Anterior Vertebral Body Height Research Articles

[Effectiveness of unilateral biportal endoscopy combined with percutaneous pedicle screw fixation in treatment of lumbar burst fractures with neurological symptoms].

To evaluate the effectiveness of spinal canal decompression assisted by unilateral biportal endoscopy (UBE) and percutaneous uniplanar pedicle screw internal fixation in the treatment of lumbar burst fractures with neurological symptoms. Between June 2021 and December 2022, 10 patients with single level lumbar burst fracture with neurological symptoms were treated with spinal canal decompression assisted by UBE and percutaneous uniplanar pedicle screw internal fixation. There were 7 males and 3 females with an average age of 43.1 years (range, 21-57 years). The injured vertebrae located at L 1 in 2 cases, L 2 in 4 cases, L 3 in 3 cases, and L 4 in 1 case. There were 7 cases of AO type A3 fractures and 3 cases of AO type A4 fractures. The total operation time, the time of operation under endoscopy, and complications were recorded. Pre- and post-operative visual analogue scale (VAS) score and American Spinal Injury Association (ASIA) scale (grading A-E corresponding to assigning 1-5 points for statistical analysis) were used to evaluate effectiveness. X-ray film and CT were performed to observe the fracture healing, and the ratio of anterior vertebral body height, Cobb angle, and rate of spinal canal invasion were measured to evaluate the reduction of fracture. All operations was successfully completed, and the spinal canal decompression and the bone fragment in spinal canal reduction completed under the endoscopy. Total operation time was 119 minutes on average (range, 95-150 minutes), and the time of operation under endoscopy was 46 minutes on average (range, 35-55 minutes). There was no complication such as dural sac, nerve root, or blood vessel injury during operation. All incisions healed by first intention. All patients were followed up 18.7 months on average (range, 10-28 months). The VAS score after operation significantly decreased when compared with that before operation ( P<0.05), and further improved at last follow-up ( P<0.05). The ASIA scale after operation significantly improved when compared with that before operation ( P<0.05), and there was no significant difference ( P>0.05) in the ASIA scale between at 1 week after operation and at last follow-up. The imaging examination showed that the screw position was good and the articular process joint was preserved. During follow-up, there was no loosening, fracture, or fixation failure of the internal fixation. The ratio of anterior vertebral body height and Cobb angle significantly improved, the rate of spinal canal invasion significantly decreased after operation ( P<0.05), and without significant loss of correction during the follow-up ( P>0.05). Spinal canal decompression assisted by UBE and percutaneous uniplanar pedicle screw fixation is a feasible minimally invasive treatment for lumbar burst fractures with neurological symptoms, which can effectively restore the vertebral body sequence, as well as relieve the compression of spinal canal, and improve the neurological function.

Does Magnetic Resonance Imaging Predict Neurological Deficit in Patients with Traumatic Lower Lumbar Fractures?

A retrospective cohort study. This study aimed to understand the role of magnetic resonance imaging (MRI) in predicting neurological deficits in traumatic lower lumbar fractures (LLFs; L3-L5). Despite studies on the radiological risk factors for neurological deficits in thoracolumbar fractures, very few have focused on LLFs. Moreover, the potential utility of MRI in LLFs has not been evaluated. In total, 108 patients who underwent surgery for traumatic LLFs between January 2010 and January 2020 were reviewed to obtain their demographic details, injury level, and neurology status at the time of presentation (American Spinal Injury Association [ASIA] grade). Preoperative computed tomography scans were used to measure parameters such as anterior vertebral body height, posterior vertebral body height, loss of vertebral body height, local kyphosis, retropulsion of fracture fragment, interpedicular distance, canal compromise, sagittal transverse ratio, and presence of vertical lamina fracture. MRI was used to measure the canal encroachment ratio (CER), cross-sectional area of the thecal sac (CSAT), and presence of an epidural hematoma. Of the 108 patients, 9 (8.3%) had ASIA A, 4 (3.7%) had ASIA B, 17 (15.7%) had ASIA C, 21 (19.4%) had ASIA D, and 57 (52.9%) had ASIA E neurology upon admission. The Thoracolumbar Injury Classification and Severity score (p =0.000), CER (p =0.050), and CSAT (p =0.019) were found to be independently associated with neurological deficits on the multivariate analysis. The receiver operating characteristic curves showed that only CER (area under the curve [AUC], 0.926; 95% confidence interval [CI], 0.860-0.968) and CSAT (AUC, 0.963; 95% CI, 0.908-0.990) had good discriminatory ability, with the optimal cutoff of 50% and 65.3 mm2, respectively. Based on the results, the optimal cutoff values of CER >50% and CSAT >65.3 mm2 can predict the incidence of neurological deficits in LLFs.

The effect of the size of pedicle screw on the long-term radiological and clinical results of short-segment posterior instrumentation in the management of thoracolumbar vertebral fractures.

