Radiologic and Functional Outcomes in Unstable Thoracolumbar Fractures Treated With Short-segment Pedicle Instrumentation

Rojas-Tomba, F.; Hernández-Ruiz, Ángel; Menéndez-Quintanilla, Ismael; Quevedo-Puerta, David García de; Moriel-Durán, José; Villanueva-Pareja, Francisco

doi:10.1097/bsd.0000000000000393

Cited by 10 publications

(14 citation statements)

References 21 publications

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“…This discrepancy was inferred from chronic sustained back pain, caused by malalignment of the thoracolumbar spine (i.e., kyphosis) even with neurological improvement. Although the discrepancy of radiological outcomes and clinical outcomes are often reported by some articles [3,34,41-43], some other evidence also reported that T-L junction kyphosis led to chronic back pain and that its correction resulted in the improvement of clinical symptoms in the posttraumatic kyphosis [7,39,44].…”

Section: Discussionmentioning

confidence: 99%

Analysis of the Risk Factors for Unfavorable Radiologic Outcomes after Fusion Surgery in Thoracolumbar Burst Fracture : What Amount of Postoperative Thoracolumbar Kyphosis Correction is Reasonable?

Seo

Kim

Jung

et al. 2019

J Korean Neurosurg Soc

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Section: Discussionmentioning

confidence: 99%

Analysis of the Risk Factors for Unfavorable Radiologic Outcomes after Fusion Surgery in Thoracolumbar Burst Fracture : What Amount of Postoperative Thoracolumbar Kyphosis Correction is Reasonable?

Seo

Kim

Jung

et al. 2019

J Korean Neurosurg Soc

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“…However, anterior stabilization is less desirable due to the potentially increased morbidity and the desired preservation of spinal motion, especially in younger patients. 19,21 Therefore, the wish to obtain sufficient stabilization via a posterior only approach is present.…”

Section: Discussionmentioning

confidence: 99%

“…15 Modern surgical techniques and more sophisticated instrumentation may have contributed to the reduction in instrumentation failure. 14,19,20 Few studies were comparable to the original article of McCormack et al 5 The studies that had used the same technique either did not mention the materials used or used titanium screws and rods which makes it incomparable to the stainless steel constructs used by McCormack et al 5 Due to these improvements the LSC has not managed to maintain itself in present time. Therefore, it has lost its predictive value and thus its reliability for predicting clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…[12][13][14][15][16][17] Four did not find instrumentation failure at all. [18][19][20][21] One reported no instrumentation failure but recommended to use long-segment posterior instrumentation (LSPI) instead of short-segment posterior instrumentation (SSPI) for patients with a high LSC score. 22 The last one reported instrumentation failure, but stated that SSPI only can be used successful in patients with a high LSC.…”

Section: No Relation Between Lsc and Instrumentation Failurementioning

confidence: 99%

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The Predictive Value of the Load Sharing Classification Concerning Sagittal Collapse and Posterior Instrumentation Failure: A Systematic Literature Review

Stam

Deunk

Elzinga

et al. 2019

Global Spine Journal

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Study design: Systematic review. Objective: In 1994, the Load Sharing Classification (LSC) was introduced to aid the choice of surgical treatment of thoracolumbar spine fractures. Since that time this classification system has been commonly used in the field of spine surgery. However, current literature varies regarding its use and predictive value in relation to implant failure and sagittal collapse. The objective of this study is to assess the predictive value of the LSC concerning the need for anterior stabilization to prevent sagittal collapse and posterior instrumentation failure. Methods: An electronic search of PubMed, Medline, Embase, and the Cochrane Library was performed. Inclusion criteria were (1) cohort or clinical trial (2) including patients with thoracolumbar burst fractures (3) whose severity of the fractured vertebrae was assessed by the LSC. Results: Five thousand eighty-two articles have been identified, of which 21 articles were included for this review. Twelve studies reported no correlation between the LSC and sagittal collapse or instrumentation failure in patients treated with short-segment posterior instrumentation (SSPI). Seven articles found no significant relation; 5 articles found no instrumentation failure at all. The remaining 9 articles experienced failure in patients with a high LSC or recommended a different surgical technique. Conclusions: Although the LSC was originally developed to predict the need for anterior stabilization in addition to SSPI, many studies show that SSPI only can be sufficient in treating thoracolumbar fractures regardless of the LSC. The LSC might have lost its value in predicting sagittal collapse and posterior instrumentation failure.

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“…Historically, for Magerl, type A fracture was a strictly bony and stable injury [2]. Nonetheless, several studies have highlighted a loss of sagittal correction after fracture treatment, whether it was conservative or surgical [7][8][9]. This loss of correction was evaluated around 10% and was located in the disc for 75% and in the vertebral body for the remaining 25%.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of disc degeneration adjacent to AOspine A fractures: pre- and post-operative MRI analysis

Marie-Hardy

Ali

Khalifé

et al. 2020

SICOT-J

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Introduction: The management of type A thoracolumbar fractures varies from conservative treatment to multiple level fusion. Indeed, although Magerl defined the type A fracture as a strictly bone injury, several authors suggested associated disc lesions or degeneration after trauma. However, the preservation of mobility of the adjacent discs should be a major issue. This study was conducted to analyze the presence of immediate post-traumatic disc injuries and to know if discs degenerate after receiving treatment. Methods: We retrospectively reviewed the files of 27 patients with an AOspine A fracture, corresponding to 34 fractures (64 discs) with pre and post-operative MRI (mean follow-up: 32.4 months). Based on Pfirrmann’s and Oner’s classifications of disc injuries, two observers analyzed independently the type of lesion in the discs adjacent to the fractured vertebra in immediate post-trauma and at the last follow-up. Results: The immediate post-traumatic analysis according to Pfirrmann’s classification found 97% of the cranial adjacent discs and 100% of the caudal discs classified Pfirrmann 3 or less. The analysis on the secondary MRI revealed that 78% of cranial adjacent discs and 88% of caudal adjacent discs still were classified Pfirrmann 3 or less. Conclusions: Since, the great majority of type A fractures does not cause immediate disc injuries, these fractures are, as described by Magerl, strictly bony injuries. The quality of the body reduction seems to prevent secondary degeneration. These results may encourage surgeons not to perform arthrodesis on type A fractures even for A3 and A4.

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Radiologic and Functional Outcomes in Unstable Thoracolumbar Fractures Treated With Short-segment Pedicle Instrumentation

Cited by 10 publications

References 21 publications

Analysis of the Risk Factors for Unfavorable Radiologic Outcomes after Fusion Surgery in Thoracolumbar Burst Fracture : What Amount of Postoperative Thoracolumbar Kyphosis Correction is Reasonable?

Analysis of the Risk Factors for Unfavorable Radiologic Outcomes after Fusion Surgery in Thoracolumbar Burst Fracture : What Amount of Postoperative Thoracolumbar Kyphosis Correction is Reasonable?

The Predictive Value of the Load Sharing Classification Concerning Sagittal Collapse and Posterior Instrumentation Failure: A Systematic Literature Review

Evaluation of disc degeneration adjacent to AOspine A fractures: pre- and post-operative MRI analysis

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