Thoracolumbar Junction Fractures Research Articles

Thoracolumbar junction fracture and long instrumented fusion, a trial on a standardized surgical technique with long term clinical outcomes

AimTo investigate the role of fusion construct properties, vertebral column reconstruction (VCR) techniques, steroid therapy, laminectomy versus ligamentotaxis in treatment of thoracolumbar junction fractures (TLJF). MethodsA non-randomized clinical trial was conducted. All the eligible patients with TLJF (T12-L2) were operated with a standardized long fusion protocol and followed. Fusion rate, hardware failure, sagittal imbalance and functional outcome were identified as the primary outcome. P < 0.05 was defined as significant. ResultsNinety-nine long fusions were reviewed in the final analysis. The mean age was 35.7 ± 13.80 years with 79.8 % male predominance. Fifty-eight percent of the patients were neurological intact. Fifty-six percent underwent concurrent laminectomy and VCR using autografts while the remaining 43.4 % received ligamentotaxis. The patients follow up (median = 25 months) showed 93.9 % solid fusion rate, 70.7 % activity independency, 1% hardware failure, 10.1 % sagittal imbalance and 4 % wound complications. Sagittal imbalance was associated with steroid therapy (p = 0.006), laminectomy (p = 0.003) and preoperative neurological deficits (p = 0.0001) and age (p = 0.049). Interestingly, Steroid therapy was associated with improved neurological and functional outcomes in impaired patients (p < 0.05). Laminectomy was associated with favorable functional outcome (OR = 9.7, CI: 2.09–45.67). ConclusionOur standardized long fusion protocol was associated with significant outcomes with low morbidities. Autograft mixture yield to a robust union in and over fusion construct. Methylprednisolone therapy in non-intact patients was associated with improved clinical outcomes but simultaneously, has negative impact on sagittal imbalance. Laminectomy and steroid therapy should be carefully considered in impaired patients due to their negative impact on sagittal balance.

Usefulness of Percutaneous Pedicle Screw Fixation for Treatment of Lower Lumbar Burst (A3-A4) Fractures: Comparative Study with Thoracolumbar Junction Fractures.

Percutaneous pedicle screw fixation (PPSF) without fusion has been recently recommended in the treatment of thoracolumbar fracture to reduce the adverse effects associated with the conventional open approaches and to restore range of motion. However, those studies report on the thoracolumbar junction, and there is no report on lower lumbar fracture. To assess effectiveness of PPSF without fusion for treating lower lumbar burst (A3 and A4) fractures. A retrospective analysis was made to evaluate consecutive 50 patients with AO type A3 and A4 thoracolumbar fracture underwent PPSF. Patients were divided into a thoracolumbar junction (TLJ) group (T11-L2) and lower lumbar (LL) group (L3-5). The following items were measured and compared between the two groups. Vertebral height and consolidation, retropulsed fragment, sagittal curve and fixation failure were assessed with certain interval regularly. The average height at pre- and post-reduction were 56.2% (36.2-74.3), 95.3% (84.2-98.3) in TLJ group and 65.7% (45.7-86.2), 91% (73.1-100) in LL group. The average canal area occupancy rate at pre- and post-reduction were 46.1% (37.4%-67.5%), 38.1% (31.3%-40.8%) in TLJ group and 40.4% (15.0-65.7), 19.3% (9.4-26.6) in LL group. Consolidation was completed within 12months after surgery in both groups. There was no significant difference between two groups in clinical and radiographic parameters except cobb angle loss. Patients with lower lumbar fracture can be effectively managed with PPSF without fusion. PPSF following the implant removal can restore the movement of the lower lumbar spine, which is essential for daily life.

Bilateral rod loosening and sequential distal migration after thoracolumbar junction fracture stabilisation.

Distal rod migration remains uncommon and has been reported in a variety of anatomical locations, including the retroperitoneal region, the knee, and the pelvis. It is postulated that spinal fixation without fusion might allow the mechanical system some vulnerability to motion effects of the spine. Bilateral distal rod migration is rarer still. We report the interesting scenario of sequential and delayed bilateral rod migration 17 months after thoracolumbar fracture stabilisation.

