SURGICAL TREATMENT OF THORACIC AND LUMBAR SPINE FRACTURES USING TRANSPEDICULAR VERTEBROPLASTY AND FIXATION

Objective. To analyze treatment results in patients with fractures of thoracic and lumbar vertebal bodies after transpedicular vertebroplasty and fixation through minimally invasive percutaneous and open approaches.

Material and Methods. A total of 154 patients with uncomplicated type A2, A3 fractures of the thoracic and lumbar vertebral bodies were operated on. All patients were examined with X-ray densitometry, spondylography, and CT. Group 1 included 53 patients who underwent vertebroplasty with deproteinized bone graft and percutaneous transpedicular fixation. Patients of Group 2 (n = 41), Group 3 (n = 43) and Group 4 (n = 17) underwent open transpedicular fixation and vertebroplasty with deproteinized bone graft (Group 2) and titanium nikilide granules (Groups 3 and 4).

Results. Intraoperative blood loss during open vertebroplasty combined with short-segment transpedicular fixation exceeded that during percutaneous vertebroplasty.
Parameters of kyphotic deformity, the wedge index and the loss of correction did not differ significantly except for Group 4. Significant improvement in ODI and VAS scores was noted after percutaneous vertebroplasty as compared with control groups.

Conclusion. Transpedicular verteboplasty and transpedicular fixation, both open and percutaneous, performed for the treatment of type A2 and A3 spinal fractures provide reliable stabilization of the injured spinal segments, allow vertebral body height restoration to a greater extent and correction of the kyphotic deformity.

1. Аветисян А.Р. Пластика тел грудных и поясничных позвонков пористыми био-керамическими гранулами (экспериментальное исследование): Дис. … канд. мед. наук. Новосибирск, 2015. [Avetisyan AR. Thoracic and lumbar veretebroplasty with porous bioceramic granules (experimental study): MD/PhD Thesis. Novosibirsk, 2015. In Russian].

2. Бююль А., Цефель П. SPSS: искусство обработки информации. М., 2005. [Buyul A, Cefel P. SPSS: The Art of Information Processing. Moscow, 2005. In Russian].

3. Гланц С. Медико-биологическая статистика. М., 1999. [Glants S. Medico-Biological Statistics. Moscow, 1999. In Russian].

4. Кирилова И.А. Анатомо-функциональные свойства кости как основа создания костно-пластических материалов для травматологии и ортопедии (анатомо-экспериментальное исследование): Дис. ... д-ра мед. наук. Новосибирск, 2011. [Kirilova IA. Anatomical and functional properties of bone as a basis for creating osteoplastic materials for traumatology and orthopaedics (anatomical and experimental study): DMSc Thesis. Novosibirsk, 2011. In Russian].

5. Рерих В.В., Байдарбеков М.У., Аникин К.А. Устройство для введения костно-пластического материала: Пат. 2579305 РФ, МПК A 61 B 17/56; заяв. 23.03.2015; опубл. 10.04.2016, Бюл. № 10. [Rerikh VV, Baidarbekov MU, Anikin KA. Device for administering bone-plastic material. Patent RU 2579305. Appl. 23.03.2015; publ. 10.04.2016. Bull. 10. In Russian].

6. Рерих В.В., Садовой М.А., Рахматиллаев Ш.Н. Остеопластика в системе лечения переломов тел грудных и поясничных позвонков // Хирургия позвоночника. 2009. № 2. С. 25–34. [Rerikh VV, Sadovoy MA, Rakhmatillaev SN. Application of Osteoplasty for Complex treatment of the thoracic and lumbar vertebrae fractures Hir. Pozvonoc. 2009;(2):25–34. In Russian]. DOI: http://dx.doi.org/10.14531/ss2009.2.25-34.

7. Садовой М.А., Рерих В.В., Байдарбеков М.У. Способ транскутанной пластики тела позвонка: Пат. 2573101 РФ; заявл. 29.08.2014; опубл. 20.01.2016, Бюл. № 2. [Sadovoy MA, Rerikh VV, Baidarbekov MU. Method for transcutaneous repair of vertebral body. Patent RU 2573101. Appl. 29.08.2014; publ. 20.01.2016. Bull. 2. In Russian].

8. Barbagallo GM, Yoder E, Dettori JR, Albanese V. Percutaneous minimally invasive versus open spine surgery in the treatment of fractures of the thoracolumbar junction: a comparative effectiveness review. Evid Based Spine Care J. 2012;3:43–49. DOI: 10.1055/s-0032-1327809.

9. Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine. 2000;25:2940-2952.

10. Fantini GA, Pawar AY. Access related complications during anterior exposure of the lumbar spine. World J Orthop. 2013;4:19–23. DOI: 10.5312/wjo.v4.i1.19.

11. Fischer S, Vogl TJ, Kresing M, Marzi I, Zangos S, Mack MG, Eichler K. Minimally invasive screw fixation of fractures in the thoracic spine: CT-controlled pre-surgical guidewire implantation in routine clinical practice. Clin Radiol. 2016;71:997–1004. DOI: 10.1016/j.crad.2016.06.112.

12. Giorgi H, Blondel B, Adetchessi T, Dufour H, Tropiano P, Fuentes S. Early percutaneous fixation of spinal thoracolumbar fractures in polytrauma patients. Orthop Traumatol Surg Res. 2014;100:449–454. DOI: 10.1016/j.otsr.2014.03.026.

13. Hamdan AD, Malek JY, Schermerhorn ML, Aulivola B, Blattman SB, Pomposelli FB Jr. Vascular injury during anterior exposure of the spine. J Vasc Surg. 2008;48:650–654. DOI: 10.1016/j.jvs.2008.04.028.

14. Hua YJ, Wang RY, Guo ZH, Shu CH, Li CH. [Clinical studies of pedicle screw-rod fixation of thoracolumbar burst fractures through posterior unilateral approach after vertebrae corpectomy fusion]. Zhongguo Gu Shang. 2016;29:27–32. In Chinese.

15. Huang QS, Chi YL, Wang XY, Mao FM, Lin Y, Ni WF, Xu HZ. [Comparative percutaneous with open pedicle screw fixation in the treatment of thoracolumbar burst fractures without neurological deficit]. Zhonghua Wai Ke Za Zhi. 2008;46:112–114. In Chinese.

16. Jo DJ, Kim KT, Kim SM, Lee SH, Cho MG, Seo EM. Single-stage posterior subtotal corpectomy and circumferential reconstruction for the treatment of unstable thoracolumbar burst fractures. J Korean Neurosurg Soc. 2016;59:122–128. DOI: 10.3340/jkns.2016.59.2.122.

17. Kanna RM, Shetty AP, Rajasekaran S. Posterior fixation including the fractured vertebra for severe unstable thoracolumbar fractures. Spine J. 2015;15:256–264. DOI: 10.1016/j.spinee.2014.09.004.

18. Koreckij T, Park DK, Fischgrund J. Minimally invasive spine surgery in the treatment of thoracolumbar and lumbar spine trauma. Neurosurg Focus. 2014;37:E11. DOI: 10.3171/2014.5.FOCUS1494.

19. Korovessis PG, Baikousis A, Stamatakis M. Use of the Texas Scottish Rite Hospital Instrumentation in the treatment of thoracolumbar injuries. Spine. 1997;22:882–888.

20. Lee JK, Jang JW, Kim TW, Kim TS, Kim SH, Moon SJ. Percutaneous short-segment pedicle screw placement without fusion in the treatment of thoracolumbar burst fractures: is it effective?: comparative study with open short-segment pedicle screw fixation with posterolateral fusion. Acta Neurochir (Wien). 2013;155:2305–2312. DOI: 10.1007/s00701-013-1859-x.

21. Li DP, Yang HL, Huang YH, Xu XF, Sun TC, Hu L. Transpedicular intracorporeal grafting for patients with thoracolumbar burst fractures. Saudi Med J. 2014;35:50–55.

22. Li Q, Yun C, Li S. Transpedicular bone grafting and pedicle screw fixation in injured vertebrae using a paraspinal approach for thoracolumbar fractures: a retrospective study. J Orthop Surg Res. 2016;11:115. DOI: 10.1186/s13018-016-0452-4.

23. Li Q, Liu Y, Chu Z, Chen J, Chen M. [Treatment of thoracolumbar fractures with transpedicular intervertebral bone graft and pedicle screws fixationin injured vertebrae]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2011;25:956–959. In Chinese.

24. Liao JC, Fan KF. Posterior short-segment fixation in thoracolumbar unstable burst fractures – Transpedicular grafting or six-screw construct? Clin Neurol Neurosurg. 2017;153:56–63. DOI: 10.1016/j.clineuro.2016.12.011.

25. Liao JC, Fan KF, Chen WJ, Chen LH, Kao HK. Transpedicular bone grafting following short-segment posterior instrumentation for acute thoracolumbar burst fracture. Orthopedics. 2009;32:493. DOI: 10.3928/01477447-20090527-11.

