Short Posterior Stabilization in Combination With Cement Augmentation for the Treatment of Thoracolumbar Fractures and the Effects of Implant Removal

Abstract

Study Design:Retrospective case series.Objective:Short posterior stabilization with vertebroplasty is one treatment option for thoracolumbar burst fractures (AO A3). Whether it avoids progression in segmental kyphosis, especially after implant removal, is unclear. In a retrospective case-control study, its stability and the effect on intervertebral discs with and without implant removal was studied.Methods:Fifty-nine consecutive patients were treated with bisegmental short posterior instrumentation and additional vertebroplasty of the fractured vertebra. Twenty-nine patients (male/female 17/12; age: 41.7 ± 15.4 years) underwent implant removal. Changes of segmental kyphosis and disc heights between both groups (with and without implant removal) were compared on lateral X-rays preoperative, postoperative, after 1 year and after implant removal. Risk factors for loss of reduction were analyzed.Results:Kyphosis increased up to 12 months after implant removal. The loss of bisegmental correction was 6.0 ± 4.2 (range 0° to 16°) 12 months after implant removal. Risk factors for loss of reduction are younger patient age, fractures of the thoracolumbar junction (Th12), and degree of traumatic kyphosis. Intervertebral discs traversed by the stabilization lose height and don’t recover within 1 year after implant removal. Without implant removal, disc height of the lower adjacent level is reduced after 24 months.Conclusions:Short posterior stabilization in combination with vertebroplasty is a treatment alternative for thoracic and lumbar AO A3 fractures. After implant removal kyphosis increases, predominantly in the segment above the augmented vertebra. Risk factors for loss of reduction include younger age, fractures of the thoracolumbar junction (T12), and higher fracture kyphosis.

Implant Removal Versus Implant Retention Following Posterior Surgical Stabilization of Thoracolumbar Burst Fractures: A Systematic Review and Meta-Analysis

“…This is a notable finding given the routine removal of implants following surgical stabilization with or without arthrodesis has previously remained controversial. 3,4,45 It is vital to recognize that our study deliberately excluded the cohort of overtly symptomatic patients, such as those with pain or disability, related to infection or hardware failure. Stavridis et al have already observed markedly improved pain scores following instrumentation removal in these circumstances.…”

“…This is a notable finding given the routine removal of implants following surgical stabilization with or without arthrodesis has previously remained controversial. 3 , 4 , 45 …”

Should kyphoplasty curettes be used in nonosteoporotic patients? A cautionary tale

“…As demonstrated by Figure , the T10 fracture is associated with the almost complete destruction of the anterior one‐third of the vertebral body. Although some may argue that cement augmentation should be reserved for osteoporotic fractures, there is an extensive literature, albeit mostly of retrospective nature, supporting the role of such therapeutic alternative in traumatic fractures …”

“…Although some may argue that cement augmentation should be reserved for osteoporotic fractures, there is an extensive literature, albeit mostly of retrospective nature, supporting the role of such therapeutic alternative in traumatic fractures. 4,5 Ultimately, because of the comminuted pattern of the T10 burst fracture and the multilevel nature of the injuries, the patient was offered the option of proceeding with a minimally invasive navigation-guided T8 to L1 posterior screw and rod fixation and T10, T11, and L2 kyphoplasties. After placement of the screws, the kyphoplasties were conducted ( Figure 3).…”

“…Although the literature supporting the use of cement augmentation for traumatic fractures is less robust than that of osteoporotic vertebral fractures, such techniques have been extensively employed, either by themselves or in combination with minimally invasive screw and rod fixation for the treatment of thoracolumbar vertebral body fractures, especially those associated with extensive STIR changes in the vertebral body as demonstrated by MRI.…”