Evaluation of vertebral shortening and interbody fusion with short segment pedicle screw fixation for unstable thoracolumbar fractures

BackgroundVarious operative procedures have been described for the treatment of traumatic paraplegia caused by unstable thoracolumbar fractures. We prospectively evaluated interbody fusion (IBF) with SS-PSF in these cases with regard to clinico-radiological outcome with the objectives: (1) Does IBF and short segment pedicle screw fixation (SS-PSF) prevent progression of kyphotic angle after surgery? (2) Can this procedure be safely performed in the setting of acute trauma?. MethodsSixteen patients suffering from traumatic paraplegia caused by acute unstable thoracolumbar fractures were enrolled prospectively and underwent IBF with SS-PSF. They were evaluated for magnitude of shortening in spine, progression of kyphotic angle, and neurological improvement by American spinal injury association scale (ASIA). ResultsOut of total sixteen, 14 patients were ASIA grade A and 2 were grade C, at the time of presentation. Thirteen out of these 14 remained grade A and one improved to B. Both the patients who had grade C involvement at the time of presentation improved to grade D at one-year follow-up. The mean blood loss was 750 ml (range; 650 ml–1150 ml). Mean kyphotic angle decreased from 20.6° (range; 13° to 37°) preoperatively to 6.2° (range; 3° to 10°) at postoperative day 2 (p = 0.002). Its mean value after 6 months was 6.5° (range; 3° to 11°). The procedure resulted in mean spinal column shortening of 18 mm (range; 16 mm–22 mm) in the spinal column. All the patients achieved bony union by a mean duration of 3.9 months (range; 3 months–6 months). ConclusionsIBF with SS-PSF has the shortest possible instrumented construct for thoracolumbar junction fusion done by posterior approach. The interbody fusion for unstable thoracolumbar junction fractures prevents the progression of kyphotic angle post-operatively. Level of evidenceLevel 4.

Patient-reported outcomes after posterior surgical stabilization for thoracolumbar junction fractures: A pilot study with combined patient-reported outcome measure methodology.

Thoracolumbar junction fractures (TLJFs) attract controversy for several parameters, including surgery versus conservative treatment, fusion versus stabilization, open versus percutaneous surgery, construct length, and downstream metalwork extraction. The aim of this pilot study was to assess the effectiveness of surgical treatment in patients with burst (AO Classification Type A4) TLJFs using patient-reported outcome measures (PROMs) and evaluate and compare different PROMs in this clinical scenario. Patient records of consecutive patients who underwent posterior stabilization surgery for TLJFs were retrospectively reviewed. Data were collected on demographics, medical and social history, neurological examination, and postoperative complications. Telephone interviews and a combined PROM methodology (Numerical Rating Scale [NRS], EuroQol [EQ]-5D-5L, and Oswestry Disability Index [ODI]) were utilized to assess the effectiveness of intervention. Descriptive statistics were used to analyze exposure variables and outcome measures. Spearman's rank correlation was used for the outcome measures. Thirteen patients were included. The mean age was 42 ± 16 years; the male: female ratio was 8:5; the mean follow-up was 18.9 ± 6.4 months. The mean NRS score was 3.3 ± 2.5, in line with a median score of 2 (2) on EQ-5D-5L pain/discomfort scale. Statistically significant correlations were found between several PROMs: pain-EQ-5D-5L and NRS (rs = 0.8, P = 0.002), pain-EQ-5D-5L and ODI (rs = 0.8, P = 0.001), usual anxiety/depression-EQ-5D-5L, and ODI (rs = 0.7, P = 0.008). A combined PROM methodology showed supportive evidence for safety and efficacy in the surgical stabilization of burst TLJFs. This alleviated significant pain and prevented neurological deficit and major disability. The preliminary widespread correlation between these PROMs supports further larger studies of their combined use in clinical practice, to measure the outcomes of spine trauma patients.

Thoracolumbar fractures after the 2023 Türkiye earthquake and controversial mechanism of occurrence.

