REVIEW OF MCCORMACK CLASSIFICATION FOR THORACOLUMBAR SEGMENT FRACTURES

ABSTRACT Objective: The aim of this study was to evaluate the success and complications rates of thoracolumbar fractures with a score equal or superior to 7 according to the load sharing classification (McCormack), surgically treated with short posterior fixation at three points. Methods: We evaluated 40 patients with thoracolumbar fractures and score by the load sharing classification greater than or equal to 7, treated exclusively by surgery by short posterior fixation. We assessed epidemiological data, increased kyphosis, loss of vertebral body height and complications at 2-year follow-up. Results: Although there was a statistically significant increase in kyphosis and a decrease in vertebral height, there was no clinical repercussion. Conclusion: We conclude that the McCormack classification is not a fundamental predictor for indication of anterior approach complementary to the short posterior fixation.

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Circumferential management of unstable thoracolumbar fractures using an anterior expandable cage, as an alternative to an iliac crest graft, combined with a posterior screw fixation: results of a series of 85 patients

Neurosurgical FOCUS ◽

10.3171/2014.5.focus1452 ◽

2014 ◽

Vol 37 (1) ◽

pp. E10 ◽

Cited By ~ 5

Author(s):

Thomas Graillon ◽

Patrick Rakotozanany ◽

Benjamin Blondel ◽

Tarek Adetchessi ◽

Henry Dufour ◽

...

Keyword(s):

Vertebral Body ◽

Anterior Approach ◽

Body Height ◽

Posterior Fixation ◽

Thoracolumbar Fractures ◽

Vertebral Body Height ◽

Kyphosis Angle ◽

Significant Difference

Object The optimal management of unstable thoracolumbar fractures remains unclear. The objective of the present study was to evaluate the results of using an expandable prosthetic vertebral body cage (EPVBC) in the management of unstable thoracolumbar fractures. Methods Eighty-five patients with unstable T7–L4 thoracolumbar fractures underwent implantation of an EPVBC via an anterior approach combined with posterior fixation. Long-term functional outcomes, including visual analog scale and Oswestry disability index scores, were evaluated. Results In a mean follow-up period of 16 months, anterior fixation led to a significant increase in vertebral body height, with an average gain of 19%. However, the vertebral regional kyphosis angle was not significantly increased by anterior fixation alone. No significant difference was found between early postoperative, 3-month, and 1-year postoperative regional kyphosis angle and vertebral body height. Postoperative impaction of the prosthetic cage in adjacent endplates was observed in 35% of the cases, without worsening at last follow-up. Complete fusion was observed at 1 year postoperatively and no cases of infections or revisions were observed in relation to the anterior approach. Conclusions The use of EPVBCs for unstable thoracolumbar fractures is safe and effective in providing long-term vertebral body height restoration and kyphosis correction, with a moderate surgical and sepsis risk. Anterior cage implantation is an alternative to iliac bone graft fusion and is a viable option in association with a posterior approach, in a single operation without additional risks.

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Minimal Invasive Circumferential Management of Thoracolumbar Spine Fractures

BioMed Research International ◽

10.1155/2015/639542 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

S. Pesenti ◽

T. Graillon ◽

N. Mansouri ◽

P. Rakotozanani ◽

B. Blondel ◽

...

Keyword(s):

Vertebral Body ◽

Anterior Approach ◽

Body Height ◽

Thoracolumbar Spine ◽

Fusion Rate ◽

Minimal Invasive ◽

Reduced Form ◽

Thoracolumbar Fractures ◽

Vertebral Body Height

Introduction. While thoracolumbar fractures are common lesions, no strong consensus is available at the moment.Objectives. The aim of this study was to evaluate the results of a minimal invasive strategy using percutaneous instrumentation and anterior approach in the management of thoracolumbar unstable fractures.Methods. 39 patients were included in this retrospective study. Radiologic evaluation was based on vertebral and regional kyphosis, vertebral body height restoration, and fusion rate. Clinical evaluation was based on Visual Analogic Score (VAS). All evaluations were done preoperatively and at 1-year follow-up.Results. Both vertebral and regional kyphoses were significantly improved on postoperative evaluation (13° and 7° versus −1° and −9° P<0.05, resp.) as well as vertebral body height (0.92 versus 1.16,P<0.05). At 1-year follow-up, mean loss of correction was 1°. A solid fusion was visible in all the cases, and mean VAS was significantly reduced form 8/10 preoperatively to 1/10 at the last follow-up.Conclusion. Management of thoracolumbar fractures using percutaneous osteosynthesis and minimal invasive anterior approach (telescopic vertebral body prosthesis) is a valuable strategy. Results of this strategy offer satisfactory and stable results in time.

