Anterior Vertebral Body Research Articles

Twenty year outcomes following short-segment posterior instrumentation and fusion for thoracolumbar burst fractures: A retrospective observational study.

This study reviews the long-term efficacy of short-segment posterior instrumentation and fusion (SSPIF) in treating thoracolumbar burst fractures. Authors retrospectively reviewed the radiographic results of single-level thoracolumbar burst fractures treated by SSPIF. Vertebral body height and wedge angles were measured on the preoperative, postoperative, and follow-up radiographic images. The degree of pain and work ability was measured using the Denis scale. The analysis consisted of 12 patients with a mean age of 39.7 years (range 21-60) and a mean follow-up of 225.6 ± 20.3 months. There were significant differences among the wedge angles at preoperative and other periods of time, but there was no significant difference between the early postoperative and all other time periods afterwards (P < .001, P = .567, P = .937, P = .879). SSPIF effectively restored the anterior and middle vertebral body height and wedge angle deformities, and the improvement was maintained for almost 20 years after the surgery. Therefore, SSPIF is a safe and effective modality of treatment for thoracolumbar burst fractures.

Compensatory thoracic curve correction in lumbar anterior vertebral body tether (VBT) versus lumbar posterior spinal fusion (PSF).

Anterior vertebral body tethering (VBT) is a non-fusion surgical option for skeletally immature patients with idiopathic scoliosis. Prior studies demonstrated compensatory correction of the thoracic curve after lumbar posterior spinal fusion (PSF); however, no studies have examined thoracic curve correction after lumbar VBT. Patients with Lenke 5 + 6 lumbar scoliosis who underwent VBT and at least 2years' follow-up were compared to matched lumbar PSF patients. Groups were compared for major lumbar (L) and compensatory thoracic (T) curve correction, coronal/sagittal balance, and complications. 24 AVBT and 24 PSF patients were matched 1:1 for skeletal maturity and curve flexibility. There were no significant differences between VBT and PSF for average pre-operative or 2year post-operative major L or compensatory T curves. Average final L curve correction was 50% VBT and 60% PSF (p = 0.08); average T curve correction was 17% VBT and 20% PSF (p = 0.18). Compared to pre-operative flexibility radiographs, the final post-op thoracic curves were 6° (VBT) and 5° (PSF) larger. PSF had better coronal balance by average of 17mm (p < 0.0001). There were seven (24%) reoperations in the VBT group: two overcorrections relaxed, two T adding-on (extended to T by PSF-1, VBT-1), one broken tether converted to PSF. There was one (4%) reoperation in the PSF group (10-year post-op extension). Compensatory thoracic correction was achieved to a similar degree for lumbar VBT and PSF patients. There was little change in thoracic curve magnitude over time, and, on average, the correction did not reach the pre-operative flexibility curve measurement. There was better coronal balance by PSF, and a higher rate of re-operation in VBT patients. III.

Apical stress redistribution during anterior vertebral body tethering for thoracic adolescent idiopathic scoliosis: a finite element analysis of a novel surgical technique.

Apical stress redistribution (ASR) is proposed to mitigate failure risks after anterior vertebral body tethering for adolescent idiopathic scoliosis. It consists in releasing set-screws at peri-apical levels following curve tensioning to redistribute stresses within the construct. This study determines the biomechanical impact and curve correction obtained with ASR. Finite element models of anterior vertebral body tethering were constructed for three typical scoliotic patients with Lenke 1 curves. ASR was simulated by releasing tension on the cable at the level of the three apical set screws (i.e. untightening three consecutive periapical set screws), followed by retightening of the set screws without further tensioning. Cable tension, implant forces and spine geometry were compared before and after performing ASR. Periapical cable tension decreased post-ASR, and ASR alsoreduced the maximum tensions proximally and distally. Postoperative disc height was similar between conventional and ASR approaches. Apical intervertebral disc stresses were shifted from concave to convex compression intra and postoperatively, with a similar pattern between the conventional and ASR techniques. The ASR technique achieved scoliotic curve corrections of 54%, 68%, and 79%, while the conventional technique resulted in corresponding corrections (54%, 68%, and 80%) for subjects 1, 2, and 3. The periapical coronal curves exhibited similar patterns. ASR demonstrated promising apical cable and implant forces re-equilibrium compared to the conventional approach. This novel technique did not impair immediate and postoperative curve correction, while maintaining similar apical intervertebral stress distribution. ASR shows potential to modulate growth while reducing maximum cable tension infra- and supra-apical.

