Does kyphotic deformity correlate with functional outcomes in fractures at the thoracolumbar junction treated by 360° instrumented fusion?

Abstract Background The surgical approaches to thoracolumbar junction (T12-L1) tuberculosis were controversial. We aimed to compare the safety and efficacy of three different procedures through a multicentre retrospective study. Methods The medical records of thoracolumbar junction tuberculosis patients (n = 177) from January 2005 to January 2015 were collected and reviewed. Forty-five patients underwent anterior debridement and instrumented fusion (Group A), 52 underwent anterior combined with posterior debridement and instrumented fusion (Group B) and 80 underwent posterior-only debridement and instrumented fusion (Group C). Patients with neurological deficit were 10 in Group A, 23 in Group B, 36 in Group C. All patients had a standard preoperative and postoperative anti - tuberculous therapy regimen. Clinical outcomes, laboratory indexes and radiological evaluation of the three groups were compared. Operations at each centre were performed by the respective senior medical teams of the six different hospitals. Results All three surgical approaches achieved bone fusion and pain relief. Cases with neurological deficits had different degrees of improvement after surgery. The operative time was 330.2 ± 45.4 min, 408.0 ± 54.3 min, 227.9 ± 58.5 min, and the blood loss was 744.0 ± 193.8 ml, 1134.6 ± 328.2 ml, 349.8 ± 289.4 ml in groups A, B and C respectively. The average loss of correction was 5.5 ± 3.7° in group A, 1.6 ± 1.9° in group B, 1.7 ± 2.2° in group C, and the difference between groups except B vs C were of statistically significant (P < 0.05). Conclusions For patients with thoracolumbar junction (T12-L1) tuberculosis, the posterior-only procedure is the better than the anterior-only procedure in the correction of kyphosis and maintenance of spinal stability. The posterior-only procedure is recommended because it achieves the same efficacy as combined procedure with shorter operation time, less blood loss and trauma.

Download Full-text

Comparison of Functional Outcomes following Surgical Decompression and Posterolateral Instrumented Fusion in Single Level Low Grade Lumbar Degenerative versus Isthmic Spondylolisthesis

Clinics in Orthopedic Surgery ◽

10.4055/cios.2014.6.2.185 ◽

2014 ◽

Vol 6 (2) ◽

pp. 185 ◽

Cited By ~ 6

Author(s):

Farzad Omidi-Kashani ◽

Ebrahim Ghayem Hasankhani ◽

Mohammad Dawood Rahimi ◽

Reza Khanzadeh

Keyword(s):

Functional Outcomes ◽

Surgical Decompression ◽

Low Grade ◽

Isthmic Spondylolisthesis ◽

Instrumented Fusion ◽

Single Level

Download Full-text

Comparison of three surgical approaches for thoracolumbar junction (T12-L1) tuberculosis: a multicentre, retrospective study

10.21203/rs.2.13914/v3 ◽

2019 ◽

Author(s):

Yanping Zeng ◽

Peng Cheng ◽

Jiulin Tan ◽

Zhilin Li ◽

Yuan Chen ◽

...

Keyword(s):

