Anterior Vertebral Height Ratio Research Articles

Effectiveness of injured vertebra fixation with inclined-long pedicle screws combined with interbody fusion for thoracolumbar fracture dislocation with disc injury

To investigate the effectiveness of injured vertebra fixation with inclined-long pedicle screws combined with interbody fusion for thoracolumbar fracture dislocation with disc injury. Between January 2017 and June 2022, 28 patients with thoracolumbar fracture dislocation with disc injury were underwent posterior depression, the injured vertebra fixation with inclined-long pedicle screws, and interbody fusion. There were 22 males and 6 females, with a mean age of 41.4 years (range, 22-58 years). The causes of injury included falling from height in 18 cases, traffic accident in 5 cases, and bruise in 5 cases. Fracture segment included 1 case of T 11, 7 cases of T 12, 9 cases of L 1, and 11 cases of L 2. According to the American Spinal Injury Association (ASIA) scale, the spinal injuries were graded as grade A in 4 cases, grade B in 2 cases, grade C in 11 cases, and grade D in 11 cases. Preoperative spinal canal encroachment ratio was 17.7%-75.3% (mean, 44.0%); the thoracolumbar injury classification and severity score (TLICS) ranged from 9 to 10 (mean, 9.9). Seventeen patients were associated with other injuries. The time from injury to operation ranged from 1 to 4 days (mean, 2.3 days). The perioperative indicators (operation time, intraoperative blood loss, and the occurrence of complications), clinical evaluation indicators [visual analogue scale (VAS) score and Oswestry Disability Index (ODI)], radiologic evaluation indicators [anterior vertebral height ratio (AVHR), kyphosis Cobb angle (KCA), intervertebral space height (ISH), vertebral wedge angle (VWA), displacement angle (DA), and percent fracture dislocation displacement (PFDD)], neurological function, and interbody fusion were recorded. The operation time was 110-159 minutes (mean, 130.2 minutes). The intraoperative blood loss was 200-510 mL (mean, 354.3 mL). All incisions healed by first intention, and no surgical complications such as wound infection or hematoma occurred. All patients were followed up 12-15 months (mean, 12.7 months). The chest and lumbar pain significantly relieved, VAS scores and ODI after operation were significantly lower than those before operation, and further decreased with the extension of postoperative time, with significant differences ( P<0.05). At last follow-up, the ASIA classification of neurological function of the patients was grade A in 3 cases, grade B in 1 case, grade C in 1 case, grade D in 10 cases, and grade E in 13 cases, which was significantly different from preoperative one ( Z=-4.772, P<0.001). Imaging review showed that AVHR, KCA, ISH, VWA, DA, and PFDD significantly improved at 1 week, 3 months and last follow-up ( P<0.05). There was no significant difference between different time points after operation ( P>0.05). At last follow-up, according to the modified Brantigan score, all patients achieved good intervertebral bone fusion, including 22 complete fusion and 6 good intervertebral fusion with a few clear lines. No complications such as internal fixation failure or kyphosis occurred during follow-up. The injured vertebra fixation with inclined-long pedicle screws combined with interbody fusion is an effective treatment for thoracolumbar fracture dislocation with disc injury, which can correct the fracture dislocation, release the nerve compression, restore the injured vertebral height, and reconstruct spinal stabilization.

Percutaneous monoplanar screws versus hybrid fixed axial and polyaxial screws in intermediate screw fixation for traumatic thoracolumbar burst fractures: a case-control study.

To compare the clinical and radiological outcomes of monoplanar screws (MSs) versus hybrid fixed axial and polyaxial screws (HSs) in percutaneous short-segment intermediate screw fixation (PSISF) for traumatic thoracolumbar burst fractures (TTBFs) in patients without neurologic impairment. A consecutive series of 100 patients with single-segment TTBFs and no neurologic impairment who underwent PSISF with 6 monoplanar screws (MS group) or correct were retrospectively enrolled. The demographic data, radiologic evaluation indicators, perioperative indicators and clinical assessment indicators were analysed between the MS group and HS group. The demographic data and perioperative indicators were not significantly different in the two groups (P > 0.05). The postoperative anterior vertebral height ratio (AVHR), kyphosis Cobb angle (KCA), vertebral wedge angle (VWA) and spinal canal encroachment rate (SCER) were significantly improved in both groups (*P < 0.05). The MS group obtained better correction than the HS group in terms of improvement in the AVHR, KCA and VWA after surgery (*P < 0.05). At the last follow-up, the MS group had less correction loss of AVHR, KCA and VWA (*P < 0.05). The MS group presented greater improvement in the SCER at the last follow-up (*P < 0.05). The visual analogue scale (VAS) score and Oswestry Disability Index (ODI) score of all patients were significantly better postoperatively than those preoperatively (*P < 0.05), and the scores collected at each follow-up visit did not differ significantly between the two groups (P > 0.05). In the MS group, no internal fixation failure was observed during the follow-up period, but, in the HS group, two cases of internal fixation failure were observed at the last follow-up (one case of rod loosening and one case of screw breakage). Both MSs and HSs fixation are effective treatments for TTBFs and have comparable clinical outcomes. In contrast, MSs fixation can improve the correction effect, better improve the SCER, and further reduce correction loss as well as reduce the incidence of instrumentation failure. Therefore, MSs fixation might be a better option for treating TTBFs in patients without neurological deficits.

