RESEARCH PAPER
Evaluation of long-term surgical treatment outcomes of thoraco-lumbar spinal fractures – follow-up period of over 10 years
1
University of Physical Education in Warsaw, branch in Biała Podlaska, Poland
2
Centre of Oncology of the Lublin Region St. Jana z Dukli, Poland
3
Department of Human Anatomy, Medical University, Lublin, Poland
Corresponding author
Robert Węgłowski
University of Physical Education in Warsaw, branch in Biała Podlaska, Akademicka 2, 21-500, Biała Podlaska, Poland
University of Physical Education in Warsaw, branch in Biała Podlaska, Akademicka 2, 21-500, Biała Podlaska, Poland
Ann Agric Environ Med. 2021;28(2):339-344
KEYWORDS
TOPICS
ABSTRACT
Introduction and objective:
Agricultural accidents often result in spinal injuries, particularly in fractures of the thoraco-lumbar spine. Surgical treatment of thoraco-lumbar fractures continues to comprise a major medical problem. The aim of this study was to assess and compare the long-term effects of surgical treatments of thoracic and lumbar spinal fractures treated with transpedicular stabilization, combined with posterior interbody spinal fusion (PLIF, also known as spondylodesis) or Daniaux reconstruction.
Material and methods:
A retrospective analysis was conducted on 66 patients with a thoracic or lumbar spinal fracture (Th10-L3) type A in the AO classification system, operated in 2000–2005. All patients underwent a short segment transpedicular stabilization, which in 36 patients was combined with posterior interbody spinal fusion, and in 30 other patients combined with Daniaux reconstruction. Radiological assessment was performed based on X-ray imaging. A lateral X-ray image of the spine was used to measure the vertebral wedging angle of the fractured vertebrae, the height ratio of the anterior to posterior vertebral body, and the angle of segmental kyphotic deformation. Subjective long-term assessment of the patient was conducted using the Oswestry Instability Score. The results were analyzed for statistical significance.
Results:
In both groups, similar improvements in all measured parameters were observed. Despite all patients losing some of the correction in the long-term, this loss was significantly smaller following Daniaux reconstruction.
Conclusions:
Spinal stabilization combined with vertebral reconstruction allows for long-term and improved treatment results for thoraco-lumbar fracture than posterior interbody spinal fusion (spondylodesis).
Agricultural accidents often result in spinal injuries, particularly in fractures of the thoraco-lumbar spine. Surgical treatment of thoraco-lumbar fractures continues to comprise a major medical problem. The aim of this study was to assess and compare the long-term effects of surgical treatments of thoracic and lumbar spinal fractures treated with transpedicular stabilization, combined with posterior interbody spinal fusion (PLIF, also known as spondylodesis) or Daniaux reconstruction.
Material and methods:
A retrospective analysis was conducted on 66 patients with a thoracic or lumbar spinal fracture (Th10-L3) type A in the AO classification system, operated in 2000–2005. All patients underwent a short segment transpedicular stabilization, which in 36 patients was combined with posterior interbody spinal fusion, and in 30 other patients combined with Daniaux reconstruction. Radiological assessment was performed based on X-ray imaging. A lateral X-ray image of the spine was used to measure the vertebral wedging angle of the fractured vertebrae, the height ratio of the anterior to posterior vertebral body, and the angle of segmental kyphotic deformation. Subjective long-term assessment of the patient was conducted using the Oswestry Instability Score. The results were analyzed for statistical significance.
Results:
In both groups, similar improvements in all measured parameters were observed. Despite all patients losing some of the correction in the long-term, this loss was significantly smaller following Daniaux reconstruction.
Conclusions:
Spinal stabilization combined with vertebral reconstruction allows for long-term and improved treatment results for thoraco-lumbar fracture than posterior interbody spinal fusion (spondylodesis).
REFERENCES (35)
1.
Mathur N, Jain S, Kumar N, Srivastava A, Purohit N, Patni A. Spinal cordinjury: scenario in an Indian state. Spinal Cord. 2015; 53: 349–52. https://doi.org/10.1038/sc.201....
2.
Rastogi D, Meena S, Sharma V, Singh GK. Causality of injury and outcome in patientsadmitted in major trauma center in North India. Int J Crit IIln Inj Sci. 2014; 4: 298–302. https://doi.org/10.4103/2229-5....
