Local Kyphosis Angle Research Articles

Intervertebral bridging ossifications increase the risk of intravertebral cleft formation following a vertebral compression fracture.

To determine whether the presence of intervertebral bridging ossifications is associated with intravertebral cleft (IVC) formation following a vertebral compression fracture (VCF). Patients with a VCF who received conservative treatment for a minimum of 3months were recruited over a 3-year period. Baseline radiographs obtained within a month of onset were compared between 50 patients who developed an IVC at 3-month follow-up (IVC group) and 100 patients without an IVC (control group). Intervertebral bridging ossification was defined as complete bridging of the intervertebral space by ossification. The presence of bridging ossification was assessed at each intervertebral level from T9/10 to L5/S. In addition to the absolute levels of bridging ossifications, the level relative to a fresh VCF was recorded. The incidence of bridging ossification at levels T9/10 and T10/11 was significantly higher in the IVC group than in the control group. IVC group patients showed a significantly higher incidence of bridging ossification at the second proximal intervertebral segment than those in the control group. IVC group patients also had a significantly greater sagittal wedge angle and a greater local kyphosis angle than control group patients. A fresh VCF with bridging ossification at the second proximal intervertebral level is associated with increased risk of IVC formation. Careful observation and strict conservative treatment are recommended in such cases.

Modified Posterior Vertebral Column Resection for the Treatment of Osteoporotic Fractures with Neurological Deficits in Elderly Patients

Introduction The purpose of this retrospective study was to evaluate the results of spinal canal decompression and anterior column support via modified posterior vertebral column resection (PVCR) (Unilateral hemilaminectomy, pediculectomy, subtotal vertebrectomy) performed for eliminating the disadvantages of the anterior or combined A + P approaches, in the management of osteoporotic vertebral fractures with neurological deficits in elderly patients. Patients and Methods A total of 55 patients (40 females and 15 males) with more than 2 years of follow-up were included in this study. The fractures were in the thoracic spine in 16 patients, and thoracolumbar spine in 39 patients. Overall, 11 patients had ASIA grade C and 41 patients had ASIA grade D neurological deficits. Clinical and radiological outcome and complications were also evaluated. Surgical technique included placement of fenestrated titanium pedicle screws, followed by hemilaminectomy, unilateral pediculectomy, and decompression of the spinal canal by subtotal vertebrectomy, and support of anterior column by titanium cage. Contralateral facet joint fusion and grafting was made. Prophylactic vertebroplasties were made in one level above and one level below in all patients. Results Mean age was 74.2 years (range, 66–92), and mean follow-up was 43.5 months (range, 28–102). Mean operation time was 252 minutes (range, 160–340), and blood loss was 580 mL (range, 420–800). Mean preoperative local kyphosis angle was 18.5 degrees and improved to 4.2 degree after the operation and 4.8 degree at the final follow-up. Visual analog scale (VAS) score was eight before the operation and improved to two at final follow-up. Full neurological recovery was achieved in all patients. There were no pseudoarthroses. The major complication was adjacent segment fracture was made three patients (5.4%). The minor complications were superficial wound infections in five patients and dural tear in four patients (16.3%). Conclusion Treatment of osteoporotic vertebral fracture with neurological deficit is a challenging procedure in elderly patients. Modified PVCR provides effective decompression of neural structures. Contralateral intact lamina, pedicle, and cortex of the vertebra increase primary stability and provides more bony surface for fusion.

Surgical Treatment of Sharp Angular Kyphotic Deformity with Neurological Deficit due to Neglected Dorsal Hemivertebra in Adult Population