Comparison Between Intraoperative Target Area Cement-Enhanced Percutaneous Vertebroplasty and Conventional Percutaneous Vertebroplasty for Osteoporotic Thoracolumbar Non-Total Vertebral Fractures.

To compare the efficacy and feasibility of target area cement-enhanced percutaneous vertebroplasty (PVP) and conventional PVP in osteoporotic thoracolumbar non-total vertebral fractures. Retrospective analysis of one hundred and two patients treated in our hospital from March 2020 to May 2021 and divided into groups A (targeted) and B (conventional PVP). The Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), anterior vertebral height ratio, intraoperative bleeding, operative time, bone cement volume, complications, and refracture of the injured vertebra were evaluated in both groups. The 2 days and 1-year post-operative VAS and ODI scores improved significantly in both groups (p < 0.05). The 2 days post-operative VAS and ODI scores were better in group A (p < 0.05), and there was no significant difference in the scores between the groups at the last follow-up (p > 0.05). The anterior vertebral height ratios were significantly higher in both groups 2 days postoperatively (p < 0.05); however, there was no significant difference in the 2 days and 1-year post-operative ratios in group A (p > 0.05). The anterior vertebral height ratio reduced in group B after 1 year compared to the 2 days post-operative value (p < 0.05). There was no statistical difference in intraoperative bleeding and the operative time between the groups (p > 0.05), and the bone cement volume was lesser in group A (p < 0.05). Six patients in group A and four patients in group B demonstrated cement leakage, the difference was not statistically significant (p > 0.05). Three patients in group A and 11 patients in group B demonstrated refracture, the difference was statistically significant (p < 0.05). Target area cement-enhanced PVP can effectively relieve short-term pain and functional disability and reduce the long-term possibility of secondary collapse. Therefore, it is a technically feasible and efficacious method for the treatment of osteoporotic thoracolumbar non-total vertebral fractures.

The efficacy of different segments fixation for treatment thoracolumbar fractures: A Bayesian network meta-analysis.

We did this network meta-analysis to comprehensively compare the efficacy of different segments [intermediate segment (IS), short segment (SS) and long segment (LS)] in the fixation of thoracolumbar fractures. We searched studies from inception until January 20, 2023 through PubMed, Embase, Web of Science, and the Cochrane Library. All studies comparing different segments in the fixation of thoracolumbar fractures were included in this meta-analysis. Outcomes were anterior vertebral height ratio (AVHR), sagittal Cobb angle (SCA), visual analogue scale score, and implant failure rate. This network meta-analysis was performed by R software with gemtc package. Finally, a total of 22 studies were finally included in this network meta-analysis. IS (WMD 2.43, 95% CrI 2.04-2.91) was more effective than SS in terms of the AVHR, and the difference was statistically significant. IS was more effective than LS in reducing SCA (WMD -2.87, 95% CrI -3.79 to -1.96) with statistically significant. Compared with SS, IS significantly reduced the SCA with statistically significant (WMD -2.52, 95% CrI -3.31 to -1.72). IS (WMD -2.87, 95% CrI -3.78 to -1.96) was more effective than LS, and the difference was statistically significant. Moreover, IS (WMD -2.52, 95% CrI -3.31 to -1.72) was more effective than SS, and the difference was statistically significant. IS was associated with a significant reduction in SCA, implant failure rate, and visual analogue scale compared to SS and LS, while having the most favorable impact on AVHR among all the treatments assessed.

Modified posterior osteotomy for osteoporotic vertebral collapse with neurological dysfunction in thoracolumbar spine: a preliminary study