Effect of screw insertion depth into fractured vertebrae in the treatment of thoracolumbar fractures

PurposeThe study’s objective was to assess the effect of the screw insertion depth into fractured vertebrae in treating thoracolumbar fractures.Materials and methodsThis was a retrospective analysis of 92 patients with thoracolumbar fractures from December 2018 to February 2020. Patients had AO type A2, A3 thoracolumbar fractures. The patients were divided into two groups according to the screw insertion depth. The vertebral wedge angle (VWA), Cobb angle (CA), anterior vertebral body height (AVBH), middle vertebral body height (MVBH), visual analog scale (VAS) score, and Oswestry Disability Index (ODI) were compared preoperatively and at one week and 12 months postoperatively. The correlation between Vertebral height loss and potential risk factors, such as sex, age, BMD and BMI was evaluated.ResultsCompared with the preoperative data, the postoperative clinical and radiographic findings were significantly different in both groups, But no significant difference between the two groups at 1 week. At 1 year postoperatively, there was a significant difference in the CA (p < 0.0001), VWA (p = 0.047), AVBH (p < 0.0001), MVBH (p < 0.0001), VAS score (p < 0.0001), and ODI (p < 0.0001) between the two groups, Except for age, bone density and other influencing factors the long screw group had better treatment results than the short screw group.ConclusionA longer screw provides greater grip on the fractured vertebral body and stronger support to the vertebral plate. The optimal screw placement depth exceeds 60% of the vertebral body length on the lateral view.

Efficacy and safety of short segment pedicle screw fixation in patients with neurologically intact burst fractures of the lower thoracic and lumbar spine: a meta-analysis of studies published over the last 20 years

Objective. To conduct a systematic review and meta-analysis of studies on the surgical treatment of patients with uncomplicated burst fractures of the lower thoracic and lumbar spine and to determine the effectiveness and safety of short transpedicular fixation (TPF) in this patient group.Material and Methods. The study included articles with the following criteria: publication date from January 1, 2004, to December 31, 2023; patient sample descriptions involving uncomplicated burst fractures from T10 to L5; TPF involving one segment adjacent to the fractured vertebra in both cranial and caudal directions without spinal fusion; descriptions of treatment outcomes or complications; and an average follow-up period of at least 12 months. Meta-analysis was conducted using the Comprehensive Meta-Analysis software, version 2.2.064. Depending on the level of heterogeneity (I² test), either a fixed-effects or random-effects model was applied. Begg’s or Egger’s test was used to assess publication bias, and any bias present was corrected using the trim-and-fill method.Results. The application of TPF resulted in a significant reduction in the overall Cobb angle by 5.9 degrees in the percutaneous group and by 7.6 degrees when using a midline approach. Regarding AVBCR (anterior vertebral body compression ratio), a reduction of 24.0 % and 24.8 % was observed in both groups, respectively. The overall complication rates were as follows: superficial infection, 2.2 %; deep infection, 2.0 %; and implant-associated complications, 5.6 %. No patient developed a neurological deficit. The levels of work adaptation W1 and W2 on the Denis scale were achieved in 70.9 % of patients. The overall quality of life, as measured by the Oswestry Disability Index, averaged 13.4 %.Conclusions. Short transpedicular fixation without additional spinal fusion or laminectomy appears to be an effective and safe method for treating burst fractures of the lower thoracic and lumbar spine without neurological deficits. This method allows for regression of kyphotic deformity in the long-term post-injury period by at least 5.9 degrees and restoration of anterior vertebral height by 24 %. The approach demonstrated relatively low overall postoperative complication rates. More than 90 % of patients were able to return to full-time work, either in their previous position or with reduced physical demands.

