Review of 31 cases of anterior thoracolumbar fixation with the anterior thoracolumbar locking plate system

Abstract

<jats:p>Anterior fixation devices for the thoracolumbar spine have gained wide acceptance as viable alternatives to long-segment posterior fixation in cases of thoracolumbar spine trauma. This review was undertaken to evaluate the safety and efficacy of the Synthes anterior thoracolumbar locking plate (ATLP) system.</jats:p> <jats:p>Over a 3-year period, 31 patients with unstable traumatic fractures of the thoracolumbar spine underwent corpectomy, placement of a structural bone graft, and anterior fixation in which the Synthes ATLP system was used. Long-term follow-up data were obtained in 29 patients. Two patients were lost to follow up, one at 4 months and the other at 1 year. In the remaining patients, the average length of follow up was 20 months. In all patients radiographic evidence of solid bone fusion was demonstrated on follow-up plain x-ray films, and there were no signs or symptoms of pseudarthrosis. No patient suffered neurological deterioration as a result of surgery, and there was relatively little morbidity associated with this plating system. To date, none of the patients in this study has developed any delayed complications related to the fixation device. In one patient, who had sustained a severe flexion injury, loosening of the anterior fixation device occurred, and the patient developed progressive kyphosis, which required a posterior stabilization procedure.</jats:p> <jats:p>These results appear slightly better than those obtained in published studies in which other anterior plating systems were used, indicating that this system is safe and effective in the treatment of unstable fractures of the thoracolumbar spine.</jats:p>

Implications of the center of rotation concept for the reconstruction of anterior column lordosis and axial preloads in spinal deformity surgery

“…This was not the case with the LZ+TLS in which the tactile feedback of increasing recoil forces indicated stopping the lordosizing maneuver. With all endplate-based techniques, correction was stopped when cracks or very small injuries occurred, in anticipation of endplate failure, which might explain why we did not observe significant correlations between correction and BMD or age of specimens as we 1,37,38,49,86,87 In our experience standard spreaders are successful at opening the 1-level discectomy defect, but the current study stressed that with a lamina spreader and its edges cutting into the endplates, only little and pure distractive correction can be applied. Application of external forces at the apex of a kyphosis is a successful measure to open a corpectomy defect and insert a VBR press-fit.…”

“…One method is to apply external forces against the patient's back after corpectomy. 34,55 Other methods consist of the use of lamina and arthrodesis spreaders to open the intervertebral space, 1,37,38,86,87 distractors placed on bolt screws, 6 manufactured distractors (such as Kaneda instruments), 66,83 an anterior rigid plate with in situ expandability and reduction features, 17 or customized distractive forceps. 49 A concern is that current techniques apply mainly distractive forces to the vertebra adjacent to a corpectomy, which can cause functional unlocking of the facets and compromise the fulcrum of the COR that is otherwise provided by the posterior facets.…”

Contribution of Round vs. Rectangular Expandable Cage Endcaps to Spinal Stability in a Cadaveric Corpectomy Model

“…Some authors have advocated the use of anterior-only fixation in certain conditions, including up to three-column thoracolumbar injuries, as demonstrated with promising results in clinical studies. 15,[26][27][28] Conversely, Hitchon et al 29 recommend combined anterior-posterior fixation for threecolumn injuries. Anterior-only fixation has the advantage of being performed through the same surgical approach as the anterior column support; alleviating the need for a second posterior surgery and minimizing potential risks.…”

Acesso anterior para pacientes com fraturas traumáticas do tipo compressão do segmento toracolombar (T11 a L2) da coluna vertebral

“…Wilson et al 20 Wood et al 6 realizaram estudo comparativo utilizando a abordagem anterior ou posterior nos pacientes com fraturas toracolombares estáveis sem déficit neurológico, analisando as diferenças radiográficas, clínicas e os resultados funcionais. os autores concluíram que, embora os resultados com os pacientes fossem similares, a fusão e a instrumentação anterior tendem a apresentar menos complicações ou necessidade de cirurgias adicionais.…”