Earthquakes are devastating events that may severely injure the human body. The spine is one of the important parts of the human body that may be affected by earthquake trauma. The aim of this study is to focus on thoracolumbar fractures secondary to the 2023 Turkey Earthquake. The data of 15 patients who were affected by the earthquake, rescued from the rubble, and subsequently treated for spinal fractures in our department were reviewed retrospectively. The clinical, radiological, and surgical features of the patients were recorded, and the outcomes were investigated. Among the 15 patients, 12 were female, and 3 were male. Their ages ranged from 22 to 79 years. The average duration of being trapped under debris was 4.7 hours. According to the Frankel classification, 12 patients (80%) were categorized as Frankel E, 2 patients (13.3%) as Frankel A, and 1 patient (6.6%) as Frankel C. Of these patients, 6 underwent surgical treatment, while a total of 9 patients received conservative treatment. Multiple vertebral fractures were identified in 4 patients. While 3 patients with multiple fractures were treated conservatively, 1 patient underwent surgery due to an L1 fracture. All surgeries consisted of spinal canal de-compression and spinal instrumentation. Among patients without thoracolumbar junction fractures, 1 had a T8 fracture, 1 had an L4 fracture, and 1 had a sacral fracture along with an accompanying lumbar plexus injury. Thoracolumbar fractures are frequently observed after earthquakes. However, the exact mechanism of these fractures is not well known. Surgical management should be reserved for patients with progressive neurological deficits, while conservative treatment is the option for stable fractures.

Surgical management of thoracolumbar junction fractures: An evidence-based algorithm

BackgroundThe management of thoracolumbar junction (TLJ) fractures, involving the restoring anatomical stability and biomechanics properties, still remains a challenge for neurosurgeons.Despite the high frequency of these injuries, specific treatment guidelines, set on biomechanical properties, have not yet been assumed. The present study is meant to propose an evidence-based treatment algorithm. The primary aim for the protocol validation was the assessment of postoperative neurological recovery. The secondary objectives concerned the evaluation of residual deformity and rate of hardware failure. Technical nuances of surgical approaches and drawbacks were further discussed. MethodsClinical and biomechanical data of patients harboring a single TLJ fracture, surgically managed between 2015 and 2020, were collected. Patients' cohorts were ranked into 4 groups according to Magerl's Type, McCormack Score, Vaccaro PLC point, Canal encroachment, and Farcy Sagittal Index. The outcome measures were the early/late Benzel-Larson Grade and postoperative kyphosis degree to estimate neurological status and residual deformity, respectively. Results32 patients were retrieved, 7, 9, 8, and 8 included within group 1, 2, 3, and 4, respectively. Overall neurological outcomes significantly improved for all patients at every follow-up stage (p ​< ​0.0001). Surgeries gained a complete restoration of post-traumatic kyphosis in the entire cohort (p ​< ​0.0001), except for group 4 which experienced a later worsening of residual deformity. ConclusionsThe choice of the most appropriate surgical approach for TLJ fractures is dictated by morphological and biomechanical characteristics of fracture and the grade of neurological involvement. The proposed surgical management protocol was reliable and effective, although further validations are needed.

Common Vertebral Fracture Level After the 2023 Turkey Earthquake: Thoracolumbar Junction - Due to Hyper-Flexed and Fixed Posture - at Triangle of Life Areas.

To assess the frequency of thoracolumbar junction (TLJ) fractures (T10-L2) in survivors of the 2023 East Turkey earthquake. This single-center retrospective stdy evaluated 10 earthquake survivors, who were trapped under the rubble and rescued alive by rescue teams, and were assessed for spinal trauma after the earthquake in Eastern Turkey on February 6, 2023. All patients underwent full spinal magnetic resonance imaging and computed tomography examinations to determine the level of spinal fracture and decide the treatment methods. All patients had sustained spinal fractures. Eight underwent surgery, while two were managed conservatively. Nine out of ten patients had TLJ fractures. Five patients had L1 fractures, four of them were treated surgically. Three patients had a T12 level fracture, two of whom were treated surgically. One patient with a T7-level fracture was treated surgically. Only one patient had multiple fractures (T12 and L2 levels) and was treated surgically. The TLJ was the commonest vertebral fracture level as of the 2023 Turkey earthquake survivors in our study population. In the event of an earthquake, people tend to attain a fetal posture (fix and hyperflex the spine) when taking shelter in a narrow area (triangle of life). This position might place an excessive load on the TLJ, predisposing it to injuries.