Percutaneous Mesh-Container-Plasty versus Percutaneous Kyphoplasty in the Treatment of Osteoporotic Compression Fractures with Up-Endplate Injury: A Retrospective Study

Percutaneous mesh-container-plasty(PMCP), a modified traditional percutaneous kyphoplasty(PKP)technique, is increasingly being used to treat osteoporotic vertebral compression fractures(OVCF) with up-endplate injury. This retrospective study aimed to compare the clinical and radiological results of PKP and PMCP for the treatment of this disease. We retrospectively analyzed the medical records of patients with osteoporotic compression fractures and upper endplate injuries treated at our hospital between January 2019 and December 2021. A total of 192 patients who met the inclusion and exclusion criteria were enrolled. Of these, 103 underwent PKP and 89 underwent PMCP. Key outcome measures included surgical safety, clinical efficacy, and radiological results. Both the PKP and PMCP groups showed significant improvements in VAS (Visual Analog Scale) and ODI (Oswestry Disability Index) scores postoperatively. Additionally, anterior vertebral body height ratio (AVBHr) and Cobb's angle improved in both groups, though no statistically significant difference was observed between them. The hospital stay duration was similar between the two cohorts. Notably, the PMCP group required a larger volume of bone cement injection, yet exhibited a significantly lower incidence of cement leakage and adjacent vertebral fractures (9/89 and 2/89, respectively) compared to the PKP group (24/103 and 11/103, respectively) (p < 0.05). Moreover, the PMCP group had shorter operation times (34.64 ± 9.88 minutes) and reduced fluoroscopy frequency (35.43 ± 5.46 instances) compared to the PKP group (27.23 ± 8.54 minutes and 23.87 ± 5.59 instances, respectively) (p < 0.05). PMCP provided superior clinical outcomes for the management of osteoporotic compression fractures with upper endplate injuries. It was associated with reduced operation and fluoroscopy times, as well as lower risks of adjacent vertebral fractures and cement leakage, compared to PKP.

Segmental range-of-motion by vertebral level in fused and unfused patients with adolescent idiopathic scoliosis: a systematic review of the literature.

This study aims to understand global and segmental spinal ROM in surgical and nonsurgical AIS patients. This systematic review examined segmental vertebral ROM in AIS patients using PubMed, SPORTDiscus, MEDLINE, and Web of Science until October 8th, 2023. Inclusion criteria were articles on segmental motion in AIS patients, both operative and non-operative, under 18years old. Seventeen articles met eligibility criteria from 2511 initially retrieved. All patients (n = 996) had AIS (549 non-operative; 447 were operative), with a frequency-weighted mean age of 15.1 ± 1.6years and a baseline Cobb angle of 51.4 ± 13.3 degrees. Studies showed heterogenous segmental flexibility in the unfused spine, with the apical curve and upper thoracic segments being more rigid and lower segments more flexible at -5 disk segments from the apex. Most studies showed a predictable loss of motion in fused spinal regions postoperatively and a variable loss of global motion depending on the LIV and number of fused segments. A 7° global loss of total trunk flexion per level was observed with increasingly caudal LIV, starting at L1. Anterior vertebral body tethering (AVBT) preserved motion post-surgery but reduced coronal plane motion. AVBT saw less motion loss compared to posterior spinal fusion (PSF) but had higher revision and complication rates. Preservation of spinal segments correlated with improved motion postoperatively. Increasing caudal LIV in PSF showed sagittal flexion loss. AVBT preserved more sagittal ROM than PSF but increased coronal motion loss, complications, and revision rates, with the largest benefit at LIV L4. Data on segmental motion are limited and further research on postoperative segmental ROM is required.

