scholarly journals Thoracoscopic Vertebral Body Replacement of Burst Fractures in the Thoracolumbar Spine with a Distractable Titanium Cage

2016 ◽  
Vol 6 (1_suppl) ◽  
pp. s-0036-1582674-s-0036-1582674
Author(s):  
Christof Wutte ◽  
Reinhold Ortmaier ◽  
Herbert Resch ◽  
Fabian Plachel ◽  
Robert Bogner
Keyword(s):  
Vertebral Body ◽  
Thoracolumbar Spine ◽  
Vertebral Body Replacement ◽  
Titanium Cage ◽  
Burst Fractures

scholarly journals Lesión dural asociada a fracturas de charnela toracolumbar y lumbares con compromiso del muro posterior. Relación con las variables del sistema de clasificación AOSpine. [Thecal sac injury secondary to burst fractures of the thoracolumbar and lumbar spine, and its association with the AOSpine Classification System variables].

2019 ◽  
Vol 84 (3) ◽  
pp. 216-223
Author(s):  
Guillermo Alejandro Ricciardi ◽  
Ignacio Gabriel Garfinkel ◽  
Gabriel Genaro Carrioli ◽  
Daniel Oscar Ricciardi
Keyword(s):  
Vertebral Body ◽  
Neurological Deficit ◽  
Classification System ◽  
Spinal Canal ◽  
Body Wall ◽  
Thoracolumbar Spine ◽  
Cauda Equina ◽  
Acute Angle ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures

Introducción: Las lesiones del saco dural con atrapamiento de la cauda equina entre los fragmentos óseos pueden estar asociadas con fracturas toracolumbares.Objetivo: Realizar un análisis retrospectivo de las variables clínico-radiográficas y el sistema de clasificación AOSpine y la posibilidad de lesión dural asociada en una serie de fracturas toracolumbares por estallido, tratadas en nuestro Centro.Materiales y Métodos: Estudio retrospectivo, observacional de una serie de pacientes con fracturas toracolumbares con compromiso del muro posterior operados en nuestra institución, entre enero de 2012 y diciembre de 2017.Resultados: Se incluyeron 46 pacientes, 16 casos con lesión del saco dural asociada. Las variables porcentaje de ocupación del canal, distancia interpedicular, ángulo del fragmento retropulsado y déficit neurológico asociado mostraron diferencias estadísticamentesignificativas según la comparación en función de la presencia o ausencia de lesión dural (p = 0,046, p = 0,007, p = 0,046 y p = 0,004, respectivamente).Conclusiones: Según nuestros resultados, la lesión dural traumática podría ser contemplada en la planificación del tratamiento de fracturas toracolumbares ante fragmentos voluminosos del muro posterior con ángulo agudo, compromiso severo del canal raquídeo, distancia interpedicular elevada y daño neurológico asociado, tal como se propone en la bibliografía. AbstractIntroduction: Fractures of the thoracolumbar spine can trigger thecal sac injuries due to the impingement of the cauda equina between bone fragments.Objective: To carry out a retrospective analysis of clinical and radiological variables, the AOSpine Classification System and the possibility of secondary thecal sac injury in a series of thoracolumbar burst fractures treated at our center.Materials and Methods: A retrospective, observational study of a series of patients with thoracolumbar fractures with compromise of the posterior vertebral body wall, who underwent surgery at our center between January 2012 and December 2017.Results: Forty-six patients were included, 16 of which had secondary thecal sac injury. The differences in the variables—percentage of spinal canal involvement, interpedicular distance, angle of the retropulsed fragment, neurological deficit and type C fractures—were statistically significant according to the comparison made with the presence or absence of thecal sac injury (p=0.046, p=0.007, p=0.046, p=0.004, p=0,001 respectively).Conclusions: This study suggests that traumatic thecal sac injury could be suspectedwhen managing burst fractures with prominent fragments in the posterior vertebral body wall, acute angle of the retropulsed fragment, severe compression of the spinal canal, wide interpedicular distance, neurological deficit and fracture displacement (fracturetype C according to the AOSpine Classification System).

scholarly journals Dorsal instrumentation with and without vertebral body replacement in patients with thoracolumbar osteoporotic fractures shows comparable outcome measures

2021 ◽  
Author(s):  
Maximilian Schwendner ◽  
Stefan Motov ◽  
Yu-Mi Ryang ◽  
Bernhard Meyer ◽  
Sandro M. Krieg
Keyword(s):  
Vertebral Body ◽  
Thoracolumbar Spine ◽  
Osteoporotic Fractures ◽  
The Elderly ◽  
Vertebral Body Replacement ◽  
Inclusion Criteria ◽  
Dorsal Instrumentation ◽  
The Individual

Abstract Purpose In the surgical treatment of osteoporotic spine fractures, there is no clear recommendation, which treatment is best for the individual patient with vertebra plana and/or neurological deficit requiring instrumentation. The aim of this study was to evaluate clinical and radiological outcomes after dorsal or 360° instrumentation of osteoporotic fractures of the thoracolumbar spine in a cohort of patients representing clinical reality. Methods A total of 116 consecutive patients were operated on between 2008 and 2020. Inclusion criteria were osteoporotic fracture, thoracolumbar location, and dorsal instrumentation. In 79 cases, vertebral body replacement (VBR) was performed additionally. Patient outcomes including complications, EQ-5D at follow-up, and sagittal correction were analyzed. Results Medical and surgical complications occurred in 59.5% of patients with 360° instrumentation compared to 64.9% of patients with dorsal instrumentation only (p = 0.684). Dorsal instrumentation plus VBR resulted in a sagittal correction of 9.3 ± 7.4° (0.1–31.6°) compared to 6.0 ± 5.6° (0.2–22.8°) after dorsal instrumentation only, respectively (p = 0.0065). EQ-5D was completed by 79 patients after 4.00 ± 2.88 years (0.1–11.8 years) and was 0.56 ± 0.32 (− 0.21–1.00) for VBR compared to 0.56 ± 0.34 (− 0.08–1.00) without VBR after dorsal instrumentation (p = 0.994). Conclusion 360° instrumentation represents a legitimate surgical technique with no additional morbidity even for the elderly and multimorbid osteoporotic population. Particularly, if sufficient long-term construct stability is in doubt or ventral stenosis is present, there is no need to abstain from additional ventral reinforcement and decompression.

