Thoracolumbar Spine Fractures Research Articles

A Systematic Review of the Long-Term Outcomes of Surgical Versus Non-surgical Management for Types A3 and A4 Thoracolumbar Spinal Fractures With No Neurological Deficits

A Systematic Review of the Long-Term Outcomes of Surgical Versus Non-surgical Management for Types A3 and A4 Thoracolumbar Spinal Fractures With No Neurological Deficits

WITHDRAWN: Robotic Assisted Pedicle Screw Placement for Traumatic Thoracolumbar Spine Fractures Using the Mazor X Robot

WITHDRAWN: Robotic Assisted Pedicle Screw Placement for Traumatic Thoracolumbar Spine Fractures Using the Mazor X Robot

Outcome Measures of Open versus Minimally Invasive Surgery for Thoracolumbar Spinal Traumatic Fractures: A Systematic Review and Meta-Analysis.

Objective: To evaluate the efficacy of open and percutaneous pedicle screw fixation in the treatment of thoracolumbar fractures. Methods: Online databases MEDLINE (PubMed), SCOPUS, and Cochrane were searched for English language articles published between January 2001 and December 2023, limited to articles that included the clinical and radiological outcomes of adult patients. The main outcome measures of the study were the Oswestry Disability Index (ODI), the Numeric Rating Scale (NRS) score, and the Cobb angle. Results: A total of 7 studies involving 909 patients were included; 374 (41.1%) procedures were performed with open surgery (OS), while 535 (58.9%) procedures were conducted with minimally invasive surgery (MIS). The mean value of ODI in the MIS group was 8.29% [CI 95% 4.82-11.76], compared to the other group, which was 14.22% (p-value 0.87). Patients receiving a MIS had an average NRS of 1.54 [CI95% 0.98-2.10] whilst OS had 2.31 [CI95% 1.50-3.12] (p-value 0.12). Conclusions: The percutaneous technique is equally safe and effective in resolving the deformity, but the clear advantages are represented by the reduction in blood loss, shorter operative times, a lower incidence of infection, shorter hospitalization, shorter postoperative rehabilitation, and therefore good results in terms of quality of life.

Influence of Hospital Transfer Status on Surgical Outcomes for Traumatic Thoracolumbar Spine Fractures: Insights from a Multicenter Investigation

Surgical intervention for unstable thoracolumbar spine fractures is common, but delayed management and complications can impact outcomes. This study compares perioperative outcomes between patients directly admitted and those transferred from another facility for thoracolumbar spine surgery, aiming to identify predictors of complications and mortality. A multicenter retrospective cohort study used the American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2021 identified 61,626 patients undergoing fusion surgeries for thoracolumbar spine fractures, excluding spinal cord injury or pathological fractures. Patients were categorized as Direct (admitted from the emergency department) and Transfer (transferred from another facility). Perioperative outcomes, including operative time, length of stay (LOS), 30-day mortality, and complications, were compared. Our patient population (54.3% female, mean age 62.4±12.9years) comprised 12.2% Transfer and 87.8% Direct patients. Following propensity score matching, Transfer patients had a longer hospital LOS (5.1 ± 5.7days vs. 4.5 ± 4.6days, P < 0.001). Transfer exhibited higher rates of superficial incisional surgical site infection (1.7% vs. 1.1%, P= 0.003), sepsis (1.7% vs. 1.3%, P= 0.038), pneumonia (1.7% vs. 1.2%, P= 0.019), postoperative reintubation (0.9% vs. 0.6%, P= 0.036), and failure to wean off ventilator >48hours postsurgery (0.7% vs. 0.3%, P= 0.005) compared to Direct admissions. Direct group had a higher rate of perioperative transfusion (16.5% vs. 13.4%, P < 0.001). Transfer patients also had a higher 30-day mortality rate compared to Direct admissions (1.1% vs. 0.6%, P= 0.002). Interhospital transfers significantly affect hospital LOS, postoperative morbidity, and mortality in thoracolumbar spine surgery. Enhancing postoperative monitoring for transfer patients is crucial.

Outcomes of Thoracolumbar Burst Fractures Treated With Open Versus Minimally Invasive Percutaneous Posterior Spinal Stabilization: A Retrospective Study at a Rural Teaching Hospital in South India.