Assessment of age-dependent sexual dimorphism in paediatric vertebral size and density using a statistical shape and statistical appearance modelling approach

This work focuses on the growth patterns of the human fourth lumbar vertebra (L4) in a paediatric population, with specific attention to sexual dimorphism. The study aims to understand morphological and density changes in the vertebrae through age-dependent statistical shape and statistical appearance models, which can describe full three-dimensional anatomy. Results show that the main growth patterns are associated with isotropic volumetric vertebral growth, a decrease in the relative size of the vertebral foramen, and an increase in the length of the transverse processes. Moreover, significant sexual dimorphism was demonstrated during puberty. We observe significant age and sex interaction in the anterior vertebral body height (P = 0.005), where females exhibited an earlier increase in rates of vertebral height evolution. Moreover, we also observe an increase in cross-sectional area (CSA) with age (P = 0.020), where the CSA is smaller in females than in males (significant sex effect P = 0.042). Finally, although no significant increase in trabecular bone density with age is observed (P = 0.363), a trend in the statistical appearance model suggests an increase in density with age.

Clinical application of a modified wiltse approach in middle and lower thoracic vertebrae: a case-control study of thoracic fracture patients

BackgroundThe Wiltse approach has been extensively employed in thoracolumbar surgeries due to its minimal muscle damage. However, in the middle and lower thoracic spine, the conventional Wiltse approach necessitates the severance of the latissimus dorsi and trapezius muscles, potentially leading to muscular injury. Consequently, we propose a modified Wiltse approach for the middle and lower thoracic vertebrae, which may further mitigate muscular damage.MethodsFrom May 2018 to April 2022, 60 patients with spinal fractures in the middle and lower thoracic vertebrae (T5-12) were enrolled in this study. Thirty patients underwent surgery using the modified Wiltse approach (Group A), while the remaining 30 patients received traditional posterior surgery (Group B). The observation indices included operation time, intraoperative blood loss, incision length, number of C-arm exposures, postoperative drainage, postoperative ambulation time, discharge time, as well as preoperative and postoperative Cobb’s angle, percentage of anterior vertebral body height (PAVBH), visual analog scale (VAS) Score, and Oswestry disability index (ODI).ResultsCompared to the traditional posterior approach, the modified Wiltse approach demonstrated significant advantages in operation time, intraoperative blood loss, length of incision, postoperative ambulation time, postoperative drainage, and discharge time, as well as postoperative VAS and ODI scores. No significant differences were observed between the two groups in terms of number of C-arm exposures, postoperative Cobb’s angle, or postoperative PAVBH.ConclusionWe propose a modification of the Wiltse approach for the middle and lower thoracic vertebral regions, which may further minimize muscular damage and facilitate the recovery of patients who have undergone surgery in the middle and lower thoracic vertebrae.

Chest tube management following two row vertebral body tethering for adolescent idiopathic scoliosis

Background The current gold standard of scoliosis correction procedures is still posterior spinal fusion, an extensively studied procedure. anterior vertebral body tethering is a newer surgical technique for the correction of scoliotic curves. Consequently, best practices have yet to be determined. Methods A single-institution, retrospective, review of all patients diagnosed with adolescent idiopathic scoliosis who underwent two row anterior vertebral body tethering between June 2020 and April 2022 was performed. Results Over the study period, 95 patients met inclusion: 79 females (83.2%) and 16 males (16.8%), age 14.4 ± 2.5 years, with a body mass index of 20.0 ± 2.9, and an average of 8.4 ± 2.1 levels treated. 28 (29.5%) procedures were for double curves and 67 (70.5%) for single curves. After tethering, a chest tube was positioned in each corrected side. A total of 123 chest tubes were analyzed, including 67 single curves and 28 double curves. The average chest tube duration was 2.5 ± 1.1 days and the average length of stay was 5.0 ± 2.0 days. The average chest tube output eight hours prior to removal was 61.1 ± 45.6 mL. There was no significant difference in average length of stay for patients who underwent correction of a single curve versus a double curve nor was there a difference in average length of stay or chest tube duration for revisions compared to primary procedures. For the entire cohort, the 30-day emergency department visit rate was 7.4% (n = 7) and the readmission rate was 4.2% (n = 4). Conclusions This early review of a 2-year two row vertebral body tethering postoperative experience provides a report of a safe and effective approach to chest tube management at a single academic center.

Anterior Vertebral Body Tethering: A Single-Center Cohort with 4.3 to 7.4 Years of Follow-up.