Introduction Treatment of neurological deficit and deformity because of the neglected dorsal hemivertebra is a challenging procedure. Restoration of the sagittal balance is also technically demanding because of the sharp, angular kyphotic deformity. The aim of this study is to evaluate the results of the patients treated by dorsal hemivertebra resection via posterior approach for spinal decompression and deformity correction. Patients and Methods A total of 11 patients (8 M and 3 F) with average age 32.1 years (range, 19–49 years) were operated via dorsal hemivertebrectomy with posterior only approach. In the surgical technique, following 2 to 3 levels above and below pedicle screw fixation, wide laminectomy was performed one level above and below the apex of the deformity and spinal canal was decompressed by removing the dorsal hemivertebra. Deformity correction included sequential gradually compression from posterior and distraction from anterior column to prevent any dural buckling. Finally, an expandable cage was placed for anterior column support and distracted while final compression applied from posterior to correct local kyphosis totally. Spinal cord monitoring was used at all stages of surgery in all patients. Sagittal and pelvic parameters were measured on pre-op and post-op standing X-rays. Results The mean follow-up was 27.5 months (range, 24–32 months). The mean surgical time was 6.5 hours (range, 5–9 hours), average blood loss was 3,200 mL. Pre-op average local kyphosis angle was 57.250 and improved to 9.30 with a correction rate of 83%. There was no significant improvement in other parameters. All patients with neurologic deficit (eight patients ASIA grade D, two patients ASIA grade C, and one patient ASIA grade B) had significant improvement to ASIA grade E. There were no major complications including pseudarthrosis and implant failure. Minor complications included two (18%) superficial wound problems and one (9%) hematoma which responded well to debridement. Conclusion Posterior wide laminectomy and dorsal hemivertebra resection provide decompression of the neural structures. Correction of the local kyphosis and restoring sagittal balance are very challenging in sharp angular kyphosis. Ideal correction technique should include anterior column elongation with gradual posterior compression sequentially and placement of expandable cage to prevent any dural buckling.

Modified Posterior Vertebral Column Resection for the Treatment of Vertebral Infections in Elderly Patients

Introduction Modified posterior vertebral column resection (PVCR) technique described in this study enables resection of infected material, decompression of the spinal canal, restoration of the anterior column, and posterior stabilization at the same time. Multilevel resections (two or more) can be performed with low-complication rates. Patients and Methods A total of 24 elderly patients (16 females and 8 males average age of 73.8 years [range, 68–83 years]) with pulmonary comorbidity were included. Etiologic diagnoses were spinal tuberculosis in 10 patients and nonspecific spondylodiscitis in 14 patients. Surgical technique included placement of fenestrated titanium pedicle screws, followed by hemilaminectomy, unilateral pediculectomy, decompression of the spinal canal by subtotal vertebrectomy, and anterior column support by expandable cage. One level above and one level below prophylactic vertebroplasty were performed. Results There were 6 single level, 17 two level, and 1 four level resections. The mean operation time was 2.5 hours and the average blood loss was 670 mL. Average follow-up was 47 months (range, 14–80 months). Average resected level was 1.9 (range, 1–4). The mean preoperative local kyphosis angle 32.7∞ was decreased by 67.8%. Overall, 14 patients with partial neurologic deficit (10 patients ASIA grade D and 4 patients ASIA grade C) had significant improvement. The major complications were post-op deep infection in three patients (12.5%) and death because of the cardiac failure in one (4%) patient. The minor complication rate was 29.1% with three hematomas and four dural tears. None of the remaining patients required revision surgery for recurrence of infection or implant failure or pseudoarthrosis. Conclusion Modified PVCR seems to be good alternative to anterior or combined A + P approaches in treatment of vertebral infections in elderly patients with pulmonary comorbidity, as technique enables multilevel resections (two or more) with low-recurrence and low-complication rates.

Ostéosynthèse segmentaire courte postérieure associée à une vertébroplastie au ciment de sulfate de calcium pour fractures en compression thoraco-lombaire : résultats radiographiques y compris les pseudarthroses et autres complications

ObjectiveTo evaluate the radiographic outcomes of short-segment posterior instrumentation plus vertebroplasty using injectable calcium sulfate cement (CSC) for thoracolumbar compression fractures. Materials and methodsTwenty-eight patients with a single-level thoracolumbar compression fracture, who underwent short-segment pedicle screw fixation and CSC vertebroplasty, were included in the study. The anterior vertebral body height ratio, local kyphosis angle, and the height of the intervertebral disk adjacent to the fractured vertebra were used to evaluate the radiographic results. Complications including bone nonunion, instrument failure, cement leakage, and disc vacuum formation were also assessed. ResultsThe patients were followed up for an average of 24.20±5.40months. The relative preoperative anterior body height was 55.71±15.29%, which improved to 94.93±5.39% immediately after surgery (P<0.001), and at final follow-up showed a 6.50±3.89% loss of height correction (P<0.001). The mean preoperative local kyphosis angle was 22.23±5.65°, which corrected to 2.67±4.43° immediately after surgery (P<0.001), but reverted to 6.71±4.95° at final follow-up, showing a 4.04±1.91° loss of correction (P<0.001). The mean height of the intervertebral disk proximal to the fractured vertebra was 9.87±0.91mm before surgery, 12.53±0.98mm after operation (P<0.001), and the loss of correction at final follow-up was 2.35±1.15mm with a significant difference compared to immediate postoperative values (P<0.001). Bone nonunion occurred in 7 patients, 2 patients had hardware failure, 9 patients had cement leakage, and 10 patients had disc vacuum phenomenon adjacent to the fractured vertebra. ConclusionsThe patients who underwent this procedure had a loss of correction of vertebral height and local kyphosis. Complications such as bone nonunion, instrument failure, cement leakage, and disc vacuum may occur. Rapid CSC resorption accounts for these radiographic outcomes and complications. Level of evidenceLevel IV, retrospective study.