Background Thoracolumbar spine fractures are the most prevalent type of axial skeleton fractures, with approximately two-thirds occurring between T11 and L2. Percutaneous pedicle screw fixation has been reported to be an effective treatment for thoracolumbar fractures. Minimally invasive percutaneous pedicle screw fixation yields outcomes comparable to those of the standard open procedure and has the advantages of less stress, bleeding, and pain, as well as rapid postoperative recovery. The main objective of this research was to compare the clinical and radiological outcomes of two surgical approaches (open and percutaneous posterior spinal stabilization), concentrating on nonosteoporotic AO Spine Type A3 thoracolumbar burst fractures between T11 and L2. Materials and methods We conducted a retrospective study in our hospital, where cases of thoracolumbar burst fractures meeting the inclusion criteria were chosen retrospectively from April 2022 to March2023. A total of 54 patients (aged 18-60 years) who underwent spinal stabilization were included in this investigation. The population was divided into two cohorts, with 27 patients in each: Group A underwent open posterior spinal stabilization, and Group B underwent percutaneous posterior spinal stabilization. Data retrieved from medical records were analyzed with at least a six-month follow-up, mainly assessing the demographic data, intraoperative parameters, duration of hospitalization, clinical outcomes (Visual Analog Scale, Oswestry Disability Index, and McGill Pain Questionnaire scores), and radiological outcomes (vertebral wedge angle and correction loss). Results Both groups had a male preponderance. There were statistically meaningful distinctions between both groups regarding intraoperative parameters (blood loss and surgical duration) and primary clinical outcome parameters (Visual Analog Scale, Oswestry Disability Index, and McGill Pain Questionnaire scores) in the early phase of the study. However, there were no statistically significant differences concerning radiological parameters (vertebral wedge angle and correction loss) or primary clinical outcome parameters at the last follow-up. Conclusion The treatment modalities (open and percutaneous posterior spinal stabilization surgery) were equally safe and effective. However, the percutaneous group demonstrated significant reductions in the length of the surgical procedure, blood loss during surgery, duration of hospital stay, and immediate postoperative pain scores, all of which could potentially benefit patients.

Relationship between spinal alignment and functional disability after thoracolumbar spinal fractures: A systematic review

Thoracolumbar spinal fractures (TLSF) can cause pain, neurological deficits, and functional disability. Operative treatments aim to preserve neurological function, improve functional status, and restore spinal alignment and stability. In this review, we evaluate the relationship between spinal alignment and functional impairment in patients with TLSF. We performed a systematic review in accordance with the PRISMA guidelines to identify full-text articles that evaluate the correlation between spinal alignment and functional outcomes of TLSF. The artificial intelligence software Rayyan assisted the screening process. Functional outcomes referred to activity/disability, quality of life, and pain scores, as well as return to work metrics. Radiological assessments included were vertebral compression angle, Cobb and Gardner angles, sagittal vertical axis, pelvic incidence, and pelvic tilt. Statistical analyses were performed for the data provided by articles using the SPSS v24. Of 1,616 articles reviewed, 6 were included for final analysis. Only 1 study primarily addressed the effects of spinopelvic parameters and functional outcomes. Four studies correlated Cobb angles with functional outcome, while 3 others compared vertebral compression angles with functional outcomes. Outcomes were assessed using work status or a combination of VAS pain and spine score, ODI, SF-36, and RMDQ-24. Neither the analysis done within the articles, nor the one made with the raw data provided by them, showed a significant correlation between the radiological measurements assessed at time of injury and final functional outcomes. A correlation between the assessed spinal radiological measurements assessed with the functional outcomes of TLSF was not found in this review. Further well-designed prospective studies are necessary to evaluate spinal alignment measurements in TLSF with functional outcomes.

3D-CT reconstruction for pedicle outer width assessment in patients with thoracolumbar spine fractures: a comparative analysis between age groups

