A Comparative Study on Efficacies of Posterior Microscopic Mini-open and Open Technique for Thoracolumbar Burst Fractures Accompanied With Severe Traumatic Spinal Stenosis

Purpose To compare the efficacies of minimal invasive decompression by posterior microscopic mini-open technique combined with percutaneous pedicle fixation (hereafter MOT) and traditional open surgeries in patients with severe traumatic spinal canal stenosis resulting from AO Type A3 or A4 thoracolumbar burst fractures and provide references for clinical treatment. Methods The clinical materials of 133 patients with severe traumatic spinal canal stenosis caused by AO Type A3 or A4 thoracolumbar burst fractures who underwent MOT (group A) or traditional open surgery (group B) were retrospectively enrolled. The patient demographic and radiological data were analyzed between the two groups. Results A total of 64 patients were finally recruited in this study. There were no significant differences in gender, age, follow-up time, injury mechanism, injured level, Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification, American Spinal Injury Association (ASIA) score, Visual analogue scale (VAS) score and hospital stay between the two groups (P>0.05). After procedures, the prevertebral height ratio (PHR), the Cobb angle, and the mid-sagittal canal diameter compression ratio (MSDCR) in two groups were significantly improved (P<0.05). Meanwhile, group A with little intraoperative bleeding volume, and the VAS score improved better at post-operation and last follow up, but the operative time was longer (P<0.05). The PHR, the Cobb angle in the two groups at the post-operation and last follow up without significantly different (P>0.05), the MSDCR was improved at last follow up when compared with the value at post-operation (P<0.05). However, the Cobb angle in group A was well maintained than in group B at last follow up (P<0.05) and the MSDCR in group B at last follow up improved better than in group A (P<0.05). Conclusions Both the MOT and traditional open surgery can treat AO type A3 and A4 thoracolumbar burst fractures accompanied with severe traumatic spinal stenosis effectively. The MOT has advantages including minimal invasion, extremely fine spinal canal decompression, lower intraoperative bleeding volume and obvious pain relief. We suggest that MOT should be preferentially selected for AO type A3 or A4 thoracolumbar burst fractures accompanied with severe traumatic spinal stenosis.

PERCUTANEOUS INSTRUMENTATION WITHOUT ARTHRODESIS FOR THORACOLUMBAR BURST FRACTURES (A3/A4, B): A RETROSPECTIVE STUDY

ABSTRACT Objective: There is still no consensus as to the treatment options for thoracolumbar burst fractures, although these fractures are widely described in the literature. The aim of this study was to evaluate the clinical and radiological outcomes of percutaneous instrumentation without arthrodesis as a method of fixation of these lesions. Methods: This retrospective, cross-sectional study evaluated 16 patients by measuring regional kyphosis using the Cobb method and the scores for quality of life and return to work (Oswestry Disability Index, VAS, SF-36 and Denis). Results: Six months after surgical treatment, 62.5% of all patients showed minimal disability according to the Oswestry Disability Index, maintenance of regional kyphosis correction and no synthesis failure. Conclusions: The clinical and radiological outcomes of the study suggest that minimally invasive fixation is indicated for the treatment of thoracolumbar burst fractures. Level of evidence IV; Observational study: retrospective cohort.

Surgical versus non-surgical treatment for thoracolumbar burst fractures without neurological deficit: A systematic review and meta-analysis v1

The aim of this systematic review is to compare the outcomes of burst fracture between non-operative treatments and operative treatments.