ObjectiveThe risk of osteoporotic vertebral collapse (OVC) associated with delayed neurological dysfunction (DND) is substantial, and performing surgery for this condition in elderly patients presents challenges. The focus of the current research is on simplifying surgical procedures while maintaining their effectiveness. This study was designed to contribute clinical data supporting the use of modified posterior osteotomy for treating thoracolumbar OVC with DND. The study compares perioperative clinical parameters, imaging data characteristics, and changes in efficacy outcome indicators to provide evidence for the advancement of this technique.MethodsA total of 12 patients diagnosed with osteoporotic vertebral collapse and neurological dysfunction were included in the study. All patients underwent modified posterior osteotomy. Data regarding perioperative and radiological parameters as well as complications such as surgery duration, blood loss, ASIA grade, VAS, ODI, regional kyphosis angle (RKA), anterior vertebral height ratio (AVHr), and spinal canal clearance ratio (SCCr), were collected retrospectively. These parameters were then analysed to evaluate the clinical efficacy and safety of the modified posterior osteotomy technique.ResultsA total of 12 patients were included in the study, with a mean age of 65.5 ± 9.7 years. The average follow-up period was 29.4 ± 5.0 months. The mean operative blood loss was 483.3 ± 142.0 ml, and the average operative time was 3.7 ± 0.7 h. The visual analogue scale (VAS) score decreased from a preoperative value of 5.8 ± 0.7 to a final follow-up value of 1.3 ± 0.8 (P < 0.05), indicating a significant improvement in pain. The ODI decreased from 65.2 ± 6.0 before surgery to 20.5 ± 7.0, indicating a decrease in disability, and the postoperative neurological function showed a significant improvement. Correction of the RKA was observed, with the angle changing from 35.8 ± 10.8° before surgery to 20.0 ± 3.5° after surgery and to 22.5 ± 3.1° at the final follow-up. Similarly, correction of the AVHr was observed, with the height changing from 39.3 ± 18.0 to 63.0 ± 14.3 after surgery and to 53.9 ± 8.9 at the final follow-up. Correction of the SCCr was also observed, with the ratio changing from 54.9 ± 5.4 to 68.1 ± 5.3 after surgery and to 68.68 ± 6.76 at the final follow-up.ConclusionsPosterior modified osteotomy is an effective treatment for thoracolumbar osteoporotic fractures with OVC combined with DND. It can significantly preserve vertebral height, increase vertebral canal volume, correct kyphotic angle, and improve postoperative neurological function. The simplified osteotomy also offers advantages in terms of operating time, blood loss, postoperative VAS score, and improvement in lumbar function.

The difference and clinical application of modified thoracolumbar fracture classification scoring system in guiding clinical treatment

ObjectiveThis study aimed to evaluate the feasibility of the modified thoracolumbar injury classification and severity score system in guiding clinical treatment.MethodsA retrospective study was conducted on a cohort of 120 patients with thoracolumbar fractures who were admitted to the Department of Spinal Surgery at Ningbo Sixth Hospital between December 2019 and June 2021. The study population consisted of 68 males and 52 females, with an average age of 36.7 ± 5.7 years. The severity of the fractures was assessed based on comprehensive scores incorporating fracture morphology, neurological function, posterior ligament complex integrity, and disc injury status. The evaluation was performed using the total score T, which guided the formulation of the clinical treatment strategy. Furthermore, the study compared the treatment options, imaging data, and clinical efficacy between two classification systems.ResultsThe analysis of 120 patients revealed no statistically significant difference in the total score or treatment method between the TLICS system and the modified TLICS system. However, the operation rate for the modified TLICS system (73.3%) was slightly lower compared to the TLICS system (79.2%). All patients were followed up for a mean duration of 19.2 ± 4.6 months, ranging from 11 to 27 months. At the last follow-up, the visual analogue scale score was 1.94 ± 0.52, and the modified Japanese Orthopaedic Association score was 28.8 ± 4.5, indicating a significant improvement compared to the scores obtained prior to treatment. The neurological status exhibited varying degrees of improvement. Notably, the anterior vertebral height ratio was 87.10 ± 7.17%, the sagittal index was 90.35 ± 7.72%, and the Cobb angle was 3.05 ± 0.97 degrees at the last follow-up. All these measurements demonstrated statistically significant differences compared to the values observed prior to treatment (P < 0.05). Additionally, two cases of pedicle screw breakage and seven cases of pedicle screw wear and cutting in the vertebral body were observed at the last follow-up, resulting in varying degrees of low back pain. However, no instances of rod breakage were reported.ConclusionThe modified TLICS system is a practical tool for the classification and assessment of thoracolumbar fractures. It has guiding significance for clinical treatment, and the operation rate was slightly lower than that of TLICS system.

Risk Factors for New Vertebral Compression Fracture After Percutaneous Vertebral Augmentation: A Retrospective Study.

BACKGROUND Percutaneous vertebral augmentation is the mainstream treatment of osteoporotic vertebral compression fracture (OVCF). New vertebral compression fracture (NVCF) after percutaneous vertebral augmentation may be an issue that cannot be ignored. Nevertheless, the risk factors for NVCF are still uncertain. This research aimed to study the risk factors for NVCF after percutaneous vertebral augmentation. MATERIAL AND METHODS All patients who underwent percutaneous vertebral augmentation for OVCF from January 2019 to December 2020 were enrolled in the study. These patients were divided into NVCF and control groups according to whether they had NVCF. The covariates including sex, age, BMI, diabetes, hypertension, smoking, alcohol, fracture level, surgical method, cement leakage, cement volume, preoperative anterior vertebral height ratio, and Hounsfield unit (HU) value were reviewed. Univariate and multivariate analyses were performed to identify risk factors. RESULTS A total of 279 patients were included in this study, of which 47 had NVCF after percutaneous vertebral augmentation. Univariate analysis demonstrated that there were significant differences in age (OR=1.040, 95% CI=1.003-1.078, P=0.033), BMI (OR=0.844, 95% CI=0.758-0.939, P=0.002) and HU value (OR=0.945, 95% CI=0.929-0.962, P<0.001) between the 2 groups. Multivariate regression analysis revealed that HU value (OR=0.942, 95% CI=0.924-0.960, P<0.001) were independent risk factor for NVCF after percutaneous vertebral augmentation. CONCLUSIONS Hounsfield unit value was an independent risk factor for new vertebral compression fracture after percutaneous vertebral augmentation, whereas age and BMI were not.

