Trisegmentale Fusion durch Wirbelkörperersatzimplantate View Full Text


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Article Info

DATE

2017-03-03

AUTHORS

Michael Kreinest, Dorothee Schmahl, Paul A. Grützner, Stefan Matschke

ABSTRACT

BackgroundAround 5% of all trauma patients suffer from spinal trauma. Spinal fractures are mainly located in the thoracic and lumbar spine. For multisegmental vertebral fractures categorized as instable, combined dorsal instrumentation and ventral stabilization is recommended. Numerous vertebral body replacement systems are available for ventral stabilization.ObjectivesThe aim of the current study was to analyze radiological results following the implantation of a hydraulic expandable vertebral body replacement and the evaluation of patients’ outcome three years after implantation.Materials and MethodsAll patients who suffered traumatic multisegmental fractures of the thoracic or lumbar spine in the period from September 2009 to September 2012 were included in this study. Patients with additional injuries or abnormal sensitivity or motor function were excluded from the current study. All patients underwent dorsal percutaneous instrumentation. Afterwards, implantation of the vertebral body replacement was performed via the mini-open approach at our level I trauma center.In the computed tomography and X‑ray imaging, the sagittal kyphotic angle was measured. Furthermore, the clinical outcome (patients’ satisfaction, VAS spine score) was analyzed using a questionnaire.ResultsDuring the above mentioned period, seven patients (four female; three male) underwent dorsal instrumentation and ventral trisegmental fusion and were identified fitting the inclusion/exclusion criteria and thus could be included in the study. Most fractures were located in the thoracic-lumbar junction and were categorized A4 according to the AO Spine classification system. The analysis of the radiological data showed a pre-operative average traumatic segmental angle of 18.1 ± 14.9°, which could be decreased by reposition procedure to 6.4 ± 1.7°. The complete follow-up, including the data three years after implantation of the vertebral body implant, was available for three patients. The traumatic segmental angle remained stable in the follow-up three years later. In one case, a subsidence of the implant of 1.5 mm was observed, having no influence on the patients’ satisfaction. All three patients indicated to be very satisfied with their outcome. The VAS spine score rating was in the range between 62.4 and 70.2.ConclusionsThe current study shows that in the case of multisegmental fractures complete reposition by ligamentotaxis and by the percutaneous instrumentation system is possible. In addition to the percutaneous dorsal instrumentation, the implantation of a hydraulically expandable vertebral body replacement may allow a stable fusion after complex traumatic fractures of the thoracic and lumbar spine. Patients are very satisfied with their outcome after this procedure. More... »

PAGES

300-305

References to SciGraph publications

  • 2013-05-07. Association of clinical parameters of operatively treated thoracolumbar fractures with quality of life parameters in EUROPEAN SPINE JOURNAL
  • 2011-01-20. Therapieempfehlungen zur Versorgung von Verletzungen der Brust- und Lendenwirbelsäule in DER UNFALLCHIRURG
  • 2003-08. Untersuchung der Lebensqualität nach dorsoventraler Stabilisierung von Wirbelkörperfrakturen des thorakolumbalen Übergangs in DER UNFALLCHIRURG
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  • 1994-08. A comprehensive classification of thoracic and lumbar injuries in EUROPEAN SPINE JOURNAL
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  • 2009-01-28. Operative Behandlung traumatischer Frakturen der Brust- und Lendenwirbelsäule in DER UNFALLCHIRURG
  • 2009-03-08. Operative Behandlung traumatischer Frakturen der Brust- und Lendenwirbelsäule in DER UNFALLCHIRURG
  • 2012-10-16. Outcome after thoracoscopic ventral stabilisation of thoracic and lumbar spine fractures in JOURNAL OF TRAUMA MANAGEMENT & OUTCOMES
  • 2013-04-13. Six-year outcome of thoracoscopic ventral spondylodesis after unstable incomplete cranial burst fractures of the thoracolumbar junction: ventral versus dorso-ventral strategy in INTERNATIONAL ORTHOPAEDICS
  • 2003-01. Verletzungen der Brust- und Lendenwirbelsäule in DER UNFALLCHIRURG
  • 2010-05-25. Operative treatment of 733 patients with acute thoracolumbar spinal injuries: comprehensive results from the second, prospective, internet-based multicenter study of the Spine Study Group of the German Association of Trauma Surgery in EUROPEAN SPINE JOURNAL
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s00113-017-0335-0