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Vertebral body height changes in acute symptomatic osteoporotic vertebral compression fractures treated with vertebral cement augmentation. Which factors affect vertebral body height?

10.21203/rs.3.rs-430234/v1 ◽

2021 ◽

Author(s):

Jesús Payo-Ollero ◽

Rafael Llombart-Blanco ◽

Carlos Villas ◽

Matías Alfonso

Keyword(s):

Vertebral Body ◽

Body Height ◽

Cement Augmentation ◽

Vertebral Compression Fractures ◽

Vertebral Augmentation ◽

Vertebral Height ◽

Vertebral Body Height ◽

Post Surgery ◽

Osteoporotic Vertebral Fractures

Abstract Changes in vertebral body height depend on various factors which were analyzed in isolation and not as a whole. The aim of this study is to analyze what factors might influence restoration of vertebral body height after vertebral augmentation. We analyzed 48 patients (108 vertebrae) with osteoporotic vertebral fractures underwent vertebral augmentation when conservative treatment proved unsatisfactory. Analyses were carried out at the time of the fracture, during surgery (pre-cementation and post-cementation), at first medical check-up (6 weeks post-surgery) and at last medical check-up. Average vertebral height was measured and differences from preoperative values calculated at each timepoint. Pearson correlation coefficient and linear multivariable regression were carried out at the different timepoints. The time since vertebral fracture was 60.4 ± 41.7 days. Patients’ average age was 70.9 ± 9.3-years. The total follow-up was 1.43 ± 1-year. After vertebral cementation there was an increase in vertebral body height of + 0.3cm (13.6%). During post-operative follow-up, there was a progressive collapse of the vertebral body and pre-surgical height was reached. The factors that most influenced vertebral height restoration were: grade III collapse, intervertebral-vacuum-cleft (IVVC), and use of a flexible trocar before cement augmentation. The factor that negatively influenced vertebral body height restoration was location in the thoracolumbar spine.

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Treatment of Thoracolumbar Type A3 Fractures Using a Percutaneous Intravertebral Expandable Titanium Implant: Long-term Follow-up Results of a Pilot Single Center Study

January 2018 - Pain Physician ◽

10.36076/ppj.2021.24.e631 ◽

2021 ◽

pp. E631-E638

Keyword(s):

Vertebral Body ◽

Body Height ◽

Titanium Implant ◽

Cement Leakage ◽

Thoracolumbar Fractures ◽

Single Center ◽

Vertebral Body Height ◽

Burst Fractures

BACKGROUND: There are controversies about the optimal management of AO subtype A3 burst fractures. The most common surgical treatment consists of posterior fixation with pedicle screw and rod augmentation. Nevertheless, a loss of correction in height restoration and kyphotic reduction has been observed. OBJECTIVES: The aim of this study was to assess long-term outcomes of a minimally invasive technique using a percutaneous intravertebral expandable titanium implant (PIETI). STUDY DESIGN: This prospective, single center, pilot study was carried out on a consecutive case series of 44 patients with acute (< 2 weeks) traumatic thoracolumbar fractures AO type A3. The average follow-up was 5.6 years. SETTING: A single center in Castilla y Leon, Spain METHODS: Clinical outcomes (pain intensity on visual analog scale [VAS], Oswestry Disability Index [ODI], analgesic consumption) and radiographic outcomes (anterior/mid/posterior vertebral body height, vertebral area, local kyphosis angle, traumatic regional angulation) were analyzed before surgery, at one month after surgery, and at the end of the follow-up period. RESULTS: At one-month postsurgery, significant improvements in VAS score and ODI score were observed. PIETI achieved significant vertebral body height restoration with median height increases of 2.9 mm/4.3 mm/2.3 mm for anterior/middle/posterior parts, respectively. Significant correction of the local kyphotic angle and improvement of the traumatic regional angulation were accomplished. All these improvements were maintained throughout the follow-up period. The only complication reported was a case of cement leakage. LIMITATIONS: In our opinion, the main limitation of the study is the small number of patients. However, the sample is superior to that shown in other papers. CONCLUSIONS: This study showed that using a PIETI in the treatment of fractures type A3 is a safe and effective method that allows marked clinical improvement, as well as anatomical vertebral body restoration. Unlike with other treatments, results were maintained over time, allowing a better long-term clinical and functional improvement. The rate of cement leakage was lower than other reports. KEY WORDS: Traumatic thoracolumbar fractures, burst fractures, AO type A3 fractures, kyphoplasty, percutaneous intravertebral expandable titanium implant