Indirect Spinal Canal Decompression Using Ligamentotaxis Compared With Direct Posterior Canal Decompression in Thoracolumbar Burst Fractures: A Prospective Randomized Study.

There is still no standard of care to manage thoracolumbar burst fractures. With all the recent advances, posterior approaches are still one of the mainstays of treatment. On the other hand, while spinal canal decompression in neurological impaired patients is an important goal of treatment, its technique remains controversial.This study compared the effects of direct laminectomy decompression against ligamentotaxis/indirect canal decompression on neurological and radiographic improvements. A prospective double-blind randomized clinical trial was conducted on 60 thoracolumbar burst-fracture patients meeting our inclusion and exclusion criteria. They were randomized into 2 treatment arms: (1) direct decompression using laminectomy and (2) indirect decompression using ligamentotaxis/distraction. Each patient was observed for 6 months, and their neurological and radiographical data were collected prospectively. Statistical analysis was done by the Student t test, Friedman test, Mann Whitney-U test, Wilcoxon ranked test, and 1-way analysis of variance. Among 60 patients enrolled in our study, each treatment arm had an improvement in Frankel scores but there was no difference between the groups at any given time. After 6 months of surgery, local sagittal kyphosis improved in both groups (from 32.2 to 7.43 and 29.93 to 8.77 for the indirect and direct groups, respectively), as well as anterior vertebral height ratio (from 57.73 to 70.7 and 62.17 to 66.27 for the indirect and direct group, respectively) and posterior vertebral height ratio (from 61.17 to 74.87 and 64 to 67.5 for the indirect and direct group, respectively). For between-group comparisons after 6 months, there was a significant difference only for posterior vertebral height ratio (P = 0.040). Posterior approaches with ligamentotaxis have shown to be safe and may present the same outcome as direct decompression techniques using wide laminectomy.

Short-segment fixation and transpedicular bone grafting for the treatment of thoracolumbar spine fracture.

Thoracolumbar fracture is one of the most common fractures of spine. And short-segment posterior fixation including the fractured vertebra (SSPFI) is usually used for the surgical treatment of it. However, the outcomes of SSPFI for different types of thoracolumbar fractures are not clear, and whether it is necessary to perform transpedicular bone grafting is still controversial. This study was conducted to determine the clinical efficacy of SSPFI for the treatment of different types of single-level thoracolumbar fracture, and make clear what kind of fractures need transpedicular bone grafting during the surgery. Patients with single-level thoracolumbar fracture undergoing SSPFI surgery between January 2013 and June 2020 were included in this study. The operative duration, intraoperative blood loss, anterior vertebral height ratio (AVHR) and anterior vertebral height compressive ratio (AVHC) of the fractured vertebra, local kyphotic Cobb angle (LKA), vertebral wedge angle (VWA) and correction loss during follow up period were recorded. Outcomes between unilateral and bilateral pedicle screw fixation for fractured vertebra, between SSPFI with and without transpedicular bone grafting (TBG), and among different compressive degrees of fractured vertebrae were compared, respectively. A total of 161 patients were included in this study. All the patients were followed up, and the mean follow-upped duration was 25.2 ± 3.1 months (6-52 months). At the final follow-up, the AVHR was greater, and the LKA and VWA were smaller in patients with bilateral fixation (6-screw fixation) than those with unilateral fixation (5-screw fixation) of AO type A3/A4 fractures (P < 0.001). The correction loss of AVHR, LKA and VWA in fractured vertebra were significantly great when preoperative AVHC was >50% (P < 0.05). For patients with AVHC >50%, the correction loss in patients with TBG were less than those without TBG at the final follow-up (P < 0.05). SSPFI using bilateral fixation was more effective than unilateral fixation in maintaining the fractured vertebral height for AO type A3/A4 fractures. For patients with AVHC >50%, the loss of correction was more obvious and it can be decreased by transpedicular bone grafting.

Effects of distribution of bone cement on clinical efficacy and secondary fracture after percutaneous kyphoplasty for osteoporotic vertebral compression fractures.

