Abstract
Background
Subsidence and late fusion are commonly observed in anterior subtotal corpectomy and reconstruction for treating thoracolumbar burst fractures. The subsidence rate of this surgical method was reported from 19.6% to 75% in the literatures, which would cause treatment failure. Thus, an improvement of anterior surgery technique should be studied to reduce these complications.
Materials and Methods
130 patients of thoracolumbar burst fractures treated by minimal corpectomy, decompression and U cage, between January 2009 and December 2010 were included in this study. The hospital Ethical Committee approved the protocols. The American Spinal Injury Association (ASIA) scale, visual analog scales, and Oswestry Disability Index (ODI) scores were used for clinical evaluation. The local kyphosis angle, vertebral height (one level above the fractured vertebral to one level below), canal stenosis, and fusion status were used to assess radiological outcome. All complications and demographic data such as number of male/female patients, average age, mode of trauma, burst level involved, mean surgery time and blood lost were reported.
Results
120 patients were followed up for 24 months. Most patients had improvement of at least 1 ASIA grade, and all experienced pain reduction. The mean ODI score steadily decreased after the surgery (P < 0.01). Approximately, 83.3% of patients achieved solid fusion at 3 months and reached 98.3% at 6 months. The kyphosis angle and radiographic height were corrected significantly after the surgery and with a nonsignificant loss of correction at 24 months (P > 0.05). The average canal stenosis index was increased from 39% to 99% after surgery. No cage subsidence or implant failure was observed.
Conclusions
The clinical outcomes described here suggest that the selective corpectomy and rectangular cage reconstruction can effectively promote solid fusion and eliminate complications related to subsidence or implant failure.
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References
Yang X, Song Y, Liu L, Liu H, Zeng J, Pei F. Anterior reconstruction with nano-hydroxyapatite/polyamide-66 cage after thoracic and lumbar corpectomy. Orthopedics 2012;35:e66–73.
Suzuki T, Abe E, Miyakoshi N, Murai H, Kobayashi T, Abe T, et al. Anterior decompression and shortening reconstruction with a titanium mesh cage through a posterior approach alone for the treatment of lumbar burst fractures. Asian Spine J 2012;6:123–30.
Oskouian RJ Jr., Shaffrey CI, Whitehill R, Sansur CA, Pouratian N, Kanter AS, et al. Anterior stabilization of three-column thoracolumbar spinal trauma. J Neurosurg Spine 2006;5:18–25.
Dvorak MF, Kwon BK, Fisher CG, Eiserloh HL 3rd, Boyd M, Wing PC. Effectiveness of titanium mesh cylindrical cages in anterior column reconstruction after thoracic and lumbar vertebral body resectio. Spine (Phila Pa 1976) 2003;28:902–8.
Lee GJ, Lee JK, Hur H, Jang JW, Kim TS, Kim SH. Comparison of clinical and radiologic results between expandable cages and titanium mesh cages for thoracolumbar burst fracture. J Korean Neurosurg Soc 2014;55:142–7.
Chen Y, Chen D, Guo Y, Wang X, Lu X, He Z, et al. Subsidence of titanium mesh cage: A study based on 300 cases. J Spinal Disord Tech 2008;21:489–92.
Tosun B, Erdemir C, Yonga O, Selek O. Surgical treatment of thoracolumbar tuberculosis: A retrospective analysis of autogenous grafting versus expandable cages. Eur Spine J 2014;23:2299–306.
Tokuhashi Y, Ajiro Y, Umezawa N. Subsidence of metal interbody cage after posterior lumbar interbody fusion with pedicle screw fixation. Orthopedics 2009;32. pii: Orthosupersite.com/view.asp?rID=38061.
Kumar N, Judith MR, Kumar A, Mishra V, Robert MC. Analysis of stress distribution in lumbar interbody fusio. Spine (Phila Pa 1976) 2005;30:1731–5.
Klezl Z, Bagley CA, Bookland MJ, Wolinsky JP, Rezek Z, Gokaslan ZL Harms titanium mesh cage fracture. Eur Spine J 2007;16 Suppl 3:306–10.