This study aims to compare the utilization of 3D-CT reconstruction in measuring pedicle outer width (POW) between younger/middle-aged patients (<60 years) and older patients (≥60 years) with thoracolumbar spine fractures (TSF). We conducted a retrospective study from January 2021 to December 2022, involving a total of 108 patients with TSF. The study population consisted of 62 patients aged ≥60 years (observation group) and 46 patients aged <60 years (control group). We compared the POW on both the right and left sides of the thoracolumbar spine between the two groups. Additionally, we analyzed the POW by gender within each group and calculated the incidence of patients falling below the critical values for arch root puncture (5 mm) and arch root nailing (7 mm) in both groups. There were no statistically significant differences observed in the POW between the two groups on both the left and right sides of each corresponding vertebra (P > 0.05). In the observation group, both male and female patients had significantly smaller POW compared to the control group (P < 0.05). However, no significant difference in POW was observed between the same-sex groups in the L4 to L5 vertebrae (P > 0.05). In the observation group, the POW was less than 5 mm in 9.33% (81/868) of cases and less than 7 mm in 49.88% (433/868) of cases, primarily observed from T11 to L3. In the control group, 4.81% (31/644) of cases had a POW of less than 5 mm, and 13.81% (88/644) had a POW of less than 7 mm. Utilizing preoperative 3D-CT reconstruction to measure POW in patients with TSF not only facilitates the assessment of surgical feasibility but also aids in surgical pathway planning, thus potentially reducing the incidence of postoperative complications.

Evaluation of minimally invasive percutaneous transpedicular screw fixation as an evolving modality for the treatment of thoracolumbar fractures

BackgroundPercutaneous transpedicular screw fixation was recently introduced as a minimally invasive approach for the treatment of thoracolumbar spine fracture. This approach is superior to the traditional open surgical approaches in decreasing intraoperative blood loss, infection rates, and paraspinal muscle damage with less hospital stay.ObjectiveThis study aims to report our surgical experience, the feasibility and safety of percutaneous transpedicular screw fixation of thoracolumbar spine fractures.Methodwe retrospectively reviewed the charts of all adult patients with thoracolumbar spine fractures who underwent percutaneous transpedicular screw fixation during the period between January 2020 to January 2023 at Ain Shams University Hospitals and Prince Mohamed Ibn Abdelaziz Hospital. Collected data included: demographics, pre- and postoperative neurological assessment, radiological data including type of fracture and cobb’s angle pre- and postoperatively, operative time and amount of intraoperative blood loss.ResultsForty-three percutaneous pedicle screw fixation procedures were done for 42 patients. Thirty patients were males. Dorsal spine fractures accounted for 18 cases. Preoperative American spinal injury Association score was E in 37 cases. Mean operative time was 133 min (± 46.5), and mean intraoperative blood loss was 107.1 ml (± 84). The mean follow-up period was 8 months, and the average hospital stay was 7.7 days. Radiological complete bony fusion was achieved in 77% of fractures, and 93% had improved kyphotic angle with a mean correction degree of 7.9 (± 9).ConclusionPercutaneous transpedicular screw fixation is a safe and effective treatment option for the management of thoracolumbar spine fractures with or without spine decompression that provides satisfactory functional outcomes.

Modified 5-Item Frailty Index: A Useful Tool for Assessing the Impact of Frailty on Postoperative Morbidity and Mortality Following Surgical Fixation of Thoracolumbar Fractures

The modified 5-item frailty index (mFI-5) is a comorbidity-based risk stratification tool to predict adverse events following various neurologic surgeries. This study aims to quantify the association between increased mFI-5 and postoperative complications and mortality following surgical fixation of traumatic thoracolumbar fractures. The 2011-2021 American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) dataset was used to identify patients undergoing fusion surgeries for thoracolumbar spine fractures. The mFI-5 score was calculated based on the presence of 5 major comorbidities: congestive heart failure within 30days before surgery, insulin-dependent or noninsulin-dependent diabetes mellitus, chronic obstructive pulmonary disease, partially dependent or totally dependent functional health status at the time of surgery, and hypertension requiring medication. Multivariate analysis assessed the independent impact of increasing mFI-5 scores on postoperative 30-day morbidity and mortality while controlling for baseline clinical characteristics. A total of 66,904 patients were included in our analysis (54.2% female, mean age 62.27±12.93years). On univariate analysis, higher mFI-5 score was significantly associated with increased risks of superficial surgical site infection, deep surgical site infection, wound dehiscence, unplanned reoperation, pneumonia, unplanned intubation, postoperative ventilator use, progressive renal insufficiency, acute renal failure, urinary tract infection, stroke, myocardial infarction, cardiac arrest, pulmonary embolism, deep vein thrombosis, bleeding requiring transfusion, sepsis, septic shock, and longer hospital length of stay (LOS). On multivariate logistic regression, increasing mFI-5 score versus a mFI-5 score of zero was associated with higher odds of overall complications (mFI-5 ≥2: odds ratio [OR] 1.38 CI: 1.24-1.54, P < 0.001; mFI-5=1: OR 1.18 CI: 1.11-1.24, P < 0.001) and 30-day mortality (mFI-5 ≥2: OR 2.33 CI: 1.60-3.38, P < 0.001). This study demonstrates that frailty, when measured using the mFI-5, independently predicts postoperative complications, hospital LOS, and 30-day mortality after surgical repair of thoracolumbar fractures. These findings are important for risk stratification in patients undergoing thoracolumbar fusion surgery and for standardization in reporting outcomes after those procedures.