To investigate the effect of bilateral bone cement distribution on the clinical efficacy of percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fracture (OVCF). According to strict inclusion and exclusion criteria, 109 cases of OVCF patients treated with bipedicular PKP were included in this study from August 2018 to July 2020. According to the distribution morphology of bilateral bone cement in vertebral body, patients were divided into 3 groups, including Group A (n = 44): bilateral diffuse type; Group B (n = 31): bilateral dense type; Group C (n = 34): mixed type. To assess the clinical and radiographic efficacy of the surgery, the visual analogue scale (VAS) score, Oswestry disability index (ODI) score, anterior vertebral height (AVH), anterior vertebral height ratio (AVHR) and local kyphotic angle (LKA) were recorded at preoperatively, 2 days after surgery and 1 year after surgery. Compared with the preoperative recorded value, the VAS score, ODI score, AVH, AVHR and LKA of the three groups were significantly improved at 2 days after surgery and 1 year after surgery (p < 0.05). At 1 year after surgery, the VAS score of Group A was better than that of groups B and C (p < 0.05), and there were significantly differences in ODI score, AVH, and LKA between Group A and Group B (p < 0.05). Compared with other bone cement distribution patterns, the incidence of recompression in bilateral diffuse bone cement distribution pattern was lower (p < 0.05). In the mid-term follow-up of patients undergoing bipedicular PKP, diffuse and symmetrical distribution of bone cement can obtain better clinical improvement and lower the incidence of secondary compression.

Effect of cement distribution type on clinical outcome after percutaneous vertebroplasty for osteoporotic vertebral compression fractures in the aging population.

ObjectiveThe study aimed to investigate the effect of the type of bone cement distribution on clinical outcomes following percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCF) in the elderly.MethodsRetrospective analysis of 160 patients diagnosed with OVCF who underwent PVP treatment from March 2018 to December 2020. Based on the kind of postoperative bone cement distribution, bone cement was classified as types I, II, III, IV, and V. Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Cobb angle, anterior vertebral height ratio, refracture rate of injured vertebrae, and incidence of adjacent vertebral fractures were compared for the five types before and after three days, and one year of operation.ResultsVAS and ODI at three days and one year postoperative were significantly lower than those preoperative (P < 0.05) for all five distribution types. VAS and ODI for types I, II, and III were lower at one year postoperatively than for types IV and V (P < 0.05). There was no significant difference in Cobb angle and anterior vertebral body height ratio between preoperative and three days postoperative groups (P < 0.05); however, there were significant differences between three days and one-year postoperative and preoperative groups (P < 0.05). Following one year of surgery, the Cobb angle and the anterior vertebral height ratio of types IV and V were significantly different from those of types I, II, and III (P < 0.05), and there was a statistically significant difference between types IV and V (P < 0.05). In terms of the incidence of injured vertebral refractures and adjacent vertebral fractures, the evenly distributed types I, II, and III were significantly lower than the unevenly distributed types IV and V, and the incidence of type V was higher (P < 0.05).ConclusionsThe clinical efficacy of cement distribution following PVP of types I, II, and III is better than that of types IV and V, which can better relieve pain with long-lasting efficacy and minimize the occurrence of refractures of injured vertebrae and adjacent vertebral body fractures.

Effectiveness and postoperative rehabilitation of one-stage combined anterior-posterior surgery for severe thoracolumbar fractures with spinal cord injury

BACKGROUNDThoracolumbar fractures are generally combined with spinal cord injury to varying degrees, which may cause deterioration of the patients' condition and increase the difficulty of clinical treatment. At present, anterior or combined anterior-posterior surgery is preferred for severe thoracolumbar fractures.AIMTo investigate the effectiveness and postoperative rehabilitation of one-stage combined anterior-posterior surgery for severe thoracolumbar fractures with spinal cord injury.METHODSOne-hundred-and-twenty patients who received surgery for severe thoracolumbar fractures with spinal cord injury at our hospital from February 2018 to February 2020 were randomly enrolled. They were randomly divided into group 1 (one-stage combined anterior-posterior surgery, n = 60) and group 2 (one-stage anterior-approach surgery, n = 60). Treatment efficacy was compared between the two groups.RESULTSBlood loss was greater and the operation time was longer in group 1 than in group 2, and the differences were statistically significant (P < 0.05). Incision length, intraoperative X-rays, and length of hospital stay were not significantly different between the two groups (P > 0.05). Preoperative function of the affected vertebrae was not significantly different between the two groups (P > 0.05). In each group, the patients showed significant improvement after surgery. The anterior vertebral height ratio and the posterior vertebral height ratio in group 1 after surgery were significantly higher than those in group 2. The Cobb angle after surgery was significantly lower in group 1 than in group 2 (P < 0.05). The canal-occupying ratio of the affected vertebrae was not significantly different between the two groups (P > 0.05). Before surgery, there was no significant difference in the quality of life scores between the two groups (P > 0.05). The above indicators were significantly improved after surgery compared with before surgery in each group. In addition, these indicators were markedly better in group 1 than in group 2 after surgery (P < 0.05 for each).CONCLUSIONOne-stage combined anterior-posterior surgery effectively improves the function of the affected vertebrae and the life quality of patients with severe thoracolumbar fractures and spinal cord injury. This surgical approach is worthy of popularization in clinical use.

