STUDY DESIGN: A systematic review of the literature, pertaining surgical treatment of traumatic thoracic and lumbar spine fractures, was performed. OBJECTIVES: To provide information on surgical techniques for traumatic spine fracture management, their respective performance and complication rates, based on previously published information. SUMMARY OF BACKGROUND DATA: The treatment of traumatic fractures of the thoracic and lumbar spine remains controversial. There is insufficient evidence in the literature to choose between the various surgical options. In absence of conclusive studies, a systematic review can be an alternative to obtain more convincing information. METHODS: Full-text papers from 1970 until 2001 were included if strict inclusion criteria were met. Five surgical subgroups were recognized: posterior short-segment (PS), posterior long-segment (PL), reports on both posterior short- and long-segment (PSL), anterior (A), and anterior combined with posterior (AP) techniques. Clearly defined and generally accepted parameters were scored and subsequently analyzed. The preoperative injury severity of the surgical groups was compared. The neurologic, radiologic, and functional outcome and complications of all groups were assessed. RESULTS: A total of 132 papers, the majority being retrospective case-series, were included representing 5,748 patients. The preoperative injury severity revealed an inequality between the subgroups. Partial neurologic deficits had the potential to resolve irrespective of treatment choice. None of the five techniques used was able to maintain the corrected kyphosis angle. The functional outcome after surgery seems to be better than generally believed. Complications are relatively rare. CONCLUSIONS: In general, surgical treatment of traumatic spine fractures is safe and effective. Surgical techniques can only be compared using randomized controlled trials.

Adult↗

PubMed2004

Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit.

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Evidence-Based Medicine↗

PubMed2004

Histologic changes after vertebroplasty.

BACKGROUND: Vertebroplasty with use of polymethylmethacrylate cement is gaining popularity in the treatment of some specific painful lesions of the spine. It remains unclear, however, what possible side effects this type of cement might have upon the vertebral body. We performed a histologic and radiographic analysis of the end plate and disc to determine whether there was a difference between vertebroplasty with polymethylmethacrylate cement and vertebroplasty with calcium phosphate cement in the surrounding tissue of the goat spine. Furthermore, we assessed whether a defect in the end plate, simulating end-plate fracture and allowing for direct contact of cement with disc tissue, had any effect on end-plate or disc degeneration. METHODS: Twenty-four mature goats were divided between two follow-up periods (six weeks and six months). All animals underwent a bilateral transpedicular vertebroplasty at two lumbar levels, where one of the following treatments was applied: vertebroplasty with calcium phosphate cement with or without an end-plate defect, and vertebroplasty with polymethylmethacrylate cement with or without an end-plate defect. The effect of the various treatments on the integrity of the intervertebral disc, end plate, and surrounding tissue was examined with semiquantitative histologic analysis and radiography. RESULTS: No sign of disc or end-plate degeneration was seen in any of the analyzed sections. The mean disc height did not decrease from the postoperative period to the time that the animals were killed in any group, thereby supporting the histologic findings. A mild inflammatory reaction was found in four vertebral bodies in the polymethylmethacrylate groups only. CONCLUSIONS: Calcium phosphate cement and polymethylmethacrylate cement both seem to be adequate bone-void fillers in terms of biological behavior in the vertebral body.

Animals↗

PubMed2002

Balloon vertebroplasty with calcium phosphate cement augmentation for direct restoration of traumatic thoracolumbar vertebral fractures.

STUDY DESIGN: A human cadaveric model was used to evaluate balloon vertebroplasty in traumatic vertebral fractures. OBJECTIVES: To assess the feasibility and safety of balloon vertebroplasty followed by calcium phosphate cement augmentation to prevent recurrent kyphosis. SUMMARY OF BACKGROUND DATA: Failure after short-segment pedicle-screw fixation for the treatment of vertebral fractures is probably caused by a redistribution of disc material through the fractured endplate into the vertebral body, causing a decrease in anterior column support. This lack of support can give rise to instrument breakage and recurrent kyphosis after removal of the instrumentation. Restoration of the endplate morphology could prevent these events. METHODS: Twenty-three traumatic fractures of thoracolumbar vertebrae were created. All fractures were distracted and fixated with short-segment pedicle screws and rods. Transpedicularly introduced inflatable bone tamps and subsequent injection of calcium phosphate cement were used to restore the endplates. Quantitative analyses of magnetic resonance images obtained at three time points were used to evaluate the morphology of the vertebral body and disc-space. After slicing all specimens, macroscopical examination was performed to detect leakage of cement or bone displacement in undesired directions. RESULTS: No technical problems were encountered during the study. The balloon vertebroplasty resulted in a significant (P = 0.0014) decrease of cranial endplate impression. No cement leakage or undesired bone displacement could be detected radiologically or macroscopically. CONCLUSIONS: The present study suggests that balloon vertebroplasty may be a safe and feasible procedure for the restoration of traumatic thoracolumbar vertebral fractures.

Aged↗

PubMed2002

Hemicortical allograft reconstruction after resection of low-grade malignant bone tumours.

Low-grade surface tumours of bone may theoretically be treated by hemicortical resection, retaining part of the circumference of the cortex. An inlay allograft may be used to reconstruct the defect. Since 1988 we have performed 22 hemicortical procedures in selected patients with low-grade parosteal osteosarcoma (6), peripheral chondrosarcoma (6) and adamantinoma (10). Restricted medullary involvement was not a contraindication for this procedure. There was no evidence of local recurrence or distant metastasis at a mean follow-up of 64 months (27 to 135). Wide resection margins were obtained in 19 patients. All allografts incorporated completely and there were no fractures or infections. Fractures of the remaining hemicortex occurred in six patients and were managed successfully by casts or by osteosynthesis. The functional results were excellent or good in all except one patient. Hemicortical procedures for selected cases of low-grade surface tumours give excellent oncological and functional outcomes. There was complete remodelling and fewer complications when compared with larger intercalary procedures. The surgery is technically demanding but gives good clinical results.

Adolescent↗

PubMed2001

Traumatic lumbosacral dislocation: case report.

STUDY DESIGN: A case report of a bilateral lumbosacral dislocation without a fracture is presented. OBJECTIVE: To report the diagnosis and treatment of a traumatic lumbosacral dislocation. SUMMARY OF BACKGROUND DATA: Lumbosacral dislocations without fractures are rare injuries, with only four cases reported in literature. The recommended treatment consists of an anterior lumbar interbody fusion after posterior reduction with pedicle screw instrumentation. METHODS: The 1-year follow-up evaluation of a 17-year-old male with a traumatic lumbosacral dislocation, diagnosed with computed tomography and magnetic resonance imaging, and treated with a posterior lumbar interbody fusion procedure combined with a posterolateral fusion is reported. RESULTS: At 1 year after surgery the patient is asymptomatic and has resumed his heavy manual work. Radiologic evidence of interbody fusion is present. CONCLUSIONS: Lumbosacral dislocations are rare injuries. The authors demonstrate the feasibility of a posterior lumbar interbody fusion procedure in combination with posterolateral instrumentation and fusion.

Accidents, Occupational↗