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Five-year follow-up examination after purely minimally invasive posterior stabilization of thoracolumbar fractures: a comparison of minimally invasive percutaneously and conventionally open treated patients

  • Trauma Surgery
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Abstract

Introduction

It is well known that during posterior stabilization of the spinal column conventionally open methods are predominantly used. However, in this study a minimally invasive method was chosen to decrease the morbidity of the operative access and to protect the paravertebral musculature, which serves as an important spine-stabilizing factor during posterior stabilization. The aims of this retrospective non-randomized case-control study were to compare the clinical and radiological results of minimally invasive on the one hand and conventionally open posterior surgery on the other with each other and to measure the loss of correction after purely posterior stabilization.

Methods

Twenty-one consecutive non-randomized patients with thoracolumbar vertebral body fractures, which had been stabilized posteriorly without any intervertebral body fusion between 1996 and 1997, and without any neurological symptoms, were examined retrospectively more than 5 years after trauma. Eleven patients had been treated conventionally open and 10 patients minimally invasive. As methods of evaluation, the intra- and postoperative amount of blood loss, the X-ray time, the Hannover-Spine-Score, the SF-36 Health Questionnaire and radiological assessment of the bisegmental wedge and vertebral body angle were made use of.

Results

The blood loss was significantly lower among those patients who had been operated in a minimally invasive way. The operating time, the time of X-ray exposure and the loss of correction were identical in both groups. The first year after implant removal, the loss of correction was the highest with 2.1° for the body angle and 6.86° for the bisegmental wedge angle. Neither in the Hannover-Spine-Score nor in the SF-36 Health Questionnaire did both groups show a difference. A correlation between the loss of correction and the clinical results could not be demonstrated.

Conclusion

The minimally invasive posterior stabilization leads to lower blood loss in comparison to the conventionally open method and can be carried out without any special effort limited to A-fractures without any neurological symptoms.

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References

  1. Aebi M, Etter C, Kehl T et al (1987) Stabilization of the lower thoracic and lumbar spine with the internal spinal skeletal fixation system. Indications, techniques, and first results of treatment. Spine 12(6):544–551

    Article  PubMed  CAS  Google Scholar 

  2. Aebi M, Etter C, Kehl T et al (1988) The internal skeletal fixation system.A new treatment of thoracolumbar fractures and other spinal disorders. Clin Orthop 227:30–43

    PubMed  CAS  Google Scholar 

  3. Benson DR, Burkus JK, Montesano PX et al (1992) Unstable thoracolumbar and lumbar burst fractures treated with the AO fixateur interne. J Spinal Disord 5(3):335–343

    Article  PubMed  CAS  Google Scholar 

  4. Blauth M, Knop C (1996) Studie zur Therapie thorakolumbaler Frakturen. Hefte zu der Unfallchirurgie 257:479–483

    Google Scholar 

  5. Blauth M, Tscherne H, Gotzen L et al (1987) Results of different surgical procedures in the treatment of fresh injuries of the thoracic and lumbar spine. Unfallchirurg Jun 90(6):260–273

    CAS  Google Scholar 

  6. Boden SD (1998) Outcome assessment after spinal fusion: why and how? Orthop Clin North Am Oct 29(4):717–728

    Article  CAS  Google Scholar 

  7. Bombardier C (2000) Outcome assessments in the evaluation of treatment of spinal disorders: summary and general recommendations. Spine 25(24):3100–3103

    Article  PubMed  CAS  Google Scholar 

  8. Briem D, Linhart W, Lehmann W et al (2003) Investigation of the health-related quality of life after a dorso ventral stabilization of the thoracolumbar junction. Unfallchirurg 106(8):625–632

    Article  PubMed  CAS  Google Scholar 

  9. Briem D, Rueger JM, Linhart W (2003) Osseous integration of autogenous bone grafts following combined dorso-ventral instrumentation of unstable thoracolumbar spine fractures. Unfallchirurg 106(3):195–203

    Article  PubMed  CAS  Google Scholar 

  10. Brown T, Hansen RJ, Yorra AJ (1957) Some mechanical tests on the lumbosacral spine with particular reference to the intervertebral discs; a preliminary report. J Bone Joint Surg Am 39A(5):1135–1164

    Google Scholar 

  11. Bullinger M (1996) Assessment of health related quality of life with the SF-36 Health Survey. Rehabilitation (Stuttg.) Aug 35(3):17–27; quiz 27–29

    Google Scholar 

  12. Bullinger M, Kirschberger I (1998) SF-36-Fragebogen zum Gesundheitszustand. Handanweisung. Hogreife, Göttingen

  13. Daniaux H (1986) Transpedicular repositioning and spongioplasty in fractures of the vertebral bodies of the lower thoracic and lumbar spine. Unfallchirurgy 89(5):197–213

    CAS  Google Scholar 

  14. Esses SI, Botsford DJ, Wright T et al (1991) Operative treatment of spinal fractures with the AO internal fixator. Spine 16(Suppl 3):S146–S150

