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Risk factors for kyphosis recurrence after implant removal in percutaneous osteosynthesis for post-traumatic thoracolumbar fracture

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Abstract

Purpose

Short-segment minimally invasive percutaneous spinal osteosynthesis has now become one of the treatments of choice to treat thoracolumbar fractures. The question of implant removal once the fracture has healed is still a matter of debate since this procedure can be associated with loss of sagittal correction. Therefore, we analyzed risk factors for kyphosis recurrence after spinal implants removal in patients treated with short-segment minimally invasive percutaneous spinal instrumentation for a thoracolumbar fracture.

Methods

A total of 32 patients who underwent implant removal in percutaneous osteosynthesis for post-traumatic thoracolumbar fracture were enrolled in our study. Patient’s medical record, operative report and imaging examinations carried out at the trauma and during the follow-up were analyzed.

Results

Every patient experienced fracture union. Vertebral kyphotic angle (VKA) and Cobb angle (CA) improved significantly after stabilization surgery. VKA, CA, upper disk kyphotic angle (UDKA) and lower disk kyphotic angle (LDKA) significantly gradually decreased during follow-up. Traumatic disk injury (p: 0.001), younger age (p: 0.01), canal compromise (p: 0.04) and importance of surgical correction (p < 0.001) were significantly associated with kyphosis recurrence after implant removal. Anterior body augmentation did not affect loss of correction (CA and VKA) during the follow-up period (p: 0.57).

Conclusion

Despite correction of the fracture after stabilization, we observed a progressive loss of correction over time appearing even before implant removal. Particular attention should be paid to post-traumatic disk damage or canal invasion, to young patients and to surgical overcorrection of the traumatic kyphosis.

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Availability of data and material

Dr. LAINE had full access to all the data in the study and takes responsibility for the integrity of the data. Data are available on request to the corresponding author.

Code availability

N/A.

Abbreviations

BMI:

Body mass index

CA:

Cobb angle

CT:

Computed tomography

LDKA:

Lower disk kyphosis angle

MRI:

Magnetic resonance imaging

PACS:

Picture archiving and communication system

TDI:

Traumatic disk injury

TPLI:

Traumatic posterior ligamentous injury

SCDR:

Sagittal canal diameter ratio

STIR:

Short T1 inversion recovery

UDKA:

Upper disk kyphosis angle

VKA:

Vertebral kyphotic angle

VBTP:

Vertebral body translation percentage

References

  1. Danison AP, Lee DJ, Panchal RR (2017) Temporary stabilization of unstable spine fractures. Curr Rev Musculoskelet Med 10:199–206. https://doi.org/10.1007/s12178-017-9402-y

    Article  PubMed  PubMed Central  Google Scholar 

  2. Aono H et al (2017) Temporary short-segment pedicle screw fixation for thoracolumbar burst fractures: comparative study with or without vertebroplasty. Spine J. https://doi.org/10.1016/j.spinee.2017.03.022

    Article  PubMed  Google Scholar 

  3. Lorente R, Palacios P, Vaccaro A, Mariscal G, Diamantopoulus J, Lorente A (2021) Safety and utility of implant removal after percutaneous osteosynthesis of type A thoracolumbar and lumbar fracture. Orthop Traumatol Surg Res 107(7):102740. https://doi.org/10.1016/j.otsr.2020.08.013

    Article  PubMed  Google Scholar 

  4. Jentzsch T, Gomes de Lima V, Seifert B et al (2016) The benefits of elective spinal implant removal: a retrospective study of 137 patients. Eur Spine J 25:856–864. https://doi.org/10.1007/s00586-015-4211-8

    Article  PubMed  Google Scholar 

  5. Kweh BTS, Tan T, Lee HQ et al (2022) Implant removal versus implant retention following posterior surgical stabilization of thoracolumbar burst fractures: a systematic review and meta-analysis. Glob Spine J 12:700–718. https://doi.org/10.1177/21925682211005411

    Article  Google Scholar 

  6. Hanson B, van der Werken C, Stengel D (2008) Surgeons’ beliefs and perceptions about removal of orthopaedic implants. BMC Musculoskelet Disord 24(9):73. https://doi.org/10.1186/1471-2474-9-73

    Article  Google Scholar 

  7. Waelchli B, Min K, Cathrein P, Boos N (2002) Vertebral body compression fracture after removal of pedicle screws: a report of two cases. Eur Spine J 11:504–506. https://doi.org/10.1007/s00586-002-0417-7

    Article  PubMed  PubMed Central  Google Scholar 

  8. Potter BK, Kirk KL, Shah SA, Kuklo TR (2006) Loss of coronal correction following instrumentation removal in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 31(1):67–72. https://doi.org/10.1097/01.brs.0000192721.51511.fe