Liang B, Ding Z, Liu T, Kang L, Zai W, Sha M, et al. Design and biomechanical properties of a new reconstruction device for treating thoracolumbar burst fractures. Orthopedics 2012;35:el785–91.
Rihn JA, Anderson DT, Harris E, Lawrence J, Jonsson H, Wilsey J, et al. A review of the TLICS system: A novel, user-friendly thoracolumbar trauma classification system. Acta Orthop 2008;79:461–6.
Huang ZY, Ding ZQ, Liu HY, Fang J, Liu H, Sha M. Anterior D-rod and titanium mesh fixation for acute mid-lumbar burst fracture with incomplete neurologic deficits: A prospective study of 56 consecutive patients. Indian J Orthop 2015;49:471–7.
Bridwell KH, Lenke LG, McEnery KW, Baldus C, Blanke K. Anterior fresh frozen structural allografts in the thoracic and lumbar spin. Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects? Spine (Phila Pa 1976) 1995;20:1410–8.
Shi R, Liu H, Zhao X, Liu X, Gong Q, Li T, et al. Anterior single segmental decompression and fixation for Denis B type thoracolumbar burst fracture with neurological deficiency: Thirty-four cases with average twenty six month followu. Spine (Phila Pa 1976) 2011;36:E598–605.
Zahra B, Jodoin A, Maurais G, Parent S, Mac-Thiong JM. Treatment of thoracolumbar burst fractures by means of anterior fusion and cage. J Spinal Disord Tech 2012;25:30–7.
Xu JG, Zeng BF, Zhou W, Kong WQ, Fu YS, Zhao BZ, et al. Anterior Z-plate and titanic mesh fixation for acute burst thoracolumbar fractur. Spine (Phila Pa 1976) 2011;36:E498–504.
Tang J, Liu Y, Hu Y, Cao Z, Lu X, Lin B. Anterior decompression with single segmental spinal interbody fusion for Denis type B thoracolumbar burst fracture: A midterm followup study. Int Orthop 2013;37:2205–9.
Schnake KJ, Stavridis SI, Krampe S, Kandziora F. Additional anterior plating enhances fusion in anteroposteriorly stabilized thoracolumbar fractures. Injury 2014;45:792–8.
Schmoelz W, Schaser KD, Knop C, Blauth M, Disch AC. Extent of corpectomy determines primary stability following isolated anterior reconstruction in a thoracolumbar fracture model. Clin Biomech (Bristol, Avon) 2010;25:16–20.
Wlodarski KH, Galus R. Histological aspects of bone fracture healing. Ortop Traumatol Rehabil 2005;7:351–60.
Tan JS, Bailey CS, Dvorak MF, Fisher CG, Oxland TR. Interbody device shape and size are important to strengthen the vertebra-implant interfac. Spine (Phila Pa 1976) 2005;30:638–44.
Pekmezci M, McDonald E, Kennedy A, Dedini R, McClellan T, Ames C, et al. Can a novel rectangular footplate provide higher resistance to subsidence than circular footplates? An ex vivo biomechanical stud. Spine (Phila Pa 1976) 2012;37:E1177–81.
Deukmedjian AR, Manwaring J, Le TV, Turner AW, Uribe JS. Corpectomy cage subsidence with rectangular versus round endcaps. J Clin Neurosci 2014;21:1632–6.
Lowe TG, Hashim S, Wilson LA, O’Brien MF, Smith DA, Diekmann MJ, et al. A biomechanical study of regional endplate strength and cage morphology as it relates to structural interbody suppor. Spine (Phila Pa 1976) 2004;29:2389–94.
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Liang, B., Huang, G., Ding, L. et al. Early results of thoraco lumbar burst fracture treatment using selective corpectomy and rectangular cage reconstruction. IJOO 51, 43–48 (2017). https://doi.org/10.4103/0019-5413.197524
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DOI: https://doi.org/10.4103/0019-5413.197524