Racial Disparities in Outcomes Following Surgical Fixation of Traumatic Thoracolumbar Fractures: A National Database Analysis

This study aims to assess race as an independent risk factor for postoperative complications after surgical fixation of traumatic thoracolumbar fractures for African American and Asian American patients compared with White patients. The 2011-2021 American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) dataset was used to identify patients undergoing fusion surgeries for thoracolumbar spine fractures. Patient comorbidity burden was assessed using a modified 5-item frailty index score (mFI-5). Chi-squared and ANOVA tests were used to compare baseline clinical characteristics between groups. Multivariate analysis was performed to compare African American and Asian American patients with White patients controlling for age, BMI, and American Society of Anesthesiologists (ASA) score. African American patients experienced longer operative times compared to Asian American and White patients (3.74±1.87hours vs. 3.04±1.71hours and 3.48±1.81hours, P < 0.001). African American and Asian American patients demonstrated higher comorbidity burden with mFI-5>2 compared to White patients (30.7% and 25.6% vs. 19.9%, P < 0.001). African American and Asian American patients had a higher risk of postoperative complications than White patients (22.4% and 20% vs. 19.7%, P < 0.001). African American race was an independent risk factor of postoperative 30-day morbidity (OR 1.19, CI 1.11-1.28, P < 0.001). African American and Asian American patients undergoing thoracolumbar fusion surgeries exhibit disproportionate comorbidity burden, longer LOS, and greater postoperative complications compared with White patients. Furthermore, the African American race was associated with an increased rate of 30-day postoperative complications.

The Impact of Specialized Nursing Care at Fracture Sites Coordinated with Disease Progression Monitoring in Thoracolumbar Spine Fractures

This study aims to investigate the impact of specialized nursing care at fracture sites coordinated with disease progression monitoring in thoracolumbar spine fractures. Patients diagnosed with definitive thoracolumbar spine fractures and underwent surgical treatment at our hospital between February 2022 and August 2023 were selected. Patients were divided into a treatment group (specialized nursing care at fracture sites coordinated with disease progression monitoring)and a control group (conventional care) based on different nursing methods. A comparative assessment was conducted to evaluate the role and significance of specialized nursing care at fracture sites coordinated with disease progression monitoring in thoracolumbar spine fracture rehabilitation. The results showed that compared to conventional care, specialized nursing care at fracture sites coordinated with disease progression monitoring could better promote the recovery of patients' neurological functions, alleviate pain, and effectively improve symptoms and functional recovery, thus enhancing patients' quality of life and satisfaction. The study confirms the effectiveness of specialized nursing care at fracture sites coordinated with disease progression monitoring in clinical practice post thoracolumbar spine fractures.

Progress in the Treatment of Thoracolumbar Spinal Fractures with Internal Fixation of Injured Vertebrae with Screws

Progress in the Treatment of Thoracolumbar Spinal Fractures with Internal Fixation of Injured Vertebrae with Screws

Time to Mobility Is Associated With Pulmonary Complications in Patients With Spine Fractures.

Treatment of spine fractures may require periods of prolonged immobilization which prevents effective pulmonary toileting. We hypothesized that patients with longer time to mobilization, as measured by time to first physical therapy (PT) session, would have higher pulmonary complications. We performed a retrospective review of all trauma patients with cervical and thoracolumbar spinal fractures admitted to a level 1 trauma center over a 12-month period. Demographic data collection included age, gender, BMI, pulmonary comorbidities, concomitant rib fractures, admission GCS, Injury Severity Score (ISS), GCS at 24h, treatment with cervical or thoracolumbar immobilization, and time to first PT evaluation. The primary outcome was the presence of any one of the following complications: unplanned intubation, pneumonia, or mortality at 30days. Multivariable logistic regression analysis was used to assess significant predictors of pulmonary complication. In total, 491 patients were identified. In terms of overall pulmonary complications, 10% developed pneumonia, 13% had unplanned intubation, and 6% died within 30days. In total, 19% developed one or more complication. Overall, 25% of patients were seen by PT <48h, 33% between 48 and 96h, 19% at 96h to 1week, and 7% > 1week. Multivariable logistic regression analysis showed that time to PT session (OR 1.010, 95% CI 1.005-1.016) and ISS (OR 1.063, 95% CI 1.026-1.102) were independently associated with pulmonary complication. Time to mobility is independently associated with pulmonary complications in patients with spine fractures.