    Article  PubMed  Google Scholar 

  9. Deckey JE, Court C, Bradford DS (2000) Loss of sagittal plane correction after removal of spinal implants. Spine (Phila Pa 1976) 25(19):2453–2460. https://doi.org/10.1097/00007632-200010010-00006

    Article  CAS  PubMed  Google Scholar 

  10. Choi W, Song S, Chae S et al (2017) Comparison of the extent of degeneration among the normal disc, immobilized disc, and immobilized disc with an endplate fracture. Clin Orthop Surg 9:193–199

    Article  PubMed  PubMed Central  Google Scholar 

  11. Aono H, Ishii K, Takenaka S et al (2019) Risk factors for a kyphosis recurrence after short-segment temporary posterior fixation for thoracolumbar burst fractures. J Clin Neurosci 66:138–143. https://doi.org/10.1016/j.jocn.2019.04.035

    Article  PubMed  Google Scholar 

  12. Verheyden AP et al (2018) Treatment of fractures of the thoracolumbar spine: recommendations of the spine section of the German society for orthopaedics and trauma (DGOU). Glob Spine J 8(2 suppl):34S-45S

    Article  Google Scholar 

  13. Vaccaro AR, Oner C, Kepler CK et al (2013) AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine 38:2028–2037. https://doi.org/10.1097/BRS.0b013e3182a8a381

    Article  PubMed  Google Scholar 

  14. Keynan O, Fisher CG, Vaccaro A, Fehlings MG, Oner FC, Dietz J, Kwon B, Rampersaud R, Bono C, France J, Dvorak M (2006) Radiographic measurement parameters in thoracolumbar fractures: a systematic review and consensus statement of the spine trauma study group. Spine (Phila Pa 1976) 31(5):E156–E165. https://doi.org/10.1097/01.brs.0000201261.94907.0d

    Article  PubMed  Google Scholar 

  15. Diniz JM, Botelho RV (2017) Is fusion necessary for thoracolumbar burst fracture treated with spinal fixation? A systematic review and meta-analysis. J Neurosurg Spine 27(5):584–592. https://doi.org/10.3171/2017.1.SPINE161014

    Article  PubMed  Google Scholar 

  16. Chou P-H, Ma H-L, Liu C-L et al (2016) Is removal of the implants needed after fixation of burst fractures of the thoracolumbar and lumbar spine without fusion?: a retrospective evaluation of radiological and functional outcomes. Bone Jt J 98-B:109–116. https://doi.org/10.1302/0301-620X.98B1.35832

    Article  Google Scholar 

  17. Chen J-X, Xu D-L, Sheng S-R et al (2016) Risk factors of kyphosis recurrence after implant removal in thoracolumbar burst fractures following posterior short-segment fixation. Int Orthop 40:1253–1260. https://doi.org/10.1007/s00264-016-3180-9

    Article  PubMed  Google Scholar 

  18. Kuklo TR, Polly DW, Owens BD, Zeidman SM, Chang AS, Klemme WR (2001) Measurement of thoracic and lumbar fracture kyphosis: evaluation of intraobserver, interobserver, and technique variability. Spine (Phila Pa 1976) 26:61–65

    Article  CAS  PubMed  Google Scholar 

  19. Radcliff K, Su BW, Kepler CK, Rubin T, Shimer AL, Rihn JA, Harrop JA, Albert TJ, Vaccaro AR (2012) Correlation of posterior ligamentous complex injury and neurological injury to loss of vertebral body height, kyphosis, and canal compromise. Spine (Phila Pa 1976) 37(13):1142–1150

    Article  PubMed  Google Scholar 

  20. Hiyama A, Watanabe M, Katoh H, Sato M, Nagai T, Mochida J (2015) Relationships between posterior ligamentous complex injury and radiographic parameters in patients with thoracolumbar burst fractures. Injury 46(2):392–398

    Article  PubMed  Google Scholar 

  21. Wang XY, Dai LY, Xu HZ, Chi YL (2008) Kyphosis recurrence after posterior short-segment fixation in thoracolumbar burst fractures. J Neurosurg Spine 8:246–254

    Article  PubMed  Google Scholar 

  22. Sander AL, Lehnert T, El Saman A, Eichler K, Marzi I, Laurer H (2014) Outcome of traumatic intervertebral disk lesions after stabilization by internal fixator. AJR Am J Roentgenol 203:140–145

    Article  PubMed  Google Scholar 

  23. Kerttula LI, Serlo WS, Tervonen OA, Paakko EL, Vanharanta HV (2000) Post-traumatic findings of the spine after earlier vertebral fracture in young patients: clinical and MRI study. Spine (Phila Pa 1976) 1 25(9):1104–1108

