Short vs long posterior fixation of thoracolumbar spine injuries

Introduction. More than a quarter of total number of posterior fixations of thoracolumbar spine is unsuccessful. Material and methods. The aim is to compare short and long fixation of thoracolumbar spine injuries. During the period of 2006 to 2015 we examined 99 patients at the Department of Orthopedic Surgery and Traumatology of Clinical Center of Vojvodina. Short fixation was performed in 63 cases and long fixation in 36 cases. All patients underwent clinical, radiographic and neurological evaluation. Mean age in the short fixation group was 47 (18-66) and in the long fixation group it was 43 (17-70). Mean follow-up time was 4,5 years. Results. Implants were extracted in 14 cases of short and in 4 cases of long fixation. Collapse of anterior part of vertebral body developed in 28,45% in the short fixation group and in 22,43% in the long fixation group whereas angulation value was 10,2o and 12,3o respectively. Mean low back outcome scale value was 61 points in the short fixation group and 50 in the long fixation group. There were 22 patients with neurological deficit. Full recovery was recorded in 8 patients (36,4%) of the short fixation group and in 17 patients (22,7%) of the long fixation group. Complications developed in 15 patients (23,8%) of the short fixation group and 11 (30,6%) of the long fixation group. Conclusion. Short fixation is biomechanically weaker but provides a better functional recovery than long fixation.

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Outcome of Unstable Thoracolumbar Fracture Following Long Segment Posterior Fixation

Journal of Bangladesh College of Physicians and Surgeons ◽

10.3329/jbcps.v39i2.52410 ◽

2021 ◽

Vol 39 (2) ◽

pp. 114-122

Author(s):

Abdullah Al Mamun Choudhury ◽

Md Shah Alam ◽

Abul Kalam Azad ◽

Kohinoor Akhter

Keyword(s):

Functional Outcome ◽

Neurological Deficit ◽

Thoracolumbar Spine ◽

Case Series ◽

Fusion Rate ◽

Spine Injury ◽

P Value ◽

Posterior Fixation ◽

Thoracolumbar Region

Introduction: Fractures of the thoracolumbar region are the most common injuries of the vertebral column and burst fractures are the most frequent. The purpose of this study was to see the radiological and functional outcome after long segment posterior fixation in unstable thoracolumbar spine injury with incomplete neurological deficit. Methods: A total of 146 cases were included in this prospective case series from January 2014 to December 2018 through non randomized purposive sampling. All the patients were operated with long segment posterior fixation and postero-lateral fusion by Autogenous cancellous bone graft. Postoperative functional outcome was assessed both clinically by ODI, VAS, ASIA and radiologically by Bridwell criteria. Postoperative follow up was conducted at 2nd, 6th,12th and finally 6 monthly. Results: The mean Cobb angle at pre-operative was 21.5 ±8.9 and at final follow-up was 11±4.57 in this study (p-value<0.05). At final follow up 1 grade improvement occurred in 116(79.5%) patients and 2 grade improvement in 36 (20.5%). Regarding ODI and VAS, moderate disability (25%) with mild pain (16%) was found at final follow up with a Bridwell fusion grade II (48%). Conclusion: Long segment transpedicular screw fixation in unstable thoracolumbar spine injury with incomplete neurological deficit is an effective method of treatment. This method enhances neurological and functional recovery with an acceptable fusion rate J Bangladesh Coll Phys Surg 2021; 39(2): 114-122

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183 Short Segment Posterior Fixation with Index Level Screws Versus Long Segment Posterior Fixation for Thoracolumbar Spine Fracture: Angle of Correction and Pain

Neurosurgery ◽

10.1093/neuros/nyx417.183 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 248-248

Author(s):

Ahmed Mamdouh Sallam

Keyword(s):

