Treatment of thoracolumbar fractures by temporary posterior instrumentation with selective fusion schemes

Xiaochen Zheng,Jia Liu,Enze Jiang,Yixuan Tan,Xiuwei Hou,Peng Li,Dongyang Niu,Guohua Xu

doi:10.1080/02688697.2021.1976391

Abstract

Objective This retrospective study investigated the clinical and radiographic outcomes following temporary transpedicular posterior instrumentation between two cohorts of patients with thoracolumbar fractures (TLF) who underwent selective or bi-segments intervertebral articular process fusion. Methods Patients with TLF who underwent the temporary posterior fixation with selective fusion (Group SF), or bi-segments fusion (Group BF) were studied. Superior intervertebral articular process and interlaminar fusion were performed in Group SF, whereas in Group BF, the patients underwent bi-segments fusion in both superior and inferior articular processes, as well as interlaminar fusion. We measured the distal and proximal intervertebral mobility, regional kyphotic angle, and vertebral height before and after surgery in both groups. Greenough Low-Back Outcome Score was used to assess the clinical outcomes. Results Sixty-five patients with TLF from T12 to L2 fractures were enrolled in the study period: 33 patients in the Group SF and 32 patients in the Group BF. All the patients experienced fracture healing (mean follow-up time: 19.7 months). The mean postoperative functional outcomes were 65.0 ± 2.0 points for the Low-Back Outcome Score in the Group SF and 65.2 ± 1.8 for the Group BF. A progressive regional kyphotic angle was observed with time regardless of fusion but was not significantly different between the two groups. There was a statistical difference between unfused inferior proximal adjacent and inferior distal adjacent segment regardless of fracture segments. Conclusions The strategy of selective fusion is reported to be useful for the treatment of patients with TLF. The motion in the un-fused and adjacent segment could be better regained after instrumentation removal in the selective fusion group. Level of Evidence Level 3.

Highlights

Fractures of the thoracolumbar junction and upper lumbar spine (T12–L2) are common injuries as a result of high-energy trauma with potentially devastating consequences including pain, neurological injury, and loss of function[1]
Sixty-five patients with thoracolumbar fractures (TLF) from T12 to L2 fractures were enrolled in the study period: 23 patients in the Group selective fusion (SF) and 22 patients in the Group bi-segments fusion (BF)
A progressive regional kyphotic angle was observed with time regardless of fusion but was not significantly different between the two groups

Summary

Introduction

Fractures of the thoracolumbar junction and upper lumbar spine (T12–L2) are common injuries as a result of high-energy trauma with potentially devastating consequences including pain, neurological injury, and loss of function[1]. The main strategy of surgical treatment for thoracolumbar fractures (TLF) has been neurologic decompression, anatomic reduction, stabilization, and fusion[2, 3]. We proposed the selective fusion schemes for TLF with the superior intervertebral articular process and interlaminar fusion, regardless of bi-segments fusion. This approach aimed at post-operative, preservation of spine motion, stabilization of fracture, and restoration of spinal alignment. In order to validate the effectiveness of selective fusion schemes, we compared the regional kyphotic angles, intervertebral mobility to the fractured segment, and the distal adjacent segments following temporary posterior fixation in TLF patients who underwent either selective (superior) intervertebral articular process or bi-segments (superior-inferior) articular process fusion

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Results

Conclusion