Risk factors for a kyphosis recurrence after short-segment temporary posterior fixation for thoracolumbar burst fractures

Aono, Hiroyuki; Ishii, Keisuke; Takenaka, Shota; Tobimatsu, Hidekazu; Nagamoto, Yukitaka; Horii, Chiaki; Yamashita, Tomoya; Furuya, Masayuki; Iwasaki, Motoki

doi:10.1016/j.jocn.2019.04.035

“…In this study, nal kyphotic deformity and loss of correction were set as the objective variables. To our knowledge, only two previous studies have investigated the predictors of kyphosis following implant removal in posterior pedicle screw xation without fusion for thoracolumbar burst fracture [16,17]. These studies set loss of correction alone as the objective variable, although the clinical signi cance of loss of correction following implant removal is as yet unclear in the literature [16,17].…”

Section: Discussionmentioning

confidence: 99%

“…Also, in a comparative retrospective study by Aono et al, initial severe kyphosis at the time of injury was associated with loss of correction. In their study, they used an increase of more than than 10° in the kyphotic angle at the nal observation compared with kyphotic angle after posterior xation, and they evaluated initial severe kyphosis in the same way as in our study [17]. We decided to use an increase of more than 15° in our study based on a review article by Mazel et al in which thoracolumbar burst fracture with kyphosis of 15° or more was considered to require correction [18].…”

Section: Discussionmentioning

confidence: 99%

Vacuum Phenomenon as a Predictor of Kyphosis After Implant Removal Following Posterior Pedicle Screw Fixation Without Fusion for Thoracolumbar Burst Fracture: a Single-center Retrospective Study

Hirahata

¹

,

Kitagawa

²

,

Yasui

³

et al. 2021

Preprint

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Background: Posterior pedicle screw fixation without fusion has been commonly applied for thoracolumbar burst fracture. Implant removal is performed secondarily after bone union. However, the occurrence of secondary kyphosis has recently attracted attention. Secondary kyphosis results in poor clinical outcomes. The purpose of this was to determine predictors of kyphosis after implant removal following posterior pedicle screw fixation without fusion for thoracolumbar burst fracture.Methods: This retrospective study reviewed 60 consecutive patients with thoracolumbar burst fracture who underwent implant removal following posterior pedicle screw fixation without fusion. Inclusion criteria were non-osteoporotic fracture and T11-L4 burst fracture. Old age, sex, initial severe wedge deformity, initial severe kyphosis, and vacuum phenomenon were examined as factors potentially associated with final kyphotic deformity (defined as kyphotic angle greater than 25°) or loss of correction. Logistic regression analysis was performed using propensity score matching.Results: Among the 31 female and 29 male patients (mean age 39 years), final kyphotic deformity was found in 17 cases (28%). Multivariate analysis showed a significant association with the vacuum phenomenon. Loss of correction was found in 35 cases (58%) and showed a significant association with the vacuum phenomenon. There were no significant associations with other factors.Conclusions: The findings of this study suggest that the vacuum phenomenon before implant removal may be a predictor of secondary kyphosis of greater than 25° after implant removal following posterior pedicle screw fixation without fusion for thoracolumbar burst fracture, but that old age, sex, initial severe kyphosis, and initial severe wedge deformity may not be predictors.

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“…In this study, nal kyphotic deformity and loss of correction were set as the objective variables. To our knowledge, only two previous studies have investigated the predictors of kyphosis following implant removal in posterior pedicle screw xation without fusion for thoracolumbar burst fracture [16,17]. These studies set loss of correction alone as the objective variable, although the clinical signi cance of loss of correction following implant removal is as yet unclear in the literature [16,17].…”

Section: Discussionmentioning

confidence: 99%

Vacuum Phenomenon As A Predictor of Kyphosis After Implant Removal Following Posterior Pedicle Screw Fixation Without Fusion For Thoracolumbar Burst Fracture: A Single-Center Retrospective Study

