Surgical Management of Lumbar and Thoracolumbar Spinal Fractures: Indications, Surgical Technique and Evaluation on a Series of 64 Patients Treated with Percutaneous Posterior Osteosynthesis Combined with Kyphoplasty or Anterior Arthrodesis
Introduction: Fractures of the lumbar spine and thoracolumbar junction are common in
spinal trauma. The aim of this work is to analyze the nature of the
indications, the morbidity as well as the results of these treatment regimens. Patients and Methods: A
retrospective, single-center study, based on a review of 64 patients with
lumbar spine and thoracolumbar junction fractures (T10-L2) without neurological
disorders, was collected in the neurosurgery department of the North Hospital
and University Hospital (CHU), Marseille over a period of 2 years from January
2015 to December 2016. Posterior percutaneous osteosynthesis were more or less
associated with kyphoplasty preceded anterior arthrodesis. Clinical and
radiological endpoints were collected at least 6 months later. Results: The mean follow-up was 9.5
months (6 - 24). The clinical evaluation found a mean VAS at last follow-up at
14/100 (0 - 30) and an average Oswestry score at the last follow-up at 88%. The
initial average vertebral kyphosis went from 13° to 4° at the
last follow-up with a correction loss of 1°, an absolute gain of 8°.
No postoperative neurological complications were noted in our series. Conclusion: The implementation of a
two-step therapeutic strategy with anterior reconstruction in Magerl’s lumbar
spine or A3.3 thoracolumbar junction fractures allows effective and
long-lasting correction of lumbar lordosis and thoracic kyphosis, and obtaining
a balanced spine in the sagittal plane. Our functional results are close to
normal, with low morbidity and a low complication rate.
References
[1]
Magerl, F., Aebi, M., Gerstein, S., Harms, J. and Nazarian, S. (1994) A Comprehensive Classification of Thoracic and Lumbar Injuries. European Spine Journal, 3, 184-201. https://doi.org/10.1007/BF02221591
[2]
Tropiano, P., Huang, R.C., Louis, C.A., Poitout, D.G. and Louis, R.P. (2003) Functional and Radiographic Outcome of Thoracolumbar and Lumbar Burst Fractures Managed by Closed Orthopaedic Reduction and Casting. Spine, 28, 2459-2465.
https://doi.org/10.1097/01.BRS.0000090834.36061.DD
[3]
Mumford, J., Weinstein, J.N., et al. (1993) Thoracolumbar Burst Fractures. The Clinical Efficacy and Outcome of Nonoperative Management. Spine, 18, 955-970.
https://doi.org/10.1097/00007632-199306150-00003
[4]
Denis, F., Armstrong, G.W., Searls, K. and Matta, L. (1984) Acute Thoraco-Lmbar Burst Fractures in the Absence of Neurologic Deficit. Clin Orthop, 189, 142-149.
[5]
Knop, C., et al. (2000) Surgical Treatment of Injuries of the Thoracolumbar Transition. 2: Operation and Roentgenologic Findings. Der Unfallchirurg, 103, 1032-1047.
https://doi.org/10.1007/s001130050667
[6]
Chen, J.-F. and Lee, S.-T. (2003) Percutaneous Vertebroplasty for the Treatment of Thoraclumbar Spine Bursting Fracture. Surgical Neurology, 62, 494-500.
https://doi.org/10.1016/j.surneu.2003.10.049
[7]
Amoretti, N., et al. (2005) Burst Fracture of the Spine Involving Vertebrae Presenting No Other Lesions. The role of vertebroplasty. Clinical Imaging, 29, 379-382.
https://doi.org/10.1016/j.clinimag.2005.07.006
[8]
Verlaan, J.J., Dhert, W.J., Verbout, A.J. and Oner, F.C. (2005) Balloon Vertebroplasty in Combination with Pedicle Screw Instrumentation: A Novel Technique to Treat Thoracic and Lumbar Burst Fractures. Spine, 30, E73-E79.
https://doi.org/10.1097/01.brs.0000152162.64015.fb
[9]
Lowery, G.L. and Kulkarni, S.S. (2000) Posterior Percutaneous Spine Instrumentation. European Spine Journal, 9, S126-S130. https://doi.org/10.1007/PL00008318
[10]
Frankel, H., Hancock, D.O. and Hislop, G. (1969) The Value of Postural Reduction in the Initial Management of Closed Injuries of the Spine with Paraplegia and Tetraplegia. Part I, Paraplegia, 7, 179-192.
[11]
Stagnara, P., DeMauroy, J.C. and Dran, G. (1982) Reciprocal Angulation of Vertebral Bodies in a Sagittal Plane: Approach to the References for the Evaluation of Kyphosis and Lordosis. Spine, 7, 335.
https://doi.org/10.1097/00007632-198207000-00003
[12]
McCormack, T., Karaikovic, E. and Gaines, R.W. (1994) The Load Sharing Classification of Spine Fractures. Spine, 15, 1741-1744.
