Thorakolumbale Wirbelfrakturen nach konservativer und operativer Behandlung

Katscher, S.; Verheyden, P.; Gonschorek, O.; Glasmacher, Stefan; Josten, Christoph

doi:10.1007/s00113-002-0459-7

Cited by 40 publications

(19 citation statements)

References 18 publications

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“…At this high age, multiple complications can result in a prolonged wound healing. Local infection rates after dorsoventral approach ranged between 7% and 14% [25-27]. The next problem consists in the osteoporotic vertebrae themselves: We were able to observe fractures of the vertebrae in the next segment that was located caudal or cephalad to the fixateur interne.…”

Section: Resultsmentioning

confidence: 99%

Safe surgical technique: cement-augmented pedicle screw instrumentation and balloon-guided kyphoplasty for a lumbar burst fracture in a 97-year-old patient

et al. 2013

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BackgroundDuring the last few years, an increasing number of unstable thoracolumbar fractures, especially in elderly patients, has been treated by dorsal instrumentation combined with a balloon kyphoplasty. This combination provides additional stabilization to the anterior spinal column without any need for a second ventral approach.Case presentationWe report the case of a 97-year-old male patient with a lumbar burst fracture (type A3-1.1 according to the AO Classification) who presented prolonged neurological deficits of the lower limbs - grade C according to the modified Frankel/ASIA score. After a posterior realignment of the fractured vertebra with an internal screw fixation and after an augmentation with non-absorbable cement in combination with a balloon kyphoplasty, the patient regained his mobility without any neurological restrictions.ConclusionEspecially in older patients, the presented technique of PMMA-augmented pedicle screw instrumentation combined with balloon-assisted kyphoplasty could be an option to address unstable vertebral fractures in “a minor-invasive way”. The standard procedure of a two-step dorsoventral approach could be reduced to a one-step procedure.

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Section: Resultsmentioning

confidence: 99%

Safe surgical technique: cement-augmented pedicle screw instrumentation and balloon-guided kyphoplasty for a lumbar burst fracture in a 97-year-old patient

et al. 2013

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“…Posterior, anterior and combined operative techniques have been used for operative stabilization of thoracolumbar burst fractures. Anterior decompression allows decompression under direct vision,928–30 however, anterior approach is associated with increased morbidity as compared to posterior approach 233132. Recent studies showed no clear advantage when anterior was compared with posterior surgery 3334.…”

Section: Discussionmentioning

confidence: 99%

Treatment of acute thoracolumbar burst fractures with kyphoplasty and short pedicle screw fixation: Transpedicular intracorporeal grafting with calcium phosphate: A prospective study

Korovessis

Repantis²,

Petsinis³

2007

Indian J Orthop

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Background:In the surgical treatment of thoracolumbar fractures, the major problem after posterior correction and transpedicular instrumentation is failure to support the anterior spinal column, leading to loss of correction and instrumentation failure with associated complaints. We conducted this prospective study to evaluate the outcome of the treatment of acute thoracolumbar burst fractures by transpedicular balloon kyphoplasty, grafting with calcium phosphate cement and short pedicle screw fixation plus fusion.Materials and Methods:Twenty-three consecutive patients of thoracolumbar (T9 to L4) burst fracture with or without neurologic deficit with an average age of 43 years, were included in this prospective study. Twenty-one from the 23 patients had single burst fracture while the remaining two patients had a burst fracture and additionally an adjacent A1-type fracture. On admission six (26%) out of 23 patients had neurological deficit (five incomplete, one complete). Bilateral transpedicular balloon kyphoplasty with liquid calcium phosphate to reduce segmental kyphosis and restore vertebral body height and short (three vertebrae) pedicle screw instrumentation with posterolateral fusion was performed. Gardner kyphosis angle, anterior and posterior vertebral body height ratio and spinal canal encroachment were calculated pre- to postoperatively.Results:All 23 patients were operated within two days after admission and were followed for at least 12 months after index surgery. Operating time and blood loss averaged 45 min and 60 cc respectively. The five patients with incomplete neurological lesions improved by at least one ASIA grade, while no neurological deterioration was observed in any case. The VAS and SF-36 (Role physical and Bodily pain domains) were significantly improved postoperatively. Overall sagittal alignment was improved from an average preoperative 16° to one degree kyphosis at final followup observation. The anterior vertebral body height ratio improved from 0.6 preoperatively to 0.9 (P<0.001) postoperatively, while posterior vertebral body height improved from 0.95 to 1 (P<0.01). Spinal canal encroachment was reduced from an average 32% preoperatively to 20% postoperatively. Cement leakage was observed in four cases (three anterior to vertebral body and one into the disc without sequalae). In the last CT evaluation, there was a continuity between calcium phosphate and cancellous vertebral body bone. Posterolateral radiological fusion was achieved within six months after index operation. There was no instrumentation failure or measurable loss of sagittal curve and vertebral height correction in any group of patients.Conclusions:Balloon kyphoplasty with calcium phosphate cement secured with posterior short fixation in the thoracolumbar spine provided excellent immediate reduction of posttraumatic segmental kyphosis and significant spinal canal clearance and restored vertebral body height in the fracture level.

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“…Nach konservativer Therapie traten insgesamt weniger Korrekturverluste auf als nach operativer Behandlung. Einen möglichen Grund hierfür sehen wir in einer nicht zusätzlich stattfindenden Schädigung der Bandscheiben durch die Immobilisation im Fixateur interne [5].…”

Section: Korrekturverlustunclassified