Langzeitergebnisse nach Hybridstabilisierung inkompletter Berstungsfrakturen der thorakolumbalen Wirbelsäule des älteren Patienten

Abstract

To offer a correct treatment strategy for osteoporotic vertebral body fractures remains a huge challenge in modern spine surgery. In the years 2002 and 2003 5 patients with incomplete burst fractures (AO type A3.1) of the thoracolumbar spine were included in this study (4 men, 1 woman, average age: 62.6 years, follow-up rate: 100 %). All 5 were treated by kyphoplasty and additional dorsal bisegmental instrumentation. Unlike today, dorsal instrumentation was done without cement augmentation. Inclusion criteria were age above 60 years, an adequate trauma, and a fracture between thoracic body 11 and lumbar body 3. Data acquisition was performed prospectively before and after the operation, after 3, 6, 12, 18 months, and after 5 years, including visual analogue scale (VAS) spine score, spinal function score, X-ray examination or in cases of complaints or limited assessability a CT examination, and SF 36 score after 5 years. As comparison group, we used 4 patients, suffering the same fracture type with a similar fracture location (1 man, 3 women, average age: 67.3 years), who were treated with kyphoplasty alone during the same time period. No clinically relevant intra- and postoperative complications were registered in our study group. The operative bisegmental kyphotic reduction was slightly higher in our study group. Afterwards the correction loss was 9.8° in our study group, exceeding the reduction by 3.6°, whereas the comparison group suffered from a correction loss of 11.8°, exceeding the operative reduction by 8.5°, respectively. These differences were not statistically significant. Similarly, no statistically significant differences were registered with respect of physical component summary (PSC), mental component summary (MSC) score and VAS spine score. Both groups had comparable PSC and MSC scores to a norm group of the same age. After 5 years the therapy concept seems to be of low risk and not being associated with major complications. The PCS and MCS scores are comparable to a norm group of the same age. The correction loss exceeded the operative reduction marginally but turned out to be slightly lower compared to that of an isolated kyphoplasty.