Temporary Percutaneous Pedicle Screw Stabilization Without Fusion of Adolescent Thoracolumbar Spine Fractures

Cui, Shari; Busel, Gennadiy; Puryear, Aki

doi:10.1097/bpo.0000000000000520

Cited by 21 publications

(9 citation statements)

References 33 publications

(32 reference statements)

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“…In the present study, blood loss and operation time in the P group were lower than those in the O group. DISH patient with spinal fracture may be a good candidate for PPS fixation because (1) they do not need bone grafting, (2) they do not lose range of motion because segments are already fused by hyperostosis, (3) majority of patients are elderly with general comorbidities, and (4) removal of the spinal implants for the purpose of retrieving the segmental motion 24 is not mandatory.…”

Section: Discussionmentioning

confidence: 99%

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Spinal fractures in diffuse idiopathic skeletal hyperostosis: Advantages of percutaneous pedicle screw fixation

Okada

Shiono

Nishida

et al. 2019

J Orthop Surg (Hong Kong)

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To validate the effectiveness of percutaneous pedicle screw (PPS) fixation for spinal fractures associated with diffuse idiopathic skeletal hyperostosis (DISH) by comparing surgical outcomes for PPS fixation and conventional open posterior fixation. Patients with DISH are vulnerable to unstable spinal fractures caused by trivial trauma, and these fractures have high rates of delayed paralysis, postoperative complications, and mortality. Methods: This retrospective study assessed surgical outcomes for 16 patients with DISH (12 men; mean age 76.1 + 9.4 years) who underwent PPS fixation for spinal fractures (pedicle screw (PS) group), and for a control group of 25 patients with DISH (18 men; mean age 77.9 + 9.9 years) who underwent conventional open fixation (O group) at our affiliated hospitals from 2007 to 2017. We evaluated the preoperative physical condition (American Society of Anesthesiologists (ASA) classification), neurological status (Frankel grade), and improvement after surgery, fusion length, operating time, estimated blood loss, and perioperative complications. Results: Preoperatively, the PS group consisted of one ASA-1 patient, eight ASA-2 patients, six ASA-3 patients, and one ASA-4 patient; by Frankel grade, there were 2 grade B patients, 13 grade C, 4 grade D, and 6 grade E patients. The O group had 2 ASA-1 patients, 13 ASA-2, 9 ASA-3, and 1 ASA-4 patients. Frankel grades in the O group reflected severe neurological deficits, with 3 grade C patients, 2 grade D, and 11 grade E (p ¼ 0.032) patients. The two groups had similar rates of neurological improvement (33.3% of PS and 40.0% of O patients; p ¼ 0.410) and mean fusion length (PS 5.1 + 0.8 segments; O 4.9 + 1.2). The mean operating time and estimated blood loss were 168.1 + 46.7 min and 133.9 + 116.5 g, respectively, in the PS group, and 224.6 + 49.8 min and 499.9 + 368.5 g in the O group. Three O-group patients died of hypovolemic shock, respiratory failure, and pneumonia, respectively, within a year of surgery. Conclusion: Conventional open posterior fixation and PPS fixation for DISH-related spinal fractures were similar in fusion length and neurological improvement. However, PPS fixation was less invasive and had lower complication rates.

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Section: Discussionmentioning

confidence: 99%

“…they do not lose range of motion because segments are already fused by hyperostosis, (3) majority of patients are elderly with general comorbidities, and (4) removal of the spinal implants for the purpose of retrieving the segmental motion 24 is not mandatory.…”

Section: Pps Fixation For Thoracolumbar Injurymentioning

confidence: 99%

Spinal fractures in diffuse idiopathic skeletal hyperostosis: Advantages of percutaneous pedicle screw fixation

Okada

Shiono

Nishida

et al. 2019

J Orthop Surg (Hong Kong)

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“…This increased stiffness renders the region above the fusion site the last mobile segment, thereby leading to degenerative changes and adjacent segment disease [52]. Fusion is therefore avoided when possible, especially in younger populations, due to the increased lifelong risk of adjacent segment disease, or in the pediatric population where the spine must be allowed to grow [53]. In addition, many of the studies showing the inadequacy of spinal instrumentation alone were conducted decades ago, with older, less stable constructs than what is available today [47].…”

Section: Spinal Instrumentation and Fusionmentioning

confidence: 99%

“…As these ligamentous injuries may not heal effectively, the safety of hardware removal after bony healing may be questioned. However, there is increasing evidence that thoracolumbar injuries with a ruptured PLC may be effectively treated by temporary spinal fixation without fusion, with little to no progressive kyphosis or sagittal imbalance being reported up to 10 years after hardware removal (Figures 8a, 8b) [38,46,53,66,74]. showing no increased kyphosis.…”