Analysis of a Hybrid Spine Fixation Approach for the Treatment of Unstable Thoracolumbar Fractures.

Introduction The treatment of unstable thoracolumbar burst fractures and fracture dislocations of the thoracolumbar spine remains ever evolving. Anterior or posterior approaches both have equal efficacy, but the posterior approach has been preferred in our study due to its ease of application, less extensile nature, and reduced intra-operative bleeding. Posterior approaches can employ short-segment fixation or long-segment fixation techniques. Long segment fixation may need implant removal later to increase mobility in nonfusion surgeries. The thoracolumbar segment is a transition zone where the thoracic spine is a less flexible zone, and the lumbar spine is a more flexible zone. Lumbar motion is important to preserve. Hence, we proposed to study spinal fixation two levels above and one level below the fracture for stabilization. This may provide increased stability along with preservation of the motion segment at the lumbar level. Methods We retro-prospectively reviewed the results ofunstable thoracolumbar junction fractures with incomplete or intact neurology in 34 consecutive cases operated with alternate two above and one below fixation approach between June 2018 and June 2019 at our institute. Five cases were excluded due to incomplete follow up and the remaining 29 patients were included in the study. Regular follow-up in the postoperative period at three, six, and 12 months was conducted. Data analysis was done by SPSS software version 22 (IBM Corp., Armonk, NY). Results Twenty-nine patients were included in the study out of which 16 were males and 13 were females. The average age was 36.31±1.46 years (range, 14-60 years). The average follow-up duration was 14.31 months. The average injury to surgery interval was 7.17±7.31 days (range, 1-30 days). On analysis via paired t-test, pre-operative kyphotic angle (mean=20.06±8.34º) improved to immediate post-operative (mean=8.44±5.76º, p=0.0001). The postoperative kyphotic angle at 12 months follow-up showed significant stability (Mean=14.13±5.27º, p=0.0001). A median average pre-operative neurological compromise was ASIA score C and Frankel Grade C and the median average disability was an ODI score of 61%-80%. At the end of 12 months of follow-up the median average neurological compromise improved to ASIA Score D and Frankel Grade D and the median average disability improved to an ODI score of 21%-40%. Conclusion Two levels above and one level below hybrid pedicle screw fixation with decompression for the treatment of unstable thoracolumbar fractures with partial and intact neurology was successful within the limited time frame we had for follow-up in preserving progressive post-operative kyphosis, preserving one-motion segment, improving the neurological outcome and disability of the patients without any major complications.

Translated article] Immediate standing X-ray predicts the final vertebral collapse in elderly patients with thoracolumbar burst fracture

ObjectiveTo see if, in elderly patients with traumatic thoracolumbar fracture, standing X-rays with orthoses 24–48h after admission can predict vertebral collapse after consolidation. Material and methodsProspective cohort study endorsed by the Clinical Research Ethics Committee. Inclusion criteria: age >65 years, acute thoracolumbar junction fracture due to fall, hospital admission, treatment with orthesis. Exclusion criteria: various levels, suspected malignancy, non-immediate fracture or atraumatic. Variables: Farcy index (F), regional kyphosis (C: Cobb from cranial to caudal to broken vertebra) – both measured at admission (F0 and C0), at 24–48h in standing position with orthesis (F1 and C1) and 3 months, without brace (F2 and C2), collapse (increase from F0 to F1 —F0F1— and from F1 to F2 —F1F2—; as well as from C0 to C1 —C0C1— and from C1 to C2 —C1C2—), age and gender. Statistical analysis: R package. ResultsSeries of 40 patients, with a mean age of 75 years (66–87). Nine men and 31 women. Neither gender nor age were correlated with any variable. Six required surgery at follow-up. There were no differences in F1, C1, F0F1 or C0C1 between the six patients who required surgery and the other 34. Subsequently, data analysis was performed only for those patients who did not require surgery.The values obtained in the Farcy index were 8°+7° (F0), 12°+7° (F1) and 15°+8° (F2) and in kyphosis (three vertebrae, Cobb) they were: C0=8°+13°; C1=11.5°+14° and C2=13°+13°. There was a correlation of F2 with F0 and F1 (p<.001), with F0F1 (p=.038) and F1F2 (p=.007). The most powerful was with F1 (Rho Spearman=.889, 95% CI=.776–.947), with a linear regression line: F2=2.61288+F1×1.01237 (R2=.79). C2 was correlated with C0 and C1 (p<.001), especially with C1 (Rho Spearman=.952, 95% CI=.899–.977). Linear regression: C2=2.23371+C1×0.93758 (R2=.927). ConclusionsImmediate standing collapse predicts alignment at consolidation (3 months). It is therefore advisable to perform that radiography in the follow-up protocol.