X-ray and CT scan predictors of damage to the posterior ligamentous complex in fractures of the vertebral bodies of the thoracolumbar junction: systematic review and meta-analysis

Objective of the review was to identify, basing on literature data, the most reliable X-ray and CT signs of damage to the posterior ligamentous complex (PLC) in fractures of the vertebral bodies of the thoracolumbar junction, initially interpreted as type A according to the AOSpine classification. The systematic review was carried out according to the recommendations of PRISMA. The search in PubMed, MEDLINE and Cochrane Library databases revealed 491 articles on relevant issues. Once the inclusion and exclusion criteria have been met, 7 original articles from peer-reviewed scientific journals for the last 10 years were selected for a systematic review, 6 of which were included in the meta-analysis. In all articles, the authors identified two groups of patients: with and without damage to the PLC. The PLC damages were confirmed by MRI and intraoperatively. Radiographic and CT spondylometric parameters were identified, which had statistically significant differences between the groups. To determine predictors of PLC damage, the values of these parameters were subjected to regression analysis. This was followed by a meta-analysis of random and fixed effects models depending on the homogeneity of the data. Statistical heterogeneity was assessed using the X-square test with the null hypothesis of the absence of significant differences in all studies, as well as the heterogeneity index – I2. For the graphical display of the results, forest plots were built. Local kyphosis angle &gt;25°, Cobb angle &gt;16° and difference between interspinous distances &gt;2.54 mm are CT scan predictors of PLC damage. The parameters characterizing the interspinous relationship were studied in no more than two studies, but at the same time they always had statistically significant differences between the groups with and without PLC injuries, therefore, they cannot be ignored during diagnosis. Anterior/posterior vertebral height ratio, anterior vertebral height ratio, sagittal index and suprajacent/subjacent parameters are not the predictors of PLC damage.

Clinical Outcomes of Fracture Haemorrhage Aspiration for Percutaneous Vertebroplasty in Treating Osteoporotic Vertebral Compression Fractures.

BackgroundA retrospective study aimed to introduce a new method for improving the diffusion degree of bone cement and to observe its clinical efficacy in percutaneous vertebroplasty treating osteoporotic vertebral compression fractures (OVCFs).MethodsFrom January 2019 to March 2020, a total of 83 patients were enrolled and reviewed. The patients were divided into two groups according to the operation method. The clinical and radiographic parameters were recorded and compared between these two groups. Those who received percutaneous vertebroplasty with haemorrhage aspiration were recorded as group A (n=42). In group A, the haemorrhage in the vertebral fracture was aspirated compared with conventional percutaneous vertebroplasty. Patients who underwent conventional percutaneous vertebroplasty were classified as group B (n=41).ResultsVisual analogue scale (VAS) values and Oswestry Disability Index (ODI) scores showed no significant difference between the two groups preoperatively, postoperatively or at the final follow-up (FU) (P>0.05). The intraoperative VAS score (bone cement injection) in group A was significantly lower than that in group B (3.83±0.79 vs 5.44±1.32, P < 0.01). The local kyphotic angle (LKA) (final follow-up), LKA loss, fractured vertebral anterior height loss (FVAHL) and anterior vertebral height loss ratio (AVHLR) were significantly lower in group A than in group B. The anterior vertebral height ratio (AVHR) at the final FU in group A was higher than that in group B (P=0.013). The distribution of bone cement was significantly different (P=0.034). By analysing the distribution pattern of bone cement, it was found that the values of LKA loss, FVAHL and AVHLR were superior in the type A bone cement distribution to those in types B and C.ConclusionCompared with traditional surgical methods, bone haemorrhage aspiration could improve the diffusion degree of bone cement and reduce the height loss and deformity of injured vertebrae. This method provides a feasible new scheme for improving the dispersion of bone cement.

Clinical Outcomes of Thoracolumbar Burst Fracture Treated by Trans-Kambin triangle versus Transpedicular Bone Grafting Combined with Posterior Internal Fixation

The ideal management of thoracolumbar burst fracture (TLBF) remains controversial. We conducted this study to compare the effectiveness and safety of trans-Kambin triangle versus transpedicular bone grafting combined with posterior internal fixation (PIF) for TLBF. Fifty-four patients were retrospectively analyzed and divided into 2 groups: the observation group (PIF combined with bone grafting via the Kambin triangle, n= 28) and the control group (PIF combined with bone grafting via transpedicular, n= 26). The anterior vertebral height ratio, sagittal Cobb angle, visual analog scale score, Oswestry Disability Index, bone healing rate, and neurologic complications were measured. All patients were followed up regularly for a mean period of 17.94 months (12- 24 months). The anterior vertebral height ratio in the observation group was higher than that in the control group (93.93 ± 2.92 vs. 89.90 ± 5.54%, P= 0.006), and the loss of correction was lower (1.59 ± 1.20 vs. 3.00 ± 1.98%, P= 0.008). The observation group had lower sagittal Cobb angle at final follow-up (8.68 ± 3.75 vs. 11.33 ± 4.77 degrees, P= 0.046) and less correction loss (1.96 ± 1.32 ± 1.15 vs. 3.90 ± 2.39 degrees, P= 0.002). The visual analog scale score and Oswestry Disability Index in the observation group were lower (0.61 ± 0.43 vs. 0.92 ± 0.38, P= 0.016; 15.86 ± 4.11 vs. 19.18 ± 4.04, P= 0.010), while the fracture healing rate showed no significant difference (P>0.05). No internal fixation failure or neurologic complications occurred in both groups during the follow-up. Bone grafting via the Kambin triangle combined with PIF is a safe and effective technology for thoracolumbar burst fracture.

