The Establishment of a Novel Therapy-Oriented Classification of Vertebral Fracture Nonunion Based on the Manifestation of Extended CT Reconstruction Images

Abstract

Introduction To the best of our knowledge, there is not an optimal classification for vertebral fracture nonunion (VFNU), this study is to investigate the value of establishment of the novel therapy-oriented classification of VFNU based on the manifestation of extended CT reconstruction images. Patients and Methods All of the senior patients suffered from thoracolumbar spine fracture (December 2009 to March 2013) were retrospectively reviewed, 36 cases of VFNU were included in this study according to inclusion criteria. The reducibility and stability of index vertebrae were evaluated with extended CT reconstruction images, and all patients with VFNU were divided into three subgroups, type A owns the reducibility and stability, which is recommended to treat by percutaneous vertebroplasty in extension posture, type B owns the reducibility, but lacks stability, which should be treated by in situ fixation and fusion in extension posture, type C loses the reducibility, which is eligible for the spine deformity correction by osteotomy or canal decompression. Whether the patients were treated according to this classification and the perioperative complication were recorded. The clinical outcome was investigated by the comparison of VAS and ODI in preoperation, 3 months after surgery and last follow-up, the transformation of profile of index vertebrae was evaluated radiographically with the local kyphotic Cobb angle and anterior height of VFNU vertebrae in the above time points. Results Overall, 39 level of VFNU vertebrae in 36 patients were located in the region of T9 to L4, in which the thoracolumbar segments were compromised frequently, and 16 level of VFNU existed in L1. According to extended CT reconstruction images, 25 level of type A, 7 level of type B, 7 level of type C VFNU were identified. Overall, 24 cases of type A VFNU accepted percutaneous vertebroplasty in extension posture, 4 cases of type B VFNU were treated by in situ fixation and fusion in extension posture, but 2 of them also accepted percutaneous vertebroplasty in extension posture like type A patients, 6 cases of type C VFNU were treated by spinal deformity correction by osteotomy or decompression, no severe complication occurred in both of type A and type B patients, except that 2 patients of type B VFNU, who accepted PVP, had notable but asymptomatic bone cement leakage, however, 1 case of type C VFNU had a deep wound infection, and 1 case got heart function failure during perioperative period. The different treatment oriented by this novel classification could be effective in the corresponding types of VFNU, by which the VAS, ODI could be improved, local kyphotic angle, and anterior height of VFNU could be corrected significantly ( p < 0.05). Conclusion The validity of this novel therapy–oriented classification has been investigated by clinical and finite element study, which is beneficial to make more accurate evaluation and select the eligible surgery procedure before operation, and decrease the rate of usage of aggressive operations, like spinal osteotomy and decompression, in the older patients.