It was aimed at evaluating the effect of the size of the pedicle screw placed on the fractured vertebra on the long-term radiological and clinical results of short-segment posterior instrumentation applied in the surgical treatment of thoracolumbar vertebral fractures. This retrospective study included 36 patients who underwent short-segment posterior instrumentation surgery for a single-level thoracolumbar (T11-L2) fracture between January 2015 and March 2021. The patients included in the study were divided into 2 groups according to the size of the pedicle screw placed in the fractured vertebra (group A: intermediate screw 4.5 mm, ≤35 mm+less than 50% of the vertebral corpus length, m/f: 13/4, n: 17, age: 36.5; group B: intermediate screw 5.5 mm, ≥40 mm+more than 70% of the vertebral corpus length, m/f: 11/8, n: 19, age: 42.6). All patients were periodically evaluated clinically and radiologically. Vertebral compression angle (VCA), anterior and posterior vertebral body height (ABH-PBH), intraoperative parameters (instrumentation time and intraoperative fluoroscopy number), and complications were compared between the 2 groups. Both groups were comparable with respect to age, sex, level of injury, AO classification, mechanism of injury, and American Spinal Cord Injury Association impairment scale. Restoration of VCA and vertebral corpus heights was achieved sufficiently in both groups after operation (P < .0001). There was no significant difference between the 2 groups in terms of early postoperative VCA, VCA measured at final follow-up, or loss of correction in VCA. At the last follow-up, PBH was statistically significantly better preserved in group B (P=.0424). There was no difference between the 2 groups in terms of operation time and the number of intraoperative fluoroscopies. Implant failure was observed in 1 patient in group A. This study has revealed that using a long, thick pedicle screw placed in the fractured vertebra can better preserve the PBH at the final follow-up. No correlation was found between the size of the intermediate screw and the preservation of the correction in the postoperative vertebral heights and VCA during the follow-up. Level III, Therapeutic Study.

Percutaneous versus traditional open approaches for the treatment of thoracolumbar fractures in patients without neurologic deficits: a meta-analysis of 35 cohort studies.

At present, percutaneous surgery is widely used to treat thoracolumbar fractures. However, the actual safety, feasibility, and effectiveness of percutaneous surgery are not clear. Through systematic review and meta-analysis, we compared the efficacies of percutaneous pedicle screw fixation and open pedicle screw fixation in the treatment of thoracolumbar fractures without nerve root symptoms. We systematically searched the PubMed, Embase, and Cochrane libraries for articles published on or before June 2023. All results were evaluated by standard methods recommended for meta-analysis, continuous data were expressed by standard mean differences (SMDs), and binary variables were analyzed by odds ratios (ORs) and 95% confidence intervals (95% CIs). We also explored the main sources of heterogeneity and the stability of the results through sensitivity analysis, Begg's funnel plots, and Egger's test. Thirty-five cohort studies with a total of 3039 patients were included. The study found that patients who undergo percutaneous approaches have less intraoperative blood loss (IBL), shorter length of hospital stay (LOS), shorter operation time, and shorter incision. Moreover, percutaneous approaches had more advantages in terms of visual analog scale (VAS) scores, Oswestry Disability Index (ODI) scores, and infection rates. However, there was no significant difference in anterior vertebral body height (AVB), Cobb angle (CA), or screw errors between the two groups. In the long run, the clinical and surgical results of the percutaneous approach are better than those of the open approach, but the radiological results of both operations do not seem to show an advantage for any specific approach. Because of publication bias and heterogeneity, our findings must be interpreted with caution. However, this paper will provide some support for clinicians to choose suitable surgical methods for the treatment of thoracolumbar fractures.

Short segment posterior fixation of unstable thoracolumbar vertebral fractures with fractured vertebra augmentation with intermediate pedicle screw - a clinicoradiological analysis.

Unstable thoracolumbar burst fractures are routinely encountered in orthopedic practice. Recently, short-segment fixation with pedicle screw augmentation of the fractured vertebra for unstable thoracolumbar burst fractures has gained popularity. Nonetheless, the maintenance of the kyphotic correction during the follow-up period remains controversial. This study aimed to examine the clinical-radiological outcomes, complications, and functional outcomes of fractured vertebrae augmentation with intermediate pedicle screws in short-segment instrumentation in acute thoracolumbar spine fractures. This retrospective study was conducted in the Department of Orthopedics, All India Institute of Medical Sciences, Jodhpur, using medical records from January 2021 to October 2022. Parameters such as local kyphosis correction, loss of kyphotic correction at final follow-up, anterior body height correction (%), and loss of correction (%) at final follow-up were measured as primary outcomes. Various other parameters such as operative time, blood loss, length of hospital stay, and visual analog scale were measured as secondary outcomes. The mean correction obtained via surgery in the immediate postoperative period was 13.7±2.3 degrees. The mean loss of correction at the final follow-up was 4.1±2.0 degrees, and the mean final local kyphotic angle was 7.2±2.4 degrees (P<0.05). The mean correction obtained via surgery in the immediate postoperative period was 37.2%±9.0%. The mean loss of correction at the final follow-up was 10.5%±5.3%, and the mean final anterior vertebral body height maintained was 72%±11.0% (P<0.05). Short-segment posterior fixation with pedicle screw augmentation achieves good correction of local kyphotic angle and anterior vertebral height in the immediate postoperative period, but some loss of correction at final follow-up is common. In our study, the loss of correction corresponded directly to the load-sharing score.

