Comparison Between Posterior Short-segment Instrumentation Combined With Lateral-approach Interbody Fusion and Traditional Wide-open Anterior-Posterior Surgery for the Treatment of Thoracolumbar Fractures

AbstractThe aim of the study was to compare the radiographic and clinical outcomes between posterior short-segment pedicle instrumentation combined with lateral-approach interbody fusion and traditional anterior-posterior (AP) surgery for the treatment of thoracolumbar fractures.Lateral-approach interbody fusion has achieved satisfactory results for thoracic and lumbar degenerative disease. However, few studies have focused on the use of this technique for the treatment of thoracolumbar fractures.Inclusion and exclusion criteria were established. All patients who meet the above criteria were prospectively treated by posterior short-segment instrumentation and secondary-staged minimally invasive lateral-approach interbody fusion, and classified as group A. A historical group of patients who were treated by traditional wide-open AP approach was used as a control group and classified as group B. The radiological and clinical outcomes were compared between the 2 groups.There were 12 patients in group A and 18 patients in group B. The mean operative time and intraoperative blood loss of anterior reconstruction were significantly higher in group B than those in group A (127.1 ± 21.7 vs 197.5 ± 47.7 min, P < 0.01; 185.8 ± 62.3 vs 495 ± 347.4 mL, P < 0.01). Two of the 12 (16.7%) patients in group A experienced 2 surgical complications: 1 (8.3%) major and 1 (8.3%) minor. Six of the 18 (33%) patients in group B experienced 9 surgical complications: 3 (16.7%) major and 6 (33.3%) minor. There was no significant difference between the 2 groups regarding loss of correction (4.3 ± 2.1 vs 4.2 ± 2.4, P = 0.89) and neurological function at final follow-up (P = 0.77). In both groups, no case of instrumentation failure, pseudarthrosis, or nonunion was noted.Compared with the wide-open AP surgery, posterior short-segment pedicle instrumentation, combined with minimally invasive lateral-approach interbody fusion, can achieve similar clinical results with significant less operative time, blood loss, and surgical complication. This procedure seems to be a reasonable treatment option for selective patients with thoracolumbar fractures.

[1]  J. Jennings,et al.  Extreme lateral interbody fusion for the treatment of adult degenerative scoliosis , 2013, Journal of Clinical Neuroscience.

[2]  C. Lamartina,et al.  Far lateral approaches (XLIF) in adult scoliosis , 2013, European Spine Journal.

[3]  K. Yone,et al.  Combined Posterior and Delayed Staged Mini-open Anterior Short-segment Fusion for Thoracolumbar Burst Fractures , 2012, Journal of spinal disorders & techniques.

[4]  Steven Kirshblum,et al.  International standards for neurological classification of spinal cord injury, revised 2011. , 2012, Topics in spinal cord injury rehabilitation.

[5]  J. Allain.  Anterior spine surgery in recent thoracolumbar fractures: An update. , 2011, Orthopaedics & traumatology, surgery & research : OTSR.

[6]  S. Nimjee,et al.  Extreme Lateral Interbody Fusion Approach for Isolated Thoracic and Thoracolumbar Spine Diseases: Initial Clinical Experience and Early Outcomes , 2011, Journal of spinal disorders & techniques.

[7]  A. Sama,et al.  Lateral Lumbar Interbody Fusion: Clinical and Radiographic Outcomes at 1 Year A Preliminary Report , 2011, Journal of spinal disorders & techniques.

[8]  Edward J. Gerber,et al.  Intraoperative and Early Postoperative Complications in Extreme Lateral Interbody Fusion: An Analysis of 600 Cases , 2011, Spine.

[9]  P. Huddleston.  Minimally Invasive Surgery: Lateral Approach Interbody Fusion: Results and Review , 2011 .

[10]  F. Phillips,et al.  A Prospective, Nonrandomized, Multicenter Evaluation of Extreme Lateral Interbody Fusion for the Treatment of Adult Degenerative Scoliosis: Perioperative Outcomes and Complications , 2010, Spine.

[11]  P. McAfee,et al.  Minimally Invasive Surgery: Lateral Approach Interbody Fusion: Results and Review , 2010, Spine.