    PubMed  CAS  Google Scholar 

  15. Eysel P, Rompe JD, Hopf C et al (1994) Significance of the intervertebral disk in failed reduction of surgically stabilized fractures of the truncal spine. Unfallchirurg 97(9):451–457

    PubMed  CAS  Google Scholar 

  16. Faciszewski T, Winter RB, Lonstein JE et al (1995) The surgical and medical perioperative complications of anterior spinal fusion surgery in the thoracic and lumbar spine in adults. A review of 1223 procedures. Spine 20(14):1592–1599

    Article  PubMed  CAS  Google Scholar 

  17. Freidel K, Petermann F, Reichel D et al (2002) Quality of life in women with idiopathic scoliosis. Spine 27(4):E87–E91

    Article  PubMed  Google Scholar 

  18. Fürderer S, Wenda K, Thiem N et al (2001) Traumatic intervertebral disc lesion–magnetic resonance imaging as a criterion for or against intervertebral fusion. Eur Spine J 10(2):154–163

    Article  PubMed  Google Scholar 

  19. Gelb DE, Lenke LG, Bridwell KH et al (1995) An analysis of sagittal spinal alignment in 100 asymptomatic middle and older aged volunteers. Spine 20(12):1351–1358

    Article  PubMed  CAS  Google Scholar 

  20. Gertzbein SD (1992) Scoliosis Research Society. Multicenter spine fracture study. Spine 17(5):528–540

    PubMed  CAS  Google Scholar 

  21. Grevitt M, Khazim R, Webb J, et al. (1997) The short form-36 health survey questionnaire in spine surgery. J Bone Joint Surg Br 79(1):48–52

    Article  PubMed  CAS  Google Scholar 

  22. Haas N, Blauth M, Tscherne H (1991) Anterior plating in thoracolumbar spine injuries. Indication, technique, and results. Spine Mar 16(Suppl 3):S100–S111

    CAS  Google Scholar 

  23. Hall SE, Criddle RA, Comito TL et al (1999) A case-control study of quality of life and functional impairment in women with long-standing vertebral osteoporotic fracture. Osteoporos Int 9(6):508–515

    Article  PubMed  CAS  Google Scholar 

  24. Katscher S, Verheyden P, Gonschorek O et al (2003) Thoracolumbar spine fractures after conservative and surgical treatment. Dependence of correction loss on fracture level. Unfallchirurg 106(1):20–27

    Article  PubMed  CAS  Google Scholar 

  25. Khoo LT, Beisse R, Potulski M (2002) Thoracoscopic-assisted treatment of thoracic and lumbar fractures: a series of 371 consecutive cases. Neurosurgery 51(Suppl 5):S104–S117

    PubMed  Google Scholar 

  26. Kim DH, Jahng TA, Balabhadra RS et al (2004) Thoracoscopic transdiaphragmatic approach to thoracolumbar junction fractures. Spine 4(3):317–328

    Article  Google Scholar 

  27. Knop C, Bastian L, Lange U et al (2002) Complications in surgical treatment of thoracolumbar injuries. Eur Spine J 11(3):214–226

    Article  PubMed  CAS  Google Scholar 

  28. Knop C, Blauth M, Bastian L et al (1997) Fractures of the thoracolumbar spine. Late results of dorsal instrumentation and its consequences. Unfallchirurg 100(8):630–639

    Article  PubMed  CAS  Google Scholar 

  29. Knop C, Blauth M, Buhren V et al (1999) Surgical treatment of injuries of the thoracolumbar transition. 1: Epidemiology. Unfallchirurg 102(12):924–935

    Article  PubMed  CAS  Google Scholar 

  30. Knop C, Blauth M, Buhren V et al (2000) Surgical treatment of injuries of the thoracolumbar transition. 2: Operation and roentgenologic findings. Unfallchirurg 103(12):1032–1047

    Article  PubMed  CAS  Google Scholar 

  31. Knop C, Blauth M, Buhren V et al (2001) Surgical treatment of injuries of the thoracolumbar transition–3: Follow-up examination. Results of a prospective multi-center study by the “Spinal” Study Group of the German Society of Trauma Surgery. Unfallchirurg 104(7):583–600

    Article  PubMed  CAS  Google Scholar 

  32. Knop C, Fabian HF, Bastian L et al (2001) Late results of thoracolumbar fractures after posterior instrumentation and transpedicular bone grafting. Spine 26(1):88–99

    Article  PubMed  CAS  Google Scholar 

  33. Kraemer WJ, Schemitsch EH, Lever J et al (1996) Functional outcome of thoracolumbar burst fractures without neurological deficit. J Orthop Trauma 10(8):541–544

    Article  PubMed  CAS  Google Scholar 

  34. Kramer M, Katzmaier P, Eisele R et al (2001) Surface electromyography-verified muscular damage associated with the open dorsal approach to the lumbar spine. Eur Spine J 10(5):414–420

    Article  PubMed  CAS  Google Scholar 

  35. Lee SW, Lim TH, You JW et al (2000) Biomechanical effect of anterior grafting devices on the rotational stability of spinal constructs. J Spinal Disord 13(2):150–155