Radiological and Clinical Outcome of Thoracolumbar Burst Fracture Following Short Segment and Long Segment Pedicle Screw Fixation

INTRODUCTION: The indications for operative treatment and type of stabilization procedures for the treatment of thoracolumbar fracture remains controversial. Long-segment pedicle screw fixation permits correction of kyphotic deformity while short-segment pedicle screw fixation preserves motion segments, reduces costs and time of surgery. Our aim is to study the correlation and comparison between clinical and radiological outcome of both fixations and identify factors that might contribute to the outcome. MATERIALS AND METHODS: 60 patients with thoracolumbar spine fracture from 2017 to 2022 were identified. Age, gender, mechanism of injury, classification of fracture, duration of hospital stays and one-year post-operative outcome of Visual Analogue (VAS) pain score, and Oswestry Disability Index (ODI) score were documented. Pre- and post-operative AP/Lateral radiographs measurements of local kyphotic angle, Cobb angle were measured. Signs of fixation failure were examined at follow-up. RESULTS: Subjects mean age is 42.4, male predominance (85%) and work-related. The highest incidence was at level of L1 (56.7 %) in the long-segment and 46.7 % in short-segment. Most common injury was burst fracture (AO classification A3 A4 group) due to fall from height. There is shorter hospital stay documented in the short-segment fixation. Radiological outcome measured in both groups were comparable with no signs of fixation failure. Short-segment fixation group also resulted in better clinical and functional outcome at one-year follow-up. CONCLUSION: There is no significant difference in radiologic outcome of Cobb and kyphotic angle in both fixation groups. Short-segment fixation has significantly better clinical and functional outcome post-operative and at 1-year follow up.

373 Modified 5-Item Frailty Index: A Useful Tool for Assessing the Impact of Frailty on Postoperative Morbidity and Mortality Following Surgical Fixation of Thoracolumbar Fractures

INTRODUCTION: The modified 5-item frailty index (mFI-5) is a comorbidity-based risk stratification tool that has been shown to predict adverse events following various neurological surgeries. METHODS: The 2011-2021 American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) dataset was used to identify patients undergoing fusion surgeries for thoracolumbar spine fractures. The mFI-5 score was calculated based on the presence of the 5 comorbidities: congestive heart failure, diabetes mellitus, chronic obstructive pulmonary disease, partially dependent or totally dependent functional health status, and hypertension. Multivariate analysis was used to assess the independent impact of increasing mFI-5 score on postoperative 30-day morbidity and mortality while controlling for baseline clinical characteristics. RESULTS: A total of 66,904 patients were included in our analysis (54.2% female, mean age 62.27 ± 12.93 years). On univariate analysis, higher mFI-5 score was significantly associated with increased risks of superficial surgical site infection(SSI), deep SSI, wound dehiscence, unplanned reoperation, pneumonia, unplanned intubation, postoperative ventilator use, progressive renal insufficiency, acute renal failure, urinary tract infection, stroke, myocardial infarction, cardiac arrest, pulmonary embolism, deep vein thrombosis, bleeding requiring transfusion, sepsis, septic shock, and longer hospital length of stay (LOS). On multivariate logistic regression, increasing mFI-5 score versus mFI-5 = 0 was associated with higher odds of overall complications (mFI-5 =2: odds ratio [OR] 1.44 CI: 1.35–1.52, p &lt; 0.001; mFI-5 = 1: OR 1.18 CI: 1.12–1.24, p &lt; 0.001) and 30-day mortality (mFI-5 =2: OR 2.32 CI: 1.60–3.37, p &lt; 0.001). CONCLUSIONS: This study demonstrates that frailty, when measured using the mFI-5, independently predicts postoperative complications, hospital LOS, and 30-day mortality after surgical repair of thoracolumbar fractures. These findings are important for risk stratification in patients undergoing thoracolumbar fusion surgery and for standardization in reporting outcomes after those procedures.