Short-segment posterior instrumentation combined with calcium sulfate cement vertebroplasty for thoracolumbar compression fractures: Radiographic outcomes including nonunion and other complications

ObjectiveTo evaluate the radiographic outcomes of short-segment posterior instrumentation plus vertebroplasty using injectable calcium sulfate cement (CSC) for thoracolumbar compression fractures. Materials and methodsTwenty-eight patients with a single-level thoracolumbar compression fracture, who underwent short-segment pedicle screw fixation and CSC vertebroplasty, were included in the study. The anterior vertebral body height ratio, local kyphosis angle, and the height of the intervertebral disc adjacent to the fractured vertebra were used to evaluate the radiographic results. Complications including bone nonunion, instrument failure, cement leakage, and disc vacuum formation were also assessed. ResultsThe patients were followed up for an average of 24.20±5.40 months. The relative preoperative anterior body height was 55.71±15.29%, which improved to 94.93±5.39% immediately after surgery (P<0.001), and at final follow-up showed a 6.50±3.89% loss of height correction (P<0.001). The mean preoperative local kyphosis angle was 22.23±5.65°, which corrected to 2.67±4.43° immediately after surgery (P<0.001), but reverted to 6.71±4.95° at final follow-up, showing a 4.04±1.91° loss of correction (P<0.001). The mean height of the intervertebral disc proximal to the fractured vertebra was 9.87±0.91mm before surgery, 12.53±0.98mm after operation (P<0.001), and the loss of correction at final follow-up was 2.35±1.15mm with a significant difference compared to immediate postoperative values (P<0.001). Bone nonunion occurred in 7 patients, 2 patients had hardware failure, 9 patients had cement leakage, and 10 patients had disc vacuum phenomenon adjacent to the fractured vertebra. ConclusionsThe patients who underwent this procedure had a loss of correction of vertebral height and local kyphosis. Complications such as bone nonunion, instrument failure, cement leakage, and disc vacuum may occur. Rapid CSC resorption accounts for these radiographic outcomes and complications. Level of evidenceLevel IV, retrospective study.

Superior Mesenteric Artery Syndrome due to a Vertebral Hemangioma and Postpartum Osteoporosis following Treatment.

In pregnancy, advanced vertebral hemangiomas may be seen, and these require treatment. The case reported here is of a 35-year-old female in the 32nd week of pregnancy who was admitted to the orthopaedics clinic with a history of backache and difficulty walking. A burst fracture of L1 associated with a vertebral hemangioma was identified with an L3 compression fracture secondary to osteoporosis. The local kyphosis angle between T12 and L2 was 27°. Kyphotic deformity was corrected and postoperatively, the measured T12–L2 local kyphotic angle was 9°. Twelve hours postoperatively, oral nutrition was allowed, but she developed nausea and vomiting and twenty-four hours postoperatively, an electrolyte imbalance developed. Postoperatively, the patient was diagnosed with superior mesenteric artery syndrome. To the best of our knowledge, this is the first reported case of superior mesenteric artery syndrome, which occurred following the correction of a kyphotic deformity that had developed secondary to an advanced hemangioma in pregnancy.

