scholarly journals Anterior reconstruction of spine by posterior approach in cases of unstable thoracolumbar burst fractures

2018 ◽  
Vol 4 (3) ◽  
pp. 421
Author(s):  
Anurag Tiwari ◽  
Ankit Thora ◽  
Mukul Mohindra ◽  
Amit Sharma ◽  
Sumit Sural ◽  
...  
Keyword(s):  
Blood Loss ◽  
Posterior Approach ◽  
Japanese Orthopaedic Association ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures ◽  
Thoracolumbar Injury ◽  
Duration Of Surgery ◽  
The Mean ◽  
Anterior Reconstruction

<p class="abstract"><strong>Background:</strong> The purpose of this study is to evaluate neurological, functional and radiological outcome of the anterior reconstruction of spine by posterior approach in cases of unstable thoracolumbar burst fractures.</p><p class="abstract"><strong>Methods:</strong> Ten patients with acute unstable burst fractures at thoracolumbar junction (T-11 to L-3) with partial or complete neurological deficit in the age group of 18-50 years with McCormack’s score six or more and thoracolumbar injury severity score (TLISS) five or more were included. Neurological status, Japanese Orthopaedic association score (JOA score), visual analogue scale (VAS), angle of kyphotic deformity, McCormack’s score and TLISS score were evaluated.<strong></strong></p><p class="abstract"><strong>Results:</strong> The mean duration of surgery was 282 minutes. The mean blood loss was 1885 ml. Five patients with neurologic deficit recovered an average of 1.40 ASIA grades at last 24 months’ follow-up. The JOA score improved from -6 preoperatively to 11 at 24 months follow up. The mean kyphotic angle was 19 degrees preoperative improved to -0.6<sup>o</sup> postoperatively. Visual analogue score improved from 6.1 to 1.7.</p><p class="abstract"><strong>Conclusions:</strong> The familiar posterior approach is a safe and reliable surgical approach for reconstruction of all the columns of spine. It has the advantage of doing anterior decompression and reconstruction with posterior instrumentation in single stage, reducing the operative time and blood loss. It reduces the morbidity of anterior approach (isolated or two staged) in the hands of an average orthopaedic surgeon.</p>

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 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.

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.

scholarly journals Treatment of irreducible atlantoaxial dislocation using one-stage retropharyngeal release and posterior reduction

2019 ◽  
Vol 27 (3) ◽  
pp. 230949901987046 ◽  
Author(s):  
Xianfeng Ren ◽  
Feng Gao ◽  
Siyuan Li ◽  
Jiankun Yang ◽  
Yongming Xi
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Japanese Orthopaedic Association ◽  
Operation Time ◽  
Atlantoaxial Dislocation ◽  
Efficacy And Safety ◽  
Estimated Blood Loss ◽  
Irreducible Atlantoaxial Dislocation ◽  
The Mean

Introduction: Irreducible atlantoaxial dislocation (IAAD) has been challenging for spine surgeons. Various methods have been used to treat IAAD, but no consensus has been reached. This study aimed to retrospectively analyze the efficacy of anterior submandibular retropharyngeal release and posterior reduction and fixation for IAAD. Methods: From March 2007 to May 2015, 13 patients diagnosed with IAAD underwent anterior submandibular retropharyngeal release and sequential posterior reduction and fixation. The operation time, blood loss, postoperative complications, and Japanese Orthopaedic Association (JOA) scores were retrospectively recorded. Results: The surgeries were accomplished successfully. The mean operative time was about 3.8 h. The mean estimated blood loss was about 130 mL. The patients experienced postoperative pharyngeal pain. Only one patient had a vague voice and increased oral discharge postoperatively. At the final follow-up, JOA scores had significantly increased ( p < 0.05), and all the patients had solid bony fusion. Conclusion: The present study reinforces the efficacy and safety of anterior submandibular retropharyngeal release and posterior reduction and fixation for IAAD. It can achieve satisfactory clinical outcomes and is safe for experienced spine surgeons.

scholarly journals THORACOLUMBAR BURST FRACTURES, SHORT X LONG FIXATION: A META-ANALYSIS

2016 ◽  
Vol 15 (1) ◽  
pp. 78-84 ◽  
Author(s):  
Carlos Alberto Assunção Filho ◽  
Filipe Cedro Simões ◽  
Gabriel Oliveira Prado
Keyword(s):  
Blood Loss ◽  
Clinical Outcomes ◽  
Postoperative Period ◽  
Operative Time ◽  
Meta Analysis ◽  
Thoracolumbar Burst Fractures ◽  
Kyphosis Correction ◽  
Burst Fractures ◽  
Significant Difference