3.
Kaneda P, Taneichi H, Abumi K, Hashimoto T, Satoh S, Fujiya M. Anterior decompression and stabilization with the Kaneda device for thoracolumbar burst fractures associated with neurological deficits. J Bone Joint Surg Am. 1997; 79: 69–83. https://doi.org/10.2106/000046....
4.
Alanay A, Acaroglu E, Yazici M, Oznur A, Surat A. Short-segment pedicle instrumentation of thoracolumbar burst fractures: Does transpedicular intracorporeal grafting prevent early failure? 2001; 26: 213–217. https://doi.org/10.1097/000076....
5.
Chen H, Wang W, Li K, Chen T. Biomechanical effects of the body augumenter for reconstruction of the vertebral body. Spine. 2004; 29: 382–387. https://doi.org/10.1097/01.brs....
6.
Briem D, Lehmann W, Ruecker A, Windolf J, Rueger J, Linhart W. Factors influencing the quality of life after burst fractures of the thoracolumbar transition. Arch Orthop Trauma Surg. 2004; 124: 461–468. https://doi.org/10.1007/s00402....
7.
Wang S, Ma H, Liu C, Yu W, Chang M, Chen T. Is fusion necessary for surgical treated burst fractures of the thoracolumbar and lumbar spine?: A prospective, randomized study. Spine. 2006; 31: 2646–2652. https://doi.org/10.1097/01.brs....
8.
Daniaux H, Seykora P, Genelin A. Application of posterior plating and modification in thoraco-lumbar spine injuries. Indication, techniques and results. Spine. 1991; 16: 125–133. https://doi.org/10.1097/000076....
9.
Jacobs R, Casey M. Surgical management of thoracolumbar spinal injuries: general principles and controversial considerations. Clin Orthop Relat Res. 1984; 189: 22–31.
10.
Crawford R, Ashin G. Fixation of thoracolumbar fractures with Dick fixator: the influence of transpedicular bone grafting. Eur Spine J. 1994; 3: 45–51. https://doi.org/10.1007/bf0242....
11.
Aebi M, Etter C, Kehl T, Thalgott J. Stabilization of the lower thoracic and lumbar spine with the internal spinal skeletal fixation system: indications, techniques, and first results of treatment. Spine. 1987; 12: 544–551. https://doi.org/10.1097/000076....
12.
Liljenquist U, Mommen U. Die operative Behandlung thoracolumbalen Wirbelsäule-verletzungen mit dem Fixateur interne und trans-pedikuläre Spongiosaplastik. Unfallchirurg. 1995; 21: 30–36. https://doi.org/10.1007/bf0258....
13.
Dai L, Jiang L, Jiang S. Posterior short-segment fixation with or with -out fusion for thoracolumbar burst fractures. A five to seven-year prospective randomized study. J Bone Joint Surg Am. 2009; 91: 1033–1041. https://doi.org/10.2106/jbjs.h....
14.
Knop C, Bastian L, Lange U, Blauth M. Transpedicular fusion of the thoraco-lumbar junction. Clinical, radiographic and CT results. Orthopade. 1999; 28: 703–713. https://doi.org/10.1007/s00132....
15.
Fairbank JC, Pynsent PB. The Oswestry Distability Index. Spine. 2000; 25: 2940–2952. https://doi.org/10.1097/000076....
16.
Müller U, Berlemann U, Sledge J, Schwarzenbach O. Treatment of thoracolumbar burst fractures without neurologic deficit by indirect reduction and posterior instrumentation: bisegmental stabilization with monosegmental fusion. Eur Spine J. 1999; 8: 284–289. https://doi.org/10.1007/s00586....
17.
Sasso P, Best N, Reilly T, McGuire R. Anterior-only stabilization of three-column thoracolumbar injuries. J Spinal Disord Tech. 2005; 18: 7–14. https://doi.org/10.1097/01.bsd....
18.
Alvine G, Swain J, Asher M, Burton D. Treatment of thoracolumbar burst fractures with variable screw placement or Isola instrumentation and arthrodesis: case series and literature review. J Spinal Disord Tech. 2004; 17: 251–264. https://doi.org/10.1097/01.bsd....
19.
Kim BG, Dan JM, Shin DE. Treatment of thoracolumbar fracture. Asian Spine J. 2015; 9(1): 133–46. https://doi.org/10.4184/asj.20....