Surgical treatment of post-traumatic kyphosis using modified pedicle subtraction osteotomy

Background data Pedicle subtraction osteotomy (PSOS) is a pure closed wedge osteotomy that has been recently introduced for the correction of post-traumatic kyphosis (PTK). Modified PSOS uses the disc as part of the resected wedge together with the upper endplate, thus allowing excision of the degenerated disc material for better fusion and preventing failure. In PTK, the upper endplate is deficient and the upper disc is degenerated. Insertion of a spacer into the intervertebral gap ensures good bony contact and fusion and increases the angle of correction by making the correction in a manner of closed-open wedge rather than a pure closed wedge osteotomy. Purpose The aim of this work was to study the clinical and radiological results of surgical treatment of PTK using modified PSOS with insertion of a cage as a spacer into the intervertebral defect. Study design This was a prospective study conducted on 24 patients with symptomatic PTK. Patients and methods All patients were treated using the modified PSOS technique, with insertion of a cage into the intervertebral gap. Patients were assessed clinically and radiologically. Functional results were assessed using the Oswestry disability index (ODI) score and the Denis pain and work scale. Radiological assessment included local kyphosis angle and sagittal index immediately postoperatively and at the final follow-up, and the state of bony fusion and loss of correction at the last follow-up. Results The average follow-up period was 34.21 ± 4.47 (range 24-50 months). Local kyphosis angle improved from 39.08 ± 3.86° preoperatively to -0.25 ± 4.74° postoperatively, with insignificant change at the last follow-up. The sagittal index significantly improved from 41.33 ± 4.89° preoperatively to 1.81 ± 1.26° postoperatively, without significant change at the last follow-up. All patients showed solid bony fusion at the last follow-up. There were no major complications. All patients improved clinically as evidenced by improvement in pain and neurological status. Functional outcome significantly improved as evidenced by improvement in ODI score and return of most of the patients to their previous level of activity. Conclusion Modified PSOS is more anatomical, less technically demanding, and safe procedure that achieves good radiological and clinical outcomes with lower operative morbidity.

Treatment of thoracolumbar burst fractures using combined pedicle screw-laminar hook fixation

The aim of this study was to evaluate the mid-term outcome of pedicle screw-laminar hook (PS-LH) fixation in the surgical treatment of thoracolumbar burst fractures. Nineteen patients (12 male, 7 female; mean age: 34.4 years, range: 19 to 57 years) with thoracolumbar burst fractures treated using PS-LH between 1996 and 2006 were evaluated. The 17 patients (11 male, 6 female) who had a minimum of 2 years follow-up were included in the study. Radiographic outcome was evaluated by measuring the local kyphosis angle (LKA) and anterior vertebral height (AVH). Mean follow-up was 81 (range: 38 to 122) months and 15 patients completed more than 5 years of follow-up. Preoperative vertebral height loss and LKA of 41.2% (range: 29% to 64%) and 16.8° (range: 5° to 36°), respectively, were corrected to 16.3% (range: 0% to 44%) and -1.2° (range: -17° to 10°), respectively, after the operation. Mean losses of correction for vertebral height and local kyphosis were 1.8 ± 7.9% and 4.3 ± 7.1 degrees, respectively, at the 2-year follow-up and -1.8 ± 4.5% and 0.5 ± 1.5 degrees, respectively, between 2 years and 5 years. Loss of correction was significant for the LKA (p=0.023) but not for vertebral height (p=0.360). Five patients had losses of correction of more than 5 degrees. Changes between 2 and 5 years were not significant for vertebral height loss and local kyphosis (p=0.147 and p=0.205, respectively) and remained improved when compared with the preoperative values (p<0.001). Average SF-36 scores of the 15 patients evaluated at the final follow-up were comparable with the general Turkish population. The PS-LH construct provided a significant correction of the local kyphotic deformity. Augmentation of the upper and lower pedicle screw by the sublaminar hook did not completely prevent correction loss but was found to stabilize at the 5th year of follow-up without any clinical problems.

Short segmental pedicle instrumentation via the paraspinal approach for the treatment of thoracolumbar fractures complicated with posterior ligamentous complex injury

