scholarly journals Single-Stage Posterior Vertebral Column Resection With Circumferential Reconstruction for Thoracic/Thoracolumbar Burst Fractures With or Without Neurological Deficit: Clinical Neurological and Radiological Outcomes

2020 ◽  
pp. 219256822096445
Author(s):  
Azmi Hamzaoglu ◽  
Mustafa Elsadig ◽  
Selhan Karadereler ◽  
Ayhan Mutlu ◽  
Yunus Emre Akman ◽  
...  
Keyword(s):  
Neurological Deficit ◽  
Vertebral Column ◽  
Single Stage ◽  
Anterior Column ◽  
Vertebral Column Resection ◽  
Posterior Vertebral Column Resection ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures ◽  
The Mean

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.

scholarly journals POSTERIOR VERTEBRAL COLUMN RESECTION IN MULTIPLE LEVELS IN CHILDREN WITH VERTEBRAL TUBERCULOSIS

2019 ◽  
Vol 18 (3) ◽  
pp. 217-221
Author(s):  
ALDERICO GIRÃO CAMPOS DE BARROS ◽  
LUIS EDUARDO CARELLI TEIXEIRA DA SILVA ◽  
MARCELO GLAUBER DA SILVA PEREIRA ◽  
ANDRE LUIZ LOYELO BARCELLOS ◽  
LUCAS ROCHA CAVALCANTI
Keyword(s):  
Neurological Deficit ◽  
Vertebral Column ◽  
Spinal Tuberculosis ◽  
Vertebral Column Resection ◽  
Posterior Vertebral Column Resection ◽  
Cord Injury ◽  
The Mean ◽  
Multiple Levels ◽  
Tuberculosis In Children

ABSTRACT Objective To evaluate the clinical and radiological results of posterior vertebral column resection in the treatment of kyphosis due to vertebral tuberculosis in children under 9 years of age with neurological deficit. Methods Retrospective study of a series of 5 cases, 4 females and 1 male, mean age of 4.7 years at the time of surgery, with spinal tuberculosis and mean kyphosis of 89 degrees. Results All patients underwent surgical treatment with PVCR in multiple levels, with a mean number of 3.6 resected vertebrae, mean surgical time of 359 minutes, mean postoperative stay of 21.2 days. The mean follow-up was 29 months. The mean kyphosis correction was 62.6%. Before surgery, all patients had signs of spinal cord injury, one of which did not present a deficit of strength or sensibility (ASIA E), but there were pyramidal signs and a history of falls. The other 4 had some degree of sensory-motor dysfunction, with ASIA score varying from A to D. Postoperative complications included two dehiscences of suture, one pneumothorax and one pneumonia, all with favorable evolution. Four patients progressed with neurological improvement and one of them had persistence of the neurological deficit until the last follow-up. Conclusions Multiple-level PVCR has proven to be a safe and effective option for the treatment of kyphotic deformity in spinal tuberculosis in children with neurological deficit. Level of evidence IV; Case Series.

scholarly journals Congenital scoliosis treated with posterior vertebral column resection in patients younger than 18 years: longer than 10-year follow-up

2016 ◽  
Vol 25 (2) ◽  
pp. 225-233 ◽  
Author(s):  
Dong-Gune Chang ◽  
Jae Hyuk Yang ◽  
Jung-Hee Lee ◽  
Jin-Hyok Kim ◽  
Seung-Woo Suh ◽  
...  
Keyword(s):  
Cobb Angle ◽  
Vertebral Column ◽  
Congenital Scoliosis ◽  
Rigid Fixation ◽  
Vertebral Column Resection ◽  
Posterior Vertebral Column Resection ◽  
Time Of Surgery ◽  
The Mean

OBJECTIVE There have been no reports on the long-term radiographic outcomes of posterior vertebral column resection (PVCR) in patients with congenital scoliosis. The purpose of this study was to evaluate the surgical outcomes and complications after PVCR and its long-term effects on correcting this deformity in children with congenital scoliosis. METHODS The authors retrospectively analyzed the medical records of 45 patients with congenital scoliosis who were younger than 18 years at the time of surgery and who underwent PVCR and fusion with pedicle screw fixation (PSF). The mean age of the patients at the time of surgery was 11.3 years (range 2.4–18.0 years), and the mean length of follow-up was 12.8 years (range 10.1–18.2 years). RESULTS The mean Cobb angle of the main curve was 46.5° before PVCR, 13.7° immediately after PVCR, and 17.6° at the last follow-up. For the compensatory cranial curve, PVCR corrected the preoperative Cobb angle of 21.2° to 9.1° postoperatively and maintained it at 10.9° at the last follow-up. For the compensatory caudal curve, the preoperative Cobb angle of 23.8° improved to 7.7° postoperatively and was 9.8° at the last follow-up. The authors noted 22 complications, and the overall incidence of complications was 48.9%. CONCLUSIONS Posterior vertebral column resection is an effective procedure for managing congenital scoliosis in patients younger than 18 years. Use of PVCR and fusion with PSF for congenital scoliosis achieved rigid fixation and satisfactory deformity correction that was maintained over the long term. However, the authors note that PVCR is a technically demanding procedure and entails risks for major complications and excessive blood loss.