    Article  PubMed  CAS  Google Scholar 

  36. Leferink VJ, Keizer HJ, Oosterhuis JK, et al. (2003) Functional outcome in patients with thoracolumbar burst fractures treated with dorsal instrumentation and transpedicular cancellous bone grafting. Eur Spine J Jun 12(3):261–267

    CAS  Google Scholar 

  37. Leferink VJ, Zimmerman KW, Veldhuis EF et al (2001) Thoracolumbar spinal fractures: radiological results of transpedicular fixation combined with transpedicular cancellous bone graft and posterior fusion in 183 patients. Eur Spine J 10(6):517–523

    Article  PubMed  CAS  Google Scholar 

  38. Liljenqvist U, Mommsen U (1995) Surgical treatment of thoracolumbar spinal fractures with internal fixator and transpedicular spongiosa-plasty. Unfallchirurgie 21(1):30–39

    Article  PubMed  CAS  Google Scholar 

  39. Lindsey RW, Dick W (1991) The fixateur interne in the reduction and stabilization of thoracolumbar spine fractures in patients with neurologic deficit. Spine 16(Suppl 3):S140–S145

    Article  PubMed  CAS  Google Scholar 

  40. Magerl F, Aebi M, Gertzbein SD et al (1994) A comprehensive classification of thoracic and lumbar injuries. Eur Spine J 3(4):184–201

    Article  PubMed  CAS  Google Scholar 

  41. McLain RF, Benson DR (1999) Urgent surgical stabilization of spinal fractures in polytrauma patients. Spine Aug 15 24(16):1646–1654

    Article  CAS  Google Scholar 

  42. Müller U, Berlemann U, Sledge J et al (1999) Treatment of thoracolumbar burst fractures without neurologic deficit by indirect reduction and posterior instrumentation: bisegmental stabilization with monosegmental fusion. Eur Spine J 8(4):284–289

    Article  PubMed  Google Scholar 

  43. Nickel R, Egle UT, Eysel P et al (2001) Health-related quality of life and somatization in patients with long-term low back pain: a prospective study with 109 patients. Spine 26(20):2271–2277

    Article  PubMed  CAS  Google Scholar 

  44. Oner FC, van der Rijt RR, Ramos LM et al (1998) Changes in the disc space after fractures of the thoracolumbar spine. J Bone Joint Surg Br 80(5):833–839

    Article  PubMed  CAS  Google Scholar 

  45. Reinhold M, Knop C, Lange U et al (2003) Non-operative treatment of thoracolumbar spinal fractures. Long-term clinical results over 16 years. Unfallchirurg Jul 106(7):566–576

    Article  CAS  Google Scholar 

  46. Resch H, Rabl M, Klampfer H et al (2000) Surgical versus conservative treatment of fractures of the thoracolumbar transition. Unfallchirurg 103(4):281–288

    Article  PubMed  CAS  Google Scholar 

  47. Rudig L, Runkel M, Kreitner KF et al (1997) Magnetic resonance tomography examination of thoracolumbar spinal fractures after fixateur interne stabilization. Unfallchirurg 100(7):524–530

    Article  PubMed  CAS  Google Scholar 

  48. Sanderson PL, Fraser RD, Hall DJ et al (1999) Short segment fixation of thoracolumbar burst fractures without fusion. Eur Spine J 8(6):495–500

    Article  PubMed  CAS  Google Scholar 

  49. Sjolie AN (2002) Psychosocial correlates of low-back pain in adolescents. Eur Spine J Dec11(6):582–528; Epub 2002 Sep 06

  50. Walchli B, Heini P, Berlemann U (2001) Loss of correction after dorsal stabilization of burst fractures of the thoracolumbar junction. The role of transpedicular spongiosa plasty. Unfallchirurg 104(8):742–747

    Article  PubMed  CAS  Google Scholar 

  51. Wilke HJ, Kemmerich V, Claes LE et al (2001) Combined anteroposterior spinal fixation provides superior stabilisation to a single anterior or posterior procedure. J Bone Joint Surg Br 83(4):609–617

    Article  PubMed  CAS  Google Scholar 

  52. Wood K, Buttermann G, Mehbod A et al (2003) Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit. A prospective, randomized study. J Bone Joint Surg Am 85A(5):773–781

    Google Scholar 

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Authors and Affiliations

  1. Klinik für Unfall- und Handchirurgie, Heinrich Heine Universitätsklinikum, Moorenstraße 5, 40225, Düsseldorf, Germany

    Michael H. Wild

  2. Klinik für Unfall-, Hand- und Orthopädische Chirurgie, Dr. Horst Schmidt Kliniken, Ludwig-Erhard-Straße 100, 65199, Wiesbaden, Germany

    Markus Glees, Corinna Plieschnegger & Klaus Wenda

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Correspondence to Michael H. Wild.

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Wild, M.H., Glees, M., Plieschnegger, C. et al. Five-year follow-up examination after purely minimally invasive posterior stabilization of thoracolumbar fractures: a comparison of minimally invasive percutaneously and conventionally open treated patients. Arch Orthop Trauma Surg 127, 335–343 (2007). https://doi.org/10.1007/s00402-006-0264-9

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