ABSTRACT The number of fixed segments in the surgical treatment of thoracolumbar burst fractures remains controversial. This study aims to compare the results of short and long fixation in thoracolumbar burst fractures through a meta-analysis of studies published recently. MEDLINE and Cochrane databases were used. Randomized controlled trials and non-randomized comparative studies (prospective and retrospective) were selected. Data were analyzed with the software Review Manager. There was no statistically significant difference in the Cobb angle of preoperative kyphosis. Long fixation showed lower average measurements postoperatively (MD = 1.41; CI = 0.73-2.08; p<0.0001) and in the last follow-up (MD = 3.98; CI = 3.22-4.75; p<0.00001). The short fixation showed the highest failure rates (RD = 4.03; CI = 1.33-12.16; p=0.01) and increased loss of height of the vertebral body (MD = 1.24; CI = 0.49-1.98; p=0.001), with shorter operative time (MD = -24.54; CI = -30.16 - -18.91; p<0.00001). There was no significant difference in blood loss and clinical outcomes. The high rates of kyphosis correction loss with short fixation and the lower correction rate in the immediate postoperative period were validated. There was no significant difference in the blood loss rates because arthrodesis was performed in a short segment in the analyzed studies. The short fixation was performed in a shorter operative time, as expected. No study has shown superior clinical outcomes. The short fixation had worse rates of kyphosis correction in the immediate postoperative period, and increased loss of correction in long-term follow-up, making the long fixation an effective option in the management of this type of fracture.

scholarly journals Revisiting the differences between irreducible and reducible atlantoaxial dislocation in the era of direct posterior approach and C1–2 joint manipulation

2017 ◽  
Vol 26 (3) ◽  
pp. 331-340 ◽  
Author(s):  
Arsikere N. Deepak ◽  
Pravin Salunke ◽  
Sushanta K. Sahoo ◽  
Prashant K. Prasad ◽  
Niranjan K. Khandelwal
Keyword(s):  
Posterior Approach ◽  
Clinical Status ◽  
Japanese Orthopaedic Association ◽  
Atlantoaxial Dislocation ◽  
Os Odontoideum ◽  
Radiological Findings ◽  
Current Management ◽  
Modern Times ◽  
The Mean

OBJECTIVE The current management of atlantoaxial dislocation (AAD) focuses on the C1–2 joints, commonly approached through a posterior route. The distinction between reducible AAD (RAAD) and irreducible AAD (IrAAD) seems to be less important in modern times. The roles of preoperative traction and dynamic radiographs are questionable. This study evaluated whether differentiating between the 2 groups is important in today's era. METHODS Ninety-six consecutive patients with congenital AAD (33 RAAD and 63 IrAAD), who underwent surgery through a posterior approach alone, were studied. The preoperative and follow-up clinical statuses for both groups were studied and compared using Japanese Orthopaedic Association (JOA) scores. The radiological findings of the 2 groups were compared, and the intraoperative challenges described. RESULTS A poor preoperative JOA score (clinical status) was seen in one-fifth of patients with IrAAD, although the mean JOA score was nearly similar in the RAAD and IrAAD groups. There was significant improvement in follow-up JOA score in both groups. However, segmentation defects (such as an assimilated arch of the atlas and C2–3 fusion) and anomalous vertebral arteries were found significantly more often in cases of IrAAD compared with those of RAAD. Os odontoideum was commonly seen in the RAAD group. The C1–2 joints were acute in IrAAD compared with RAAD. Preoperative traction in IrAAD resulted in vertical distraction and improvement in clinical and respiratory status. Surgery for IrAAD required much more drilling and manipulation of the C1–2 joints while safeguarding the anomalous vertebral artery. CONCLUSIONS Bony and vascular anomalies were much more common in patients with IrAAD, which made surgery more challenging than it was in RAAD despite similar approaches. An irreducible dislocation seen on preoperative radiographs made surgeons aware of difficulties that were likely to be encountered and helped them to better plan the surgery. Distraction achieved through preoperative traction reaffirmed the feasibility of intraoperative reduction. This made the differentiation between the 2 groups and the use of preoperative traction equally important.

