Post-traumatic deformities of the spine: relevance, problems, and revision surgery
https://doi.org/10.14531/ss2019.4.36-44
Abstract
Objective. To analyze tactical approaches and types of surgical interventions for post-traumatic deformity of the spine.
Material and Methods. Study design: retrospective monocentric cohort study. The study included 116 patients: Group 1 consisted of 50 patients with primary post-traumatic deformities, and Group 2 of 66 patients with secondary deformities after previously performed decompression and stabilization surgery who were admitted for revision interventions. The average age of patients was 42.1 ± 11.6 years, the long-term follow-up period varied from 2 to 60 months (16.6 ± 10.2). Methods used in the study were clinical (neurological status, ASIA, VAS) one, evaluation of treatment results according to MacNub scale, radiography, CT, radiometry (local kyphosis according to Cobb, Surgimap Spine), MRI, and statistical methods.
Results. The follow-up period of Group 1 patients was 31.3 ± 28.1 months, of Group 2 patients – 60.3 ± 48.1 months. Injuries were predominantly localized at the level of the thoracolumbar junction. In Group 2, more severe neurological disorders (ASIA) prevailed. All patients underwent primary or revision transpedicular fixation and Schwab vertebrotomy variants through posterior approach. The following types of primary deformities according to Rajasekaran were observed: type IIA in 16 (32 %) patients, IIIA in 30 (45 %), and IIIB in 4 (6 %). Patients with secondary deformities had failure of posterior instrumental fixation (100 %), failure (56 %) or absence (73 %) of anterior fusion, and progression of deformity (100 %). In Group 1, local kyphosis was 32.0° ± 9.9° before treatment and 12.5° ± 8.8° after treatment, pain VAS score before treatment 76.6 ± 6.9, and after treatment 47.6 ± 8.8. In Group 2, local kyphosis was 31.8° and 10.1°, and pain score 80.6 and 48.4, respectively. Complications were registered in 10 % of cases. Treatment results were assessed as good/satisfactory in 32 (64 %)/18 (36 %) Group 1 patients, and in 38 (57 %)/28 (42 %) Group 2 patients, respectively.
Conclusion. Classification options and tactical approaches for primary post-traumatic spinal deformities were defined; for secondary posttraumatic deformities there is no classification defining treatment tactics and criteria for assessing the parameters of local and global body balances. Joint multicenter studies are necessary for the adoption of consensual conclusions in the revision surgery of post-traumatic spinal deformities.
Material and Methods. Study design: retrospective monocentric cohort study. The study included 116 patients: Group 1 consisted of 50 patients with primary post-traumatic deformities, and Group 2 of 66 patients with secondary deformities after previously performed decompression and stabilization surgery who were admitted for revision interventions. The average age of patients was 42.1 ± 11.6 years, the long-term follow-up period varied from 2 to 60 months (16.6 ± 10.2). Methods used in the study were clinical (neurological status, ASIA, VAS) one, evaluation of treatment results according to MacNub scale, radiography, CT, radiometry (local kyphosis according to Cobb, Surgimap Spine), MRI, and statistical methods.
Results. The follow-up period of Group 1 patients was 31.3 ± 28.1 months, of Group 2 patients – 60.3 ± 48.1 months. Injuries were predominantly localized at the level of the thoracolumbar junction. In Group 2, more severe neurological disorders (ASIA) prevailed. All patients underwent primary or revision transpedicular fixation and Schwab vertebrotomy variants through posterior approach. The following types of primary deformities according to Rajasekaran were observed: type IIA in 16 (32 %) patients, IIIA in 30 (45 %), and IIIB in 4 (6 %). Patients with secondary deformities had failure of posterior instrumental fixation (100 %), failure (56 %) or absence (73 %) of anterior fusion, and progression of deformity (100 %). In Group 1, local kyphosis was 32.0° ± 9.9° before treatment and 12.5° ± 8.8° after treatment, pain VAS score before treatment 76.6 ± 6.9, and after treatment 47.6 ± 8.8. In Group 2, local kyphosis was 31.8° and 10.1°, and pain score 80.6 and 48.4, respectively. Complications were registered in 10 % of cases. Treatment results were assessed as good/satisfactory in 32 (64 %)/18 (36 %) Group 1 patients, and in 38 (57 %)/28 (42 %) Group 2 patients, respectively.
Conclusion. Classification options and tactical approaches for primary post-traumatic spinal deformities were defined; for secondary posttraumatic deformities there is no classification defining treatment tactics and criteria for assessing the parameters of local and global body balances. Joint multicenter studies are necessary for the adoption of consensual conclusions in the revision surgery of post-traumatic spinal deformities.
About the Authors
O. G. Prudnikova
Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics
Russian Federation
Russian Federation
DMSc, senior researcher at Scientific-Clinical Laboratory of axial skeleton pathology and neurosurgery, Head of Trauma-Orthopaedic Department No. 10
6 M. Ulyanovoy str., Kurgan, 640014, Russia
M. V. Khomchenkov
Russian Ilizarov Scientific Center for Restorative
Traumatology and Orthopaedics
Russian Federation
Russian Federation
trauma orthopaedist, surgeon of Trauma-Orthopaedic Department No. 10
6 M. Ulyanovoy str., Kurgan, 640014, Russia
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Review
For citations:
Prudnikova O.G., Khomchenkov M.V. Post-traumatic deformities of the spine: relevance, problems, and revision surgery. Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika). 2019;16(4):36-44. https://doi.org/10.14531/ss2019.4.36-44
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