Radiological and anatomical evaluation of the cervical spinal cord, spinal canal, and intervertebral disc morphometry in healthy adults

Purpose: The aim of this study was to examine the normal values of the cervical spinal cord, spinal canal, and intervertebral disc morphometry of healthy subjects in this study &#x0D; Materials and Methods: Cervical magnetic resonance imaging of 83 healthy subjects were examined retrospectively. The anterior and posterior height of each cervical vertebra body, anterior and posterior height of each intervertebral disc between C3-T1, and spinal canal and cord diameters were measured. Additionally, the height ratios of the cervical vertebra body and intervertebral disc were calculated.&#x0D; Results: There was no significant difference between genders in spinal cord diameters from C1 to C7, whereas there was a significant difference between genders in spinal canal diameters from C1 to C4. There were significant differences between genders in terms of anterior and posterior vertebral body height from C3 to C7 level. Moreover, significant differences between genders in terms of anterior and posterior intervertebral height from C3-4 to C7-T1 level (except C6-7 intervertebral anterior height) were found. &#x0D; Conclusion: We would like to stress that the cervical region is a clinically important structure because of its location, surgical importance, its exposure to a large number of injuries, Gender plays the most important role in spinal canal morphometry, following vertebral

Clinical efficacy of modified percutaneous kyphoplasty (PKP) vs. conventional PKP for osteoporotic vertebral compression fractures: a single-center retrospective study.

To investigate the clinical efficacy of using a standardized modified percutaneous kyphoplasty (transverse process‑pedicle approach to percutaneous kyphoplasty, TPKP) approach for the treatment of osteoporotic vertebral compression fractures (OVCFs) and to explore the possibility that it may become the preferred option in the future. A retrospective analysis was conducted on a total of 81 patients (TPKP group, 43 cases; PKP group, 38 cases) with OVCFs who underwent TPKP and PKP at the Department of Spine Surgery, Wuhan Fourth Hospital, from May 2021 to October 2021. We evaluated the patients' demographic information, intraoperative data (volume of cement injection and, duration of surgery), clinical outcomes at different time points (Visual Analog Scale, Oswestry Dysfunction Index), and radiographic data (Cobb angle, anterior vertebral body height). Statistical analysis was performed to assess the efficacy of the procedure, both within and between the two groups before and after surgery. The difference in preoperative general information between the two groups of patients was non-statistically significant (p>0.05), and they were comparable. Additionally, no statistically significant difference (p>0.05) was found between the TPKP and PKP groups in terms of operative time, length of hospital stay, recovery of injured spine height, Cobb angle, and cement leakage rate. However, significant statistical differences (p<0.05) were noted between the two groups regarding cement volume, distribution pattern, 1-day postoperative VAS scores, 1-day postoperative ODI scores, and loss of height of the injured spine. TPKP demonstrated superior performance compared to PKP in these specific areas. TPKP offers the same surgical safety as the conventional approach, with better cement distribution and better pain relief, as well as the advantage of maintaining the height of the operated vertebral body. The technique is easy to master and use when guided by standard puncture procedures.

Short-segment percutaneous fusion versus open posterior fusion with screw in the fractured vertebra for thoracolumbar junction burst vertebral fracture treatment.

The treatment options for thoracolumbar junction burst fractures remain a topic of controversy. Short-segment percutaneous fixation (SSPF) and short-segment open fixation including the fractured level (SSOFIFL) are both viable procedures for managing these fractures. At present, there is a lack of evidence in the literature demonstrating the absolute superiority of one treatment over the other. This study aimed to compare these two surgical strategies with a focus on radiological and clinical outcomes. This retrospective case-control multicenter analysis involved patients with A3 and A4 vertebral fractures at the thoracolumbar junction (T11-L2) who underwent surgical treatment with either SSPF or SSOFIFL in the participating centers. Clinical outcomes were measured using the Oswestry Disability Index and visual analogue scale (VAS) both pre- and postoperatively. Radiological outcomes included kyphotic deformity (KD), anterior vertebral body height (AVBH), segmental kyphosis, and sagittal alignment parameters. A total of 156 patients were enrolled in the study, with 81 patients in Group A (SSPF) and 75 patients in Group B (SSOFIFL). Group B demonstrated better correction of KD (Group B: 3.4 ± 2.7° vs. Group A: 8.3 ± 3.2°, P = 0.003), AVBH, and sagittal alignment. A minor loss of correction was observed in Group B with respect to Group A (0.9 ± 1.7° vs 4.3° ± 2.1°, P = 0.043). Blood losses were lower in Group A (78 ± 15 min vs. 118 ± 23 min, P = 0.021) as well as during surgery (121.3 ± 34 mL vs. 210.2 ± 52 mL, P = 0.031), but the post-operative hemoglobin levels were comparable between the two groups. SSOFIFL appears to show a major amount of KD correction and prevent loss of correction. This technique should be the preferred choice whenever possible. However, SSPF can be considered a valid alternative for damage control in polytrauma patients and fractures with low KD.

Functional and Radiological Outcome of Short Same Segment Instrumentation in Thoracolumbar Burst fracture.