Thoracolumbar Spine ◽

Spine Fracture ◽

High Rate ◽

Posterior Fixation ◽

Short Segment ◽

Cobb’S Angle ◽

Index Level ◽

Short Segment Fixation ◽

With Screws

Abstract INTRODUCTION As a simple and commonly used technique, short-segment pedicle instrumentation of thoracolumbar instability seems to have a high rate of implant failure and recurrence of instability.Data obtained from those studies suggest that the use of transpedicular screws at the fractured level provides the advantages of a stiffer construct, an increased biomechanical stability and the effect of 3-point fixation of the unstable segment leads to gardening against pulled-out. METHODS Methods: A prospective study of 61 patients, have single level thoracolumbar spine fracture with Cobb's angle = 25°, underwent posterior fixation. Of them, Thirty three patients underwent short segment fixation one level above and one level below with screws into the index level, and twenty eight patients underwent long segment fixation with two levels above and two levels below with skipped index level. All patients were followed up for about 1 year until the fusion achieved. The angle of correction and pain were regularly assessed by Cobb's angle measurement and visual analogue scale (VAS) respectively. RESULTS >The sixty one patients who underwent posterior fixation was grouped into 33 short segment cases and 28 long segment cases. the post operative mean angle of correction were 6.8° ± 2.6° and 5.8° ± 1.6° respectively (P = 0.098). After 1 year follow up, the angle of correction have become 7.8° ± 1.6° and 7.9° ± 1.8° respectively (P = 0.860). The pain was assessed by VAS on regular base follow up. In short segment group the pre-operative VAS was 5.6 ± 2.1 whereas the long segment group VAS was 5.1 ± 2.1 (P = 0.284).On one year follow up the VAS were 1.4 ± 0.5 and 1.8 ± 0.4 (P = 0.590) respectively. CONCLUSION The short segment fixation with screws into index level can maintain the angle of correction till the fusion achieved as long segment fixation

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Vertebroplasty-augmented short-segment posterior fixation of osteoporotic vertebral collapse with neurological deficit in the thoracolumbar spine: comparisons with posterior surgery without vertebroplasty and anterior surgery

Journal of Neurosurgery Spine ◽

10.3171/2010.5.spine09813 ◽

2010 ◽

Vol 13 (5) ◽

pp. 612-621 ◽

Cited By ~ 51

Author(s):

Kenzo Uchida ◽

Hideaki Nakajima ◽

Takafumi Yayama ◽

Tsuyoshi Miyazaki ◽

Takayuki Hirai ◽

...

Keyword(s):

Neurological Deficit ◽

Posterior Fixation ◽

Vertebral Collapse ◽

Kyphotic Angle ◽

Short Segment ◽

Anterior Surgery ◽

Posterior Surgery ◽

Group B ◽

Osteoporotic Vertebral Collapse

Object The surgical approach and treatment of thoracolumbar osteoporotic vertebral collapse with neurological deficit have not been documented in detail. Anterior surgery provides good decompression and solid fusion, but the surgery-related risk is relatively higher than that associated with the posterior approach. In posterior surgery, the major problem after posterior correction and instrumentation is failure to support the anterior spinal column, leading to loss of correction of kyphosis. The aim of this study was to evaluate the efficacy of reinforcing short-segment posterior fixation with vertebroplasty and to compare the outcome with those of posterior surgery without vertebroplasty and anterior surgery, retrospectively. Methods The authors studied 83 patients who underwent surgical treatment for a single thoracolumbar osteoporotic vertebral collapse with neurological deficit. Twenty-eight patients treated by posterior surgery combined with vertebroplasty (Group A), 25 patients treated by posterior surgery without vertebroplasty (Group B), and 30 patients treated by anterior surgery (Group C) were followed up for a mean postoperative period of 4.4 years. Neurological outcome, visual analog scale pain score, and radiographic results were compared in the 3 groups. Results Postoperative (4–6 weeks) and follow-up neurological outcome and visual analog scale scores were not significantly different among the 3 groups. Postoperative kyphotic angle was significantly reduced in Group B compared with Group C (p = 0.007), whereas the kyphotic angle was not significantly different among the 3 groups at follow-up. The mean ± SD loss of correction at follow-up was 4.6° ± 4.5°, 8.6° ± 6.2°, and 4.5° ± 5.9° in Groups A, B, and C, respectively. The correction loss at follow-up in Group B was significantly higher compared with Groups A and C (p = 0.0171 and p = 0.0180, respectively). Conclusions The results suggest that additional reinforcement with vertebroplasty reduces the kyphotic loss and instrumentation failure, compared with patients without the reinforcement of vertebroplasty. Vertebroplasty-augmented short-segment fixation seems to offer immediate spinal stability in patients with thoracolumbar osteoporotic vertebral collapse; the effect seems equivalent to that of anterior reconstruction.

