Outcomes Of Thoracolumbar Fractures Research Articles

A Novel Device for Closed Reduction and Percutaneous Fixation of Thoracolumbar Fractures

Open surgical reduction/fixation of thoracolumbar fractures results in significant soft-tissue trauma and related complications. Minimally-invasive technical developments could deliver similar radiological outcomes, while avoiding the related complications. We evaluated radiological and perioperative outcomes in thoracolumbar fractures by using a novel minimally-invasive device.Twenty-six patients with 29 thoracolumbar fractures using the NForce device were analyzed. Postoperative reduction and alignment were assessed by radiographic measurement of the local kyphosis angle (LKA) up until a follow-up period of 9 months.Postoperative imaging revealed an average reduction of traumatic kyphosis of 8.25° (±7.72°) with an average postoperative LKA of 3.24° (±8.97°). The highest degree of reduction was 27.39°. The mean LKA had increased to 5.08° (±5.17°) at 3 months postoperative, 5.43° (±4.32°) at 6 months and 6.21° (±3.82°) at 9 months.The minimally invasive NForce system is effective in performing anatomic percutaneous reduction/fixation.

Clinical and radiological outcomes in thoracolumbar fractures using the SpineJack device. A prospective study of seventy-four patients with a two point three year mean of follow-up.

The aim of this study was to assess clinical and radiological results of SpineJack on the treatment of vertebral body fractures in a continuous prospective series of patients. Between May 2012 and April 2015, all patients operated using the SpineJack device were prospectively included in this monocentric study. Demographic data, clinical, and radiological results were recorded. Complications and surgical managements were recorded. At a mean follow-up of 2.3years, 74 patients with 77 fractured vertebrae were included. The stand-alone SpineJack group comprised 60 patients with 63 fractured vertebrae (group 1) and the group with additional posterior fixation 14 patients with 14 fractured vertebrae (group 2). The average initial vertebral wedge angle was 13.3 ± 6.1 degrees for group 1 and 15.3 ± 5.7 degrees for group 2 (p = 0.25). Post-operative values were 6.5 ± 4.6 degrees for group 1 and 5.1 ± 3.9 degrees for group 2 (p = 0.31). The differences within the same group were highly significant (p < 0.0005). The loss of reduction at last follow-up was 0.8 ± 1.6 degrees in group 1 and 0.6 ± 2.0 degrees in group 2 (p = 0.77). Subjective results were considered as very good or good for 57 patients (95%) in group 1 and for 11 patients (79%) in group 2, p = 0.07. The SpineJack seems to be a promising tool in the treatment of traumatic vertebral fractures with a correction in the sagittal plane comparable with what can be found in the literature.

Surgical outcomes in thoracolumbar fractures with pure conus medullaris syndrome

BackgroundPure conus medullaris syndrome is defined as a combination of signs and symptoms of bladder/bowel incontinence and impotence without the presence of lower limbs weakness. The purpose of the study is to assess the recovery of voiding, sexual, and sensory function in patients with isolated conus medullaris syndrome after surgical treatments. MethodsFrom January 2005 to December 2012, patients with a single level burst fracture with pure conus medullaris syndrome were assessed. Level of injury, use of steroid, surgical time, surgical approach, preoperative radiographic parameters, and types of neurogenic bladder were recorded. Bladder function was evaluated using urodynamic study; sexual function was assessed by self-report questionnaire. The final outcomes were focused on the recovery of voiding, sexual, and sensory function. ResultsEight patients met the criteria of pure conus medullaris syndrome with thoracolumbar burst fracture. The injury level were all located at L1 vertebra. There were 6 males and 2 females. Four patients had overactive neurogenic bladder, and the other 4 patients had underactive type. At final, five patients regained self-voiding function, and three required intermittent catheterization. Two male patients were sexually active, and four male patients had some sexual dysfunction. Two female patients could have normal sexual intercourse but the frequency decreased. One female patients had prolonged perineum numbness at final follow-up. ConclusionsAlthough extremely rare, pure conus medullaris syndrome may occur with L1 burst fracture. Despite surgical treatment, only one half of the patients regained normal bladder and sexual function.

Evaluation of Functional and Radiographic Outcomes of Thoracolumbar Fractures

Evaluation of Functional and Radiographic Outcomes of Thoracolumbar Fractures

Comparison of Surgical Outcomes in Thoracolumbar Fractures Operated with Posterior Constructs Having Varying Fixation Length with Selective Anterior Fusion

PurposeSurgical treatment in the case of thoracolumbar burst fractures is very controversial. Posterior instrumentation is most frequently used, however, but the number of levels to be instrumented still remains a matter of debate.Materials and MethodsA total of 94 patients who had a single burst fracture between T11 and L2 were selected and were managed using posterior instrumentation with anterior fusion when necessary. They were divided into three groups as follows; Group I (n = 28) included patients who were operated by intermediate segment fixation, Group II (n = 32) included patients operated by long segment fixation, and Group III (n = 34) included those operated by intermediate segment fixation with a pair of additional screws in the fractured vertebra. The mean follow-up period was twenty one months. The outcomes were analyzed in terms of kyphosis angle (KA), regional kyphosis angle (RA), sagittal index (SI), anterior height compression rate, Frankel classification, and Oswestry Disability Index questionnaire.ResultsIn Groups II and III, the correction values of KA, RA, and SI were much better than in Group I. At the final follow up, the correction values of KA (6.3 and 12.1, respectively) and SI (6.2 and 12.0, respectively) were in Groups II and III found to be better in the latter.ConclusionThe intermediate segment fixation with an additional pair of screws at the fracture level vertebra gives results that are comparable or even better than long segment fixation and gives an advantage of preserving an extra mobile segment.