Thoracolumbar region is important biomechanics transition zone in which rigid thoracic and flexible lumbar spine meet. This area is highly vulnerable to traumatic spinal fracture.Among all spine fracture, compression type is most common and managed conservatively. Thoracolumbar spine fracture can be associated with neurological deficit, spinal instability. The optimal treatment for these injuries is still controversy and subject for research. This retrospective study included 30 patients with single level thoracolumbar fracture.All the patients clinical and radiological parameters were evaluated preoperative, post-operative and 1 year follow up. Clinical parameters were included Visual analogue score, Oswestry disability index. Radiologic measurement were regional kyphotic angle by cobb's method and anterior vertebral body height loss (Mumford' santerior body compression equation method) in X-ray. All the data were analysed in SPSS version 20. A total of 30 patients were included in this study,19 were male.The mean age of the patients were 40.8±13.The main cause of injury was fall from height,26 patients. The most common level of fracture vertebra was L1,11 patients.The mean difference of preop and postop kyphosis was 11.70±50 with P<0.05.The mean difference of preop Oswestry disability index and postop Oswestry disability index score was 30.7±7.6 with T score 22(P<0.05).The preop and postop Visual analogue score score also improved ,mean difference was 2.8±1(P<0.05). Short segment instrumentation with placement of pedicle screw at fracture vertebra is one option in the treatment of thoracolumbar burst fracture.

A Comparison of Outcomes between the Wiltse Approach with Pedicle Screw Fixation and the Percutaneous Pedicle Screw Fixation for Multi-Segmental Thoracolumbar Fractures.

Multi-segmental thoracolumbar fracture (MSF) generally refers to fractures occurring in two or more segments of the thoracolumbar spine. With the development of minimally invasive concept, there is little research on its application in the field of MSF. The purpose of this study is to compare two minimally invasive surgical techniques and determine which one is more suitable for treating patients with neurologically intact MSF. We retrospectively analyzed the clinical data of 49 MSF patients with intact nerves who were admitted from January 2017 to February 2019. Among them, 25 cases underwent percutaneous pedicle screw fixation (PPSF), and 24 cases underwent Wiltse approach pedicle screw fixation (WAPSF). The operation time, number of fixed segments, blood loss, length of incision, postoperative ambulation time, accuracy of pedicle screw placement, facet joint violation (FJV), number of C-arm exposures, as well as pre- and postoperative visual analogue scale (VAS), Oswestry disability index (ODI), local Cobb's angle (LCA), and percentage of anterior vertebral body height (PAVBH) were recorded for both groups. Paired sample t-test was used for intra-group comparison before and after surgery while independent sample t-test was used for inter-group comparison. The differences in the number of fixed segments, intraoperative bleeding, postoperative bed time, accuracy rate of pedicle screw placement, VAS, and ODI between the two groups were not statistically significant (p > 0.05). However, the operative time and total surgical incision length were significantly shorter in the WAPSF group than in the PPSF group (p < 0.05), and the FJV was significantly higher in the PPSF group than in the WAPSF group (p < 0.05). Also, the PPSF group received more intraoperative fluoroscopy (p < 0.05). The result of LCA and PAVBH in the WAPSF group were significantly better than in the PPSF group (p < 0.05). Both PPSF and WAPSF were found to be safe and effective in the treatment of MSF without neurological deficits through our study. However, considering radiation exposure, FJV, vertebral height restoration, correction of kyphosis, and learning curve, WAPSF may be a better choice for neurologically intact MSF.

Therapeutic Efficacy and Safety of Percutaneous Curved Vertebroplasty in Osteoporotic Vertebral Compression Fractures: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis is aimed to provide higher quality evidence regarding the efficacy and safety between PCVP and PVP/KP in OVCFs. We searched the Cochrane Library, PubMed, Web of Science, and Embase databases for all randomized controlled trials (RCTs) and observational studies (cohort or case-control studies) that compare PCVP to PVP/KP for OVCFs. The Cochrane Collaboration's Risk of Bias Tool and Newcastle-Ottawa Scale (NOS) were used to evaluate the quality of the RCTs and non-RCTs, respectively. Meta-analysis was performed using RevMan 5.4 software. A total of seven articles consisting of 562 patients with 593 diseased vertebral bodies were included. Statistically significant differences were found in the postoperative visual analog scale (VAS) at 1 day (MD = -0.11; 95% CI: [-0.21 to -0.01], p = 0.03), but not at 3 months (MD = -0.21; 95% CI: [-0.41-0.00], p = 0.05) or 6 months (MD = 0.03; 95% CI: [-0.13-0.20], p = 0.70). There was no statistically significant difference in postoperative Oswestry disability index (ODI) at 1 day (MD = -0.28; 95% CI: [-0.62-0.05], p = 0.10), 3 months (MD = -1.52; 95% CI: [-3.11-0.07], p = 0.06), or 6 months (MD = 0.18; 95% CI: [-0.13-0.48], p = 0.25). Additionally, there were no statistically significant differences in Cobb angle (MD = 0.30; 95% CI: [-1.69-2.30], p = 0.77) or anterior vertebral body height (SMD = -0.01; 95% CI: [-0.26-0.23], p = 0.92) after surgery. Statistically significant differences were found in surgical time (MD = -8.60; 95% CI: [-13.75 to -3.45], p = 0.001), cement infusion volume (MD = -0.82; 95% CI: [-1.50 to -0.14], P = 0.02), and dose of fluoroscopy (SMD = -1.22; 95% CI: [-1.84 to -0.60], p = 0.0001) between curved and noncurved techniques, especially compared to bilateral PVP. Moreover, cement leakage showed statistically significant difference (OR = 0.40; 95% CI: [0.27-0.60], p < 0.0001). Compared with PVP/KP, PCVP is superior for pain relief at short-term follow-up. Additionally, PCVP has the advantages of significantly lower surgical time, radiation exposure, bone cement infusion volume, and cement leakage incidence compared to bilateral PVP, while no statistically significant difference is found when compared with unilateral PVP or PKP. In terms of quality of life and radiologic outcomes, the effects of PCVP and PVP/KP are not significantly different. Overall, this meta-analysis reveals that PCVP was an effective and safe therapy for patients with OVCFs.