Outcome of Long-Segment Fixation versus Inclusion of the Fractured Level in Short-Segment Fixation for Thoracolumbar Junction Fractures.

Objective The aim of this study was to compare the radiological outcomes of long-segment fixation and short-segment fixation, including the fracture level in patients treated for thoracolumbar junction fractures. Methods Data collected from records of patients with thoracolumbar junction fractures who were operated at our department. Neurological evaluation was done using American Spinal Injury Association classification score. Radiological parameters used were the Cobb's angle, vertebral body compression ratio, the anteroposterior spinal canal diameter, and the anterior and the posterior vertebral body heights. Patients were divided into two groups: group A included patients who underwent long-segment fixation and group B included patients who underwent short-segment fixation with inclusion of the fracture level. Results The mean preoperative Cobb angle was 22.51 degrees in group A and 19.37 degrees in group B. Both groups showed improvement in the postoperative Cobb angle as the mean in group A was 14.17 degrees and in group B was 11.77 degrees. The mean preoperative compression ratio in group A was 82.8%, while in group B it was 76%. The postoperative mean in group A was 89.2%, while in group B, it was 84%. The mean preoperative anterior vertebral body height of the fractured vertebra in group A was 16.7 mm, while in group B, it was 15.18 mm. The mean preoperative posterior vertebral body height in group A was 16.33 mm and that of group B was 19.41 mm. The mean postoperative anterior vertebral body height in group A was 17.66 mm and that of group B was 17.10 mm. The mean postoperative posterior vertebral body height in group A was 17.11 mm and that of group B was 20.79 mm. Conclusion Posterior short-segment fixation with additional screws at the fracture level provides similar-if not better-clinical and radiological outcomes to long-segment fixation in the treatment of thoracolumbar junction fractures.

Long versus short segment with intermediate screw fixation for burst fractures of thoracolumbar junction: radiological and clinical results.

Long segment fixation has been frequently used to treat thoracolumbar burst fractures. In our study we want to compare the long and short segment with intermediate screw fixation of thoracolumbar junction burst fractures in relation to radiological and clinical outcomes. We collected the data of 115 patients, with thoracolumbar junction (T11-L2) burst fracture A3 or A4, according to AO classification. Patients were divided into two groups. Group A was treated by long segment fixation. Group B was treated by short segment fixation. At admission, after surgery, and at 12-month follow-up the patients were radiographically assessed for local kyphotic angle using the Cobb method. Patients were clinically evaluated with the Visual Analogue Scale (VAS) for back pain. The mean difference of the preoperative, immediate postoperative, and 12-month follow-up Cobb angle was significant in both groups (p = 0.018). The mean difference of the preoperative and immediate postoperative Cobb angle, Δ1, was significantly greater in group A than in group B (p = 0.038), indicating that the Cobb angle correction immediately postoperative was better in patients with double level fixation. The mean difference of the immediate postoperative and 12-month follow-up Cobb angle, Δ2, was significantly greater in group A than in group B (p = 0.007), indicating that the maintenance of local Cobb angle correction was better in patients with double level, long fixation. There was no difference in VAS values between Group B (single) and Group A (double) segment fixation immediately post operatively (p = 0.356) or after 12 months (p = 0.147). In A3 and A4 thoracolumbar junction fractures, long segment fixation can correct the local kyphosis Cobb angle and maintain the correction at 12-month follow-up better than short segment fixation with intermediate screws in the fractured vertebra. The radiological difference, however, was not predictive of clinical results.