Objective To study the efficacy and safety of short segmental pedicle instrumentation via the paraspinal approach for the management of neurologically intact patients with thoracolumbar burst fracture and posterior ligamentous complex injury.Methods From October 2008 to June 2010,70 such patients were treated in our department.They were 44 males and 26 females,with an average age of 33.4 years (range,from 19 to 55 years).They were divided into 2 groups according to 2 different operative methods.In group A,35 patients were treated via the paraspinal approach while 35 patients in group B were treated via the traditional open approach.The 2 approaches were compared in terms of operation time,intraoperative bleeding,postoperative ambulant time,hospital stay,changes in local kyphosis angle (LKA) and vertebral body height (VBH) at preoperation,postoperation and the last follow-up,postoperative complications and accuracy of screw insertion.Results The time for follow-up ranged from 24 to 36 months (mean,29.3 months).The operation time,intraoperative bleeding,postoperative ambulant time and hospital stay in group B were significantly more than in group A(P ＜ 0.05).No implant failure occurred in either group.There was no significant difference in pedicle screw cut-out between the 2 groups [7 (5.0％) versus 6 (4.3％)] (P ＞0.05).The LKA and VBH increased significantly at postoperation and the last follow-up compared with the preoperation in both groups (P ＜ 0.05),but there was no significant difference between the postoperation and the last follow-up (P ＞ 0.05).There were no significant differences between the 2 groups regarding LKA and VBH at preoperation,postoperation and the last follow-up (P ＞ 0.05).Conclusion The paraspinal approach may result in a good and safe clinical outcome in the treatment of thoracolumbar burst fractures with posterior ligamentous complex injury,because it can maintain the fracture reduction effectively and minimize the iatrogenic injury to soft tissues. Key words: Thoracic vertebrae; Lumbar vertebrae; Fracture; Surgical procedures, minimally invasive

Outcomes of surgical intervention for cervical spondylotic myelopathy accompanying local kyphosis (comparison between laminoplasty alone and posterior reconstruction surgery using the screw-rod system)

The surgical strategy for cervical spondylotic myelopathy (CSM) accompanying local kyphosis is controversial. The purpose of the present study was to compare and evaluate the outcomes of two types of surgery for CSM accompanying local kyphosis: (1) laminoplasty alone (LP) and (2) posterior reconstruction surgery (PR) in which we corrected the local kyphosis using a pedicle screw or lateral mass screw. Sixty patients who presented with local kyphosis exceeding 5° were enrolled. LP and PR were each performed on a group of 30 of these patients; 30 CSM patients without local kyphosis, who had undergone LP, were used as controls. The follow-up period was 2years or longer. Preoperative local kyphosis angles in LP and PR were 8.3°±4.4° and 8.8°±5.7°, respectively. Preoperative C2-7 angles in LP, PR and controls were -1.7°±9.6°, -0.4°±7.2° and -12.0°±5.6°, respectively. The recovery rate of the JOA score, local kyphosis angle and C2-7 angle at post-op and follow-up were compared between the groups. The recovery rate of the JOA score in the LP group (32.6%) was significantly worse than that in the PR group (44.5%) and that of controls (53.8%). Local kyphosis angles in the PR and LP groups at follow-up were 4.0°±8.6° and 8.0°±6.0°, respectively. However, although the C2-7 angle at follow-up was improved to -11.1°±12.7° in PR, and maintained at -11.6°±6.2° in controls, it deteriorated to 0.5°±12.7° in LP. The present study is the first to compare the outcomes between LP alone and PR for CSM accompanying local kyphosis. It revealed that PR resulted in a better clinical outcome than did LP alone. This result may be due to reduction of local kyphosis, stabilization of the unstable segment, and/or the maintenance of C2-7 angle until follow-up in the PR group.

Percutaneous transvertebral fixation of thoracolumbar fractures with monoaxial and polyaxial pedicle screws

Objective To evaluate effect of percutaneous transvertebral fixation of thoracolumbar fractures using both monoaxial and polyaxial pedicle screws.Methods The study involved single-level thoracolumbar fracture patients without neurological deficits undergone minimally invasive percutaneous fixation with CD-Horizon Longitude system from January 2010 to December 2011.Three level vertebras were immobilized by six pedicle screws.They were randomized into two groups:control group fixed with polyaxial screws for the fractured vertebra as well as the upper and lower adjacent vertebras and study group fixed with monoaxial screws for the superior adjacent vertebra and polyaxial screws for the injured vertebra and inferior adjacent vertebra.General information,height of fracture vertebral body,Gardner segmental kyphotic deformity,GSKD) and local kyphosis angle were assessed and compared between groups after operation so as to estimate correction ability of kyphosis deformity.Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate alteration of back pain and lower limb function.Incidence of screw breakage was also compared between groups.Results Totally,30 patients were enrolled in the trial and received an average follow-up of 10.5 months (range,6-18 months).Two groups were similar in general information (sex,age,fracture levels,and fracture types) and perioperative information (operation time,intraoperative blood loss,proportion of antalgic supplement and hospital stay).GSKD and local kyphosis angle were significantly higher in study group than in control group after operation [(15.0 ± 5.4) °vs (8.8 ± 5.4) °,(16.0-6.5) ° vs (9.0 ± 5.5) ° respectively,P ＜ 0.01].While,correction loss of GSKD and local kyphosis was similar between study and control groups [(2.6 ±1.3)°vs (1.9 ± 1.5)°,(3.7 ±2.1)° vs (2.7 ±2.2)° respectively,P ＞0.05].Correction of anterior vertebral body height and correction loss of posterior vertebral body height were superior in study group to control group [(33.0 ± 11.4) ％ vs (22.7 ± 11.4) ％,(1.2 ± 1.2) ％ vs (2.5 ± 2.1) ％ respectively,P ＜ 0.05].Correction loss of anterior vertebral body height and correction of posterior vertebral body height were similar between study and control groups [(2.8 ± 2.7) ％ vs (5.4 ± 4.7) ％,(5.0 ±4.8) ％ vs (3.1 ± 2.9) ％ respectively,P ＞ 0.05].Besides,there were no significant differences of VAS and ODI between the two groups in the same period after operation.Conclusion Combined use of monoaxial and polyaxial pedicle screws in minimally invasive percutaneous fixation improves kyphosis deformity and correction ability of anterior height and decreases correction loss of posterior height of the fractured vertebral body. Key words: Spinal fractures; Thoracic vertebrae; Lumbar vertebrae; Fracture fixation,internal; Surgical procedures,minimally invasive