Comparative Outcomes of Percutaneous and Conventional Open Pedicle Screw Fixation for Single-level Thoracolumbar Spine Injury: Randomised Controlled Trial.

To compare post-operative outcomes of percutaneous pedicle screw fixation (PPSF) vs open pedicle screw fixation (OPSF) in patients with thoracolumbar spine fractures with no neurological deficits. In a randomised controlled trial, patients received short-segment fixation with intermediate screws. We assessed post-operative back pain (Visual Analog Scale or VAS), blood loss, operative/fluoroscopy times, radiographic parameters, and oswestry disability index (ODI) scores at 1, 2, 3, 6, 9, and 12 months. Between January 2018 and October 2019, 31 patients received PPSF and 30 OPSF. Mean intra-operative blood loss was 66.45 (±44.29) ml for PPSF vs 184.83 (±128.36) ml for OPSF (p<0.001). Fluoroscopy time averaged 2.36 (±0.76) minutes for PPSF vs 0.58 (±0.51) minutes for OPSF (p<0.001). No significant differences existed in operative time or post-operative VAS scores. Radiographic parameters (kyphosis angle and vertebral height ratios) didn't significantly differ post-operatively or at 12 months. However, ODI scores differed significantly at 6 months (p=0.025), with no difference at 12 months. In this trial, PPSF was comparable to OPSF in improving ODI scores at 12 months but showed earlier improvement at 6 months and reduced blood loss. Radiographic outcomes remained similar between groups over 12 months.

Percutaneous Pedicle Screw for Thoracolumbar Fractures: A Long-term Follow-up.

Objective: This is a retrospective cohort study to analyze the long-term outcomes of thoracolumbar spine fracture patients who underwent minimally invasive percutaneous fixation. Methods: The cases of 17 patients with thoracolumbar spine fractures who had percutaneous fixation between 2009 and 2011 were the subject of a retrospective analysis. Clinical and radiographic variables were collected. For the clinical evaluation the questionnaires SF-36 and Oswestry were used. Radiographic parameters were evaluated using fracture's classification based on Magerls's criteria, the fractured vertebra's wedging angle, and the affected segment's segmental Cobb angle. The measures were made at different stages: before surgery, immediately after surgery, one year later, and at a late follow-up (5 years later). Trauma associated injuries, post-surgical and implant related complications were among the additional information taken into account. Results: The SF-36 questionnaire showed averages above 63,5% in all domains in the late postoperative data (from 5 years after the surgery). Oswestry questionnaire answers showed minimal or no physical limitations in 80% of the patients with a mean score of 10,8%±10,5. The average preoperative Cobb angle value was 5,53° ± 13,80° of kyphosis, the immediate postoperative 2,18° ± 13,38° of kyphosis, one year postoperative 5,26 ± 13,95° of kyphosis, and the late follow-up 8,78° ± 15,06° of kyphosis. The mean correction was 3,35°, and mean loss of correction was 6,6°. There were no complications observed, no case of neurological deficit, infection or implant failure occurred. Conclusion: Thoracolumbar vertebrae fractures can be surgically treated with positive late clinical and radiological outcomes and low complication rates using a minimally invasive percutaneous method.

Evaluating somatosensory evoked potentials in predicting treatment outcomes for thoracolumbar spinal compression fractures using closed reduction and over-extension techniques.

To evaluate the predictive value of somatosensory evoked potentials (SEPs) for the efficacy of closed reduction combined with over-extension reduction technique (PVP) in managing thoracolumbar spinal compression fractures. Data were collected from 125 patients who underwent closed reduction with PVP and SEP monitoring from February 2021 to July 2023. We evaluated surgery success rates, incidence of bone cement leakage, and patient recovery outcomes including vertebral anterior height, Oswestry Disability Index (ODI), and Cobb angle restoration. SEP results were analyzed to categorize patients into effective and ineffective treatment groups. Differences in SEP waveforms between these groups were examined, and ROC analysis was used to assess the predictive value of these differences. Multivariate logistic regression was employed to identify risk factors affecting treatment efficacy. Post-treatment assessments showed significant improvements in vertebral anterior height, ODI, and Cobb angle. SEP monitoring correlated well with intraoperative findings and physical examinations. During reduction, changes in SEP latency and amplitude were noted in 37 patients, with 7 patients meeting SEP amplitude alarm criteria, which normalized after adjustments. During PVP, 28 patients exhibited SEP amplitude fluctuations and 5 experienced a 30% reduction in amplitude following initial cement injection, with no significant latency changes. Treatment was deemed effective in 93 patients and ineffective in 32. SEP amplitudes during vertebral compression and PVP were significantly lower in the effective group (P<0.05). The AUC for predicting treatment efficacy was 0.819 and 0.859, respectively. Multivariate analysis revealed low preoperative vertebral compression ratio, number of fractures, and abnormal SEP amplitudes as independent risk factors for treatment outcomes. SEP monitoring provides an accurate reflection of spinal cord function during closed reduction with PVP, aiding in predicting treatment safety and efficacy. The use of SEP monitoring is thus recommended for clinical application in this context.