Posterior vertebral column resection for correction of rigid spinal deformity curves greater than 100°

2012 ◽  
Vol 17 (6) ◽  
pp. 540-551 ◽  
Author(s):  
Jingming Xie ◽  
Yingsong Wang ◽  
Zhi Zhao ◽  
Ying Zhang ◽  
Yongyu Si ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Vertebral Column ◽  
Sagittal Plane ◽  
Coronal Plane ◽  
Plane Curves ◽  
Vertebral Column Resection ◽  
Posterior Vertebral Column Resection ◽  
Correction Rate ◽  
The Mean

Object The surgical treatment of severe and rigid spinal deformities poses difficulties and dangers. In this article, the authors summarize their surgical techniques and evaluate patient outcomes after performing posterior vertebral column resection (PVCR) for the correction of spinal deformities with curves greater than 100°, and investigate the crucial points to ensure neurological safety during this challenging procedure. Methods The authors retrospectively reviewed their experience with 28 patients with extremely severe (Cobb angles in the coronal or sagittal plane > 100°) and rigid thoracic or thoracolumbar spine deformities who underwent PVCR. The average patient age was 20.2 years and all patients underwent a minimum follow-up of 24 months (range 24–60 months). Patients were divided into groups according to their morphological classification as follows: kyphosis alone (Group A, 6 patients with a mean Cobb angle of 109.0° [range 105°–120°]); kyphoscoliosis with coronal plane curves notably greater than sagittal plane curves (Group B, 14 patients with mean scoliotic curves of 116.6° [range 102°–170°] and kyphotic curves of 77.7° [range 42°–160°]); and kyphoscoliosis with sagittal curves notably greater than coronal plane curves (Group C, 8 patients with a mean coronal curve of 85.4° [range 65°–110°] and a mean sagittal curve of 117.6° [range 102°–155°]). Results A total of 36 vertebrae were removed in 28 patients who had a severe rigid spinal deformity, and the mean fusion extent was 13.3 vertebrae (range 7–17 vertebrae). The mean operating time was 620 minutes (range 320–920 minutes) with an average operative blood loss of 6,680 ml (range 3,000–24,000 ml). The overall final correction rate of scoliosis was 59.0%, and average postoperative kyphotic Cobb angles ranged from 30.4° to 95.9°. In Group A the mean preoperative sagittal angle of 109.0° was corrected to a mean postoperative angle of 32.0°. In the Group B kyphoscoliotic patients, the correction rate in the coronal plane was 58.6%; the Cobb angle in the sagittal plane was corrected from a mean of 77.7° preoperatively to 25.1° postoperatively; in Group C, the correction rate in the coronal plane was 58.5%, and the mean sagittal angle was reduced from a mean of 117.6° preoperatively to 39.0°. Of the 28 patients who underwent PVCR, 46 complications were observed in 18 patients intra- and postoperatively. There were 5 neurological complications including 1 case of late-onset paralysis and 4 cases of thoracic nerve root pain, all of which resolved during the early follow-up period. Nonneurological complications occurred more often in kyphoscoliotic patients (41 complications). The mean follow-up of all patients was 33.7 months (range 24–60 months). Conclusions Posterior vertebral column resection was effective in correcting severe rigid spinal deformity, although the procedure was technically demanding, exhaustingly lengthy, and was associated with a variety of complications. The PVCR technique created a space for spinal correction and spinal cord tension adjustment and the correction could be performed under direct inspection and by palpation of the tension in the spinal cord through the space. Therefore, in terms of the spinal cord, the deformity correction process involved in the PVCR procedure is relatively safe.

scholarly journals Posterior monoaxial screw fixation combined with distraction-compression technology assisted endplate reduction for thoracolumbar burst fractures: a retrospective study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Xuhong Xue ◽  
Sheng Zhao
Keyword(s):  
Retrospective Study ◽  
Pedicle Screw ◽  
Screw Fixation ◽  
Pedicle Screws ◽  
Pedicle Screw Fixation ◽  
Thoracolumbar Burst Fractures ◽  
Correction Rate ◽  
Burst Fractures ◽  
The Mean