The results of closing wedge osteotomy with posterior instrumented fusion for the surgical treatment of congenital kyphosis

There exist not much data regarding the surgical treatment of pure congenital kyphosis (CK) in the literature. The purpose of this study was to evaluate the results of closing wedge osteotomy with posterior instrumented fusion in patients with congenital kyphotic deformity. We retrospectively evaluated the radiographical results of 10 patients who were subject to closing wedge vertebral osteotomy and posterior instrumented fusion due to CK. The mean age of the patients at surgery was 12.6 ± 3.72 years (range 8-18 years). Radiographical measurements including local kyphosis, correction loss, global kyphosis and sagittal balance values were noted for the preoperative, postoperative and final follow up periods, respectively. The data obtained from those periods underwent statistical analysis. Average follow-up period was 51.8 ± 29.32 months (range 26-96 months). The mean local kyphosis angle was 67.7° ± 15.64° (range 42°-88°) prior to the surgery, 31.5° ± 17.12 (range 14°-73°) following the surgery and 31.9° ± 15.98° (range 14°-71°) during the follow up-period, respectively (p < 0.05). A correction rate of 53.5 % was reported at the final follow up. Average sagittal balance was measured as 33.1 ± 24.48 mm (range 2-77 mm) prior to the surgery, 20.8 ± 15.46 mm (range 5-46 mm) following the surgery (p < 0.05) and 14.1 ± 9.2 mm (range 0-30 mm) during follow-up period (p > 0.05). Complications consisted of a rod fracture due to pseudoarthrosis, an implant failure with loosening of screws and a proximal junctional kyphosis. No neurological deficit or deep infection were encountered in any of the patients in the study group. Closing wedge osteotomy with posterior instrumented fusion is an efficient method of surgical treatment in terms of sagittal balance restoration and deformity correction in patients with congenital kyphosis.

Jack vertebral dilator kyphoplasty for treatment of osteoporotic vertebral compression fractures

Osteoporotic vertebral compression fractures (OVCFs) are common in the elderly population and often involve the thoracolumbar vertebrae. Clinical symptoms of OVCFs include severe pain, loss of vertebral height, progressive kyphosis and increased mortality. Jack vertebral dilator kyphoplasty is a recently developed OVCFs treatment modality, with few systematic studies present in the literature. This retrospective study was designed to investigate the safety and efficacy of Jack vertebral dilator kyphoplasty for treating thoracolumbar OVCFs. Sixteen elderly patients (55-85years) with solitary thoracolumbar OVCFs were treated with this procedure and followed-up (10-27months). The amount of injected bone cement and operative time, preoperative and postoperative visual analogue scores, anterior and middle vertebral body heights, local kyphosis angle, and complications was analysed. The results showed that the method provided long-term pain relief and restoration of the vertebral body height and spinal alignment. No serious complications occurred, but two patients experienced recompression of the vertebral body, and one patient experienced cement leakage into a disc. In conclusion, Jack vertebral dilator kyphoplasty is a safe and effective minimally invasive procedure for treatment of OVCFs.