Vertebral body tethering (VBT) is a well-recognized, non-fusion alternative for idiopathic scoliosis in children with growth remaining. To date, there have been almost no published outcome studies with postoperative follow-up of >2 years. We aimed to fill this gap by evaluating mid-term outcomes in our first 31 consecutive patients. We retrospectively assessed additional clinical and radiographic data (mean, 5.7 ± 0.7 years) from our first 31 consecutive patients. Assessments included standard deformity measures, skeletal maturity status, and any additional complications (e.g., suspected broken tethers or surgical revisions). Using the same definition of success (i.e., all residual deformities, instrumented or uninstrumented, ≤30° at maturity; no posterior spinal fusion), we revisited the success rate, revision rate, and suspected broken tether rate. Of our first 31 patients treated with VBT, 29 (of whom 28 were non-Hispanic White and 1 was non-Hispanic Asian; 27 were female and 2 were male) returned for additional follow-up. The success rate dropped to 64% with longer follow-up as deformity measures increased, and the revision rate increased to 24% following 2 additional surgical revisions. Four additional suspected broken tethers were identified, for a rate of 55%, with only 1 occurring beyond 4 years. No additional patients had conversion to a posterior spinal fusion. We observed a mean increase of 4° (range, 2° to 8°) in main thoracic deformity measures and 8° (range, 6° to 12°) in thoracolumbar deformity measures. With >5 years of follow-up, we observed a decrease in postoperative success, as progression of the deformity was observed in most subgroups, and an increase in the revision and suspected broken tether rates. No additional patients had conversion to a posterior spinal fusion, which may indicate long-term survivorship. Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

Efficacy and safety of conservative treatment in patients with neurologically intact thoracolumbar burst fractures: a meta-analysis

Objective. To conduct a meta-analysis of studies focused on the conservative treatment of thoracolumbar burst fractures, and to determine the efficacy and safety of this method in the observed group of patients.Material and Methods. The study was performed following PRISMA guidelines. Inclusion criteria for meta-analysis were as follows: availability of full-text version of the article in English or Russian; A3 or A4 type fractures according to the AOSpine classification, or burst fractures of types IIA, IIB or IIC according to the Denis classification, or a direct indication of the presence of a burst fracture without its classification; absence of neurological deficit; age over 18 years; detailed description of treatment outcomes or complications; and a follow-up for at least one year.Results. The meta-analysis included 29 articles describing the results of treatment of 1107 patients. At the time of admission, the following radiographic parameters were calculated for patients: mean kyphotic angle, 13.6 (95 % CI, 10.8–16.5), degree of vertebral body compression, 39.9 % (95 % CI, 27.7–52.0), and the degree of compression of the spinal canal lumen, 41.7 % (95 % CI, 29.2–54.2). A follow-up examination revealed a significant increase in segmental kyphosis by 3%, in vertebral body compression by 3.7 %, and lysis of bone fragments with a decrease in the degree of spinal canal stenosis by 2 times. The incidence of neurological deficit and progression of thoracic and lumbar spine instability was 5.8 % (95 % CI, 4.1–8.1) and 6.5 % (95 % CI, 4.5–9.3), respectively. Recovery of work ability according to Denis scale was as follows: W1 and W2 – 74.7 % (95 % CI, 63.9–83.1); W3 – 14.1 % (95 % CI, 10.2–19.3); and W4 and W5 – 14.8 % (95 % CI, 8.8–23.9).Conclusion. Conservative treatment of neurologically intact thoracolumbar burst fractures can be an effective and safe option if the angular deformity does not exceed 16 degrees and the anterior vertebral body compression rate is up to 52 %. With conservative therapy, a twofold reduction in spinal canal stenosis was observed due to the lysis of bone fragments. The pooled prevalence of radiculopathy or myelopathy with conservative therapy was 5.8 %. Orthopedic intervention due to the progression of instability of the damaged segment may be required in 6.5 % of patients. More than 90 % of patients returned to full-time work following conservative therapy. Comparative studieson the effectiveness of conservative therapy versus surgical treatment should be continued to form clear recommendations for the choice of treatment tactics for patients with uncomplicated fractures of the thoracic and lumbar spine.