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Magnetic resonance imaging evaluation of intervertebral disc injuries can predict kyphotic deformity after posterior fixation of unstable thoracolumbar spine injuries

Medicine ◽

10.1097/md.0000000000011442 ◽

2018 ◽

Vol 97 (28) ◽

pp. e11442 ◽

Cited By ~ 1

Author(s):

Shozo Kanezaki ◽

Masashi Miyazaki ◽

Toshinobu Ishihara ◽

Naoki Notani ◽

Hiroshi Tsumura

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Intervertebral Disc ◽

Thoracolumbar Spine ◽

Kyphotic Deformity ◽

Posterior Fixation ◽

Resonance Imaging ◽

Imaging Evaluation ◽

Magnetic Resonance Imaging Evaluation ◽

Spine Injuries

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Review of 31 cases of anterior thoracolumbar fixation with the anterior thoracolumbar locking plate system

Neurosurgical FOCUS ◽

10.3171/foc.1999.7.1.3 ◽

1999 ◽

Vol 7 (1) ◽

pp. E3 ◽

Cited By ~ 1

Author(s):

John A. Wilson ◽

Sam Bowen ◽

Charles L. Branch ◽

J. Wayne Meredith

Keyword(s):

Locking Plate ◽

Average Length ◽

Thoracolumbar Spine ◽

Posterior Fixation ◽

Fixation Device ◽

Structural Bone Graft ◽

Stabilization Procedure ◽

Long Term Follow Up ◽

Flexion Injury

Anterior fixation devices for the thoracolumbar spine have gained wide acceptance as viable alternatives to long-segment posterior fixation in cases of thoracolumbar spine trauma. This review was undertaken to evaluate the safety and efficacy of the Synthes anterior thoracolumbar locking plate (ATLP) system. Over a 3-year period, 31 patients with unstable traumatic fractures of the thoracolumbar spine underwent corpectomy, placement of a structural bone graft, and anterior fixation in which the Synthes ATLP system was used. Long-term follow-up data were obtained in 29 patients. Two patients were lost to follow up, one at 4 months and the other at 1 year. In the remaining patients, the average length of follow up was 20 months. In all patients radiographic evidence of solid bone fusion was demonstrated on follow-up plain x-ray films, and there were no signs or symptoms of pseudarthrosis. No patient suffered neurological deterioration as a result of surgery, and there was relatively little morbidity associated with this plating system. To date, none of the patients in this study has developed any delayed complications related to the fixation device. In one patient, who had sustained a severe flexion injury, loosening of the anterior fixation device occurred, and the patient developed progressive kyphosis, which required a posterior stabilization procedure. These results appear slightly better than those obtained in published studies in which other anterior plating systems were used, indicating that this system is safe and effective in the treatment of unstable fractures of the thoracolumbar spine.

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PERCUTANEOUS EPIDURAL NEUROPLASTY (PEN) USING COMBINATION OF HYALURONIDASE AND HYPERTONIC SALINE (NaCl 3%) IN TREATING FAILED BACK SURGERY SYNDROME

Neurologico Spinale Medico Chirurgico ◽

10.15562/nsmc.v1i1.1 ◽

2018 ◽

Vol 1 (1) ◽

pp. 1

Author(s):