[13]
Fairbank, J.C. and Pynsent, P.B. (2000) The Oswestry Disability Index. Spine, 25, 2940-2952. https://doi.org/10.1097/00007632-200011150-00017
[14]
Lange, U., Edeling, S., Knop, C., Bastian, L., Oeser, M., Krettek, C. and Blauth, M. (2007) Anterior Vertebral Body Replacement with a Titanium Implant of Adjustable Height: A Prospective Clinical Study. European Spine Journal, 16, 161-72.
https://doi.org/10.1007/s00586-005-0015-6
[15]
Payer, M. (2006) Unstable Burst Fractures of the Thoracolumbar Junction: Treatment by Posterior Bisegmental Correction/Fixation and Staged Anterior Corpectomy and Titanium Cage Implantation. Acta Neurochirurgica, 148, 299-306.
https://doi.org/10.1007/s00701-005-0681-5
[16]
Thomas, K.C., Bailey, C.S., Dvorak, M.F., Kwon, B., et al. (2006) Comparison of Operative and Nonoperative Treatment for Thoracolumbar Fractures in Patients without Neurological Deficit: A Systematic Review. Journal of Neurosurgery: Spine, 4, 351-358. https://doi.org/10.3171/spi.2006.4.5.351
[17]
Wood, K., et al. (2003) Operative Comparated with Nonoperative Treatment of a Thoracolumbar Burst Fracture without Neurological Deficit. A Prospective, Randomized Study. The Journal of Bone and Joint Surgery, 85, 773-781.
https://doi.org/10.2106/00004623-200305000-00001
[18]
Knop, C., Fabian, H.F., et al. (2001) Late Results of Thoracolombar Fractures after Posterior Instrumentation and Transpedicular Grafting. Spine, 26, 88-99.
https://doi.org/10.1097/00007632-200101010-00016
[19]
Reitman, C.A. (2004) Management of Thoracolumbar Fractures. American Academy of Orthopaedic Surgeons, Evanston.
[20]
Finiels, P.J., et al. (2006) Le système d’arthrodèse percutanée WSH: Résultats actuels et perspectives de développement futur. Neurochirurgie, 52, 26-36.
https://doi.org/10.1016/S0028-3770(06)71167-5
[21]
Argenson, C. and Lassale, B. (1996) Les fractures récentes du rachis thoracique et lombaire. Symposium de la 70ème réunion annuelle de la SOFCOT. Revue De Chirurgie Orthopedique Et Reparatrice De L’Appareil Moteur, 82, S61-S127.
[22]
Heary, R.F., Bono, C.M. and Black, M. (2004) Thoracic Pedicle Screws: Postoperative Computerized Tomography Scanning Assessment. Journal of Neurosurgery, 100, 325-331.
[23]
Wiesner, L., Kothe, R., Schulitz, K.P. and Ruther, W. (2000) Clinical Evaluation and Computed Tomography Scan Analysis of Tracts after Percutaneous Insertion of Pedicule Screws in the Lumbar Spine. Spine, 25, 615-621.
https://doi.org/10.1097/00007632-200003010-00013
[24]
De Falco, R., Scarano, E., Di Celmo, D., Grasso, U. and Guarnieri, L. (2005) Ballon Kyphoplasty in Traumatic Fractures of Thoracolumbar Junction. Preliminary Experience in 12 Cases. Journal of Neurosurgical Sciences, 49, 147-153.
[25]
Ryu, S.K., Park, C.K., Kim, M.C., et al. (2002) Dose-Dependent Epidural Leakage of Polymethylmethacrylate after Percutaneous Vertebroplasty in Patients with Osteoporotic Vertebral Compression Fractures. Journal of Neurosurgery, 96, 56-61.
[26]
Slomczykowski, M., Roberto, M., Schneeberger, P., Ozdoba, C. and Vock, P. (1999) Radiation Dose for Pedicle Screw Insertion. Fluoroscopic Method versus Computer-Assisted Surgery. Spine, 24, 975-982.
https://doi.org/10.1097/00007632-199905150-00009
Been, H.D. and Bouma, G.J. (1999) Comparison of Two Types of Surgery for Thoraco-Lumbar Burst Fractures: Combined Anterior and Posterior Stabilization vs. Posterior Instrumentation Only. Acta Neurochirurgica, 141, 349-357.
https://doi.org/10.1007/s007010050310
[29]
Parker, J.W., Lane, J.R. and Karaikovic, E.E. (2000) Successful Short Segment Instrumentation and Fusion for Thoracolumbar Spine Fractures. Spine, 25, 1157-1169. https://doi.org/10.1097/00007632-200005010-00018
[30]
McLain, R.F. (2004) Functional Outcomes after Surgery for Spinal Fractures: Return to Work and Activity. Spine, 29, 470-477.
https://doi.org/10.1097/01.BRS.0000092373.57039.FC