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Analysis of Related Factors on The Vertebral Height Restoration of Percutaneous Vertebral Augmentation

International Surgery ◽

10.9738/intsurg-d-15-00335.1 ◽

2019 ◽

Vol 104 (7-8) ◽

pp. 398-405

Author(s):

Weixing Xie

Keyword(s):

Vertebral Body ◽

Compression Ratio ◽

Univariate Analysis ◽

Body Height ◽

Height Loss ◽

Loss Ratio ◽

Vertebral Body Height ◽

Kyphosis Angle ◽

Local Kyphosis

Background Percutaneous vertebral augmentation (PVA) is widely applied for the treatment of osteoporotic vertebral fractures. The degree of vertebral body height restoration and deformity correction after the procedure is not consistent. Methods We retrospectively reviewed 97 patients who underwent PVA, because of osteoporotic vertebral compression fractures. The following data about the patients were recorded: age, sex, bone density, number of treated vertebrae, severity of fracture of the treated vertebrae, operative approach (PVP or PKP), volume of injected bone cement, preoperative vertebral compression ratio, preoperative local kyphosis angle, cement leakage, postoperative vertebral body height restoration ratio, follow-up period, and latest follow-up height loss ratio. Bivariate regression analysis and t-test were applied for univariate analysis, while multivariate linear regression analysis was applied for multivariate analysis. Results The postoperative vertebral body height restoration ratio was (14.7% ± 15.2%), and the last follow-up height loss ratio was (13.5% ± 11.5%). The multivariate analysis showed that the number of treated vertebrae, preoperative vertebral compression ratio, and preoperative local kyphosis angle are the main factors influencing the postoperative vertebral body height restoration. The univariate analysis also showed that only the postoperative vertebral body height restoration ratio is related to the last follow-up height loss ratio. Conclusions The number of treated vertebrae, preoperative vertebral compression ratio, and preoperative local kyphosis angle are the main influencing factors of patients' vertebral body height restoration after PVA, and the postoperative vertebral body height restoration ratio is the main factor influencing the last follow-up height loss ratio.

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Inclusion of the fractured level into the construct of short segment fixation in patients with thoracolumbar fractures: clinical and radiological outcome

Egyptian Journal of Neurosurgery ◽

10.1186/s41984-021-00137-7 ◽

2021 ◽

Vol 36 (1) ◽

Author(s):

Ali R. Hamdan ◽

Radwan Nouby Mahmoud ◽

Ahmed G. Tammam ◽

Eslam El-Sayed El-Khateeb

Keyword(s):

Cobb Angle ◽

Vertebral Body ◽

Compression Ratio ◽

Body Height ◽

Surgical Approaches ◽

Thoracolumbar Fractures ◽

Vertebral Body Height ◽

Short Segment ◽

The Mean ◽

Short Segment Fixation

Abstract Background Thoracolumbar fractures represent a widespread injuries that can cause significant disability and strain the healthcare system. Different surgical approaches are described in the literature. This study was conducted to evaluate the fractured level inclusion in short-segment fixation of thoracolumbar junction spine fractures. Results Preoperative neurological deficit was reported in seven patients ranging from ASIA grade C to D. All of these patients improved to grade E by the end of the follow-up period, except for one patient who improved from grade C to D. The mean Oswestry Disability Index was 19.87%. The mean postoperative Cobb angle was 11.77° which significantly improved compared to a preoperative value of 19.37°. There was a significant improvement in the postoperative anterior and posterior vertebral body height compared to the preoperative values. The vertebral body compression ratio significantly improved during the postoperative period to a mean of 84% compared to 76% preoperative. Conclusions There was significant improvement of the postoperative values of the mean Cobb angle, the anterior and the posterior vertebral body height as well as the vertebral body compression ratio compared to the preoperative values.