Wawan Mulyawan ◽

Yudi Yuwono Wiwoho ◽

Syaiful Ichwan

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Hypertonic Saline ◽

Failed Back Surgery Syndrome ◽

Favourable Outcome ◽

Lumbar Spine Surgery ◽

Low Back ◽

Failed Back Surgery ◽

Scale Scores

Background: Following surgical treatments for low back pain, lower extremity pain or neurologic symptoms would last or recur, this is defined as failed sack surgery syndrome (FBSS). FBSS usually occurs in 5-40% of these surgical patients. The most common cause is an epidural scar adhesion. Percutaneous epidural neuroplasty is the non-mechanical treatment for this condition. Previously, the use of hyaluronidase and hypertonic saline separately is commonly used for epidurolysis but the combination of hyaluronidase and hypertonic saline 3% has not been explored.Objective: To investigate the two-year outcomes of percutaneous epidural neuroplasty using a combination of hyaluronidase and hypertonic saline 3% in patients with FBSS.Methods: Twelve patients who experience low back pain, with or without radiculopathy, who have underwent lumbar spine surgery previously were assigned to the study. Parameters, such as the visual analogue scale scores for the back (VAS-B) and legs (VAS-L), and the Oswestry disability index (ODI), were recorded and compared between pretreatment, 1 week, 1 month, 3 months, 1 year and 2 years follow-up.Results: For all 12 patients, the postoperative VAS-B, VAS-L, and ODI were significantly different from the preoperative values in all follow-up periods: 1 month, 3 months, 1 year, and 2 years.Conclusion: Based off this study group, percutaneous epidural neuroplasty using a combination of hyaluronidase and hypertonic saline 3% has a favourable outcome in the 2 years follow-up

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Continued Follow-Up by a Hospital Diabetes Care Team Improves HbA1c at 1 Year after Elective Orthopedic Surgery

Diabetes ◽

10.2337/db18-2317-pub ◽

2018 ◽

Vol 67 (Supplement 1) ◽

pp. 2317-PUB

Author(s):

RAJESH GARG ◽

SHREYA BHANDARI ◽

RAQUEL REIN ◽

MARIE E. MCDONNELL

Keyword(s):

Orthopedic Surgery ◽

Diabetes Care ◽

Care Team

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Faculty Opinions recommendation of The effectiveness of endoscopic epidurolysis in treatment of degenerative chronic low back pain: a prospective analysis and follow-up at 48 months.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.10948959.12766056 ◽

2011 ◽

Author(s):

Sukdeb Datta

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Prospective Analysis ◽

Low Back

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MDCT-Based Finite Element Analyses: Are Measurements at the Lumbar Spine Associated with the Biomechanical Strength of Functional Spinal Units of Incidental Osteoporotic Fractures along the Thoracolumbar Spine?

Diagnostics ◽

10.3390/diagnostics11030455 ◽

2021 ◽

Vol 11 (3) ◽

pp. 455

Author(s):

Nico Sollmann ◽

Nithin Manohar Rayudu ◽

Long Yu Yeung ◽

Anjany Sekuboyina ◽

Egon Burian ◽

...

Keyword(s):

Finite Element ◽

Lumbar Spine ◽

Fracture Risk ◽

Thoracolumbar Spine ◽

Areal Bone Mineral Density ◽

Mineral Density ◽

Osteoporotic Vertebral Fractures ◽

The Mean ◽

Biomechanical Strength

Assessment of osteoporosis-associated fracture risk during clinical routine is based on the evaluation of clinical risk factors and T-scores, as derived from measurements of areal bone mineral density (aBMD). However, these parameters are limited in their ability to identify patients at high fracture risk. Finite element models (FEMs) have shown to improve bone strength prediction beyond aBMD. This study aims to investigate whether FEM measurements at the lumbar spine can predict the biomechanical strength of functional spinal units (FSUs) with incidental osteoporotic vertebral fractures (VFs) along the thoracolumbar spine. Multi-detector computed tomography (MDCT) data of 11 patients (5 females and 6 males, median age: 67 years) who underwent MDCT twice (median interval between baseline and follow-up MDCT: 18 months) and sustained an incidental osteoporotic VF between baseline and follow-up scanning were used. Based on baseline MDCT data, two FSUs consisting of vertebral bodies and intervertebral discs (IVDs) were modeled: one standardly capturing L1-IVD–L2-IVD–L3 (FSU_L1–L3) and one modeling the incidentally fractured vertebral body at the center of the FSU (FSU_F). Furthermore, volumetric BMD (vBMD) derived from MDCT, FEM-based displacement, and FEM-based load of the single vertebrae L1 to L3 were determined. Statistically significant correlations (adjusted for a BMD ratio of fracture/L1–L3 segments) were revealed between the FSU_F and mean load of L1 to L3 (r = 0.814, p = 0.004) and the mean vBMD of L1 to L3 (r = 0.745, p = 0.013), whereas there was no statistically significant association between the FSU_F and FSU_L1–L3 or between FSU_F and the mean displacement of L1 to L3 (p > 0.05). In conclusion, FEM measurements of single vertebrae at the lumbar spine may be able to predict the biomechanical strength of incidentally fractured vertebral segments along the thoracolumbar spine, while FSUs seem to predict only segment-specific fracture risk.

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