Traumatic multiple-level continuous and noncontinuous thoracolumbar spinal fractures management in adult patients: A single-center experience.

This study aimed to describe our clinical experience with surgical approaches and patient management for traumatic multiple-level continuous and noncontinuous thoracolumbar spinal fractures. We retrospectively evaluated patients with continuous and noncontinuous multiple-level thoracolumbar fractures who were operated on by the same surgical team from 2019 to 2021. These patients were divided into two groups: Group 1 (n=12, continuous fractures) and Group 2 (n=14, noncontinuous fractures). We assessed the patients' age, gender, fracture levels, fracture type, classification according to the AO (Arbeitsgemeinschaft für Osteosynthesefragen) Spine Thoracolumbar Fracture Classification, status of posterior ligament damage, presence of additional traumatic pathology, status of decompression via laminectomy, levels of stabilization and fusion, preoperative and postoperative neurological status, presence of cervical trauma, duration of operation, amount of blood loss, duration of hospitalization, and lordosis and kyphosis angles in terms of fusion status and postoperative follow-up over two years. The study excluded patients over the age of 65, those with single-level fractures, and pathological fractures caused by osteoporosis, infection, or spinal tumors. Gender, age, neurological status, application of laminectomy, surgical complications, status of cervical fracture, duration of operation, amount of blood loss, duration of hospitalization, lordosis, and kyphosis angles were uniformly distributed between the groups. All patients underwent fusions, ranging from three to eight, with a median of two (range 2-4) fracture levels, and a median of five instrumented vertebrae, ranging from four to seven. Significant differences between the two groups were observed in terms of operation duration (p=0.001), blood loss (p=0.010), duration of hospitalization (p=0.003), number of fusions (p<0.001), and instrumented vertebral segments (p=0.011). Thus, a surgical approach involving decompression, vertebral fusion screws, allografts, and bone substitutes can enhance surgical outcomes for patients with continuous and noncontinuous vertebral fractures.

Short segment posterior fixation of unstable thoracolumbar vertebral fractures with fractured vertebra augmentation with intermediate pedicle screw - a clinicoradiological analysis.

Unstable thoracolumbar burst fractures are routinely encountered in orthopedic practice. Recently, short-segment fixation with pedicle screw augmentation of the fractured vertebra for unstable thoracolumbar burst fractures has gained popularity. Nonetheless, the maintenance of the kyphotic correction during the follow-up period remains controversial. This study aimed to examine the clinical-radiological outcomes, complications, and functional outcomes of fractured vertebrae augmentation with intermediate pedicle screws in short-segment instrumentation in acute thoracolumbar spine fractures. This retrospective study was conducted in the Department of Orthopedics, All India Institute of Medical Sciences, Jodhpur, using medical records from January 2021 to October 2022. Parameters such as local kyphosis correction, loss of kyphotic correction at final follow-up, anterior body height correction (%), and loss of correction (%) at final follow-up were measured as primary outcomes. Various other parameters such as operative time, blood loss, length of hospital stay, and visual analog scale were measured as secondary outcomes. The mean correction obtained via surgery in the immediate postoperative period was 13.7±2.3 degrees. The mean loss of correction at the final follow-up was 4.1±2.0 degrees, and the mean final local kyphotic angle was 7.2±2.4 degrees (P<0.05). The mean correction obtained via surgery in the immediate postoperative period was 37.2%±9.0%. The mean loss of correction at the final follow-up was 10.5%±5.3%, and the mean final anterior vertebral body height maintained was 72%±11.0% (P<0.05). Short-segment posterior fixation with pedicle screw augmentation achieves good correction of local kyphotic angle and anterior vertebral height in the immediate postoperative period, but some loss of correction at final follow-up is common. In our study, the loss of correction corresponded directly to the load-sharing score.