Retrospective Study ◽

Blood Loss ◽

Operation Time ◽

Neurological Deficits ◽

Thoracolumbar Junction ◽

Surgical Approaches ◽

Instrumented Fusion ◽

Group A ◽

Group B ◽

Multicentre Retrospective Study

Abstract Background: The surgical approaches to thoracolumbar junction (T12-L1) tuberculosis were controversial. We aimed to compare the safety and efficacy of three different procedures through a multicentre retrospective study. Methods: The medical records of thoracolumbar junction tuberculosis patients (n = 177) from January 2005 to January 2015 were collected and reviewed. 45 patients underwent anterior debridement and instrumented fusion (Group A), 52 underwent anterior combined with posterior debridement and instrumented fusion (Group B) and 80 underwent posterior-only debridement and instrumented fusion (Group C). Patients with neurological deficit were 10 in Group A, 23 in Group B, 36 in Group C. All patients had a standard preoperative and postoperative anti - tuberculous therapy regimen. Clinical outcomes, laboratory indexes and radiological evaluation of the three groups were compared. Operations at each centre were performed by the respective senior medical teams of the six different hospitals. Results: All three surgical approaches achieved bone fusion and pain relief. Cases with neurological deficits had different degrees of improvement after surgery. The operative time was 330.2±45.4min, 408.0±54.3min, 227.9±58.5min, and the blood loss was 744.0±193.8ml, 1134.6±328.2ml, 349.8±289.4ml in groups A, B and C respectively. The average loss of correction was 5.5±3.7° in group A, 1.6±1.9° in group B, 1.7±2.2° in group C, and the difference between groups except B vs C were of statistically significant (P < 0.05). Conclusions: For patients with thoracolumbar junction (T12-L1) tuberculosis, the posterior-only procedure is the better than the anterior-only procedure in the correction of kyphosis and maintenance of spinal stability. The posterior-only procedure is recommended because it achieves the same efficacy as combined procedure with shorter operation time, less blood loss and trauma.

Download Full-text

Comparison of three surgical approaches for thoracolumbar junction (T12-L1) tuberculosis: a multicentre, retrospective study

10.21203/rs.2.13914/v2 ◽

2019 ◽

Author(s):

Yanping Zeng ◽

Peng Cheng ◽

Jiulin Tan ◽

Zhilin Li ◽

Yuan Chen ◽

...

Keyword(s):

Retrospective Study ◽

Blood Loss ◽

Spinal Tuberculosis ◽

Thoracolumbar Junction ◽

Surgical Approaches ◽

Instrumented Fusion ◽

Group A ◽

Group B ◽

Posterior Debridement ◽

Multicentre Retrospective Study

Abstract Background: The surgical approaches to thoracolumbar junction (T12-L1) tuberculosis were controversial. We aimed to compare the safety and efficacy of three surgical approaches through a multicentre retrospective study. Methods: The medical records of thoracolumbar junction tuberculosis patients (n = 177) from January 2005 to January 2015 were collected and reviewed. 45 patients underwent anterior debridement and instrumented fusion (Group A), 52 underwent anterior combined with posterior debridement and instrumented fusion in a single- or two-stage procedure (Group B) and 80 underwent posterior debridement and instrumented fusion (Group C). Patients with neurological deficit were 10 in Group A, 23 in Group B, 36 in Group C. All patients had a standard preoperative and postoperative anti - tuberculous therapy regimen. Clinical outcomes, laboratory indexes and radiological results of the three groups were compared. Operations at each centre were performed by the same senior medical team in each centre. Results: All three surgical approaches achieved bone fusion and pain relief. All patients with neurological deficits had different degrees of recovery after surgery. The operative time was 330.2±45.4min, 408.0±54.3min, 227.9±58.5min, and the blood loss was 744.0±193.8ml, 1134.6±328.2ml, 349.8±289.4ml in groups A, B and C respectively. The mean loss of correction was 5.5±3.7° in group A, 1.6±1.9° in group B, 1.7±2.2° in group C, and the difference between groups except B vs C were of statistically significant (P < 0.05). Conclusions: For patients with thoracolumbar junction (T12-L1) tuberculosis, the posterior-only procedure is superior to the anterior-only procedure in the correction of kyphosis and maintenance of spinal stability. The posterior-only procedure is recommended because it achieves the same efficacy as the anterior-only or combined procedure but with shorter operation times, less trauma and less blood loss. Keywords: Spinal tuberculosis; Thoracolumbar junction lesion; Surgical treatment; Outcome.

Download Full-text

Comparison of three surgical approaches for thoracolumbar junction (T12-L1) tuberculosis: a multicentre, retrospective study

10.21203/rs.2.13914/v4 ◽

2019 ◽

Author(s):

Yanping Zeng ◽

Peng Cheng ◽

Jiulin Tan ◽

Zhilin Li ◽

Yuan Chen ◽

...