La radiografía en bipedestación inmediata predice el colapso final de la vértebra fracturada en pacientes añosos con fractura estallido toracolumbar

ObjectiveTo see if, in elderly patients with traumatic thoracolumbar fracture, standing X-rays with orthoses 24–48h after admission can predict vertebral collapse after consolidation. Material and methodsProspective cohort study endorsed by the Clinical Research Ethics Committee. Inclusion criteria: age >65 years, acute thoracolumbar junction fracture due to fall, hospital admission, treatment with orthesis. Exclusion criteria: various levels, suspected malignancy, non-immediate fracture or atraumatic. Variables: Farcy index (F), regional kyphosis (C: Cobb from cranial to caudal to broken vertebra) – both measured at admission (F0 and C0), at 24-48h in standing position with orthesis (F1 and C1) and 3 months, without brace (F2 and C2), collapse (increase from F0 to F1 —F0F1— and from F1 to F2 —F1F2—; as well as from C0 to C1 —C0C1— and from C1 to C2 —C1C2—), age and gender. Statistical analysis: R package. ResultsSeries of 40 patients, with a mean age of 75 years (66–87). Nine men and 31 women. Neither gender nor age were correlated with any variable. Six required surgery at follow-up. There were no differences in F1, C1, F0F1 or C0C1 between the six patients who required surgery and the other 34. Subsequently, data analysis was performed only for those patients who did not require surgery.The values obtained in the Farcy index were 8°+7° (F0), 12°+7° (F1) and 15°+8° (F2) and in kyphosis (three vertebrae, Cobb) they were: C0=8°+13°; C1=11.5°+14° and C2=13°+13°. There was a correlation of F2 with F0 and F1 (p<.001), with F0F1 (p=.038) and F1F2 (p=.007). The most powerful was with F1 (Rho Spearman=.889 (95% CI=.776-.947), with a Linear Regression line: F2=2.61288+F1×1.01237 (R2=.79). C2 was correlated with C0 and C1 (p<.001), especially with C1 (Rho Spearman=.952, 95% CI=.899-.977). Linear regression: C2=2.23371+C1×0.93758 (R2=.927). ConclusionsImmediate standing collapse predicts alignment at consolidation (3 months). It is therefore advisable to perform that radiography in the follow-up protocol.

Risk factors for recollapse of new vertebral compression fractures after percutaneous kyphoplasty in geriatric patients: establishment of a nomogram

BackgroundThe main objective of this study was to investigate the risk factors for recollapse of new vertebral compression fractures (NVCFs) after percutaneous kyphoplasty (PKP) treatment for osteoporotic vertebral compression fracture (OVCF) and to construct a new nomogram model.MethodsWe retrospectively analysed single-level OVCFs from January 2017 to June 2020, randomizing patients to a training set and a testing set. In the training set, independent risk factors for NVCFs in OVCF patients treated with PKP were obtained by univariate and multivariate regression analyses. These risk factors were then used as the basis for constructing a nomogram model. Finally, internal validation of the built model was performed in the testing set using the consistency index (C-index), receiver operating characteristic (ROC) curves, calibration curves and decision curve analysis (DCA).ResultsIn total, 371 patients were included in this study. NVCFs occurred in 21.7% of the training set patients, and multivariate regression analysis showed that a low Hounsfield unit (HU) value, cement leakage, and thoracolumbar (TL) junction fracture were independent risk factors for NVCF after PKP. The C-index was 0.81 (95% CI: 0.74–0.81), and the validation showed that the predicted values of the established model were in good agreement with the actual values.ConclusionsIn this study, three independent risk factors were obtained by regression analysis. A nomogram model was constructed to guide clinical work and to make clinical decisions relatively accurately to prevent the occurrence of vertebral recollapse fractures.

Establishment and Validation of a Nomogram for the Risk of New Vertebral Compression Fractures After Percutaneous Vertebroplasty in Patients With Osteoporotic Vertebral Compression Fractures: A Retrospective Study.