Abstract Background The management of thoracolumbar burst fractures traditionally involves posterior pedicle screw fixation, but it has some drawbacks. The aim of this study is to evaluate the clinical and radiological outcomes of patients with thoracolumbar burst fractures. They were treated by a modified technique that monoaxial pedicle screws instrumentation and distraction-compression technology assisted end plate reduction. Methods From March 2014 to February 2016, a retrospective study including 42 consecutive patients with thoracolumbar burst fractures was performed. The patients had undergone posterior reduction and instrumentation with monoaxial pedicle screws. The fractured vertebrae were also inserted screws as a push point. The distraction -compression technology was used as assisting end plate reduction. All patients were followed up at a minimum of 2 years. These parameters including segmental kyphosis, severity of fracture, neurological function, canal compromise and back pain were evaluated in preoperatively, postoperatively and at the final follow-up. Results The average follow-up period was 28.9 ± 4.3 months (range, 24-39mo). No patients had postoperative implant failure at recent follow-up. The mean Cobb angle of the kyphosis was improved from 14.2°to 1.1° (correction rate 92.1%). At final follow-up there was 1.5% loss of correction. The mean preoperative wedge angle was improved from 17.1 ± 7.9°to 4.4 ± 3.7°(correction rate 74.3%). The mean anterior and posterior vertebral height also showed significant improvements postoperatively, which were maintained at the final follow-up(P < 0.05). The mean visual analogue scale (VAS) scores was 8 and 1.6 in preoperation and at the last follow-up, and there was significant difference (p < 0.05). Conclusion Based on our experience, distraction-compression technology can assist reduction of collapsed endplate directly. Satisfactory fracture reduction and correction of segmental kyphosis can be achieved and maintained with the use of monoaxial pedicle screw fixation including the fractured vertebra. It may be a good treatment approach for thoracolumbar burst fractures.

Outcomes Following Single-Stage Posterior Vertebral Column Resection for Severe Thoracic Kyphosis

2018 ◽  
Vol 119 ◽  
pp. e551-e559 ◽  
Author(s):  
Cecilia L. Dalle Ore ◽  
Christopher P. Ames ◽  
Vedat Deviren ◽  
Darryl Lau
Keyword(s):  
Vertebral Column ◽  
Thoracic Kyphosis ◽  
Single Stage ◽  
Vertebral Column Resection ◽  
Posterior Vertebral Column Resection

scholarly journals Combined posterior percutaneous pedicle screw fixation with delayed anterior monosegmental column reconstruction for unstable thoracolumbar burst fractures

2020 ◽  
Author(s):  
Chao Lou ◽  
Weiyang Yu ◽  
Zhenzhong Chen ◽  
Kangtao Jin ◽  
Jiawei Gao ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Titanium Mesh ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures ◽  
Percutaneous Pedicle Screw ◽  
The Mean ◽  
Percutaneous Pedicle Screw Fixation

Abstract Objective: This study aimed to assess the feasibility as well as the clinical and radiological outcomes of posterior percutaneous pedicle screw fixation (PPSF) combined with anterior monosegmental column reconstruction in unstable thoracolumbar burst fractures. Methods: From January 2011 to August 2017, thirty-five patients with unstable thoracolumbar burst fractures were enrolled in this study. The patients underwent posterior PPSF combined surgery with delayed anterior monosegmental reconstruction utilizing titanium mesh cages. Clinical outcomes, radiological parameters, and treatment-related complications were assessed. Results: The mean age of the patients was 44.8 years. The mean operative time and blood loss were 205 min and 560 ml, respectively. The mean follow-up period was 25.2 months. The Visual analog scale (VAS) pain score was significantly improved postoperatively, and the improvement was maintained until the final follow-up. The mean sagittal kyphosis was corrected from 16.3 preoperatively to 1.5 postoperatively, which increased slightly to 2.6 at the final follow-up. In 24 patients with neurologic dysfunction, 21 (87.5 %) patients had improvement after surgery. None obvious subsidence of the titanium mesh cage and none dislodgement, loosening or breakage of the instrumentation was observed in any patient during the follow-up period. Solid bony fusion was achieved in all patients. Conclusions: Combined posterior PPSF with delayed anterior monosegmental column reconstruction for unstable thoracolumbar burst fractures can produce good clinical and radiological outcomes.

Sign in / Sign up

Export Citation Format

Share Document