Wednesday, September 26, 2018 1:00 PM – 2:00 PM Spinal Trauma: 56. Two nation comparison of surgical treatment of traumatic thoracolumbar spinal fractures: posterior only versus circumferential stabilization

Abstract

BACKGROUND CONTEXT For many traumatic thoracolumbar spinal fractures the best choice of treatment is uncertain, and if surgery is indicated, which type of surgery is also under debate. In literature, there is only poor evidence about the comparison of posterior versus circumferential stabilization. PURPOSE To compare the functional, radiological and clinical outcome of posterior-only versus circumferential stabilization in traumatic thoracolumbar fractures. STUDY DESIGN/SETTING Comparative retrospective cohort study, surgical equipoise. PATIENT SAMPLE Multicenter analysis of patients who were surgically treated for a traumatic thoracolumbar fracture between 2009 and 2015 in University Hospital Aachen (Germany), Maastricht University Hospital (Netherlands) or Zuyderland Heerlen (Netherlands). Patients in Germany were treated by circumferential stabilization and in the Netherlands by posterior only surgery. OUTCOME MEASURES Clinical outcome parameters: number of segments, length of hospital stay, surgery times, complications. Radiological parameter: regional sagittal angle (RSA). Functional outcome parameters: VAS pain and Oswestry Disability Index (ODI). METHODS Patients were included by surgical equipoise in the circumferential group (CG) or the posterior only group (PG). Data about patient characteristics, fracture type and surgery type were distracted from patient files. RESULTS Seventy-nine patients were included for analysis (40 PG, 39 CG). Seventy-one percent completed two-year follow-up. Baseline characteristics were equal except for BMI (26.8 kg/m2 in the CG and 24.5 kg/m2 in the PG; p=.02). In the CG 77% of the fractures were classified as burst fractures, and in the PG there were 45% burst and 45% B-type fractures. Clinical outcome: the length of segment fixation was longer in the PG, with a mean of 4.3 levels compared to 3.3 levels in the CG (p CONCLUSIONS This two-nation study shows similar radiological and functional outcome in surgically treated thoracolumbar spinal fractures by posterior only compared to circumferential stabilization. Surgical time, low complication rate and shorter length of stay were all in benefit of the posterior only group, while the circumferential group had the advantage of shorter segment fixation. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.