PurposeNew vertebral compression fractures(NVCFs) after minimally invasive surgery in patients with osteoporotic vertebral compression fracture (OVCF) is a challenging issue worldwide. Predicting the occurrence of NVCFs is key to addressing such questions. Therefore, we aimed to investigate the risk factors for patients who developed NVCFs after undergoing surgical treatment and establish a nomogram model to reduce the occurrence of NVCFs.MethodsThis study is a retrospective analysis that collected the general characteristics and surgical features of patients who underwent surgical treatment at 2 central institutions between January 2017 and December 2020. Patients were divided into training and testing sets based on the presence or absence of NVCFs. Independent risk factors for NVCFs were obtained in the training set of patients, and then a nomogram model was constructed. Internal and external validation of the nomogram model was performed using the consistency index (C index), receiver operating characteristic curve(ROC), calibration curves, and decision curve analysis (DCA).ResultsA total of 562 patients were included in this study. Patients from the first center were used for nomogram construction and internal validation, and patients from the second center were used as an external validation population. Multivariate regression analysis showed that age, Hounsfield unit (Hu) value, cement leakage, and thoracolumbar (TL) junction fracture were independent risk factors for NVCFs after minimally invasive surgery. The C index was .85, and the validation of internal and external validation shows that the predicted values of the established model is in good agreement with the actual values.ConclusionsIn this study, 4 independent risk factors were obtained by regression analysis, and a nomogram model was constructed to guide clinical work. The application of this model can help surgeons to make more accurate judgments to prevent the occurrence of NVCFs.

Biomechanical evaluation of the pedicle screw insertion depth and role of cross-link in thoracolumbar junction fracture surgery: a finite element study under compressive loads

Introduction. The thoracolumbar junction is one of the most frequently damaged parts of the human spine when exposed to a traumatic factor. Corpectomy in combination with posterior decompression and restoration of the spinal support function is often performed using an interbody implant and posterior transpedicular stabilization to achieve adequate decompression and stabilization in severe traumatic injuries of this level. The surgery of this type is characterized by significant instability of the operated segment and determines increased requirements for the rigidity and reliability of posterior fixation. We have modeled the situation of a two-level corpectomy with subsequent replacement of bodies with a mesh implant and posterior transpedicular stabilization with 8 screws. Objective. To study the stress-strain state of the thoracolumbar spine model after resection of the Th12-L1 vertebrae with different variants of transpedicular fixation under the influence of a compressive load. Materials and methods. A mathematical finite element model of the human thoracolumbar spine has been developed, the components of which are the Th9 ‒ Th11 and L2-L5 vertebrae (vertebrae Th12-L1 are removed), as well as elements of hardware - interbody support and transpedicular system. Four variants of transpedicular fixation were modeled: using short screws and long screws passing through the cortical layer of anterior wall of vertebral body, as well as two cross links and without them. The stress-strain state of the models was studied under the influence of a vertical compressive distributed load, which was applied to the body of the Th9 vertebra and its articular surfaces. The load value was 350 N, corresponding to the weight of the upper body. Results. d It was found that transpedicular fixation of the thoracolumbar vertebrae with the use of long screws reduces the level of tension in the bone elements of the models. In the area of screw entry into the pedicle of the T10, T11, L2 and L3 vertebral arch, the load when using short screws was 3.1, 1.7, 3.9 and 12.1 MPa, respectively, when using bicortically installed screws - 2.9, 1.8, 3.8 and 10.6 MPa. The addition of two cross-links also reduces the maximum load values in critical areas of the model to a certain extent. In case of short screws combination and two cross-links, the load in these areas was 2.8, 1.7, 3.6 and 11.5 MPa, when using bicortical screws and cross-links - 2.8, 1.6, 3.3 and 9.3 MPa. The study of the stress-strain state of other parts of the model revealed a similar trend. Conclusions. The use of long screws with fixation in the cortical bone of anterior part of the vertebral bodies reduces the level of tension in the bone elements of the models. The use of cross links provides greater rigidity to the transpedicular system, that also reduces the tension in the bone tissue.

