Skip to main content
SpringerLink
Log in

Does kyphotic deformity correlate with functional outcomes in fractures at the thoracolumbar junction treated by 360° instrumented fusion?

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Sagittal balance and its relationship with back pain and functional outcomes has become an important factor in the management of thoracolumbar fractures. The kyphosis threshold at the thoracolumbar junction (TLJ) that produces a significant functional impairment remains unclear. Ninety-four patients who were treated surgically for TLJ fractures were evaluated after a follow-up period of 2–10 years. Functional evaluation based on the Oswestry and Hannover Scores (HS) was performed. Additionally, such patients underwent clinical and radiological evaluation. A significant inversely proportional correlation between the HS and the degrees of local kyphosis (“K-Angle”) (p = 0.0172) was found. A significant directly proportional correlation between Oswestry Score and “K-Angle” (p = 0.0142) was found. Significantly poorer scores with both measurement tools (Hannover and Oswestry Scores) were found in patients with a kyphosis higher than 12°.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Alanay A, Acaroglu E, Yazici M et al (2001) Short-segment pedicle instrumentation of thoracolumbar burst fractures: does transpedicular intracorporeal grafting prevent early failure? Spine 26:213–217

    Article  CAS  PubMed  Google Scholar 

  2. Knop C, Fabian H, Bastian L et al (2001) Late results of thoracolumbar fractures after posterior instrumentation and transpedicular bone grafting. Spine 26:88–99

    Article  CAS  PubMed  Google Scholar 

  3. McCormack T, Karaikovic E, Gaines RW (1994) The load-sharing classification of spine fractures. Spine 19:1741–1744

    Article  CAS  PubMed  Google Scholar 

  4. McLain RF, Sparling E, Benson DR (1993) Early failure of short-segment pedicle instrumentation for thoracolumbar fractures. A preliminary report. J Bone Jt Surg (Am) 75-A:162–167

    Google Scholar 

  5. McLain R (2004) Functional outcome after surgery for spinal fractures: return to work and activity. Spine 29:470–477

    Article  PubMed  Google Scholar 

  6. Alanay A, Yazici M, Acaroglu E et al (2004) Course of nonsurgical management of burst fractures with intact posterior ligamentous complex: an MRI study. Spine 29:2425–2431

    Article  PubMed  Google Scholar 

  7. Cantor JB, Lebwohl NH, Garvey T et al (1993) Nonoperative management of stable thoracolumbar burst fractures with early ambulation and bracing. Spine 18:971–976

    Article  CAS  PubMed  Google Scholar 

  8. Chow GH, Nelson BJ, Gebhard JS et al (1996) Functional outcome of thoracolumbar burst fractures managed with hyperextension casting or bracing and early mobilization. Spine 21:2170–2174

    Article  CAS  PubMed  Google Scholar 

  9. Gertzbein S (1992) Scoliosis research society: multicenter spine fracture study. Spine 17:528–540

    Article  CAS  PubMed  Google Scholar 

  10. Tropiano P, Huang R, Louis C et al (2003) Functional and radiographic outcome of thoracolumbar and lumbar burst fractures managed by closed orthopaedic reduction and casting. Spine 28:2459–2465

    Article  PubMed  Google Scholar 

  11. Wood K, Butterman G, Mehbod A et al (2003) Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit. J Bone Jt Surg (Am) 85-A:773–781

    CAS  Google Scholar 

  12. Knop C, Oeser M, Bastian L et al (2001) Entwicklung und Validierung des VAS-Wirbelsäulenscores. Unfallchirurg 104:488–497

    Article  CAS  PubMed  Google Scholar 

  13. Fairbank JCT, Pynsent PB (2000) The Oswestry Disability Index. Spine 25:2940–2953

    Article  CAS  PubMed  Google Scholar 

  14. Kuklo T, Polly D, Owens B et al (2001) Measurements of thoracic and lumbar fracture kyphosis: evaluation of intraobserver, interobserver, and technique variability. Spine 26:61–66

    Article  CAS  PubMed  Google Scholar 

  15. Magerl F, Aebi M, Gertzbein S et al (1994) A comprehensive classification of thoracic and lumbar injuries. Eur Spine J 3:184–201

    Article  CAS  PubMed  Google Scholar 

  16. Lazennec JY, Ramare S, Arafati N et al (2000) Sagittal alignment in lumbosacral fusion: relations between radiological parameters and pain. Eur Spine J 9:47–55

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Roussouly P, Gollogly S, Berthonnaud E et al (2005) Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine 30:346–353

    Article  PubMed  Google Scholar 

  18. Vialle R, Levassor N, Rillardon L et al (2005) Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. J Bone Jt Surg (Am) 87-A:260–267

    Article  Google Scholar 

  19. Koller H, Acosta F, Hempfing A et al (2008) Long-term investigation of nonsurgical treatment for thoracolumbar and lumbar burst fractures: an outcome analysis in sight of spinopelvic balance. Eur Spine J 17:1073–1095