[12]  K. Wood,et al.  Therapeutic Decision Making in Thoracolumbar Spine Trauma , 2010, Spine.

[13]  Terrence T. Kim,et al.  Successful Treatment of Thoracolumbar Fractures With Short-segment Pedicle Instrumentation , 2010, Journal of spinal disorders & techniques.

[14]  P. Papagelopoulos,et al.  Thoracolumbar burst fractures: a systematic review of management. , 2010, Orthopedics.

[15]  M. Blauth,et al.  Erratum to: PLIF in thoracolumbar trauma: technique and radiological results , 2010, European Spine Journal.

[16]  B. Michael,et al.  PLIF in thoracolumbar trauma: technique and radiological results , 2010, European Spine Journal.

[17]  Rex A. W. Marco,et al.  Thoracolumbar burst fractures treated with posterior decompression and pedicle screw instrumentation supplemented with balloon-assisted vertebroplasty and calcium phosphate reconstruction. Surgical technique. , 2010, The Journal of bone and joint surgery. American volume.

[18]  Xiang-Yang Wang,et al.  Kyphosis recurrence after posterior short-segment fixation in thoracolumbar burst fractures. , 2008, Journal of neurosurgery. Spine.

[19]  D. Haschtmann,et al.  Vertebral endplate trauma induces disc cell apoptosis and promotes organ degeneration in vitro , 2008, European Spine Journal.

[20]  W. Mittelmeier,et al.  Two column lesions in the thoracolumbar junction: anterior, posterior or combined approach? A comparative biomechanical in vitro investigation , 2007, European Spine Journal.

[21]  H. Aryan,et al.  Extreme Lateral Interbody Fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. , 2006, The spine journal : official journal of the North American Spine Society.

[22]  Thomas M. Reilly,et al.  Unstable Thoracolumbar Burst Fractures: Anterior-Only Versus Short-Segment Posterior Fixation , 2006, Journal of spinal disorders & techniques.

[23]  Moe R. Lim,et al.  Surgical Decision Making for Unstable Thoracolumbar Spine Injuries: Results of a Consensus Panel Review by the Spine Trauma Study Group , 2006, Journal of spinal disorders & techniques.

[24]  M. Aebi,et al.  A comprehensive classification of thoracic and lumbar injuries , 2005, European Spine Journal.

[25]  P. McDonough,et al.  The Management of Acute Thoracolumbar Burst Fractures with Anterior Corpectomy and Z-Plate Fixation , 2004, Spine.

[26]  W. Dhert,et al.  Surgical Treatment of Traumatic Fractures of the Thoracic and Lumbar Spine: A Systematic Review of the Literature on Techniques, Complications, and Outcome , 2004, Spine.

[27]  W. Donovan,et al.  International Standards For Neurological Classification Of Spinal Cord Injury , 2003, The journal of spinal cord medicine.

[28]  A. Alanay,et al.  Short-Segment Pedicle Instrumentation of Thoracolumbar Burst Fractures: Does Transpedicular Intracorporeal Grafting Prevent Early Failure? , 2001, Spine.

[29]  R. Gaines,et al.  Successful short-segment instrumentation and fusion for thoracolumbar spine fractures: a consecutive 41/2-year series. , 2000, Spine.

[30]  W. Dhert,et al.  Changes in the disc space after fractures of the thoracolumbar spine , 1998 .

[31]  W. Dhert,et al.  Changes in the disc space after fractures of the thoracolumbar spine. , 1998, The Journal of bone and joint surgery. British volume.

[32]  K. Cho,et al.  Adding Posterior Lumbar Interbody Fusion to Pedicle Screw Fixation and Posterolateral Fusion After Decompression in Spondylolytic Spondylolisthesis , 1997, Spine.

[33]  D. Kramer,et al.  Transpedicular Instrumentation and Short-Segment Fusion of Thoracolumbar Fractures: A Prospective Study Using a Single Instrumentation System , 1995, Journal of orthopaedic trauma.

[34]  J. Dubousset.  Early failure of short-segment pedicle instrumentation for thoracolumbar fractures. A preliminary report. , 1995, The Journal of bone and joint surgery. American volume.