    DOI

    http://dx.doi.org/10.1007/s00113-017-0335-0

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    37 schema:description BackgroundAround 5% of all trauma patients suffer from spinal trauma. Spinal fractures are mainly located in the thoracic and lumbar spine. For multisegmental vertebral fractures categorized as instable, combined dorsal instrumentation and ventral stabilization is recommended. Numerous vertebral body replacement systems are available for ventral stabilization.ObjectivesThe aim of the current study was to analyze radiological results following the implantation of a hydraulic expandable vertebral body replacement and the evaluation of patients’ outcome three years after implantation.Materials and MethodsAll patients who suffered traumatic multisegmental fractures of the thoracic or lumbar spine in the period from September 2009 to September 2012 were included in this study. Patients with additional injuries or abnormal sensitivity or motor function were excluded from the current study. All patients underwent dorsal percutaneous instrumentation. Afterwards, implantation of the vertebral body replacement was performed via the mini-open approach at our level I trauma center.In the computed tomography and X‑ray imaging, the sagittal kyphotic angle was measured. Furthermore, the clinical outcome (patients’ satisfaction, VAS spine score) was analyzed using a questionnaire.ResultsDuring the above mentioned period, seven patients (four female; three male) underwent dorsal instrumentation and ventral trisegmental fusion and were identified fitting the inclusion/exclusion criteria and thus could be included in the study. Most fractures were located in the thoracic-lumbar junction and were categorized A4 according to the AO Spine classification system. The analysis of the radiological data showed a pre-operative average traumatic segmental angle of 18.1 ± 14.9°, which could be decreased by reposition procedure to 6.4 ± 1.7°. The complete follow-up, including the data three years after implantation of the vertebral body implant, was available for three patients. The traumatic segmental angle remained stable in the follow-up three years later. In one case, a subsidence of the implant of 1.5 mm was observed, having no influence on the patients’ satisfaction. All three patients indicated to be very satisfied with their outcome. The VAS spine score rating was in the range between 62.4 and 70.2.ConclusionsThe current study shows that in the case of multisegmental fractures complete reposition by ligamentotaxis and by the percutaneous instrumentation system is possible. In addition to the percutaneous dorsal instrumentation, the implantation of a hydraulically expandable vertebral body replacement may allow a stable fusion after complex traumatic fractures of the thoracic and lumbar spine. Patients are very satisfied with their outcome after this procedure.
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    44 schema:keywords A4
    45 AO Spine classification system
    46 BackgroundAround 5
    47 Fusion durch Wirbelkörperersatzimplantate
    48 MethodsAll patients
    49 Most fractures
    50 Numerous vertebral body replacement systems
    51 ObjectivesThe aim
    52 Spine classification system
    53 Trisegmentale Fusion durch Wirbelkörperersatzimplantate
    54 VAS spine score rating
    55 Wirbelkörperersatzimplantate
    56 abnormal sensitivity
    57 addition
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    59 aim
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    61 angle
    62 approach
    63 average traumatic segmental angle
    64 body implants
    65 body replacement
    66 body replacement systems
    67 cases
    68 center
    69 classification system
    70 clinical outcomes
    71 combined dorsal instrumentation
    72 complete reposition
    73 complex traumatic fractures
    74 computed tomography
    75 criteria
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    77 data
    78 data three years
    79 dorsal instrumentation
    80 dorsal percutaneous instrumentation
    81 durch Wirbelkörperersatzimplantate
    82 evaluation
    83 evaluation of patients
    84 exclusion criteria
    85 expandable vertebral body replacement
    86 follow
    87 fractures
    88 fractures complete reposition
    89 function
    90 fusion
    91 hydraulic expandable vertebral body replacement
    92 imaging
    93 implantation
    94 implants
    95 inclusion/exclusion criteria
    96 influence
    97 injury
    98 instrumentation
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    100 junctions
    101 kyphotic angle
    102 levels
    103 ligamentotaxis
    104 materials
    105 mini-open approach
    106 motor function
    107 multisegmental fractures
    108 multisegmental fractures complete reposition
    109 multisegmental vertebral fractures
    110 outcomes
    111 patients
    112 patients (four female; three male) underwent dorsal instrumentation
    113 percutaneous dorsal instrumentation
    114 percutaneous instrumentation
    115 percutaneous instrumentation system
    116 period
    117 pre-operative average traumatic segmental angle
    118 procedure
    119 questionnaire
    120 radiological data
    121 radiological results
    122 range
    123 ratings
    124 ray imaging
    125 replacement
    126 replacement system
    127 reposition
    128 reposition procedure
    129 results
    130 sagittal kyphotic angle
    131 satisfaction
    132 score ratings
    133 segmental angle
    134 sensitivity
    135 spinal fractures
    136 spinal trauma
    137 spine
    138 spine score rating
    139 stabilization
    140 stable fusion
    141 study
    142 subsidence
    143 system
    144 thoracic
    145 thoracic-lumbar junction
    146 three years
    147 tomography
    148 trauma
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    151 traumatic fractures
    152 traumatic multisegmental fractures
    153 traumatic segmental angle
    154 trisegmental fusion
    155 underwent dorsal instrumentation
    156 ventral stabilization
    157 ventral trisegmental fusion
    158 vertebral body implant
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