Can Vertical Laminar Fracture Further Discriminate Fracture Severity Between Thoracolumbar AO Type A3 and A4 Fractures?

To determine whether vertical laminar fracture (VLF) can distinguish between AO type A3 and A4 fractures. In a retrospective review of 111 consecutive acute thoracolumbar burst fractures, 5 reviewers independently analyzed computed tomography scans to classify fractures into A3 or A4 and to identify VLF. The following computed tomography parameters were measured: spinal canal stenosis >50%, anterior vertebral height ratio <50%, load sharing score >6, and local kyphosis >20°. We calculated the diagnostic performance of VLF in detecting A4 fracture. We compared the proportion of fractures with positive bony parameters, neurological deficit, dural tears, and surgical treatment between A3, A4 with VLF, and A4 without VLF. VLF was present in 62/75 (83%) A4 fractures and 2/36 (5.5%) A3 fractures (P < 0.0001). VLF yielded a high specificity of 94% (95% confidence interval 81%-99%) and moderately high sensitivity of 83% (95% CI 72%-91%) in detecting A4 fractures. A significantly higher proportion of A4 fractures with VLF had neurological deficit (24% vs. 0, P= 0.05), spinal canal stenosis >50% (25% vs. 0, P= 0.04), and anterior vertebral height ratio <50% (24% vs. 0, P=0.05) than A4 fractures with no VLF. Interrater and intrarater κ values for VLF and AO standard criterion were excellent (>0.85). We found VLF to be highly specific, sensitive, and reliable in detecting A4 fractures. A higher proportion of A4 fractures with VLF had radiographic parameters and neurological deficit than A4 fractures with no VLF. VLF could be used as a severity modifier to further discriminate A3 and A4 fractures regarding severity and potentially guide treatment decision making.

Selections of Bone Cement Viscosity and Volume in Percutaneous Vertebroplasty: A Retrospective Cohort Study

We sought to evaluate the efficacy and complications of percutaneous vertebroplasty with different viscosities and volumes of bone cement in treating osteoporotic vertebral compression fractures (OVCFs). We conducted a retrospective cohort study of 307 patients treated for a single thoracolumbar level (T12-L2) OVCF in our hospital between January 2014 and December 2019. The patients were divided into 6 groups according to different viscosities (I: low-viscosity bone cement, II: high-viscosity bone cement) and injection volumes (A, 2-4 mL; B, 4-6 mL; C, 6-8 mL) of bone cement. Clinical and radiologic characteristics including visual analog scale, local kyphotic angle, anterior vertebral height ratio, cement leakage, and vertebral body recollapse rate were collected preoperatively, 2 days postoperation, and at the last follow-up to assess the efficacy and complications of each group. Regarding efficacy, there was no significant difference between the 2 kinds of bone cement. Injecting >4 mL of cement can provide patients with good improvements of clinical indicators and a low vertebral body recollapse rate. Injecting 6-8 mL of bone cement slightly improved the radiologic indicators. However, the leakage rate of low-viscosity bone cement increased significantly when the volume exceeded 6 mL. The leakage rate of high-viscosity bone cement did not increase significantly at the volume of 6-8 mL. In summary, when treating single thoracolumbar level OVCFs, the recommended volume of low-viscosity bone cement is 4-6 mL while the optimal volume of high-viscosity bone cement is 6-8 mL.

Reduce the fractured central endplate in thoracolumbar fractures using percutaneous pedicle screws and instrumentational maneuvers: Technical strategy and radiological outcomes.

Traumatic thoracolumbar burst fracture is a common condition without a clear consensus on the best treatment approach. Percutaneous pedicle screw fixation (PPSF) techniques are widely used in practice, while its ability to correct fracture deformity is relatively weak, especially for the central area of the endplate. In this study, we reported a novel technique to reduce the fractured central endplate in thoracolumbar burst fractures. The new reduction technique uses six percutaneous pedicle screws for the fractured vertebra and its adjacent vertebrae. Pedicle screws implanted in the two adjacent vertebrae were parallel to the superior vertebral endplate, as routinely required. Two monoaxial pedicle screws implanted in the fractured vertebra were placed toward the anteroinferior portion of the fractured vertebral body. After routine instrumentation and ligamentotaxis reduction, the bolt heads of the four screws implanted in the adjacent vertebrae were first tightened, and then the bolt heads of the screws implanted in the fractured vertebra were gradually tighten to elevate the collapsed endplate. A fundamental principle of this technique is to implant the pedicle screw in the fractured vertebra towards the anteroinferior portion of the vertebra in such a way that the angle between the pedicle screw and the rod is oblique on lateral fluoroscopy. As such, when the bolt heads were tightened, the pedicle screws can be swung up to reduce the endplate fragments. The novel technique was performed in 24 patients with neurologically intact thoracolumbar AO type A3 fractures. The middle vertebral height ratio was significantly improved from 69.7%±7.6% after routine reduction to 85.1%±4.5% postoperatively (p<0.01). No complication was noticed for this new reduction technique. At 6-month follow-up, no significant correction loss of the middle and posterior vertebral height ratios, Cobb angle, and vertebral wedge angle was observed, while 5.8% of correction loss was observed for the anterior vertebral height ratio. The described reduction technique is simple, safe, and effective in reducing the collapsed central endplate in thoracolumbar burst fractures. Such a practical reduction strategy does not need additional medical costs.