Treatment of typical amyelic somatic fractures with kyphoplasty and calcium phosphate cement: a critical analysis

Vertebroplasty and more recently kyphoplasty are recognized as techniques in the treatment of osteoporotic vertebral fractures and in case of pathological fracture like in secondary tumors. The recent introduction of calcium phosphate cement (CPC) that offers, at least theoretically, an osteointegrative capacity, absent in polymethyl methacrylate (PMMA), has generated interest for its use in the treatment of traumatic fractures (type A) even in young patients. In this study, type A fractures without neurological signs were treated. A total of six male patients, of age between 21 and 55 years (mean age 38 years), were included. Fracture treatment was performed with kyphoplasty with balloon (Kyphon) and injection of calcium phosphate cement for a total of seven procedures. The results were evaluated according to the regional kyphosis angle and the local kyphosis angle. The postoperative X-ray control showed an average improvement of the regional kyphosis angle of 7.4°; however, this value was reduced by an average of 6.6° after 45 days with regard to the postoperative control. The local kyphosis angle showed an average improvement of 9° at the postoperative control with an average worsening of 9.2° in the control after 45 days. While kyphoplasty with the use of CPC in the treatment of type A traumatic fractures was effective in the treatment of pain, it has not been so far effective concerning the maintenance of the reduction obtained intra-operatively and its osteointegrative effect.

Early mobilization with customized TLSO brace in thoracolumbar burst fractures

This study aimed to research the effectiveness of customized thoracolumbosacral orthosis treatment for stable burst type thoracolumbar vertebral fractures without neurological deficits. The study included 26 patients (14 males, 12 females; mean age: 46.03 years; range: 18 to 64 years) conservatively treated for thoracolumbar (T11-L2) burst type vertebral fractures according to Denis classification between 2002 and 2009. Etiology were a fall from various heights in 12 patients (46.2%), motor vehicle accidents as an occupant in 7 (26.9%) and as a pedestrian in 4 (15.4%), and simple fall in 3 (11.5%). None of the patients had neurologic deficit and no damage was found in the posterior ligamentous complex in MRI evaluations. Denis pain and functional scales were used in the clinical evaluation. Local kyphosis angle, sagittal index and height loss percentage were measured in the radiologic evaluation. Post-fracture and follow-up values were compared. Mean follow-up period was 41.30 (range: 14 to 80) months. Mean pain and functional scores were 1.65 and 1.15 points, respectively, at the final follow-up. Twenty patients returned to their pre-trauma work and activities completely and six patients with small limitations. Mean period for returning to work was 3.64 (range: 2 to 6) months. Local kyphosis angle, sagittal index and height loss percentage values increased significantly at follow-up (p<0.05). The conservative treatment of stable thoracolumbar burst fractures is widely accepted. Early mobilization with customized TLSO brace appears to produce effective functional results despite loss of vertebral body height.

Posterior/anterior combined surgery for thoracolumbar burst fractures—posterior instrumentation with pedicle screws and laminar hooks, anterior decompression and strut grafting

A prospective clinical study. The purpose of this study was to evaluate prospectively a large group of patients with thoracolumbar burst fractures who were treated with a posterior/anterior combined procedure and to report on the surgical outcomes, complications and radiographic results. A total of 100 consecutive patients were surgically managed with posterior instrumentation, anterior decompression and anterior strut grafting. There were 71 males and 29 females; the mean age was 36 years. Patients with osteoporotic delayed vertebral body collapse were excluded. The mean follow-up period was 30 months. Surgical outcomes such as operative time, blood loss and sagittal alignment were investigated. A neurological assessment was performed by a rating system based on the American Spine Injury Association impairment scale. An interbody fusion was judged using plain X-ray and computed tomographic scans. The mean operative time was 256 min and the mean operative bleeding was 985 ml. Most of the patients were ambulatory within 3 days after surgery. Of the 76 patients with neurological injury, 54 (71.1%) recovered function following surgery. The mean local kyphosis angle was 12.2° kyphotic preoperatively and 0.8° lordotic at the final observation. The mean correction angle was 15.7° and correction loss was 2.6°. No instrumentation failure was observed and the postoperative fusion rate was 99%. Posterior/anterior combined surgery with posterior pedicle screws and hooks fixation, and reconstruction by simultaneous strut grafting and anterior decompression, achieved short segment fixation and can be a useful option for surgically treating thoracolumbar burst fractures.