[Effect of morphological changes in the sagittal plane of vertebrae and discs on degenerative kyphodeformity].

To explore the effects of morphological changes such as vertebral wedge deformation and disc degeneration (collapse) on adult thoracolumbar/lumbar degenerative kyphosis(TL/LDK) deformity. A retrospective analysis of 32 patients with spinal TL/LDK deformity admitted from August 2015 to December 2020, including 8 males and 24 females, aged 48 to 75(60.3±12.4) years old. On the long-cassette standing upright lateral radiographs, the coronal Cobb angle, sagittal thoracic lumbar/lumbar kyphosis angle(KA) of spine were measured, and the height and wedge parameters of apex vertebral(AV) and two vertebrae(AV-1, AV-2, AV+1, AV+2) above and below AV and the intervertebrae and the intervertebral disc(AV-1D, AV-2D, AV+1D, AV+2D) were evaluated, involving anterior vertebral body height(AVH), posterior vertebral body height(PVH), vertebral wedge angle(VWA), ratio of vertebral wedging(RVW), anterior disc height(ADH), posterior disc height(PDH), disc wedge angle(DWA), ratio of disc wedging(RDW), and DWA/KA. The average angle of kyphosis was (44.2±19.1)°. A significant decrease in anterior height of vertebral was observed compared to the posterior height of vertebral(P<0.005). There was no significant difference in anterior and posterior height of discs. The vertebral wedging ratio/contribution ratio:AV-2(14.98±10.95)%/(14.21±8.08)%, AV-1(21.08±12.39)%/(18.09±7.38)%, AV(26.94±11.94)%/(25.52±8.64)%, AV+1(24.19±8.42)%/(20.82±8.69)%, AV+2(20.56±7.80)%/(15.60±9.71)%, total contribution(94.23±22.25)%, the disc wedging ratio/contribution ratio:AV-2D(2.88±2.57)%/(5.27±4.11)%, AV-1D(1.98±1.41)%/(2.29±2.16)%, AV+1D(-5.54±3.75)%/(-0.57±0.46)%, AV+2D(-8.27±4.62)%/(-1.22±1.11)%, total contribution (5.77±4.79)%. And the contribution rate of AV was significantly higher than that of adjacent vertebral(P<0.05). The vertebral body and intervertebral disc shape both have influence on thoracolumbar kyphosis. However, the contribution of vertebral morphometry to the angle of TL/LDK deformity is relatively more important than the disc. The contribution of the wedge change of the AV to the TL/LDK deformity is particularly significant.

Unipedicular-Screw Index Vertebra Manipulation Technique for Minimally Invasive Short-Segment Thoracolumbar Fracture Fixation.

Minimally invasive spine surgery (MIS) has revolutionized fixation of thoracolumbar fractures with burst elements. Recent studies have proven that percutaneous pedicle screw instrumentation is as effective as open instrumentation but with reduced intraoperative blood loss and operative duration. Techniques such as short-segment pedicle screw fixation including the fractured vertebra have shown satisfactory radiological correction and functional outcomes, avoiding the need for extensile posterior constructs. In the present study, the authors our technique utilizing unipedicular index vertebra fixation and manipulation in MIS for thoracolumbar fractures with burst elements. To our knowledge, this technique is not well described in literature as open approaches are often adopted for the above. The authors sought to highlight the 2-year radiological and functional outcomes of 20 consecutive patients who underwent this technique. A retrospective review of prospectively collected data was conducted on 20 patients with thoracolumbar fractures with burst elements who underwent fixation using our technique. Patient data collected included demographic characteristics, mechanism of injury, associated injuries, neurological deficit at the time of admission, pre- and postoperative neurological evaluation, and length of hospital stay. Radiological investigations included plain radiographs, computed tomography of the spine with reconstruction, and magnetic resonance imaging of the spine, which provided data for radiological fracture classifications such as AO Spine and derivation of Thoracolumbar Injury Classification and Severity Score, as well as preoperative planning. Radiological investigations in the postoperative period were carried out by standing radiographs or EOS whole spine at each postoperative follow-up for up to 2 years. Radiological parameters-vertebral wedge angle, regional kyphosis angle, coronal Cobb angle, and anterior and posterior vertebral body heights-were recorded at preoperative, intraoperative, postoperative, and up to 2-year follow-up. Clinical outcome scores (visual analog score [VAS] and Oswestry Disability Index [ODI]) were also recorded at similar timepoints. Radiological outcomes reflect significant lordotic corrections of the vertebral wedge angles up to 2-year follow-up when compared with preoperative values (intraoperative: P = 0.06; postoperative: P = 0.001; 3 months: P = 0.002; 6 months: P = 0.004; 1 year: P = 0.011; 2 years: P = 0.016). Additionally, significant lordotic corrections of regional kyphosis angles (intraoperative: P = 0.00; postoperative: P = 0.00; 3 months: P = 0.031; 6 months: P = 0.039) and increases in anterior vertebral body heights (postoperative: P = 0.001; 3 months: P = 0.010; 6 months: P = 0.020) at up to 6-month follow-up were found. Preoperatively, median VAS of 85 (range 30-100) and ODI of 90 (range 40-98) were recorded. Statistically significant improvements in VAS and ODI were found across all timepoints when compared with preoperative values, with a mean VAS of 11.5 (SD 4.8) and ODI of 9.9 (SD 4.5) at 2-year follow-up. Surgical management of thoracolumbar fractures with or without neurological deficit has a role in reducing nursing requirements and postoperative morbidity in patients with polytrauma and other associated injuries. Our approach in treating thoracolumbar fractures with burst elements using MIS short-segment fixation and unipedicular screw manipulation technique shows satisfactory radiological correction and high rates of fracture union while reducing approach-related morbidity and improving functional outcomes.