26. Lin YC, Fan KF, Liao JC. Two additional augmenting screws with posterior shortsegment instrumentation without fusion for unstable thoracolumbar burst fracture – Comparisons with transpedicular grafting techniques. Biomed J. 2016;39:407–413. DOI: 10.1016/j.bj.2016.11.005.

27. Macnab I. Negative disc exploration. An analysis of the cause of nerve root involvement in sixty-eight patients. J Bone Joint Surg Am. 1971;53:891–903.

28. Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J. 1994;3:184–201. DOI: 10.1007/978-3-642-58824-2_4.

29. Maillard N, Buffenoir-Billet K, Hamel O, Lefranc B, Sellal O, Surer N, Bord E, Grimandi G, Clouet J. A cost-minimization analysis in minimally invasive spine surgery using a national cost scale method. Int J Surg. 2015;15:68–73. DOI: 10.1016/j.ijsu.2014.12.029.

30. Martiniani M, Vanacore F, Meco L, Specchia N. Is posterior fixation alone effective to prevent the late kyphosis after T-L fracture? Eur Spine J. 2013;22 Suppl 6:951–956. DOI: 10.1007/s00586-013-3008-x.

31. Mc Cormack T, Karaikovic E, Gaines RW. The load sharing classification of spine fractures. Spine. 1994;19:1741–1744. DOI: 10.1097/00007632-199408000-00014.

32. McLain RF, Sparling E, Benson DR. Early failure of short-segment pedicle instrumentation for thoracolumbar fractures. A preliminary report. J Bone Joint Surg Am. 1993;75:162–167.

33. Palmisani M, Gasbarrini A, Brodano GB, De Iure F, Cappuccio M, Boriani L, Amendola L, Boriani S. Minimally invasive percutaneous fixation in the treatment of thoracic and lumbar spine fractures. Spine J. 2009;18 Suppl 1:71–74. DOI: 10.1007/s00586-009-0989-6.

34. Perera A, Qureshi A, Brecknell JE. Mono-segment fixation of thoracolumbar burst fractures. Br J Neurosurg. 2015;29:358–361. DOI: 10.3109/02688697.2014.987216.

35. Pesenti S, Graillon T, Mansouri N, Rakotozanani P, Blondel B, Fuentes S. Minimal invasive circumferential management of thoracolumbar spine fractures. Biomed Res Int. 2015;2015:639542. DOI: 10.1155/2015/639542.

36. Phan K, Rao PJ, Mobbs RJ. Percutaneous versus open pedicle screw fixation for treatment of thoracolumbar fractures: Systematic review and meta-analysis of comparative studies. Clin Neurol Neurosurg. 2015;135:85–92. DOI: 10.1016/j.clineuro.2015.05.016.

37. Vu TT, Morishita Y, Yugue I, Hayashi T, Maeda T, Shiba K. Radiological outcome of short segment posterior instrumentation and fusion for thoracolumbar burst fractures. Asian Spine J. 2015;9:427–432. DOI: 10.4184/asj.2015.9.3.427.

38. Van Herck B, Leirs G, Van Loon J. Transpedicular bone grafting as a supplement to posterior pedicle screw instrumentation in thoracolumbar burst fractures. Acta Orthop Belg. 2009;75:815–821.

39. Wang W, Yao N, Song X, Yan Y, Wang C. External spinal skeletal fixation combination with percutaneous injury vertebra bone grafting in the treatment of thoracolumbar fractures. Spine. 2011;36:E606–E611. DOI: 10.1097/BRS.0b013e3181f 92dac.

40. Wegłowski R, Godlewski P, Blacha J, Kołodziej R, Mazurkiewicz T. [Results of operative treatment thoraco-lumbar fractures by posterior lumbar interbody fusion, Daniaux reconstruction or combination of both methods]. Chir Narzadow Ruchu Ortop Pol. 2011;76:83–90. In Polish.

41. Xing JM, Peng WM, Shi CY, Xu L, Pan QH. [Analysis of reason and strategy for the failure of posterior pedicle screw short-segment internal fixation on thoracolumbar fractures]. Zhongguo Gu Shang. 2013;26:186–189. In Chinese.

42. Yin F, Sun Z, Yin Q, Liu J, Gu S, Zhang S. [A comparative study on treatment of thoracolumbar fracture with injured vertebra pedicle instrumentation and cross segment pedicle instrumentation]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2014;28:227–232. In Chinese.