Recurrent kyphosis after posterior stabilization of thoracolumbar fractures: 24 cases treated with a Dick internal fixator followed for 1.5-4 years

Speth, M. J. G. M.; Öner, F. Cumhur; Kadic, M. A. C.; Klerk, Luuk W. L. de; Verbout, Abraham J.

doi:10.3109/17453679508995575

Cited by 78 publications

(42 citation statements)

References 17 publications

(22 reference statements)

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“…There was no sufficient fusion to the fracture area. d After IR there was an additional loss of correction and intevertebral fusion occurred in the posterior intervertebral area according to several authors [7,11,14,17,19,20,24,25,29,35,36,38,40]. The six patients with a partial fusion showed the non-fusion area between the graft and the fractured endplate.…”

Section: Discussionmentioning

confidence: 99%

PLIF in thoracolumbar trauma: technique and radiological results

et al. 2010

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Patients with fractures from the 11th thoracic to the 5th lumbar vertebra had a reconstruction of the anterior column with monocortical iliac crest autograft by using a single dorsal approach. The loss of correction was observed using X-rays pre-and post-operatively, at 3 months and after implant removal (IR). Successful fusion was assessed using computed tomography after the implant removal. To assess the loss of correction and intervertebral fusion rate of this technique. There are still controversial discussions about the treatment modalities of spine lesions, especially in cases of burst fractures. Dorsal, combined and ventral procedures are reported with different assets and drawbacks. We want to present a method to restore the weightbearing capability of the anterior column using a single dorsal approach. From 2001 to 2005, a total of 100 patients was treated with this technique at our department. Followup examination was possible in 82 patients. The X-rays and CT scans were proofed for loss of correction and fusion rate. The anterior column has been restored using a monocortical strut graft via a partial resection of the lamina and the apophyseal joint on one side to access the disc space. The dorsal reduction has been achieved using an angular stable pedicle screw system. The mean follow-up time was 15 months (range 8-39); 67 patients had a CT scan at follow-up and 83% showed a 360°fusion. The average post-operative loss of correction was 3.3°(range 0-21). The average duration of operation was 192 min (range 120-360) and the mean blood loss was 790 ml (range 300-3,400 ml). Regarding the complications we did not have any deep wound infections. We had two epidural haematomas postoperatively with a neurological deterioration that had to be revised. We were able to decompress the neurological structures and restore the weight-bearing capability of the anterior column in a one-stage procedure. So we think that this technique can be an alternative procedure to combined operations regarding the presented radiological results of successful fusion and loss of correction.

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Section: Discussionmentioning

confidence: 99%

PLIF in thoracolumbar trauma: technique and radiological results

et al. 2010

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“…The possibilities of vertebroplasty to reduce the endplate impression are limited and can only be achieved by building pressure on the cement, which is strongly associated with an increase in cement leakage that can result in spinal cord compression and pulmonary embolism [33][34][35]. The use of inflatable bone tamps in the treatment of osteoporotic compression fractures has received a lot of attention the last few years [36][37][38]42]. This procedure was basically invented primarily to correct the deformity by lifting the compressed part of the vertebra to a more physiologic position before polymethyl methacrylate cement injection.…”

Section: Discussionmentioning

confidence: 99%

Short segment pedicle screw instrumentation and augmentation vertebroplasty in lumbar burst fractures: an experience

Afzal¹,

Saleem²,

Dhar³

2008

Eur Spine J

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To assess the efficacy and feasibility of vertebroplasty and posterior short-segment pedicle screw fixation for the treatment of traumatic lumbar burst fractures. Short-segment pedicle screw instrumentation is a well described technique to reduce and stabilize thoracic and lumbar spine fractures. It is relatively a easy procedure but can only indirectly reduce a fractured vertebral body, and the means of augmenting the anterior column are limited. Hardware failure and a loss of reduction are recognized complications caused by insufficient anterior column support. Patients with traumatic lumbar burst fractures without neurologic deficits were included. After a short segment posterior reduction and fixation, bilateral transpedicular reduction of the endplate was performed using a balloon, and polymethyl methacrylate cement was injected. Pre-operative and post-operative central and anterior heights were assessed with radiographs and MRI. Sixteen patients underwent this procedure, and a substantial reduction of the endplates could be achieved with the technique. All patients recovered uneventfully, and the neurologic examination revealed no deficits. The postoperative radiographs and magnetic resonance images demonstrated a good fracture reduction and filling of the bone defect without unwarranted bone displacement. The central and anterior height of the vertebral body could be restored to 72 and 82% of the estimated intact height, respectively. Complications were cement leakage in three cases without clinical implications and one superficial wound infection. Posterior short-segment pedicle fixation in conjunction with balloon vertebroplasty seems to be a feasible option in the management of lumbar burst fractures, thereby addressing all the three columns through a single approach. Although cement leakage occurred but had no clinical consequences or neurological deficit.

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“…Been et al [6] compared long-term results after 6 years of posterior vs. combined instrumentations and found no clinical-functional differences between both the groups, but a higher rate of implant failure and more loss of correction after posterior surgery alone. Several studies have highlighted the importance of a sufficient reconstruction of the anterior load-bearing column as a precaution to prevent a secondary loss of correction and implant failure [51,59,60,79]. For these reasons and based on this study's finding, the concept of combined posterior-anterior (COMBINED) surgery for the treatment of Magerl type B, C and type A3 compression injuries that are perceived to be insufficient to resist a physiological axial load has become increasingly established within members of the German Spine Study Group during the past 10 years.…”

Section: Discussionmentioning

confidence: 99%

Operative treatment of 733 patients with acute thoracolumbar spinal injuries: comprehensive results from the second, prospective, internet-based multicenter study of the Spine Study Group of the German Association of Trauma Surgery

et al. 2010

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The second, internet-based multicenter study (MCSII) of the Spine Study Group of the German Association of Trauma Surgery (Deutsche Gesellschaft für Unfallchirurgie) is a representative patient collection of acute traumatic thoracolumbar (T1-L5) injuries. The MCSII results are an update of those obtained with the first multicenter study (MCSI) more than a decade ago. The aim of the study was to assess and bring into focus: the (1) epidemiologic data, (2) surgical and radiological outcome, and (3) 2-year follow-up (FU) results of these injuries.According to the Magerl/AO classification, there were 424 (57.8%) compression fractures (A type), 178 (24.3%) distractions injuries (B type), and 131 (17.9%) rotational injuries (C type). B and C type injuries carried a higher risk for neurological deficits, concomitant injuries, and multiple vertebral fractures. The level of injury was located at the thoracolumbar junction (T11-L2) in 67.0% of the case. 380 (51.8%) patients were operated on by posterior stabilization and instrumentation alone (POSTERIOR), 34 (4.6%) had an anterior procedure (ANTERIOR), and 319 (43.5%)

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Recurrent kyphosis after posterior stabilization of thoracolumbar fractures: 24 cases treated with a Dick internal fixator followed for 1.5-4 years

Cited by 78 publications

References 17 publications

PLIF in thoracolumbar trauma: technique and radiological results

PLIF in thoracolumbar trauma: technique and radiological results

Short segment pedicle screw instrumentation and augmentation vertebroplasty in lumbar burst fractures: an experience

Operative treatment of 733 patients with acute thoracolumbar spinal injuries: comprehensive results from the second, prospective, internet-based multicenter study of the Spine Study Group of the German Association of Trauma Surgery

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