebral body height (%AVB), vertebral kyphotic angle (VA) and regional kyphotic angle (RA) were collected preoperatively, postoperatively and at the final follow-up. Hardware failure was assessed on radiological images at the last follow-up. Results There were 36 patients who met the inclusion criteria with a mean follow-up duration of 53 months. The mean correction loss of %AVB, VA and RA were 10.2%, 2.9 ° and 5.6 ° , respectively. There were 6 patients (16.7%) with hardware failure at the final follow-up. Conclusion Short-segment posterior pedicle screw fixation with TIF using bone chip grafts does not completely prevent hardware failure and progressive kyphosis in the treatment of unstable thoracolumbar burst fractures.

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“…Different treatment options exist for thoracolumbar injuries, ranging from non-surgical treatments to instrumentation and spinal fusion. The management usually depends on a wide range of variables, of which spinal stability and neurological status reign supreme [7,10,16,36,37].…”

Section: Treatmentmentioning

confidence: 99%

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

Bizdikian¹,

Rachkidi²

2021

Cureus

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The soft tissues surrounding the spine play a primordial role in its stability, the most important of which are located posteriorly and are deemed the posterior ligamentous complex (PLC). Injuries to the PLC in the setting of thoracolumbar trauma are often dreaded and little attention has been given to them in the management protocols of thoracolumbar trauma. This review aims to summarize and contextualize current concepts in PLC injuries of the thoracolumbar spine with the aim to provide a clear guide for clinical management.Injuries to the PLC may be suspected on the clinical exam but are often missed, leading to serious complications, including instability and neurological compromise. The diagnosis is often made indirectly by spinal radiographs and CT-scanning or by direct visualization of soft tissues via magnetic resonance imaging. The latter remains the standard imaging modality and is mandatory for patients with a high suspicion of PLC injury. PLC injuries are associated with vertebral fractures and follow a progressive pattern of severity, depending on the mechanism of injury and extent of trauma. Surgical management is warranted, as PLC damage renders the spine unstable. Although fusion was once the standard of care and remains applicable for certain patients, recent endeavors of temporary spinal fixation without fusion are increasingly gaining traction in patients with PLC injuries.In conclusion, PLC injuries are challenging as they are often missed, poorly understood, and are not easily managed. Proper diagnosis and management are crucial to avoid long-standing complications such as spinal instability. Considering the paucity of available data on such an important topic in thoracolumbar trauma, this review article aims to contextualize current concepts in PLC injuries in order to demystify this sparsely covered subject.

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Percutaneous fixation of thoracolumbar vertebral fractures

Cited by 9 publications

References 62 publications

Risk Factors for Postoperative Loss of Correction in Thoracolumbar Injuries Caused by High-Energy Trauma Treated via Percutaneous Posterior Stabilization without Bone Fusion

Risk Factors for Postoperative Loss of Correction in Thoracolumbar Injuries Caused by High-Energy Trauma Treated via Percutaneous Posterior Stabilization without Bone Fusion

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

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

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