Comparison of anterolateral and posterior approaches in the management of thoracolumbar burst fractures

2006 ◽  
Vol 5 (2) ◽  
pp. 117-125 ◽  
Author(s):  
Patrick W. Hitchon ◽  
James Torner ◽  
Kurt M. Eichholz ◽  
Stephanie N. Beeler
Keyword(s):  
Angular Deformity ◽  
Intergroup Difference ◽  
Total Cost ◽  
Thoracolumbar Burst Fractures ◽  
Posterior Surgery ◽  
Burst Fractures ◽  
Posterior Group ◽  
The Mean ◽  
Selection Of

Object The authors undertook a retrospective cohort study of patients with T11–L2 thoracolumbar burst fractures who underwent decompression and the placement of instrumentation via the anterolateral or posterior approach. Methods There were 63 thoracolumbar burst fractures in 45 male and 18 female patients. The instrumentation was placed posteriorly in 25 patients and anterolaterally in 38. The mean follow-up duration after discharge from the hospital was 1.8 years (range 6 months–8 years). The mean preoperative Frankel scores in the anterolateral and posterior groups were 3.7 ± 1.1 and 3.5 ± 1.4, respectively (p = 0.4155). Preoperative angular deformity in the anterolateral and posterior groups measured 11.9 ± 9.7 and 4.1 ± 7.1°, respectively (p = 0.0007). Postoperatively, angular deformity had been corrected to 2.0 ± 7.9 and 3.4 ± 7.5° in both groups, respectively (p = 0.565). The follow-up Frankel scores had improved to 4.2 ± 0.8 and 4.0 ± 1.4 (p = 0.461). At the latest follow-up examination, angular deformity had progressed to 4.5 ± 9.3° in the anterolateral group and to 9.8 ± 9.4° in the posterior group (p = 0.024). Although surgeons’ fees were significantly (p = 0.0024) higher for patients who underwent anterolateral procedures ($27,940 ± 4390) than for those who underwent posterior surgery ($18,270 ± 6980), there was no intergroup difference in total cost of hospitalization. Conclusions Rigid guidelines for the selection of anterior or posterior approaches are lacking. Evaluation of the authors’ results and those of others shows that angular deformity is more successfully corrected and maintained when the anterior approach is used.

scholarly journals Efficacy and Radiographic Analysis of Posterior Mono Axial Pedicle Screw Fixation in Treating Thoracolumbar Burst Fractures

2021 ◽  
Author(s):  
Sang-Soo Lee ◽  
Jae-Hoon Shim ◽  
Eun-Min Seo
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Correction Loss ◽  
Thoracolumbar Burst Fractures ◽  
Correction Rate ◽  
Burst Fractures ◽  
The Mean ◽  
Sagittal Index

Abstract Objective: The purpose of this study was to evaluate the effectiveness of posterior mono axial pedicle screws fixation in the treatment of thoracolumbar burst fractures.Methods: In the present study we analyzed 50 patients retrospectively who had thoracolumbar burst fractures without a neurological deficit. Patients were divided into 2 groups: mono axial pedicle Screw fixation group (n = 25) and poly axial pedicle Screw fixation group (n = 25). We collected clinical data (visual analog scale score for back pain) and included radiographic measurements. The latter were used to calculate the sagittal plane kyphosis.Results: For the mono group, the preoperative mean sagittal index (SI) was O.59 ± 0.12 (range, 0.37–0.77), and the last follow up sagittal index (SI)was O.76 ± 0.09 (range, 0.56–0.89). For the poly group, the preoperative sagittal index (SI) was O.57 ± 0.11 (range, 0.34–0.82),and the last follow up sagittal index (SI) was O.65 ± 0.11 (range, 0.36–0.87). For the mono group, the mean postoperative regional kyphosis correction rate was 62.31%, and correction loss was 14.18% in late follow-up. For the poly group, the mean postoperative regional kyphosis correction rate was 52.17%, and correction loss was 33.42% in late follow-up. The mono axial pedicle screw group had good correction rate, and reduce the risks of correction loss. The mean visual analog scale (VAS) scores for back pain improved by 2.4/2.5 and 3.8/4.2 for the mono and poly groups. There was no significant difference between groups.Conclusions: The mono axial pedicle screw fixation was better for reducing and maintaining anterior vertebral height and regional kyphosis. Therefore, the mono axial pedicle screw is a better optional instrumentation to treat thoracolumbar vertebral fractures.

Sign in / Sign up

Export Citation Format

Share Document