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Contribution of postoperative vertebral remodeling to reversal of vertebral wedging and prevention of correction loss in patients with adolescent Scheuermann’s kyphosis

Journal of Neurosurgery Spine ◽

10.3171/2021.1.spine202086 ◽

2021 ◽

pp. 1-9

Author(s):

Sinian Wang ◽

Liang Xu ◽

Muyi Wang ◽

Yong Qiu ◽

Zezhang Zhu ◽

...

Keyword(s):

Vertebral Body ◽

Body Height ◽

Growth Potential ◽

Vertebral Body Height ◽

Correction Loss ◽

Scoliosis Research Society ◽

Scheuermann’S Kyphosis ◽

Patient Reported ◽

Vertebral Wedging

OBJECTIVE This study aimed to investigate reversal of vertebral wedging and to evaluate the contribution of vertebral remodeling to correction maintenance in patients with adolescent Scheuermann’s kyphosis (SK) after posterior-only instrumented correction. METHODS A retrospective cohort study of patients with SK was performed. In total, 45 SK patients aged 10–20 years at surgery were included. All patients received at least 24 months of follow-up and had Risser sign greater than grade 4 at latest follow-up. Patients with Risser grade 3 or less at surgery were assigned to the low-Risser group, whereas those with Risser grade 4 or 5 were assigned to the high-Risser group. Radiographic data and patient-reported outcomes were collected preoperatively, immediately postoperatively, and at latest follow-up and compared between the two groups. RESULTS Remarkable postoperative correction of global kyphosis was observed, with similar correction rates between the two groups (p = 0.380). However, correction loss was slightly but significantly less in the low-Risser group during follow-up (p < 0.001). The ratio between anterior vertebral body height (AVBH) and posterior vertebral body height (PVBH) of deformed vertebrae notably increased in SK patients from postoperation to latest follow-up (p < 0.05). Loss of correction of global kyphosis was significantly and negatively correlated with increased AVBH/PVBH ratio. Compared with the high-Risser group, the low-Risser group had significantly greater increase in AVBH/PVBH ratio during follow-up (p < 0.05). The two groups had similar preoperative and postoperative Scoliosis Research Society–22 questionnaire scores for all domains. CONCLUSIONS Obvious reversal in wedge deformation of vertebrae was observed in adolescent SK patients. Patients with substantial growth potential had greater vertebral remodeling and less correction loss. Structural remodeling of vertebral bodies has a positive effect and protects against correction loss. These results could be help guide treatment decision-making.

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Unilateral Versus Bilateral Kyphoplasty for Osteoporotic Vertebral Compression Fractures

Advanced Materials Research ◽

10.4028/www.scientific.net/amr.393-395.1064 ◽

2011 ◽

Vol 393-395 ◽

pp. 1064-1068 ◽

Cited By ~ 1

Author(s):

Bin Zhang ◽

Min Dai ◽

Ya Min Tang

Keyword(s):

Vertebral Body ◽

Randomized Study ◽

Body Height ◽

Vertebral Compression Fractures ◽

Clinical Effects ◽

Osteoporotic Vertebral Compression Fractures ◽

Vertebral Body Height ◽

Compression Fractures ◽

Cement Extravasation

Study Design A retrospective study of patients who underwent kyphoplasty at a single institute. Objective To examine and compare the safety and long-term radiographic and clinical effects of unilateral or bilateral kyphoplasty to treat symptomatic vertebral compression fractures (VCF). Summary of Background Data Kyphoplasty (KP) involves placement of inﬂatable bone tamp via unilateral and bilateral approaches. Few randomized study comparing the radiographic and clinical outcomes using unilateral and bilateral approaches was reported. Methods 50 patients with osteoporotic vertebral compression fractures (VCF) were allocated into two groups adopting unilateral or bilateral kyphoplasty. Preoperative and postoperative pain scores, Vertebral body height were compared and analyzed. Results Both unilateral and bilateral kyphoplasty resulted in signiﬁcant pain reduction. Signiﬁcant increases of midline vertebral body height were recorded for both groups after surgery and maintained for the period of follow-up. Asymptomatic cement extravasation occurred in 8 of 50 patients, and 2 patients developed additional fractures at untreated levels during the period of follow-up. Conclusions Both unilateral and bilateral KP can improve clinical effects of osteoporotic VCF and result in signiﬁcant vertebral height restoration for at least 18 months after treatment.