Thoracic Spine Fractures with Blunt Aortic Injury: Incidence, Risk Factors, and Characteristics

Background: The coexistence of thoracic fractures and blunt aortic injury (BAI) is potentially catastrophic and easy to be missed in acute trauma settings. Data regarding patients with thoracic fractures complicated with BAI are limited. Methods: The authors conducted a prospective, observational, single-center study including patients with thoracic burst fractures. A multivariate logistic regression model was developed to determine the risk factors of aortic injury. Results: In total, 124 patients with burst fractures of the thoracic spine were included. The incidence of BAI was 11.3% (14/124) in patients with thoracic burst fractures. Among these patients, 11 patients with BAI were missed diagnoses. The main risk factors of BAI were as follows: Injury severity score (OR 1.184; 95% CI, 1.072–1.308; p = 0.001), mechanism of injury, such as crush (OR 10.474; 95% CI, 1.905–57.579; p = 0.007), flail chest (OR = 4.917; 95% CI, 1.122–21.545; p = 0.035), and neurological deficit (OR = 8.299; 95% CI, 0.999–68.933; p = 0.05). Conclusions: BAI (incidence 11.3%) is common in patients with burst fractures of the thoracic spine and is an easily missed diagnosis. We must maintain a high suspicion of injury for BAI when patients with thoracic burst fractures present with these high-risk factors.

A Lateral Opening Injection Tool Used In Percutaneous Vertebroplasty To Treat Asymptomatic Osteoporotic Vertebral Burst Fractures: A Retrospective Study In 66 Cases

Background: This study aimed to assess the results of percutaneous vertebroplasty (PVP) with a lateral opening injection tool for treating asymptomatic osteoporotic vertebral burst fractures (OVBFs) patients.Methods: 66 patients diagnosed with acute asymptomatic OVBFs with a spinal canal occupational ratio under 20% were treated with bilateral PVP using a lateral opening injection tool in our study. The related clinical outcomes and images were assessed, including Visual Analogue Scale (VAS), vertebral height (VH) ratio (=fractured VH/ adjacent nonfractured VH), the bone union of the fractured vertebral posterior wall, bone cement distribution, and complications.Results: The VAS scores were 3.80±0.40 at postoperative one day and 0.59±0.41 at last follow-up, significantly lower than 8.37±0.49 at pre-operation (P<0.05). The vertical distribution of bone cement in 60 cases contacted the upper and lower endplates of fractured vertebras. There was no leakage of bone cement in the spinal canal or displacement of posterior wall fracture to the spinal canal in all cases. There was asymptomatic cement leakage in 7 cases. The mean anterior, middle and posterior vertebral height ratios were significantly increased after PVP compared with preoperative values in all patients (P<0.05). At 6 months follow-up, there was no significant height loss of the vertebral body. Three months postoperatively, the posterior wall of fractured vertebral bodies was healed in all cases according to CT images. Conclusions: PVP using a lateral opening injection tool was effective and safe for treating asymptomatic OVBF patients.

Comparing porous tantalum fusion implants and iliac crest bone grafts for spondylodesis of thoracolumbar burst fractures: Prospectice Cohort study

The aim of this study was to compare two different techniques of performing one-level spondylodesis for thoracolumbar burst fractures using either an autologous iliac crest bone graft (ICBG) or a porous tantalum fusion implant (PTFI). In a prospective nonrandomized study, 44 patients (20 women, 24 men; average age 43.1 ± 13.2 years) suffering from severe thoracolumbar burst fractures were treated with combined anterior–posterior stabilization. An ICBG was used in 21 cases, and a PTFI was used in the other 23 cases. A two-year clinical and radiographic follow-up was carried out. There were no statistically significant differences in age, sex, localization/classification of the fracture, or visual analog scale (VAS) before injury between the two groups. All 44 patients were followed up for an average period of 533 days (range 173–1567). The sagittal spinal profile was restored by an average of 11.1° (ICBG) vs. 14.3° (PTFI) (monosegmental Cobb angle). Loss of correction until the last follow-up tended to be higher in the patients treated with ICBG than in those treated with PTFI (mean: 2.8° vs. 1.6°). Furthermore, significantly better restoration of the sagittal profile was obtained with the PTFI than with the iliac bone graft at the long-term follow-up (mean: ICBG 7.8°, PTFI 12.3°; p < 0.005). Short-segment posterior instrumentation combined with anterior one-level spondylodesis using either an ICBG or a PTFI resulted in sufficient correction of posttraumatic segmental kyphosis. PTFI might be a good alternative for autologous bone grafting and prevent donor site morbidities.