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Non permanent Percutaneous Instrumentation and Selective Anterior Fusion for Thoracolumbar Fractures.
Backbone (Phila Pa 1976). 2017 Could 01;42(9):E523-E531
Authors: Charles YP, Walter A, Schuller S, Steib JP
Summary
STUDY DESIGN: Potential scientific trial in thoracolumbar trauma with 5-year follow-up.
OBJECTIVE: To research scientific and radiographic outcomes of minimal invasive surgical procedure, and the rational of circumferential fracture therapy with regard to age, degenerative modifications, bone mineral density, and world sagittal stability.
SUMMARY OF BACKGROUND DATA: Non-neurologic fractures with anterior column defect might be handled by posterior percutaneous instrumentation and selective anterior fusion. After consolidation, instrumentation might be eliminated at 1 12 months to supply mobility in non-fused segments.
METHODS: Fifty-one sufferers, 47 (18-75) years, had been operated for A2, A3, or B-type fractures. Visible analog scale (VAS) for again ache and Oswestry Incapacity Index (ODI) had been assessed. Radiographic measurements had 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 had 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). World 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 often. Spontaneous aspect joint fusions had been noticed in two sufferers on the fracture degree in B-type accidents.
CONCLUSION: Percutaneous instrumentation and selective anterior fusion utilizing autologous bone and mesh cages result in excessive fusion charges, which offered good long-term scientific ends in youthful sufferers with thoracolumbar fractures. Sagittal alignment was maintained after instrumentation removing with out damaging paravertebral muscle tissues. Outcomes had been worse in aged sufferers presenting osteopenia or osteoporosis.
LEVEL OF EVIDENCE: three.
PMID: 27584674 [PubMed – indexed for MEDLINE]