Comparison of Unilateral and Bilateral Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fractures.

To investigate the clinical efficacy of percutaneous kyphoplasty (PKP) with a unilateral versus bilateral approach in the treatment of osteoporotic vertebral compression fractures (OVCFs). We retrospectively analyzed a total of 147 patients (unilateral group: 79, bilateral group: 68) with OVCFs treated with PKP at the Department of Spine Surgery, Wuhan Fourth Hospital between August 2020 and January 2022. Patients' personal information, operation time, bone cement injection volume, as well as pre- and post-operative visual analogue scale (VAS), Oswestry disability index (ODI), anterior vertebral body height and Cobb angle were recorded. All 147 patients were successfully treated with PKP and were followed up for at least 6 months. Our results showed that the operative time was significantly shorter in the unilateral group (41.60±5.64) minutes than in the bilateral group (66.53±9.40) minutes, and the volume of bone cement injected was also significantly less in the unilateral group (5.27±0.73) mL than in the bilateral group (6.87±0.93) mL (P<0.01). The VAS score, ODI index, vertebral height and Cobb angle at postoperative follow-up were significantly improved in both groups compared to the preoperative period (P<0.01); However, the difference between the two groups was not statistically significant (P>0.05). Repeat thoracic and lumbar radiographs showed cement leakage in seven cases (8.86%) in the unilateral group and five cases (7.35%) in the bilateral group, but all were asymptomatic and required no further management. During our entire follow-up period, there were five adjacent vertebral fractures in the unilateral group (6.33%) and four in the bilateral group (5.88%). There was no significant difference between the two groups in terms of improvement in VAS score, ODI index, restoration of vertebral body height, and posterior convexity deformity, but unilateral puncture had the advantage of shorter operative time and less cement injection.

Functional and Surgical Outcomes of Corpectomy in Patients with Unstable Spinal Fractures.

Unstable fractures of the spine should be managed surgically. An anterior approach allows for precise decompression of the vertebral canal and reconstruction of the fractured vertebral body. The aim of the study was to evaluate the functional and surgical outcomes of anterior surgical approaches for vertebral body removal and prosthetic reconstruction. The objectives of this paper were accomplished by reviewing the course of treatment and treatment outcomes of patients operated on at the Orthopaedic Oncology Department in Brzozw and the Department of Orthopaedics and Traumatology in District Hospital in Stalowa Wola in the years 2020-2021. In total, the treatment of 54 patients was analyzed. The study only included patients with traumatic and pathological fractures who underwent a single-level corpectomy. A total of 18 patients with fractures of the cervical spine, 15 of the thoracic spine and 21 of lumbar spine were treated. Before and after treatment, patients&apos; neurological status was assessed according to the Frankel classification, performance was assessed with the Karnofsky score and pain intensity was analyzed with a VAS. The vertebral wedge angle (alpha), the ratio of the anterior height of the fractured vertebral body to the anterior height of the upper adjacent vertebral body (a/c), the ratio of the anterior height to the posterior height of the fractured vertebra (a/b) and the distance between the vertebral endplates adjacent to the fractured vertebra, measured between their anterior edges (A-B) were assessed. The most common general medical and surgical complications were also evaluated. After the surgery, significant pain relief measured using a VAS was noted (the median was 7 preoperatively and 4 postoperatively) and an improvement in performance according to the Karnofsky score was observed (the median was 50 preoperatively and 70 postoperatively). Out of the 14 patients with neurologic deficits 11 improved, while 5 regained the ability to walk. In four patients, the implant migrated into an adjacent vertebra and three patients suffered a fracture of the upper adjacent vertebra. The correction of the spine deteriorated in all 7 patients. There was no postoperative neurological deterioration of patients and no infectious complications. During the surgery, three patients suffered dura mater injury, which was identified intraoperatively and repaired. 1. Corpectomy followed by vertebral body replacement is an effective and safe method that enables the restoration of the shape of the vertebra, restoration of the physciological spinal curvature and direct neural decompression. 2. The treatment outcomes are good. Pain significantly decreases and performance improves in most patients. 3. Treatment complications are rare. The most often observed complication was migration of the implant into an adjacent vertebral endplate, fractures above the place of fixation and dura mater injury.