Hirahata

¹

,

Kitagawa

²

,

Yasui

³

et al. 2021

Preprint

Self Cite

0

View full text Add to dashboard Cite

Background: Posterior pedicle screw fixation without fusion has been commonly applied for thoracolumbar burst fracture. Implant removal is performed secondarily after bone union. However, the occurrence of secondary kyphosis has recently attracted attention. Secondary kyphosis results in poor clinical outcomes. The purpose of this was to determine predictors of kyphosis after implant removal following posterior pedicle screw fixation without fusion for thoracolumbar burst fracture.Methods: This retrospective study reviewed 60 consecutive patients with thoracolumbar burst fracture who underwent implant removal following posterior pedicle screw fixation without fusion. Inclusion criteria were non-osteoporotic fracture and T11-L4 burst fracture. Old age, sex, initial severe wedge deformity, initial severe kyphosis, and vacuum phenomenon were examined as factors potentially associated with final kyphotic deformity (defined as kyphotic angle greater than 25°) or loss of correction. Logistic regression analysis was performed using propensity score matching.Results: Among the 31 female and 29 male patients (mean age 39 years), final kyphotic deformity was found in 17 cases (28%). Multivariate analysis showed a significant association with the vacuum phenomenon. Loss of correction was found in 35 cases (58%) and showed a significant association with the vacuum phenomenon. There were no significant associations with other factors.Conclusions: The findings of this study suggest that the vacuum phenomenon before implant removal may be a predictor of secondary kyphosis of greater than 25° after implant removal following posterior pedicle screw fixation without fusion for thoracolumbar burst fracture, but that old age, sex, initial severe kyphosis, and initial severe wedge deformity may not be predictors.

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“…Thoracolumbar burst fractures at either or both endplates with the integrated posterior ligamentous complex, which are morphologically classified as type A3 or A4 by the AOSpine Classification, can be treated with posterior short-segment fixation without fusion [3][4][5]. Although this approach is widely accepted with satisfying outcomes, several studies found the vertebral body to recollapse and kyphosis to recur after surgery, especially after implant removal [6,7]. Therefore, whether the implant should be removed after vertebral healing is controversial in the context of this nonfusion surgery [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Healing pattern classification for thoracolumbar burst fractures after posterior short-segment fixation

Liang

¹

,

Liu

²

,

Liang

³

et al. 2020

BMC Musculoskelet Disord

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Background: Thoracolumbar burst fractures can be treated with posterior short-segment fixation. However, no classification can help to estimate whether the healed vertebral body will have sufficient stability after implant removal. We aimed to develop a Healing Pattern Classification (HPC) to evaluate the stability of the healed vertebra based on cavity size and location. Methods: Fifty-two thoracolumbar burst fracture patients treated with posterior short-segmental fixation without fusion and followed up for an average of 3.2 years were retrospectively studied. The HPC was divided into 4 types: type I-no cavity; type II-a small cavity with or without the violation of one endplate; type III-a large cavity with or without the violation of one endplate; and type IV-a burst cavity with the violation of both endplates or the lateral cortical shell. The intraobserver and interobserver intraclass correlation coefficients (ICCs) of the HPC were assessed. The demographic characteristics and clinical outcomes of the cohort were compared between the stable group (types I and II) and the unstable group (types III and IV). Logistic regression was conducted to evaluate risk factors for unstable healing. Results: The intraobserver and interobserver ICCs of the HPC were 0.86 (95% CI = 0.74-0.90) and 0.77 (95% CI = 0.59-0.86), respectively. While the unstable healing group (types III and IV) accounted for 59.6% of the patients, most of these patients were asymptomatic. The preoperative Load Sharing Classification (LSC) comminution score may predict the occurrence of unstable healing (OR = 8.4, 95% CI = 2.4-29.7). Conclusions: A reliable classification for assessing the stability of a healed vertebra was developed. With type I and II healing, the vertebra is considered stable, and the implant can be removed. With type III healing, the vertebra may have healing potential, but the implant should not be removed unless type II healing is achieved. With type IV healing, the vertebra is considered extremely unstable, and instrumentation should be maintained. Assessing the LSC comminution score preoperatively may help to predict unstable healing after surgery.

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Risk factors for a kyphosis recurrence after short-segment temporary posterior fixation for thoracolumbar burst fractures

Cited by 25 publications

References 22 publications

Vacuum Phenomenon as a Predictor of Kyphosis After Implant Removal Following Posterior Pedicle Screw Fixation Without Fusion for Thoracolumbar Burst Fracture: a Single-center Retrospective Study

Vacuum Phenomenon as a Predictor of Kyphosis After Implant Removal Following Posterior Pedicle Screw Fixation Without Fusion for Thoracolumbar Burst Fracture: a Single-center Retrospective Study

Vacuum Phenomenon As A Predictor of Kyphosis After Implant Removal Following Posterior Pedicle Screw Fixation Without Fusion For Thoracolumbar Burst Fracture: A Single-Center Retrospective Study

Healing pattern classification for thoracolumbar burst fractures after posterior short-segment fixation

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