    Article  CAS  Google Scholar 

  24. Pellise F, Barastegui D, Hernandez-Fernandez A, Barrera-Ochoa S, Bago J, Issa- Benitez D et al (2015) Viability and long-term survival of short-segment posterior fixation in thoracolumbar burst fractures. Spine J: Off J North Am Spine Soc 15:1796–1803

    Article  Google Scholar 

  25. Pizones J, Izquierdo E, Alvarez P et al (2011) Impact of magnetic resonance imaging on decision making for thoracolumbar traumatic fracture diagnosis and treatment. Eur Spine J 20:390–396. https://doi.org/10.1007/s00586-011-1913-4

    Article  PubMed  PubMed Central  Google Scholar 

  26. Oner FC, van der Rijt RH, Ramos LM, Groen GJ, Dhert WJ, Verbout AJ (1999) Correlation of MR images of disc injuries with anatomic sections in experimental thoracolumbar spine fractures. Eur Spine J 8:194–198

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Valdovino AG, Bastrom TP, Reighard FG, Cross M, Bartley CE, Shah SA, Yaszay B, Newton PO, Upasani VV (2019) Obesity is associated with increased thoracic kyphosis in adolescent idiopathic scoliosis patients and nonscoliotic adolescents. Spine Deform 7(6):865–869. https://doi.org/10.1016/j.jspd.2019.03.010

    Article  PubMed  Google Scholar 

  28. Formica M, Cavagnaro L, Basso M, Zanirato A, Felli L, Formica C, Di Martino A (2016) Which patients risk segmental kyphosis after short segment thoracolumbar fracture fixation with intermediate screws? Injury 47(Suppl 4):S29–S34. https://doi.org/10.1016/j.injury.2016.07.048

    Article  PubMed  Google Scholar 

  29. Verlaan JJ, Dhert WJ, Verbout AJ, Oner FC (2005) Balloon vertebroplasty in combination with pedicle screw instrumentation: a novel technique to treat thoracic and lumbar burst fractures. Spine (Phila Pa 1976) 30:E73–E79

    Article  PubMed  Google Scholar 

  30. Marco RA, Meyer BC, Kushwaha VP (2010) Thoracolumbar burst fractures treated with posterior decompression and pedicle screw instrumentation supplemented with balloon-assisted vertebroplasty and calcium phosphate reconstruction: surgical technique. J Bone Jt Surg Am 92:S67-76

    Article  Google Scholar 

  31. Toyone T, Tanaka T, Kato D et al (2006) The treatment of acute thoracolumbar burst fractures with transpedicular intracorporeal hydroxyapatite grafting following indirect reduction and pedicle screw fixation: a prospective study. Spine (Phila Pa 1976) 31:E208–E214

    Article  PubMed  Google Scholar 

  32. Smits AJ, den Ouden L, Jonkergouw A et al (2017) Posterior implant removal in patients with thoracolumbar spine fractures: long-term results. Eur Spine J 26:1525–1534. https://doi.org/10.1007/s00586-016-4883-8

    Article  CAS  PubMed  Google Scholar 

  33. Oh H-S, Seo H-Y (2019) Percutaneous pedicle screw fixation in thoracolumbar fractures: comparison of results according to implant removal time. Clin Orthop Surg 11:291. https://doi.org/10.4055/cios.2019.11.3.291

    Article  PubMed  PubMed Central  Google Scholar 

  34. Kim HS, Kim SW, Ju CI, Wang HS, Lee SM, Kim DM (2014) Implant removal after percutaneous short segment fixation for thoracolumbar burst fracture: does it preserve motion? J Korean Neurosurg Soc 55(2):73–77. https://doi.org/10.3340/jkns.2014.55.2.73

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Neurosurgery, Polyclinique Pau Pyrénées, 8 Boulevard Hauterive, 64000, Pau, France

    G. Lainé

  2. Department of Neurosurgery, Hopital Central, Centre Hospitalier Région Universitaire de Nancy, 29 Avenue Maréchal de Lattre de Tassigny, 54000, Nancy, France

    I. Mezjan, D. Masson, T. Civit & N. Mansouri

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  1. G. Lainé
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Correspondence to G. Lainé.

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All authors declare: no support from any organization for this study; no financial relationships with any organizations that might have an interest in the submitted work.

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The study complied with French legislation, and the patients did not object to the use of their data after being informed.

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This study has not been published before; it is not under consideration for publication anywhere else; its publication has been approved by all co-authors, and at the institute, where the work has been carried out.

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Lainé, G., Mezjan, I., Masson, D. et al. Risk factors for kyphosis recurrence after implant removal in percutaneous osteosynthesis for post-traumatic thoracolumbar fracture. Eur Spine J 33, 1597–1606 (2024). https://doi.org/10.1007/s00586-023-07895-y

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