Short-term Percutaneous Instrumentation and Selective Anterior Fusion for Thoracolumbar Fractures.
Backbone (Phila Pa 1976). 2017 Might 01;42(9):E523-E531
Authors: Charles YP, Walter A, Schuller S, Steib JP
STUDY DESIGN: Potential medical trial in thoracolumbar trauma with 5-year follow-up.
OBJECTIVE: To research medical and radiographic outcomes of minimal invasive surgical procedure, and the rational of circumferential fracture remedy with regard to age, degenerative adjustments, bone mineral density, and international sagittal stability.
SUMMARY OF BACKGROUND DATA: Non-neurologic fractures with anterior column defect could be handled by posterior percutaneous instrumentation and selective anterior fusion. After consolidation, instrumentation could be eliminated at 1 12 months to supply mobility in non-fused segments.
METHODS: Fifty-one sufferers, 47 (18-75) years, have been operated for A2, A3, or B-type fractures. Visible analog scale (VAS) for again ache and Oswestry Incapacity Index (ODI) have been assessed. Radiographic measurements have been: sagittal index, regional kyphosis, T4-T12 kyphosis, L1-S1 lordosis, pelvic incidence, pelvic tilt, sacral slope, and T9 tilt. Anterior fusion and aspect joints have been analyzed on computed tomography (CT) at 1 12 months.
RESULTS: The ODI was eight.eight earlier than accident, 35.four at three months, 17.eight at 2 years, 14.four at 5 years. The VAS was 2.zero at three months and 1.zero at 5 years. The sagittal index was 18.zero° preoperatively and 1.zero° at three months (P?<?zero.0001). A lack of discount of 1.1° occurred after implant removing (P?=?zero.009). International sagittal stability remained unchanged. Ten sufferers with osteopenia or osteoporosis had a worse ODI: 24.7 versus 11.9 (P?=?zero.016), and a better lack of correction: four.9° versus 1.three° (P?=?zero.007). Cages full of cancellous bone from the fractured vertebra fused commonly. Spontaneous aspect joint fusions have been noticed in two sufferers on the fracture stage in B-type accidents.
CONCLUSION: Percutaneous instrumentation and selective anterior fusion utilizing autologous bone and mesh cages result in excessive fusion charges, which supplied good long-term medical ends in youthful sufferers with thoracolumbar fractures. Sagittal alignment was maintained after instrumentation removing with out damaging paravertebral muscle mass. Outcomes have been worse in aged sufferers presenting osteopenia or osteoporosis.
LEVEL OF EVIDENCE: three.
PMID: 27584674 [PubMed – indexed for MEDLINE]