Planning of transpedicular osteosynthesis with reposition and stabilization for thoracic and lumbar spine injuries

Objective. To evaluate the effectiveness of transpedicular reposition planning in patients with single-level injuries of the thoracic and lumbar vertebrae, depending on the target parameters.

Material and Methods. The study included two representative groups, retrospective and prospective, each of 80 patients with thoracic and lumbar fractures with an average age of 39.2 ± 2.2 years. In the prospective group, morphometry of the spine was performed using CT data, to plan the restoration of the vertical dimensions of the vertebral body and closed decompression of the contents of the spinal canal using a transpedicular repositioning system within up to a month from the moment of injury. Based on the results of morphometry, the main target parameters were calculated, which were aimed at being achieved during the operation.

Results. In the main group, the lumen deficit significantly decreased (from 39.5 ± 4.1% to 14.2 ± 3.1%) versus that in the control group (from 39.3 ± 4.6 to 22.1 ± 5.1%; p = 0.01), as well as the cross-sectional area of the spinal canal (from 37.4 ± 5.1% to 14.2 ± 3.1%) versus that in the control group (from 39.6±5.3% to 24.1 ± 5.5%; p = 0.01). The anterior vertebral body height was maximally restored, and the magnitude of bone fragment displacement into the spinal canal decreased (t < 0.05). A direct correlation was found between the size of the interbody spaces and the height of the vertebral body: between the anterior interbody space and the anterior height of the vertebral body in the main group – r = 0.485, in the control group – r = 0.594; and between the posterior interbody space and the posterior height of the vertebral body in the main group – r = 0.309, in the control group – r = 0.252. A strong correlation was obtained between the posterior height of the vertebral body and the spinal canal: r = 0.625 in the main group, r = 0.461 in the control group. The difference between the initial and calculated angle after surgery was 3.1° ± 0.5° in the main group and 5.6° ± 1.2° in the control group (p = 0.01).

Conclusion. Preoperative planning which includes the use of calculated target parameters such as interbody spaces and segmental angles during surgery, allows for the maximum restoration of the vertical dimensions of the injured vertebral body and the performance of closed decompression of the spinal canal contents.

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