Effectiveness of the Endplate Reduction Technique Combined With Bone Grafting for the Treatment of Thoracolumbar Fractures by Using Posterior Short-Segment Fixation.

This study aimed to examine the effect of the endplate reduction (EPR) technique combined with bone grafting for treating thoracolumbar burst fractures using posterior short-segmental fixation. Patients with thoracolumbar fractures admitted between January 2018 and October 2021 were retrospectively analyzed, and those meeting the criteria were assigned to the EPR group and the intermediate screws (IS) group. The vertebral wedge angle (VWA), Cobb angle (CA), anterior vertebral body height (AVBH), middle vertebral body height (MVBH), upper endplate line (UEPL), upper intervertebral angle (UIVA), and upper intervertebral disc height (UIDH) indices were examined and compared preoperatively, first day postoperatively, as well as at 12 months postoperatively. The result indicated that the EPR group achieved better MVBH reduction (p < 0.001), UEPL reduction (p < 0.001), vertebral body fracture healing (p = 0.006), as well as implant breakage (p = 0.04) than the IS group; VWA (p < 0.001), CA (p = 0.005), AVBH (p < 0.001), MVBH (p < 0.001), UEPL (p < 0.001), and UIDH (p < 0.001) were lost after reduction less than those in the IS group. There was no significant difference in operative time (p = 0.315) and intraoperative bleeding (p = 0.274) between the 2 groups. The EPR group achieved better results in repositioning and maintaining MVBH and endplate morphology, with less correction loss after the reduction of the VWA, CA, AVBH, and endplate morphology. The EPR group exhibited a better healing pattern after vertebral fracture and disc degeneration was better relieved.

Percutaneous mesh-container-plasty versus percutaneous kyphoplasty for the treatment of Kümmell's disease: a retrospective cohort study

BackgroundBoth percutaneous kyphoplasty (PKP) and percutaneous mesh-container-plasty (PMCP) were important procedures for the treatment of Kümmell's disease. This study aimed to compare the clinical and radiological results of PKP and PMCP for the treatment of Kümmell's disease.MethodsThis study included patients with Kümmell's disease treated at our center between January 2016 and December 2019. A total of 256 patients were divided into two groups according to the surgical treatment they received. Clinical, radiological, epidemiological, and surgical data were compared between the two groups. Cement leakage, height restoration, deformity correction, and distribution were evaluated. The visual analog scale (VAS), Oswestry Disability Index (ODI), and short-form 36 health survey domains “role-physical” (SF-36 rp) and “bodily pain” (SF-36 bp) were calculated preoperatively, immediately after surgery, and 1-year postoperatively.ResultsThe VAS and ODI scores improved in the PKP [preoperative: 6 (6–7), 68.75 ± 6.64; postoperative: 2 (2–3), 23.25 ± 3.50, respectively] (p < 0.05) and the PMCP [preoperative: 6 (5–7), 67.70 ± 6.50; postoperative: 2 (2–2), 22.24 ± 3.55, respectively] groups (p < 0.05). There were significant differences between the two groups. The mean cost in the PKP group was lower than that in the PMCP group (3697 ± 461 vs. 5255 ± 262 USD, p < 0.05). The cement distribution in the PMCP group was significantly higher than that in the PKP group (41.81 ± 8.82% vs. 33.65 ± 9.24%, p < 0.001). Cement leakage was lower in the PMCP group (23/134) than in the PKP group (35/122) (p < 0.05). The anterior vertebral body height ratio (AVBHr) and Cobb’s angle improved in the PKP (preoperative: 70.85 ± 16.62% and 17.29 ± 9.78°; postoperative: 80.28 ± 13.02% and 13.05 ± 8.40°, respectively) and PMCP (preoperative: 70.96 ± 18.01% and 17.01 ± 10.53°; postoperative: 84.81 ± 12.96% and 10.76 ± 9.23°, respectively) groups (p < 0.05). There were significant differences in vertebral body height recovery and segmental kyphosis improvement between the two groups.ConclusionsPMCP had advantages over PKP in terms of pain relief and functional recovery for the treatment of Kümmell's disease. Moreover, PMCP is more effective than PKP in preventing cement leakage, increasing cement distribution, and improving vertebral height and segmental kyphosis, despite its higher cost.