Keyword(s):

Retrospective Study ◽

Blood Loss ◽

Operation Time ◽

Neurological Deficits ◽

Thoracolumbar Junction ◽

Surgical Approaches ◽

Instrumented Fusion ◽

Group A ◽

Group B ◽

Multicentre Retrospective Study

Abstract Background: The surgical approaches to thoracolumbar junction (T12-L1) tuberculosis were controversial. We aimed to compare the safety and efficacy of three different procedures through a multicentre retrospective study. Methods: The medical records of thoracolumbar junction tuberculosis patients (n = 177) from January 2005 to January 2015 were collected and reviewed. 45 patients underwent anterior debridement and instrumented fusion (Group A), 52 underwent anterior combined with posterior debridement and instrumented fusion (Group B) and 80 underwent posterior-only debridement and instrumented fusion (Group C). Patients with neurological deficit were 10 in Group A, 23 in Group B, 36 in Group C. All patients had a standard preoperative and postoperative anti - tuberculous therapy regimen. Clinical outcomes, laboratory indexes and radiological evaluation of the three groups were compared. Operations at each centre were performed by the respective senior medical teams of the six different hospitals. Results: All three surgical approaches achieved bone fusion and pain relief. Cases with neurological deficits had different degrees of improvement after surgery. The operative time was 330.2±45.4min, 408.0±54.3min, 227.9±58.5min, and the blood loss was 744.0±193.8ml, 1134.6±328.2ml, 349.8±289.4ml in groups A, B and C respectively. The average loss of correction was 5.5±3.7° in group A, 1.6±1.9° in group B, 1.7±2.2° in group C, and the difference between groups except B vs C were of statistically significant (P < 0.05). Conclusions: For patients with thoracolumbar junction (T12-L1) tuberculosis, the posterior-only procedure is the better than the anterior-only procedure in the correction of kyphosis and maintenance of spinal stability. The posterior-only procedure is recommended because it achieves the same efficacy as combined procedure with shorter operation time, less blood loss and trauma.

Download Full-text

Does Instrumentation of the Fractured Level in Thoracolumbar Fixation Affect the Functional and Radiological Outcome?

Global Spine Journal ◽

10.1177/2192568221991106 ◽

2021 ◽

pp. 219256822199110

Author(s):

Riaz Mohammed ◽

Roberto Carrasco ◽

Rajat Verma ◽

Irfan Siddique ◽

Saeed Mohammad ◽

...

Keyword(s):

Regression Analysis ◽

Functional Outcomes ◽

Thoracolumbar Junction ◽

Vertebral Height ◽

Single Level ◽

Radiological Parameters ◽

Significant Difference ◽

Functional Scores ◽

Sagittal Index ◽

Fracture Level

Study Design: Retrospective comparative study. Objectives: To compare radiological and functional outcomes of patients with fixation constructs utilizing pedicle screw stabilization at the fracture level (FL group) versus patients with non-fracture level (NFL group) fixation in single level fractures of the thoracolumbar junction (T11-L1). Methods: 53 patients of whom fracture level screw was used in 34 (FL group) were compared to 19 patients in NFL group. Radiological parameters analyzed were sagittal index, bi-segmental kyphosis (Cobb) angle and degree of vertebral height restoration. Prospectively collected patient reported functional outcomes and post-operative complications were also studied. Stepwise regression analysis adjusted by age, gender and functional scores was performed to account for the small numbers and unequal sizes of the groups. Results: Back pain score was significantly lower in the FL group ( P < 0.025). Core Outcome Measures Index scores and leg pain scores, though low in the FL group, were not statistically significant. The regression analysis showed that the inclusion of the fracture-level screw was independently associated with a greater change in sagittal index and vertebral height restoration post-operatively. Sagittal index was maintained through to final follow up as well. The bi-segmental Cobb’s angle correction was not associated with fracture-level screw construct. There was no significant difference between the groups for revision surgery, deep infection, implant failure or length of hospital stay. Conclusion: The inclusion of the fracture-level pedicle screws in the fixation construct significantly improves the immediate and final measured radiological parameters, with improved functional scores in single level unstable vertebral fractures of the thoracolumbar junction.

Download Full-text