Learning Curve Associated With Thoracoscopic Anterior Vertebral Body Tether and Double Anterior Vertebral Body Tether for Idiopathic Scoliosis: Analysis of Three Independent Surgeons.

Anterior vertebral body tether (VBT) is a fusionless approach to treat idiopathic scoliosis, and surgeons are beginning to implement the technique into current practice. This study aims to evaluate the learning curve for single and double VBT. A retrospective review of 3 surgeons' first 40 single and 20 double VBT was performed. Skeletally immature patients with idiopathic scoliosis who underwent thoracic (single) or thoracolumbar (double) VBT were included. Thoracic VBT was done via video-assisted thoracoscopic surgery and lumbar VBT through a mini-open retroperitoneal approach. Primary outcomes of interest were operative time, radiation exposure, and radiographic correction. Pooled and individual-surgeon analyses were performed. A total of 180 patients were included: 120 single and 60 double. Mean age was 12.7 years, and 87.8% were female. Mean segments tethered was 7.8 in single and 11.0 in double. Mean preoperative thoracic scoliosis was 51.5: single 50.5° and double 53.3°. Mean lumbar scoliosis was 36.4°: single 30.0° and double 49.0°. Average operating time was 276.2 minutes; double VBT was significantly longer (217.3 vs 394.0 minutes, P < .001). Mean blood loss was 198.5 mL, and mean fluoroscopy dose was 73.0 mGy. For single VBT, there was a decrease in operative time (283.3-174.8 minutes, P < .001) and fluoroscopy dose (70.1-53.5 mGy, P = .047) over time. Every 10 cases resulted in a 31.4 minute decrease in operative time (P < .001). There were no intraoperative complications. Single VBT resulted in 54.9% thoracic curve correction. Double VBT achieved 53.0% thoracic and 56.7% lumbar correction. There were no differences in curve correction across the learning curve. VBT is viable fusionless surgical option for scoliosis. As expected, increased experience resulted in shorter operative time; the threshold for such improvement seems to be 10 cases. Importantly, adequate and consistent curve correction can be achieved at the start of the learning curve while mitigating complications.

Three-dimensional vertebral shape changes confirm growth modulation after anterior vertebral body tethering for idiopathic scoliosis.

To evaluate three-dimensional (3D) vertebra and disk shape changes over 2years following anterior vertebral body tether (AVBT) placement in patients with idiopathic scoliosis (IS). Patients with right thoracic IS treated with AVBT were retrospectively evaluated. 3D reconstructions were created from biplanar radiographs. Vertebral body and disk height (anterior, posterior, left and right) and shape (wedging angle) were recorded over the three apical segments in the local vertebral reference planes. Changes in height and wedging were measured through 2years postoperatively. Change in patient height was correlated with changes in the spine dimensions. Forty-nine patients (Risser 0-3, Sanders 2-4) were included. The mean age was 12.2 ± 1.4years (range 8-14). The mean coronal curve was 51 ± 10° preoperatively, 31 ± 9° at first postoperative time point and 27 ± 11° at 2-year follow-up (p < 0.001). The mean patient height increased 8cm by 2years (p < 0.001). The left side of the spine (vertebra + disc) grew in height by 2.2mm/level versus 0.7mm/level on the right side (p < 0.001). This differential growth was composed of 0.5mm/vertebral level and 1.0mm/disk level. Evaluation of the change in disk heights showed significantly decreased height anteriorly (- 0.4mm), posteriorly (- 0.3mm) and on the right (- 0.5mm) from FE to 2years. Coronal wedging reduced 2.3°/level with 1.1°/vertebral level change and 1.2°/disk level. There was no differential growth in the sagittal plane (anterior/posterior height). Patient height change moderately correlated with 3D measures of vertebra + disk shape changes. Three-dimensional analysis confirms AVBT in skeletally immature patients results in asymmetric growth of the apical spine segments. The left (untethered) side length increased more than 3 × than the right (tethered) side length with differential effects observed within the vertebral bodies and disks, each correlating with overall patient height change.

Evaluating the Readability of Patient Education Materials for Anterior Vertebral Body Tethering, Distraction-Based Methods, and Posterior Spinal Fusion for the Treatment of Pediatric Spinal Deformity.

