Lateral lumbar and thoracic interbody fusion (LLIF) for thoracolumbar spine trauma (Trauma LLIF): A single-center, retrospective observational cohort study

Abstract

BackgroundPain, disability and progressive kyphosis is a common problem after traumatic injury of the thoracolumbar (TL-) junction. Surgical treatment may include long-segment posterior or short-segment anterior-posterior fusion. We aim to report our experience with the application of short-segment posterior instrumented fusion with anterior column support using lateral lumbar or thoracic interbody (LLIF) cages. MethodsIn this retrospective, single-center observational cohort study we included consecutive patients treated surgically for traumatic injury of the TL-junction (Th10/11-L2/3) by posterior instrumentation/fusion and LLIF. We measured segmental kyphosis, complications, and outcomes until last follow-up (about 3 years postoperative). ResultsWe identified 61 patients (mean age 39.0 years (SD 13.3); 23 females (37.7%)) with A3 fractures without (n=48; 78.7%) or with additional sagittal split component (n=11; 18.0%. Additional posterior tension band injury was present in n=26 (42.6%). The affected levels of injury were Th12/L1 in n=25 (41.0%) and Th11/12 in n=22 (36.1%). The segmental kyphotic angle was 14.6° (6.7°) preoperative and remained significantly reduced at all times of follow-up at discharge (5.4°±5.5°; p<0.001), at 90 days (7.2°±5.5°; p<0.001), after partial hardware removal (7.2°±6.0°; p<0.001) and at last follow-up (8.1°±6.3°; p<0.001). We noticed a tendency for less progression of kyphosis in the group with two-staged, compared to single-staged bisegmental surgery (mean difference (MD) 3.1° after partial hardware removal, p=0.064). During follow-up, n=11 experienced complications (18%), n=58 (95.1%) had an excellent or good outcome and solid fusion was noticed in n=60 (98.4%). Conclusions“Trauma LLIF” should be considered as possibility for short-segment anterior-posterior fusion for injuries of the TL- junction. We observed most reproducible and long-lasting kyphosis reduction with a temporary bisegmental, two-staged procedure resulting in monosegmental fusion (posterior instrumentation/fusion with delayed LLIF and partial hardware removal to release the non-injured caudal motion segment).