Management of Pediatric Posttraumatic Thoracolumbar Vertebral Body Burst Fractures by Use of Single-Stage Posterior Transpedicular Approach

2018 ◽  
Vol 117 ◽  
pp. e22-e33 ◽  
Author(s):  
Mohit Agrawal ◽  
Mayank Garg ◽  
Amandeep Kumar ◽  
Pankaj Kumar Singh ◽  
Guru Dutta Satyarthee ◽  
...  
2015 ◽  
Vol 5 (1_suppl) ◽  
pp. s-0035-1554162-s-0035-1554162
Author(s):  
Se-Hoon Kim ◽  
Jong-Il Choi ◽  
Bum-Joon Kim ◽  
Sung-Kon Ha ◽  
Sang-Dae Kim ◽  
...  

2021 ◽  
Vol 69 (2) ◽  
pp. 399
Author(s):  
Amandeep Kumar ◽  
Mayank Garg ◽  
PankajKumar Singh ◽  
Raman Mahalangikar ◽  
GuruDutt Satyarthee ◽  
...  

2004 ◽  
Vol 1 (3) ◽  
pp. 287-298 ◽  
Author(s):  
Jeremy C. Wang ◽  
Patrick Boland ◽  
Nandita Mitra ◽  
Yoshiya Yamada ◽  
Eric Lis ◽  
...  

Object. Patients with metastatic spine tumors often have multicolumn involvement and high-grade epidural compression, requiring circumferential decompression and instrumentation. Secondary medical and oncological issues add morbidity to combined approaches. The authors present their experience in using the single-stage posterolateral transpedicular approach (PTA) to decompress the spine circumferentially and to place instrumentation. Methods. From September 1997 to February 2004, 140 patients with spine metastases underwent the PTA. Magnetic resonance imaging revealed high-grade spinal cord compression in 120 patients (86%) and lytic vertebral body destruction in all patients. Preoperatively 84 patients (60%) received radiotherapy directed to the involved level and 42 (30%) underwent tumor embolization. Following circumferential decompression, all patients underwent anterior reconstruction with polymethylmethacrylate and Steinmann pins, and posterior segmental fixation. The median operative time was 5.1 hours, the median blood loss was 1500 ml, and the median hospital stay was 9 days. Ninety-six percent of the patients experienced postoperative pain improvement and improvement in or stabilization of neurological status. In 51 nonambulatory patients with poor Eastern Cooperative Oncology Group grades, 75% regained the ability to walk. One month postoperatively 90% of patients achieved good-to-excellent performance scores. The overall median patient survival time was 7.7 months. Patients with colon and lung carcinomas had significantly shorter survival times. Major operative complications occurred in 20 patients (14.3%). Wound complications occurred in 16 patients (11.4%), but this was not correlated with preoperative radiation treatment. Conclusions. The PTA allows circumferential epidural tumor decompression and the placement of anterior and posterior spinal column instrumention. Immediate spinal stability is achieved without the use of brace therapy. This technique achieved a high success rate for pain palliation, neurological preservation, and functional improvement, while avoiding the morbidity associated with combined approaches.


2020 ◽  
pp. 219256822096445
Author(s):  
Azmi Hamzaoglu ◽  
Mustafa Elsadig ◽  
Selhan Karadereler ◽  
Ayhan Mutlu ◽  
Yunus Emre Akman ◽  
...  

Study Design: Retrospective study. Objective: The aim of this study is to evaluate the clinical, neurological, and radiological outcomes of posterior vertebral column resection (PVCR) technique for treatment of thoracic and thoracolumbar burst fractures. Methods: Fifty-one patients (18 male, 33 female) with thoracic/thoracolumbar burst fractures who had been treated with PVCR technique were retrospectively reviewed. Preoperative and most recent radiographs were evaluated and local kyphosis angle (LKA), sagittal and coronal spinal parameters were measured. Neurological and functional results were assessed by the American Spinal Injury Association (ASIA) Impairment Scale, visual analogue scale score, Oswestry Disability Index, and Short Form 36 version 2. Results: The mean age was 49 years (range 22-83 years). The mean follow-up period was 69 months (range 28-216 months). Fractures were thoracic in 16 and thoracolumbar in 35 of the patients. AO spine thoracolumbar injury morphological types were as follows: 1 type A3, 15 type A4, 4 type B1, 23 type B2, 8 type C injuries. PVCR was performed in a single level in 48 of the patients and in 2 levels in 3 patients. The mean operative time was 434 minutes (range 270-530 minutes) and mean intraoperative blood loss was 520 mL (range 360-1100 mL). The mean LKA improved from 34.7° to 4.9° (85.9%). For 27 patients, the initial neurological deficit (ASIA A in 8, ASIA B in 3, ASIA C in 5, and ASIA D in 11) improved at least 1 ASIA grade (1-3 grades) in 22 patients (81.5%). Solid fusion, assessed with computed tomography at the final follow-up, was achieved in all patients. Conclusion: Single-stage PVCR provides complete spinal canal decompression, ideal kyphosis correction with gradual lengthening of anterior column together with sequential posterior column compression. Anterior column support, avoidance of the morbidity of anterior approach and improvement of neurological deficit are the other advantages of the single stage PVCR technique in patients with thoracic/thoracolumbar burst fractures.