A modified MRI protocol for the increased detection of sacrococcygeal fractures in patients with thoracolumbar junction fractures

This study aimed to identify concurrent thoracolumbar junction (TLJ) and sacrococcygeal (SC) fractures using a modified MRI protocol and analyze the risk factors associated with tandem fractures. We retrospectively investigated patients with MRI-confirmed TLJ fractures from January 2017 to March 2020. Patients were divided into two study groups: study 1 with a modified MRI protocol and study 2 with a routine protocol. The modified protocol included an extended field of view of sagittal scans in L-spine MRI covering the full SC spine. In study 1, frequency of concurrent TLJ and SC fractures was investigated. And we analyzed risk factors and compared CT and MRI for detecting SC fractures. In study 2, co-occurrence of both fractures was investigated. A total of 176 and 399 patients with TLJ fractures were enrolled in study 1 and 2, then SC fractures were identified in 53 (30.14%) and 36 patients (9.02%), respectively. An axial loading trauma mechanism was a significant risk factor (Odds ratio 7.0, p < 0.001), and MRI was more sensitive than CT in detecting SC fractures (p < 0.002). Thus, a modified MRI protocol was useful to detect the high occurrence of SC fractures in TLJ fractures, which concurrent fractures increased by an axial loading mechanism.

Association between Osteoporotic Vertebral Compression Fractures and Age, Bone Mineral Density, and European Quality of Life-5 Dimensions in Korean Postmenopausal Women: A Nationwide Cross-sectional Observational Study.

BackgroudThe purpose of this study was to investigate the characteristics of osteoporotic vertebral compression fractures (OVCFs) in Korean postmenopausal women and the association between OVCFs and clinical factors such as age, bone mineral density (BMD), and quality of life.MethodsAccording to the population distribution in four regions in Korea, 1,281 postmenopausal female patients were recruited from nationwide orthopedic outpatient clinics. Radiologic, asymptomatic, and within 3 months of OVCF groups were analyzed based on age, fracture location, and prevalence according to BMD. In addition, BMD, T-score, body mass index, and European Quality of Life-5 Dimensions (EQ-5D) were investigated in the three groups, and the differences between groups were compared and analyzed.ResultsThe prevalence of radiologic OVCFs at the T11–L1 was 3.7 times higher in the 70s group (44.0%) than in the 50s group (11.9%). Femur and total hip BMD were significantly lower in patients with thoracolumbar junction fractures than in patients with L2–5 fractures, whereas no difference was observed in lumbar spine BMD. Of the three OVCF groups, the within 3 months of OVCF group had the lowest lumbar spine T-score of −2.445. The asymptomatic OVCF group also showed significantly lower lumbar spine T-score than did the group without radiologic OVCFs (p < 0.001). The EQ-5D showed a significant decrease in the radiologic OVCF group (p < 0.001) and within 3 months of OVCF group (p < 0.001).ConclusionsThe prevalence of OVCFs in the thoracolumbar junction rapidly increases with old age and low BMD in Korean postmenopausal women. Femur and total hip BMD are more predictive of thoracolumbar junction fractures than lumbar spine BMD. Patients with radiologic OVCFs had a significantly lower quality of life than no OVCF group. Therefore, this study shows it is important to treat and prevent osteoporosis before an OVCF occurs.

A pilot comparison and correlation of different patient reported outcome measures (PROMs) for the surgical management of thoracolumbar junction fractures

A pilot comparison and correlation of different patient reported outcome measures (PROMs) for the surgical management of thoracolumbar junction fractures

What Are the Risk Factors for Adjacent Vertebral Fracture After Vertebral Augmentation? A Meta-Analysis of Published Studies

Study Design:Meta-analysis.Objectives:To provide up-to-date evidence-based outcomes for the incidence and risk factors of adjacent vertebral fracture (AVF) after the vertebral augmentation.Methods:The MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched for studies assessing the risk factors of adjacent vertebral fracture after vertebral augmentation until June 2020. The AVF incidence and factors potentially affecting AVF were extracted and pooled.Results:A total of 16 studies, encompassing 2549 patients were included in the meta-analysis. The pooled incidence of AVF was 14% after vertebral augmentation. Female, lower T-score, thoracolumbar junction fracture, intravertebral cleft, more injected cement volume, intradiscal cement leakage significantly increased the risk of AVF. Age, body mass index, steroid medication, Cobb angle change, postoperative Cobb angle showed no significant association with AVF.Conclusions:Identifying the risk factors of AVF can facilitate prevention strategy to avoid the AVF. Female, T-score, thoracolumbar junction fracture, intravertebral cleft, more cement volume, and intradiscal cement leakage increased the risk of AVF.