The Internet is an important source of information for patients, but its effectiveness relies on the readability of its content. Patient education materials (PEMs) should be written at or below a sixth-grade reading level as outlined by agencies such as the American Medical Association. This study assessed PEMs' readability for the novel anterior vertebral body tethering (AVBT), distraction-based methods, and posterior spinal fusion (PSF) in treating pediatric spinal deformity. An online search identified PEMs using the terms "anterior vertebral body tethering," "growing rods scoliosis," and "posterior spinal fusion pediatric scoliosis." We selected the first 20 general medical websites (GMWs) and 10 academic health institution websites (AHIWs) discussing each treatment (90 websites total). Readability tests for each webpage were conducted using Readability Studio software. Reading grade levels (RGLs), which correspond to the US grade at which one is expected to comprehend the text, were calculated for sources and independent t tests compared with RGLs between treatment types. The mean RGL was 12.1 ± 2.0. No articles were below a sixth-grade reading level, with only 2.2% at the sixth-grade reading level. AVBT articles had a higher RGL than distraction-based methods (12.7 ± 1.6 vs 11.9 ± 1.9, P = 0.082) and PSF (12.7 ± 1.6 vs 11.6 ± 2.3, P = 0.032). Materials for distraction-based methods and PSF were comparable (11.9 ± 1.9 vs 11.6 ± 2.3, P = 0.566). Among GMWs, AVBT materials had a higher RGL than distraction-based methods (12.9 ± 1.4 vs 12.1 ± 1.8, P = 0.133) and PSF (12.9 ± 1.4 vs 11.4 ± 2.4, P = 0.016). Patients' health literacy is important for shared decision-making. Assessing the readability of scoliosis treatment PEMs guides physicians when sharing resources and discussing treatment with patients. Both GMWs and AHIWs exceed recommended RGLs, which may limit patient and parent understanding. Within GMWs, AVBT materials are written at a higher RGL than other treatments, which may hinder informed decision-making and patient outcomes. Efforts should be made to create online resources at the appropriate RGL. At the very least, patients and parents may be directed toward AHIWs; RGLs are more consistent.

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.

Lumbar Vertebral Body Tethering: Single Center Outcomes and Reoperations in a Consecutive Series of 106 Patients.

Retrospective cohort study. To evaluate the outcomes and reoperation rates in patients with adolescent idiopathic scoliosis undergoing lumbar anterior vertebral body tethering (AVBT). AVBT is a viable option for growing children. The benefit of motion preservation must be balanced by a higher reoperation rate. A paucity of reports has addressed lumbar AVBT. A single-center retrospective study was conducted to identify all patients who underwent lumbar AVBT (lowest instrumented vertebra L3 or L4) with a minimum of 2 years of follow-up. Clinical and radiographic parameters, including complications and reoperations, were also collected. Statistical analysis was performed using the Student t test for qualitative variables. From a data set of 551 patients, we identified 106 patients (89% female) who underwent a lumbar AVBT (33 lumbar only, 73 bilateral thoracic/lumbar) with a mean follow-up of 4.1 ± 1.6 years at which point 85% (90/106) had reached skeletal maturity. Preoperatively, these patients were skeletally immature (age: 12.8 ± 1.3 yr, Sanders: 3.3 ± 0.8, R = 0.6 ± 0.9) with a lumbar coronal curve angle of 49.6° ± 11.2° which corrected to 19.9° ± 11.2° ( P < 0.0001) at most recent follow-up. At the latest follow-up, 76.4% (81/106) of the patients harbored a coronal curve angle of <30°. Twenty patients (18.9%) underwent 23 reoperations, with overcorrection being the most common (10/23, 43%). Broken tethers led to reoperation in 3 instances (3/23, 13%). Six patients in the cohort needed a posterior spinal fusion (6/106, 5.4%). Vertebral body tethering is a viable treatment option for skeletally immature patients with idiopathic scoliosis. This report is the largest to date for lumbar AVBT, highlighting that 84% of patients harbored a curve <35° at the latest follow-up but with an 18.9% reoperation rate. 3.

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.