Biomechanical Comparison of Expandable Cages for Vertebral Body Replacement in the Thoracolumbar Spine

Spine ◽  
2004 ◽  
Vol 29 (13) ◽  
pp. 1413-1419 ◽  
Author(s):  
Robert Pflugmacher ◽  
Philipp Schleicher ◽  
Jan Schaefer ◽  
Matti Scholz ◽  
Kathrin Ludwig ◽  
...  
Keyword(s):  
Vertebral Body ◽  
Thoracolumbar Spine ◽  
Vertebral Body Replacement ◽  
Biomechanical Comparison ◽  
Expandable Cages

Comparison of Allograft Bone and Titanium Cages for Vertebral Body Replacement in the Thoracolumbar Spine

2010 ◽  
Vol 66 (suppl_2) ◽  
pp. ons314-ons318 ◽  
Author(s):  
Raul J. Cardenas ◽  
Vijayakumar Javalkar ◽  
Shashikant Patil ◽  
Jorge Gonzalez-Cruz ◽  
Alan Ogden ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Soft Tissues ◽  
Burst Fracture ◽  
Thoracolumbar Spine ◽  
Vertebral Body Replacement ◽  
Fibular Graft ◽  
Free Standing ◽  
Titanium Cage ◽  
Anterior Corpectomy ◽  
Titanium Cages

Abstract BACKGROUND When an anterior approach to repair a burst fracture is indicated, several devices can be used to restore spinal stability (eg, bone graft, free-standing titanium cage, and expandable titanium cage). OBJECTIVE We compare the biomechanical stability and prices of each of these systems. MATERIALS AND METHODS Eight fresh human cadaver T11 through L3 vertebral specimens were harvested and cleaned of soft tissues. T11-T12 and L2-L3 were fixed by screws. The fixed ends were then set in automotive body filler (Bondo). The prepared specimens were tested in the Biaxial Instron tester (8874, Norwood, MA) after a sequence of the following: intact, after the creation of an anterior corpectomy at L1, and after insertion of both of the 2 different titanium cages and the fibular graft. A titanium screw-and-plate anterolateral system was used to secure the construct (VANTAGE, Medtronic Sofamor Danek, Memphis, TN). The conditions of displacement testing were as follows: rotation (± 3.5°), flexion and extension, and left and right bending (± 3.5 mm). For each mode of testing, the stiffness was calculated. RESULTS The stiffness data, when statistically analyzed by repeated-measures analysis of variance (at P = .05 and power ≫ 0.9), indicated no significant differences among these devices. CONCLUSION On the basis of this biomechanical study, the stiffness of the fibular graft was similar to that of the other metallic devices in this cadaver model.

Vertebral Body Replacement With an Anchored Expandable Titanium Cage in the Cervical Spine: A Clinical and Radiological Evaluation

2020 ◽  
Vol 20 (1) ◽  
pp. 109-118 ◽  
Author(s):  
Natan Yusupov ◽  
Sebastian Siller ◽  
Johann Hofereiter ◽  
Heinrich Karl Boehm ◽  
Manuel Fuetsch ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Vertebral Body ◽  
Sagittal Profile ◽  
Vertebral Body Replacement ◽  
Radiological Evaluation ◽  
Titanium Cage ◽  
Single Level ◽  
Anterior Corpectomy ◽  
Expandable Titanium Cage

Abstract BACKGROUND Expandable cervical cages have been used successfully to reconstruct the anterior spinal column. OBJECTIVE To perform clinical and radiological evaluation of vertebral body replacement with an anchored expandable titanium cage in the cervical spine after single-level and 2-level corpectomies. METHODS Between 2011 and 2017, 40 patients underwent a single-level (N = 32) or 2-level (N = 8) anterior corpectomy and fusion using an anchored expandable vertebral body replacement cage. Clinical and radiological data at admission, postoperatively, and at 3- and 12-mo follow-up were retrospectively analyzed. Clinical assessment was performed via standardized neurological evaluation, Odom score, and McCormick classification. Radiological assessment was performed via evaluation of sagittal profile, postoperative position, fusion, and subsidence rates. RESULTS Mean last follow-up was 14.8 ± 7 mo. Overall clinical and myelopathy-related improvements were shown directly after operation and at last follow-up. A stable centralized positioning of cages was achieved in 37 patients (93%). A mild ventral (>1.5 mm) malplacement was noted in 3 patients (7%) without clinical consequences. Sagittal alignment and preoperative cervical kyphosis improved significantly (7.8° gain of lordosis) and remained stable. Mean preoperative height of operated segments increased by 10 mm postoperatively and remained stable. Fusion rate in non-neoplastic patients and subsidence rate at last follow-up comprised 87.5% and 17.8%. With exception of 1 patient suffering from severe osteoporosis and cage subsidence, no patient needed additional secondary stabilization. CONCLUSION Anterior corpectomy and fusion by an expandable anchored titanium cage with anchor screws without additional instrumentation resulted in overall clinical improvement and radiological anterior column support, achieving significant and reliable restoration of the physiological sagittal cervical profile.

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