Clinical efficacy of anterior artificial vertebral body reconstruction and internal fixation after failed posterior thoracolumbar fracture surgery

Abstract

Objective To investigate the effect of anterior artificial vertebral body reconstruction and internal fixation after the failed posterior thoracolumbar fracture surgery. Methods A retrospective case series study was conducted to analyze the clinical data of 14 patients whose posterior thoracolumbar fracture surgery failed admitted to Sir Run Run Shaw Hospital School of Medicine affiliated to Zhejiang University from January 2014 to June 2017. There were eight males and six females, aged 29-69 years [(43.6±11.9)years]. The involved segments included T11 in one patient, T12 in two patients, L1 in five patients, L2 in four patients and L3 in two patients. According to AO classification, there were four patients with type A2 , six with type A3, two with type B1 and two with type B2. The thoracolumbar injury severity scores (TLICS) ranged from 4 to 8 points [(5.3±1.1)points]. There were six patients with nonunion, three with nonunion following screw loosening, three with nonunion following breakage, and two with neurological dysfunction. Revision plan: for patients with internal fixation loosening or rupture or long nail placement, the posterior internal fixation would be removed first, and then the stage I anterior revision would be performed after changing the position; for patients with complete internal fixation, only anterior revision would be performed. The operation time, intraoperative blood loss, intraoperative and postoperative complications, pain visual analogue score (VAS), Oswestry dysfunction index (ODI) score and kyphosis angle changes before and after operation were recorded. Results All patients were followed up for 12-54 months [(25.9±13.0)months]. The anterior operation time ranged from 100 to 180 minutes [(137.9±23.6)minutes]. The intraoperative blood loss ranged from 280 to 750 ml [(452.9±145.4)ml]. There were no intraoperative or postoperative complications such as spinal nerve injury, cerebrospinal fluid leakage, vascular injury, abdominal organ injury, incision infection and hemorrhage. VAS decreased from preoperative (6.1±0.9)points to (1.9±0.7)points 3 months after operation and to (1.4±0.5)points at the last follow-up; ODI increased from preoperative (30.4±7.1)points to (7.9±6.4)points 3 months after operation and to (8.1±4.3)points at the last follow-up; kyphosis degree decreased from preoperative (-20.1±6.5)° to (5.6±6.4)° 3 months after operation and to (5.4±6.8)° at the last follow-up. The VAS, ODI score and kyphosis degree were significantly improved at the last follow-up compared with those before operation (P<0.01). Conclusions For patients with failed thoracolumbar fracture posterior surgery, anterior artificial vertebral body reconstruction and internal fixation can significantly relieve back pain, improve function and kyphosis deformity, with satisfactory clinical effect, which can be an ideal treatment option for the revision of thoracolumbar fracture. Key words: Spinal fractures; Thoracic vertebrae; Lumbar vertebrae; Fracture fixation, internal; Revision