Treatment of Unstable Thoracolumbar Fractures: Does Fracture-Level Fixation Accelerate the Bone Healing?

Özbek, Zühtü; Özkara, Emre; Önner, Hasan; Baş, Gültekin; Erman, İpek Canan; Özen, Hülya; Entok, Emre; Arslantaş, Ali

doi:10.1016/j.wneu.2017.08.007

Cited by 18 publications

(6 citation statements)

References 32 publications

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“… 76 – 86 Of these, 17 were retrospective studies (89.5%; level IV), 68 , 69 , 71 – 83 , 85 , 86 and two were randomized controlled trials (10.5%; level II). 70 , 84 Mean NOS score was 6.3 ± 1.1 points. Meta-analysis of the 19 studies 68 – 86 revealed an overall RR of 1.89 (95% CI: 1.60–2.24; p < 0.001) for smokers to develop nonunion ( Fig.…”

Section: Resultsmentioning

confidence: 93%

Fracture, nonunion and postoperative infection risk in the smoking orthopaedic patient: a systematic review and meta-analysis

et al. 2021

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This systematic review and meta-analysis aimed to analyse negative effects of smoking in orthopaedic and trauma patients. A PubMed search was carried out for studies published until July 2020 regarding effects of smoking on fracture risk, nonunion, infection after orthopaedic surgery, and persisting nonunion after scaphoid nonunion surgery. Random effects models calculated for outcome parameters, and relative risks (RR) with 95% confidence intervals are provided. No adjustments for covariates were made. Heterogeneity was assessed with Higgins’ I2, publication bias with Harbord’s p (Hp), sensitivity analysis performed on funnel plots and quality of studies was analysed using the Newcastle-Ottawa Scale. Of 3362 retrieved entries, 69 were included in the final analysis. Unadjusted RR for smokers to develop vertebral (six studies, seven entries; RR: 1.61; p = 0.008; I2 = 89.4%), hip (11 studies, 15 entries; RR: 1.28; p = 0.007; I2 = 84.1%), and other fractures (eight studies, 10 entries; RR: 1.75; p = 0.019; I2 = 89.3%) was significantly higher. Postoperative infection risk was generally higher for smokers (21 studies; RR: 2.20; p < 0.001; I2 = 58.9%), and remained upon subgroup analysis for elective spinal (two studies; RR: 4.38; p < 0.001; I2 = 0.0%) and fracture surgery (19 studies; RR: 2.10; p < 0.001; I2 = 58.5%). Nonunion risk after orthopaedic (eight studies; RR: 2.15; p < 0.001; I2 = 35.9%) and fracture surgery (11 studies; RR: 1.85; p < 0.001; I2 = 39.9%) was significantly higher for smokers, as was persisting nonunion risk after surgery for scaphoid nonunion (five studies; RR: 3.52; p < 0.001; I2 = 0.0%). Sensitivity analysis for each model reduced heterogeneity whilst maintaining significance (all I2 < 20.0%). Smoking has a deleterious impact on fracture incidence, and (subsequent) development of nonunions and postoperative infections. Cite this article: EFORT Open Rev 2021;6:1006-1019. DOI: 10.1302/2058-5241.6.210058

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Section: Resultsmentioning

confidence: 93%

Fracture, nonunion and postoperative infection risk in the smoking orthopaedic patient: a systematic review and meta-analysis

et al. 2021

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“…At the thoracolumbar junction and the lumbar spine short segmental stabilization is mostly sufficient with better clinical outcomes. 28 - 30 , 32 , 33 , 35 Thereby, the implementation of intermediate screws at the fracture level has shown to increase construct stability and to minimize reduction loss. 23 - 27 Monoaxial implants should be used if no additional anterior stabilization is performed.…”

Section: Resultsmentioning

confidence: 99%

Treatment of Fractures of the Thoracolumbar Spine: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU)