THE TREATMENT OF OSTEOPOROTIC VERTEBRAL FRACTURES USING KYPHOPLASTY

In article results of treatment of 20 patients more senior 60 years with osteoporotic fractures of thoracolumbar spine. To all patients has been executed percutaneous kyphoplasty. In process kyphoplasty restoration of ventral departments of the broken vertebra on 15+6.2 % is reached. Correction of a local kyphosis angle is reached in limits 5-10e (7,3+2,5e). Recourse of a painful syndrome with 7,1+1,9 to 2,1+1,7 on a visual analogue scale is noted. In the remote period it is noted increases in a painful syndrome, increase of a local kyphosis angle and deformations of a body of a vertebra. Thus, percutaneous kyphoplasty, being a minimally invasive astabilisation technique, allows to restore strengthening characteristics of bodies of vertebras, to increase height ventral departments of bodies, correction of the biomechanical infringements resulting fracture thereby is reached.

Inter- and intra-observer reliability of the Cobb angle in the measurement of vertebral, local and segmental kyphosis of traumatic lumbar spine fractures in the lateral X-ray

Measurement of the vertebral, local and segmental kyphosis according to Cobb is a standard procedure in the assessment of traumatic, idiopathic and degenerative spinal deformities. The purpose of this study was to evaluate the inter- and intra-observer reliability of these three radiological angles on the basis of lateral X-rays in lumbar spine fractures with spinal kyphosis. A consecutive series of 88 patients with traumatic lumbar spine fractures with kyphotic deformities were included in the study. All patients were younger that 50 years of age and had an adequate trauma leading to the fracture. Three independent observers with different levels of clinical training measured the vertebral, segmental and local kyphosis of these patients on the basis of lateral X-rays. The readings were repeated 4 weeks later to assess intra-observer reliability. The most common injury mechanism was a fall from a height of more than 3 m. The first lumbar vertebra was the most commonly affected. Mean inter- and intra-observer reliabilities were good for the vertebral (mean ICC: 0.6607; mean ICC: 0.6979) and local (mean ICC: 0.7778; mean ICC: 0.7642) kyphosis and excellent (mean ICC: 0.8129; mean ICC: 0.8103) for the segmental kyphosis. In this study, the segmental-, vertebral-, and local kyphosis angle according to Cobb showed sufficient inter- and intra-observer reliability for the use in daily practice and scientific studies.

Anterior-Only Stabilization Using Plating With Bone Structural Autograft Versus Titanium Mesh Cages for Two- or Three-Column Thoracolumbar Burst Fractures

A randomized, controlled follow-up study to review patients with acute thoracolumbar burst fractures treated by anterior instrumentation and reconstruction. The objective of this study was to evaluate the results of anterior instrumentation in the treatment of thoracolumbar burst fractures and to determine whether anterior-only approach would be sufficient for highly unstable burst fractures. In this prospective follow-up study, we also compared the results of anterior reconstruction with structural grafting and with titanium mesh cage in a randomized fashion. Anterior decompression and reconstruction supplemented with instrumentation is generally believed to be superior to fixation with posterior pedicle screw instrumentation for a highly unstable burst fracture, but the indications and methods for anterior approach has not been fully documented. A total of 65 patients undergoing anterior plating for a thoracolumbar burst fracture with a load-sharing score of 7 or more between 2000 and 2003 were included this study. They were randomized to receive iliac crest autograft (group A, n = 32) or titanium mesh cages (group B, n = 33). The patients were similar in the distribution of 3-column injuries (n = 8 in group A vs. n = 9 in group B). During the minimum 4-year (range, 4-7 years) follow-up period, all patients were prospectively evaluated for clinical and radiologic outcomes. The Frankel scale, the ASIA motor score, and the Short Form 36 were used for clinical evaluation, whereas the fusion status and the loss of kyphosis correction for the local kyphosis angle were examined for radiologic outcome. All patients in this study achieved solid fusion, with significant neurologic improvement and no significant correction loss as defined by loss of kyphosis correction. The clinical and radiologic results were not significantly different (P > 0.05) at all time points between the 2 groups A and B. Twenty-six of 32 patients in group A still complained of donor site pain to some degree at the final follow-up. No significant impact of 3-column injuries (P > 0.05) were identified on the results for all comparisons. Anterior-only instrumentation and reconstruction with structural autograft or titanium mesh cages is sufficient for surgical treatment of thoracolumbar burst fractures with a load-sharing score of > or = 7 and even with 3-column injuries.