2002 ◽  
Vol 14 (05) ◽  
pp. 204-214 ◽  
Author(s):  
MING-SHIUM HSIEH ◽  
MING-DAR TSAI ◽  
YI-DER YEH ◽  
SHYAN-BIN JOU

This paper describes an image analysis method that uses automatic algorithms for the evaluation of 3D geometry of vertebral bones and spinal anatomic curve in the diagnosis of compression and burst fractures. The method uses a radial B-spline curve to approximate the ellipse-like vertebral body on a transverse section with a concave feature to evaluate the compression of the canal, and infers the anatomic curve of a vertebral body by linearly regressing the centers of B-spline approximate ellipse-like boundaries of the transversal sections passing the vertebral body. This method, then, calculates the reduced angle and height for recovering the compression fracture by comparing the regressed centerlines of neighboring bodies of the fracture body with the normal spinal anatomic curve. The prototype system can be used as a qualitative and quantitative tool for the diagnosis of compression and burst fractures using transverse sections, and for the instruction to plan accurate surgical procedures. An example demonstrates the fractured spine can be accurately diagnosed and instructed to operate by our method that achieved anatomic stability, released the syndrome of nerve compression and bone pain.


2017 ◽  
Vol 27 (6) ◽  
pp. 700-708 ◽  
Author(s):  
Scott L. Zuckerman ◽  
Ganesh Rao ◽  
Laurence D. Rhines ◽  
Ian E. McCutcheon ◽  
Richard G. Everson ◽  
...  

OBJECTIVETreatment of epidural spinal cord compression (ESCC) caused by tumor includes surgical decompression and stabilization followed by postoperative radiation. In the case of severe axial loading impairment, anterior column reconstruction is indicated. The authors describe the use of interbody distraction to restore vertebral body height and correct kyphotic angulation prior to reconstruction with polymethylmethacrylate (PMMA), and report the long-term durability of such reconstruction.METHODSA single institution, prospective series of patients with ESCC undergoing single-stage decompression, anterior column reconstruction, and posterior instrumentation from 2013 to 2016 was retrospectively analyzed. Several demographic, perioperative, and radiographic measurements were collected. Descriptive statistics were compiled, in addition to postoperative changes in anterior height, posterior height, and kyphosis. Paired Student t-tests were performed for each variable. Overall survival was calculated using the techniques described by Kaplan and Meier.RESULTSTwenty-one patients underwent single-stage posterior decompression with interbody distraction and anterior column reconstruction using PMMA. The median age and Karnofsky Performance Scale score were 61 years and 70, respectively. Primary tumors included renal cell (n = 8), lung (n = 4), multiple myeloma (n = 2), prostate (n = 2), and other (n = 5). Eighteen patients underwent a single-level vertebral body reconstruction and 3 underwent multilevel transpedicular corpectomies. The median survival duration was 13.3 months. In the immediate postoperative setting, statistically significant improvement was noted in anterior body height (p = 0.0017, 95% confidence interval [CI] −4.15 to −1.11) and posterior body height (p = 0.0116, 95% CI −3.14 to −0.45) in all patients, and improved kyphosis was observed in those with oblique endplates (p = 0.0002, 95% CI 11.16–20.27). In the median follow-up duration of 13.9 months, the authors observed 3 cases of asymptomatic PMMA subsidence. One patient required reoperation in the form of extension of fusion.CONCLUSIONSIn situ interbody distraction allows safe and durable reconstruction with PMMA, restores vertebral height, and corrects kyphotic deformities associated with severe pathological fractures caused by tumor. This is accomplished with minimal manipulation of the thecal sac and avoiding an extensive 360° surgical approach in patients who cannot tolerate extensive surgery.


Spine ◽  
1995 ◽  
Vol 20 (15) ◽  
pp. 1699-1703 ◽  
Author(s):  
Markku J. Vornanen ◽  
Ole M. Böstman ◽  
Pertti J. Myllynen

2011 ◽  
Vol 14 (6) ◽  
pp. 734-741 ◽  
Author(s):  
Ahmed Shawky Eid ◽  
Ung-Kyu Chang

Object The posterolateral transpedicular approach (PTA) is a widely used method for the surgical treatment of vertebral body metastases. It is crucial to understand the optimal location of the anterior graft in terms of sound and durable reconstruction following PTA. The purpose of this study was to investigate whether postoperative construct stability is related to the location of anterior grafts. Methods The authors conducted a retrospective review of 45 cases of metastatic spine disease with epidural tumor extension in which patients underwent circumferential decompression and fusion by means of PTA. Mechanical (anterior construct stability), pain (visual analog scale score), and neurological (American Spinal Injury Association scale) outcomes were evaluated and correlated with the anterior graft location (lateral or central) and surgical approach (unilateral or bilateral), number of decompressed levels, types of anterior graft, screw density of posterior fixation (number of screws used divided by the number of pedicles spanned), and kyphotic angle change from the immediate postoperative period to the most recent follow-up. Results Seven of 45 constructs were judged unstable—5 with a lateral location of the anterior graft and 2 with a central location. The anterior graft was located laterally in 31 cases (69%), centrally in 11 (24%), and bilaterally in 3 (7%). A unilateral approach was used in 33 cases and a bilateral approach in 12. Neither the location of the anterior graft nor the approach had a significant effect on the stability of the reconstructed spine (p > 0.05). There was a significant difference in construct stability between the single-level decompression group (33 patients) and the multiple-level decompression group (12 patients) (p = 0.0001). The types of anterior graft, screw density, and kyphotic angle change were not correlated to the mechanical outcome. Conclusions The anterior graft location showed no significant relationship to the final mechanical, pain, and neurological outcomes.


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