Section: Spinal Instrumentation Removalmentioning

confidence: 99%

Posterior Ligamentous Complex Injuries of the Thoracolumbar Spine: Importance and Surgical Implications

Bizdikian¹,

Rachkidi²

2021

Cureus

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The soft tissues surrounding the spine play a primordial role in its stability, the most important of which are located posteriorly and are deemed the posterior ligamentous complex (PLC). Injuries to the PLC in the setting of thoracolumbar trauma are often dreaded and little attention has been given to them in the management protocols of thoracolumbar trauma. This review aims to summarize and contextualize current concepts in PLC injuries of the thoracolumbar spine with the aim to provide a clear guide for clinical management.Injuries to the PLC may be suspected on the clinical exam but are often missed, leading to serious complications, including instability and neurological compromise. The diagnosis is often made indirectly by spinal radiographs and CT-scanning or by direct visualization of soft tissues via magnetic resonance imaging. The latter remains the standard imaging modality and is mandatory for patients with a high suspicion of PLC injury. PLC injuries are associated with vertebral fractures and follow a progressive pattern of severity, depending on the mechanism of injury and extent of trauma. Surgical management is warranted, as PLC damage renders the spine unstable. Although fusion was once the standard of care and remains applicable for certain patients, recent endeavors of temporary spinal fixation without fusion are increasingly gaining traction in patients with PLC injuries.In conclusion, PLC injuries are challenging as they are often missed, poorly understood, and are not easily managed. Proper diagnosis and management are crucial to avoid long-standing complications such as spinal instability. Considering the paucity of available data on such an important topic in thoracolumbar trauma, this review article aims to contextualize current concepts in PLC injuries in order to demystify this sparsely covered subject.

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“…Yetişkinlerde perkütan tespit uygulamaları ve sonuçları iyi tanımlanmış olsa da çocuk hasta popülasyonda daha fazla çalışmaya ihtiyaç vardır. [32] Teorik olarak enstrümantasyonda kullanılan implantlar, kemik ve bağlar vücudun yükünü taşıyabilecek kadar kuvvetlendiğinde çıkarılabilir ki spontan füzyonu engellemek adına bu süre ortalama 12 aydır (Şekil 2). Anterior füzyon, direkt lateral füzyon ve extreme lateral interbody füzyon diğer cerrahi tedavi seçenekleridir.…”

Section: Cerrahi̇ Tedavi̇ Endi̇kasyonlariunclassified

Çocukluk yaş döneminin torakolomber ve lomber omurga kırıkları

Söyüncü¹

2018

TOTBID

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Çocukluk yaş döneminde görülen torakolomber omurga kırıkları, sık rastlanılan minör çökme kırıklarından nadir görülen tam spinal kord hasarının eşlik ettiği kırıklı çıkıklara kadar farklılık gösterir. Çocuklarda tüm ortopedik travmalar içinde mortalite oranı en yüksek olan yaralanmalar torakolomber kırıklardır. Bu durum sıklıkla kafa travması, torakal ve abdominal yaralanmalar ile ilişkili olup %50'ye varan oranda tanıda gecikmeye bağlıdır. [2,9] Ç ocukluk ve adolesan dönemde görülen torakolomber omurganın travmatik kırıkları nadir görülen, ancak yaşamı tehdit eden yaralanmalardır ve tüm çocukluk çağı iskelet sistemi yaralanmalarının %1-3'ünü oluşturur. [1][2][3][4][5] Çocukluk yaş dönemi omurga yaralanmaların önemli kısmı servikal bölgededir. Bu durum yetişkin hastalarla karşılaştırıldığında, çocuklarda kafatası çapının bedene oranla daha büyük olması yanında, boyun bölgesindeki destek görevi gören yumuşak dokuların daha zayıf olmasına da bağlıdır. Bu nedenle, çocuklarda tüm Çocukluk yaş döneminin torakolomber ve lomber omurga kırıkları Pediatric thoracolumbar and lumbar spine fractures

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Temporary Percutaneous Pedicle Screw Stabilization Without Fusion of Adolescent Thoracolumbar Spine Fractures

Abstract: Level IV-Retrospective case series.

Cited by 21 publications

References 33 publications

Spinal fractures in diffuse idiopathic skeletal hyperostosis: Advantages of percutaneous pedicle screw fixation

Spinal fractures in diffuse idiopathic skeletal hyperostosis: Advantages of percutaneous pedicle screw fixation

Posterior Ligamentous Complex Injuries of the Thoracolumbar Spine: Importance and Surgical Implications

Çocukluk yaş döneminin torakolomber ve lomber omurga kırıkları

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