    Article  PubMed Central  PubMed  Google Scholar 

  20. Stolze D, Harms J (1999) Correction of traumatic deformities. Principles and techniques. Der Orthopäde 28:731–745

    Google Scholar 

  21. Jackson RP, Hales C (2000) Congruent spinopelvic alignment on standing lateral radiographs of adult volunteers. Spine 25:2808–2815

    Article  CAS  PubMed  Google Scholar 

  22. Jackson RP, Kanemura T, Kawakami N et al (2000) Lumbopelvic lordosis and pelvic balance on repeated standing lateral radiographs of adult volunteers and untreated patients with constant low back pain. Spine 25:575–586

    Article  CAS  PubMed  Google Scholar 

  23. Barrey C, Jund J, Noseda O et al (2007) Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases. Eur Spine J 16:1459–1467

    Article  PubMed Central  PubMed  Google Scholar 

  24. Kumar MN, Baklanov A, Chopin D (2001) Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion. Eur Spine J 10:314–319

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  25. Oda I, Cunningham B, Buckley R et al (1999) Does spinal kyphotic deformity influence the biomechanichal characteristics of the adjacent motion segments? An in vivo animal model. Spine 24:2139–2146

    Article  CAS  PubMed  Google Scholar 

  26. Glassman SD, Bridwell K, Dimar JR et al (2005) The impact of positive sagittal balance in adult spinal deformity. Spine 30:2024–2029

    Article  PubMed  Google Scholar 

  27. Folman Y, Gepstein R (2003) Late outcome of nonoperative management of thoracolumbar vertebral wedge fractures. J Orthop Trauma 17:190–192

    Article  PubMed  Google Scholar 

  28. Oner FC, van Gils APG, Faber JAJ et al (2002) Some complications of common treatment schemes of thoracolumbar spine fractures can be predicted with magnetic resonance imaging. Spine 27:629–636

    Article  CAS  PubMed  Google Scholar 

  29. Mumford J, Weinstein JN, Spratt KF et al (1993) Thoracolumbar burst fractures: the clinical efficacy and outcome of nonoperative management. Spine 18:955–970

    Article  CAS  PubMed  Google Scholar 

  30. Sanderson PL, Fraser RD, Hall DJ et al (1999) Short segment fixation of thoracolumbar burst fractures without fusion. Eur Spine J 8:495–500

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  31. Siebenga J, Leferink VJ, Segers MJ et al (2006) Treatment of traumatic thoracolumbar spine fractures: a multicenter prospective randomized study of operative versus nonsurgical treatment. Spine 31:2881–2890

    Article  PubMed  Google Scholar 

  32. Wood KB, Bohn D, Mehbod A (2005) Anterior versus posterior treatment of stable thoracolumbar burst fractures without neurologic deficit: a prospective, randomized study. J Spinal Disord Tech 18(Suppl):S15–S23

    Article  PubMed  Google Scholar 

  33. Korovessis P, Baikousis A, Zacharatos S et al (2006) Combined anterior plus posterior stabilization versus posterior short-segment instrumentation and fusion for mid-lumbar (L2–L4) burst fractures. Spine 31:859–868

    Article  PubMed  Google Scholar 

  34. Briem D, Lehmann W, Ruecker AH et al (2004) Factors influencing the quality of life after burst fractures of the thoracolumbar transition. Arch Orthop Trauma Surg 124:461–468

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

The corresponding author developed this study in the frame of a research fellowship supported by an academic institution without relationship with the biomedical or pharmacological industry (Deutscher Akademischer Austauschdienst). No other financial support, direct or indirect, was received by any of the authors.

Author information

Authors and Affiliations

  1. Hospital Clínico Universidad de Chile, Av. Santos Dumont 999, Independencia, 8380456, Santiago de Chile, Chile

    Ronald Schulz

  2. Klinikum Karlsbad-Langensteinbach, Guttmannstrasse. 1, 76307, Karlsbad-Langensteinbach, Germany

    Robert P. Melcher & Jürgen Harms

  3. Facultad de Medicina, Universidad de Chile, Av. Independencia 1027, Independencia, 8380456, Santiago de Chile, Chile

    Miguel Cumsille Garib & Karen Weissman

  4. Facultad de Medicina, Universidad de Los Andes, Santiago de Chile, Chile

    Hermann Schulz

Authors
  1. Ronald Schulz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert P. Melcher
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Miguel Cumsille Garib
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hermann Schulz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Karen Weissman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jürgen Harms
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ronald Schulz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schulz, R., Melcher, R.P., Garib, M.C. et al. Does kyphotic deformity correlate with functional outcomes in fractures at the thoracolumbar junction treated by 360° instrumented fusion?. Eur J Orthop Surg Traumatol 24 (Suppl 1), 93–101 (2014). https://doi.org/10.1007/s00590-014-1435-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-014-1435-y

Keywords

Search

Navigation