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Short term radiological outcome of inserting screw at fracture level in posterior short segment fixation in thoracolumbar burst fractures

Journal of Kathmandu Medical College ◽

10.3126/jkmc.v4i3.18236 ◽

2017 ◽

Vol 4 (3) ◽

pp. 71-76

Author(s):

Rabindra Lal Pradhan ◽

Bimal Kumar Pandey ◽

Krishna Raj Khanal

Keyword(s):

Vertebral Body ◽

Body Height ◽

Fracture Site ◽

Implant Failure ◽

Vertebral Body Height ◽

Short Segment ◽

Thoracolumbar Burst Fractures ◽

Burst Fractures ◽

Short Segment Fixation

Background: Unstable thoracolumbar burst fractures are treated surgically by short segment fixation but may be associated with high implant failure. Supplementation of anterior column by insertion of screw at fracture site makes it more biomechanically stable.Objectives: The purpose of this prospective study was to evaluate radiological parameters in thoracolumbar fractures treated with intermediate screw fixation with a minimum follow up of two years.Methods: This prospective study was conducted from 2011 till 2012 where unstable thoracolumbar fractures treated with short segment posterior instrumentation with screw at fracture site were evaluated. All patients (average age 34.64 were followed up for at least 24 months and were classified according to Thoracolumbar Injury Classification and Severity Score and load sharing classifi cation. Out of total 32 patients, four lost to follow up. Radiological parameters like vertebral body height and segmental kyphosis were evaluated and pain was evaluated by Visual Analogue Scale score.Results: Preoperative pain showed mean Visual Analogue Scale Score score of 8.29 that improved to 0.97 at fi nal follow up. Average preoperative loss of vertebral body height was 48.19 %, which improved to 11.4 % after surgery (p<.001). Final vertebral body collapse was 12.98 % with mean percentage loss of vertebral height at 1.57%. Average segmental kyphotic angle was 22.54 before surgery, which corrected to 5.89 immediately after surgery (p<0.001). Final segmental kyphosis was 8.46. Loss of kyphosis correction was 2.57. Two patients had implant failure, but was solidly united during implant removal in both cases.Conclusion: Excellent maintenance of reduction in thoracolumbar burst fractures with short segment fixation with intermediate screws at fracture site with limited decompression resulted in improved neurologic function and satisfactory clinical outcomes, with a low incidence of implant failure and progressive deformity.

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Efficacy of Computed Tomography-assisted Limited Decompression in the Surgical Management of Thoracolumbar Fractures With Neurological Deficit

10.21203/rs.3.rs-157719/v1 ◽

2021 ◽

Author(s):

Landa Shi ◽

Dean Chou ◽

Yuqiang Wang ◽

Mirwais Alizada ◽

Yilin Liu

Keyword(s):

Quality Of Life ◽

Postoperative Complications ◽

Vertebral Body ◽

Burst Fracture ◽

Body Height ◽

Height Loss ◽

Vertebral Body Height ◽

Single Segment ◽

Significant Difference

Abstract Objective: to investigate the effect of CT-assisted limited decompression in the management of single segment A3 lumbar burst fracture. Method: A retrospective study of 106 cases with a single-level Magerl type A3 lumbar burst fractures treated with short-segment posterior internal fixation and limited decompression from January 2015 to June 2019 was performed. Patients were divided into two groups: CT-assisted and non-CT-assisted. Perioperative factors, clinical outcomes, postoperative complications, imaging parameters and health-related quality of life (HRQoL) were evaluated. Results: There was no significant difference between the two groups in the kyphosis, anterior vertebral body height loss, posterior vertebral body height loss, operative time, and postoperative complications. The visual analogue score (VAS) and spinal canal encroachment in the CT-assisted group were lower than those in the non-CT-assisted group (P < 0.05). The Japanese Orthopaedic Association score (JOA), the simplified HRQoL scale and American Spinal Injury Association (ASIA) Spinal Cord Injury Grade in the CT-assisted group were higher than those in the non-CT-assisted group (P < 0.05).Conclusion: CT-assisted limited decompression in the treatment of single-segment A3 lumbar burst fracture can achieve better fracture reduction and surgical results, and improve the long-term recovery of neurological function and quality of life of the patients.

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