Correction loss following short-segment posterior fixation for traumatic thoracolumbar burst fractures related to endplate and intervertebral disc destruction

BackgroundThere has been widespread use of short-segment posterior fixation (SSPF) for traumatic thoracolumbar burst fractures. The relationship between the destruction of the vertebral endplate and adjacent disc and postoperative correction loss has been studied in only a few studies. This study investigated the risk factors for correction loss following SSPF.MethodsForty-eight patients (mean age 35.0 years) who underwent SSPF for thoracolumbar burst fractures were enrolled. The mean follow-up period was 25.7 months (12–98 months). The neurological status and postoperative back pain were assessed by the medical records. Segmental kyphotic angle (SKA) and anterior vertebral body height ratio (AVBHR) were measured radiographically to assess indirect vertebral body reduction and local kyphosis. Preoperative Sander’s traumatic intervertebral disc lesion (TIDL) classification and AO classification were used to evaluate the severity of disc and vertebral endplate injury. The corrective loss was considered present if ΔSKA was ≥10°. A multivariate logistic regression analysis was performed to identify the risk factors associated with postoperative loss of correction.ResultsThe fracture distribution was as follows: 10 at T12, 17 at L1, 10 at L2, 9 at L3, and 2 at L4. Vertebral fractures were classified in the following way: A3 in 13 patients, A4 in 11, B1 in 11, and B2 in 13. In 47 patients (98%), a union of the fractured vertebrae was achieved. SKA and AVBHR improved significantly after surgery from 11.6° to 3.5° and from 67.2 to 90.0%, respectively. However, the correction loss at follow-up was 10.4° and 9.7%, respectively. Twenty patients (42%) had severe TIDL (grade 3). Postoperative ΔSKA and ΔAVBHR were significantly higher in patients with TIDL grade 3 than with TIDL grade 0–2. The presence of cranial TIDL grade 3 and older age were significant risk factors for ΔSKA ≥10° on multivariate logistic regression analysis. All patients could walk at follow-up. TIDL grade 3 and ΔSKA ≥10° were associated with severe postoperative back pain.ConclusionsRisk factors for loss of correction after SSPF for thoracolumbar burst fractures were severe disc and endplate destruction at the time of injury and older age.

TREATMENT OF THORACOLUMBAR FRACTURES BY CLOSED REDUCTION VIA A PERCUTANEOUS SOLID PEDICLE SCREW.

Investigate the effect of closed reduction and per- cutaneous pedicle screw fixation in treating thoracolumbar fractures. This retrospective study analyzed 12 cases of single-segment thoracolumbar spine fractures without spinal cord and nerve injury at our department from March 2016 to September 2017. Patients were treated with closed reduction, percutaneous reduction, and internal fixation with solid pedicle screws. The operation time, intraoperative blood loss, anterior vertebral body height ratio (AVHR), Cobb angle (CA) of sagittal kyphosis, and VAS of back pain were determined and statistically compared. The average operation time was 147.2 ± 45.6 min, and the average intraoperative bleeding was 67.8 ± 34.2 mL. All fractured vertebrae were completely reduced, their height was restored, and kyphosis was corrected. The average follow-up period was 10.6 ± 2.7 months, with significant improvements seen in the AVHR, CA of sagittal kyphosis, and VAS score (P < 0.01). One case had a broken rod after three months, and another had a postoperative infection. All the patients achieved bony healing. The treatment of thoracolumbar fractures by closed reduction and internal fixation with a percutaneous solid pedicle screw is simple, effective, and economical. Level of Evidence VI; Therapeutic Study, Case Series .

Biomechanical Evaluation of a Novel Expandable Vertebral Augmentation System Using Human Cadaveric Vertebrae

Unacceptable sagittal alignment and cement leakage are major concerns of percutaneous vertebroplasty when treating patients with painful vertebral osteoporotic compression fractures. To maintain the restored vertebral height and reduce the reliance on cement as the major stabilizer, an expandable vertebral augment system (EVA®) made of titanium alloy consisting of a rigid tube encased by a barrel with an anterior expansion mechanism was developed. The aim of the current study was to determine whether this novel design is as effective as existing procedures in terms of height restoration and biomechanical performance. Eight osteoporotic vertebrae (T12-L3) confirmed by dual-energy X-ray absorptiometry from two fresh-frozen human cadavers (70- and 72-year-old females) were used. Twenty-five percent reduced anterior wedge vertebral compression fractures were created using a material testing machine. Four randomized specimens were augmented with EVA® (Chang Gu Biotechnology Co. Ltd., Taipei city, Taiwan), and another four randomized specimens were augmented with OsseoFix® (AlphaTec Spine Inc., Carlsbad, CA, USA). The implant size and cement volume were controlled. The anterior vertebral body height (VBH) ratio and pre/postaugmented ultimate strength and stiffness were measured and compared. The mean anterior VBH restoration ratio was 8.54% in the EVA® group and 8.26% in the OsseoFix® groups. A significant difference from augmentation was measured in both groups (p &lt; 0.05), but there was no significant difference between the EVA® and OsseoFix® groups in anterior VBH restoration. The ultimate strengths of the EVA® and OsseoFix® groups were 6071.4 ± 352.6 N and 6262.9 ± 529.2 N, respectively, both of which were statistically significantly higher than that of the intact group (4589.9 ± 474.6 N) (p &lt; 0.05). The stiffnesses of the EVA®, OsseoFix®, and intact groups were 1087.2 ± 176.9, 1154.9 ± 168.9, and 1637.3 ± 340.8 N/mm, respectively, indicating that the stiffness was significantly higher in the intact group than in both the EVA® and OsseoFix® groups (p &lt; 0.05). No significant differences were observed between the two augmentation procedures in height restoration or ultimate strength and stiffness. This novel EVA® system showed comparable height restoration and biomechanical performance to those of existing implants for human cadaveric osteoporotic compression fractures. Potential advantages of preventing cement posterior leakage and promoting cement interdigitation are expected with this ameliorated design.