20.
Wood KB, Buttermann GR, Phukan R, Harrod CC, Mehbod A, Shannon B, et al. Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit: a prospective randomized study with follow-up at sixteen to twenty-two years. J Bone Joint Surg Am. 2015; 97: 3–9. https://doi.org/10.2106/jbjs.n....
21.
Wood K, Bohn D, Mehbod A. Anterior versus posterior treatment of stable thoracolumbar burst fractures without neurologic deficit: a prospective, randomized study. J Spinal Disord Tech. 2005; 18: 15–23. https://doi.org/10.1097/01.bsd....
22.
Parker J, Lane J, Karaikovic E, Gaines R. Successful short-segment instrumentation and fusion for thoracolumbar spine fractures: a consecutive 4 ½-year series. Spine. 2000; 25: 1157–1170. https://doi.org/10.1097/000076....
23.
Sanderson P, Fraser R, Hall D, Cain C, Osti O, Potter G. Short segment fixation of thoracolumbar burst fractures without fusion. Eur Spine J. 1999; 8: 495–500. https://doi.org/10.1007/s00586....
24.
McLain R, Sparling E, Benson D. Early failure of short-segment pedicle instrumentation of thoracolumbar fractures. A preliminary report. J Bone Joint Surg Am. 1993; 75: 162–167. https://doi.org/10.2106/000046....
25.
Moon M, Choi W, Moon Y, Kim Y, Moon J. Stabilisation of fractured thoracic and lumbar spine with Cotrel-Dubousset instrument. J Orthop Surg. 2003; 11: 59–66. https://doi.org/10.1177/230949....
26.
Ko SB, Lee SW. Result of posterior instrumentation without fusion in the management of thoracolumbar and lumbar unstable burst fracture. J Spinal Disord Tech. 2014; 27: 189–95. https://doi.org/10.1097/bsd.0b....
27.
Jeon CH, Lee YS, Youn SJ, Lee HD, Chung NS. Factors affecting postural reduction in posterior surgery for thoracolumbar burst fracture. J Spinal Disord Tech. 2015; 28(4): E225–30. https://doi.org/10.1097/bsd.00....
28.
Knop C, Fabian HF, Bastian L, Rosenthal H, Lange U, Zdichavsky M, et al. Fate of the transpedicular intervertebral bone graft after posterior stabilisation of thoracolumbar fractures. Eur Spine J. 2002; 11: 251–257. https://doi.org/10.1007/s00586....
29.
Leferink V, Zimmerman K, Veldhuis E, Veldhuis E, ten Vergert E, ten Duis H. Thoracolumbar spinal fractures: radiological results of transpedicular fixation combined with transpedicular cancellous bone graft and posterior fusion in 183 patients. Eur Spine J. 2001; 10: 517–523. https://doi.org/10.1007/s00586....
30.
Zhang J, Xiao B, Xu R, Zhao L, Ma W, Ruan Y. Analysis of safety and effect of the technique of reconstructing anterior and middle columns by single posterior approach. Zhongguo Gu Shang. 2009; 22(7): 494–7.
31.
Li K, Hsieh C, Lee C, Chen T. Transpedicle body augumenter: a further step in treating burst fractures. Clin Orthop Relat Res. 2008; 466: 2555–6.
32.
Qinliang L, Cai Y, Shichun L. Transpedicular bone grafting and pedicle screw fixation in injured vertebrae using a paraspinal approach for thoracolumbar fractures: a retrospective study. J Orthop Surg Res. 2016; 11: 115. https://doi.org/10.1186/s13018....
33.
Qian B, Qiu Y, Wang B, Yu Y, Zhu Z. Effect of posterolateral fusion on thoracolumbar burst fractures. Chin J Traumatol. 2006; 9: 349–355.
34.
La Maida GA, Ruosi C, Misaggi B. Indications for the monosegmental stabilization of thoraco-lumbar spine fractures. Int Orthop. 2019; 43: 169–176. https://doi.org/10.1007/s00264....
35.
Wang X, Dai L, Xu H, Chi Y. Kyphosis recurrence after posterior short-segment fixation in thoracolumbar burst fractures. J Neurosurg Spine. 2008; 8(3): 246–254. https://doi.org/10.3171/spi/20....
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