Cone-beam computed tomography guided unipedicular central stentoplasty of the thoracolumbar spine: Early technical experience and results.

An unipedicular vertebral body stenting technique, termed 'central stentoplasty', was developed at our institution. With this technique, a single vertebral body stent was deployed percutaneously in the midline of the vertebral body using cone-beam computed tomography (CBCT) guidance. From September 2013 to July 2015, forty-four patients with fifty-six vertebral bodies underwent central stentoplasty. All fractures were of osteoporotic, traumatic or malignant aetiology. Information on vertebral body deformity, pre- and post-procedure sagittal index (SI), wedge angle (WA) and anterior vertebral height ratio was analysed. Two patients had combined ablation and stentoplasty for painful spinal metastases. There were 11 male and 33 female patients with mean age of 71.5years (51-90years). 19 fractured vertebral bodies had more than 30% loss of height. The mean pre-procedure SI was 0.82, and the mean post-procedure SI was 0.90. The pre-procedure WA was -5.56° compared with post-procedure mean WA of -3.47°. The mean pre-procedure segmental kyphosis was -4.58°, and the mean post-procedure segmental kyphosis was -1.46°. Six cases had minimal cement leak, and two cases had a haematoma at the puncture site. None of the patients underwent revision surgery, and postoperative neurological sequelae were not observed. 'Central stentoplasty' is a promising percutaneous vertebral fracture augmentation technique, which is shown to have low complication rates in the treatment of spinal compression fractures or metastases. However, long-term results need to be further evaluated.

A comparative study of spinal robot-assisted and traditional fluoroscopy-assisted percutaneous reduction and internal fixation for single-level thoracolumbar fractures without neurological symptoms

To compare the effectiveness and screw planting accuracy of percutaneous reduction and internal fixation with robot and traditional fluoroscopy-assisted in the treatment of single-level thoracolumbar fractures without neurological symptoms. The clinical data of 58 patients with single-level thoracolumbar fractures without neurological symptoms between December 2016 and January 2018 were retrospectively analysed. According to different surgical methods, the patients were divided into group A (28 cases underwent robot-assisted percutaneous reduction and internal fixation) and group B (30 cases underwent fluoroscopy-assisted percutaneous reduction and internal fixation). There was no neurological symptoms, other fractures or organ injuries in the two groups. There was no significant difference in general data of age, gender, fracture location, AO classification, time from injury to surgery, and preoperative vertebral anterior height ratio, sagittal Cobb angle, visual analogue scale (VAS) score, and Oswestry disability index (ODI) score between the two groups ( P>0.05). The screw placement time, operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, hospitalization time, operation cost, postoperative complications, VAS score, ODI score, anterior vertebral height ratio, and sagittal Cobb angle before operation, at 3 days, 6 months after operation, and at last follow-up were recorded and compared between the two groups. The accuracy of the pedicle screw placement was evaluated by Neo's criteria. The screw placement time, operation time, and intraoperative fluoroscopy frequency of group A were significantly less than those of group B, and the operation cost was significantly higher than that of group B ( P<0.05). But there was no significant difference in intraoperative blood loss and hospitalization time between the two groups ( P>0.05). Both groups were followed up 12-24 months, with an average of 15.2 months. The accuracy rate of screw placement in groups A and B was 93.75% (150/160) and 84.71% (144/170), respectively, and the difference was significant ( χ 2=5.820, P=0.008). Except for 1 case of postoperative superficial infection in group A and wound healing after dressing change, there was no complication such as neurovascular injury, screw loosening and fracture in both groups, and there was no significant difference in the incidence of complications between the two groups ( χ 2=0.625, P=0.547). The anterior vertebral height ratio, sagittal Cobb angle, VAS score, and ODI score of the two groups were significantly improved ( P<0.05); there was no significant difference between the two groups at all time points after operation ( P>0.05). The spinal robot and traditional fluoroscopy-assisted percutaneous reduction and internal fixation can both achieve satisfactory effectiveness in the treatment of single-level thoracolumbar fractures without neurological symptoms. However, the former has higher accuracy, fewer fluoroscopy times, shorter time of screw placement, and lower technical requirements for the operator. It has wide application potential.