Verheyden¹,

Spiegl²,

Ekkerlein³

et al. 2018

Global Spine Journal

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Study Design:Abstract consensus paper with systematic literature review.Objective:The aim of this study was to establish recommendations for treatment of thoracolumbar spine fractures based on systematic review of current literature and consensus of several spine surgery experts.Methods:The project was initiated in September 2008 and published in Germany in 2011. It was redone in 2017 based on systematic literature review, including new AOSpine classification. Members of the expert group were recruited from all over Germany working in hospitals of all levels of care. In total, the consensus process included 9 meetings and 20 hours of video conferences.Results:As regards existing studies with highest level of evidence, a clear recommendation regarding treatment (operative vs conservative) or regarding type of surgery (posterior vs anterior vs combined anterior-posterior) cannot be given. Treatment has to be indicated individually based on clinical presentation, general condition of the patient, and radiological parameters. The following specific parameters have to be regarded and are proposed as morphological modifiers in addition to AOSpine classification: sagittal and coronal alignment of spine, degree of vertebral body destruction, stenosis of spinal canal, and intervertebral disc lesion. Meanwhile, the recommendations are used as standard algorithm in many German spine clinics and trauma centers.Conclusion:Clinical presentation and general condition of the patient are basic requirements for decision making. Additionally, treatment recommendations offer the physician a standardized, reproducible, and in Germany commonly accepted algorithm based on AOSpine classification and 4 morphological modifiers.

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“…The studies corroborate our findings, whose segmental kyphosis decreased soon after surgery, despite the return to baseline values after 12 months. 19 - 21 In the study by Chou et al, 19 the loss of segmental kyphosis was attributed to the loss of height of the injured intervertebral disc and not the progression of kyphosis in the fracture. These findings corroborate the results of this study, as local kyphosis remained practically stable for up to 12 months.…”

Section: Discussionmentioning

confidence: 99%

“…18 In this study, it was shown that after one year of follow-up, 84% of patients reported mild and moderate pain, and 72% said they would return to work despite the small loss of the final segmental kyphosis. Recently, Özbek et al 19 reported that short fixation had better clinical results and faster fusion despite the loss of the final postoperative kyphosis. The studies corroborate our findings, whose segmental kyphosis decreased soon after surgery, despite the return to baseline values after 12 months.…”

Section: Discussionmentioning

confidence: 99%

Thoracolombar Burst Fractures: Short Fixation, Without Arthrodesis and Without Removal of the Implant

2023

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Objectives: To present the functional outcomes, through the first case series in our country, of patients with thoracolumbar burst fractures (A3,A4), submitted to short posterior fixation, without arthrodesis and without removal of the implants, until the end of the minimum follow-up of one year. Methods: Fifty five patients consecutively treated between January/2010 and January/2019 were evaluated through medical records and imaging exams. Radiographic analysis was performed by mea suring local and segmental kyphosis using the Cobb method. Functional assessment was analyzed using the non-specific SF-36 questionnaire and the 1983 Denis pain and work-specific questionnaire, applied after 12 months of follow-up. Results: With a loss of five patients (9%), 22 (44%) patients reported having minimal and occasional pain and 8 (16%) patients reported having no pain. Three (6%) patients responded that they were completely incapacitated. Patients had a mean score of 73.16 points in the SF-36 domains. There was a significant reduction in kyphosis in 12 months (9.1±5.2 [min-max 0-22]) compared to the preoperative period (14.9±7.8 [min-max 0-32]) ( p≤0.01). One patient required implant removal due to the symptomatic prominence of the implant. Conclusion: This case series suggests that the technique leads to satisfactory functional results, without implant failure or significant kyphosis after a minimum follow-up of 12 months of treatment. Evidence Level IV; Case series.

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Treatment of Unstable Thoracolumbar Fractures: Does Fracture-Level Fixation Accelerate the Bone Healing?

Cited by 18 publications

References 32 publications

Fracture, nonunion and postoperative infection risk in the smoking orthopaedic patient: a systematic review and meta-analysis

Fracture, nonunion and postoperative infection risk in the smoking orthopaedic patient: a systematic review and meta-analysis

Treatment of Fractures of the Thoracolumbar Spine: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU)

Thoracolombar Burst Fractures: Short Fixation, Without Arthrodesis and Without Removal of the Implant

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