Long-term results after thoracoscopic anterior spondylodesis with or without posterior stabilization of unstable incomplete burst fractures of the thoracolumbar junction: a prospective cohort study
Abstract Background Minimally invasive, thoracoscopic anterior spondylodesis (MIAS) is an established treatment for burst fractures of the thoracolumbar spine. Good restoration of the local sagittal alignment and good functional results have been reported. The aim of this study was to evaluate long-...
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| Format: | Article |
| Language: | English |
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BMC
2020-09-01
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| Series: | Journal of Orthopaedic Surgery and Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13018-020-01807-2 |
| _version_ | 1798038553811222528 |
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| author | Christof Hoffmann Ulrich Josef Spiegl Robert Paetzold Brian Devitt Stefan Hauck Thomas Weiss Volker Bühren Oliver Gonschorek |
| author_facet | Christof Hoffmann Ulrich Josef Spiegl Robert Paetzold Brian Devitt Stefan Hauck Thomas Weiss Volker Bühren Oliver Gonschorek |
| author_sort | Christof Hoffmann |
| collection | DOAJ |
| description | Abstract Background Minimally invasive, thoracoscopic anterior spondylodesis (MIAS) is an established treatment for burst fractures of the thoracolumbar spine. Good restoration of the local sagittal alignment and good functional results have been reported. The aim of this study was to evaluate long-term results of MIAS in patients with incomplete burst fractures and to analyze the influence on global sagittal alignment, clinical outcomes, and adjacent segment degeneration. Methods From 2002 to 2003, 18 patients were treated with MIAS for incomplete thoracolumbar burst fractures. Mono-segmental spondylodesis was performed with an iliac crest bone graft and bisegmental spondylodesis with a titanium cage. In this single-center prospective cohort study, 15 patients were available for follow-up (FU) after an average of 12.9 years (12.1–14.4). Seven patients were treated with a combined anterior and posterior instrumentation and eight patients with anterior spondylodesis only. The primary clinical outcome parameter was the Oswestry Disability Index (ODI); secondary parameters were the Short Form 36 (SF36) and the visual analog scale (VAS spine). Full spine radiographs were assessed for bisegmental Cobb angle, alignment parameters, and signs of adjacent segment degeneration (ASD). Results ODI evaluation showed a mean impairment of 11.7% with minimal limitations in 13 patients. Neither a significant deterioration over time nor significant differences between both therapy strategies were found in the clinical scores at the latest follow-up. The mean bisegmental increase of regional malalignment of reduction was 8.8° (± 7.3°) with no significant correlation to any clinical outcome scores. The majority of patients had no signs of adjacent segment degeneration. Two patients showed minor radiologic changes. All patients had a balanced sagittal spine profile. Conclusions In conclusion, MIAS leads to good clinical results with—in majority—minimal spine-related impairment at the latest follow-up. No significant deterioration at 12-year FU was detectable compared to the 6-year results for the SF36 and VAS spine scores. There was no association between sagittal alignment, clinical outcome scores, and ASD. Trial registration The study was retrospectively registered in the German Clinical Trials Register ( Nr.00015656 ). |
| first_indexed | 2024-04-11T21:41:46Z |
| format | Article |
| id | doaj.art-10f4031323394746a69629538556e89a |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-04-11T21:41:46Z |
| publishDate | 2020-09-01 |
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| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-10f4031323394746a69629538556e89a2022-12-22T04:01:33ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2020-09-0115111110.1186/s13018-020-01807-2Long-term results after thoracoscopic anterior spondylodesis with or without posterior stabilization of unstable incomplete burst fractures of the thoracolumbar junction: a prospective cohort studyChristof Hoffmann0Ulrich Josef Spiegl1Robert Paetzold2Brian Devitt3Stefan Hauck4Thomas Weiss5Volker Bühren6Oliver Gonschorek7Department of Orthopaedic and Trauma Surgery, BG Trauma Center MurnauDepartment of Orthopaedics, Trauma Surgery and Reconstructive Surgery, University Hospital LeipzigDepartment of Orthopaedic and Trauma Surgery, BG Trauma Center MurnauOrthoSport VictoriaDepartment of Orthopaedic and Trauma Surgery, BG Trauma Center MurnauDepartment of Orthopaedic and Trauma Surgery, BG Trauma Center MurnauDepartment of Orthopaedic and Trauma Surgery, BG Trauma Center MurnauDepartment of Orthopaedic and Trauma Surgery, BG Trauma Center MurnauAbstract Background Minimally invasive, thoracoscopic anterior spondylodesis (MIAS) is an established treatment for burst fractures of the thoracolumbar spine. Good restoration of the local sagittal alignment and good functional results have been reported. The aim of this study was to evaluate long-term results of MIAS in patients with incomplete burst fractures and to analyze the influence on global sagittal alignment, clinical outcomes, and adjacent segment degeneration. Methods From 2002 to 2003, 18 patients were treated with MIAS for incomplete thoracolumbar burst fractures. Mono-segmental spondylodesis was performed with an iliac crest bone graft and bisegmental spondylodesis with a titanium cage. In this single-center prospective cohort study, 15 patients were available for follow-up (FU) after an average of 12.9 years (12.1–14.4). Seven patients were treated with a combined anterior and posterior instrumentation and eight patients with anterior spondylodesis only. The primary clinical outcome parameter was the Oswestry Disability Index (ODI); secondary parameters were the Short Form 36 (SF36) and the visual analog scale (VAS spine). Full spine radiographs were assessed for bisegmental Cobb angle, alignment parameters, and signs of adjacent segment degeneration (ASD). Results ODI evaluation showed a mean impairment of 11.7% with minimal limitations in 13 patients. Neither a significant deterioration over time nor significant differences between both therapy strategies were found in the clinical scores at the latest follow-up. The mean bisegmental increase of regional malalignment of reduction was 8.8° (± 7.3°) with no significant correlation to any clinical outcome scores. The majority of patients had no signs of adjacent segment degeneration. Two patients showed minor radiologic changes. All patients had a balanced sagittal spine profile. Conclusions In conclusion, MIAS leads to good clinical results with—in majority—minimal spine-related impairment at the latest follow-up. No significant deterioration at 12-year FU was detectable compared to the 6-year results for the SF36 and VAS spine scores. There was no association between sagittal alignment, clinical outcome scores, and ASD. Trial registration The study was retrospectively registered in the German Clinical Trials Register ( Nr.00015656 ).http://link.springer.com/article/10.1186/s13018-020-01807-2Thoracolumbar burst fracturesAnterior thoracoscopic spondylodesisLong-term follow-up |
| spellingShingle | Christof Hoffmann Ulrich Josef Spiegl Robert Paetzold Brian Devitt Stefan Hauck Thomas Weiss Volker Bühren Oliver Gonschorek Long-term results after thoracoscopic anterior spondylodesis with or without posterior stabilization of unstable incomplete burst fractures of the thoracolumbar junction: a prospective cohort study Journal of Orthopaedic Surgery and Research Thoracolumbar burst fractures Anterior thoracoscopic spondylodesis Long-term follow-up |
| title | Long-term results after thoracoscopic anterior spondylodesis with or without posterior stabilization of unstable incomplete burst fractures of the thoracolumbar junction: a prospective cohort study |
| title_full | Long-term results after thoracoscopic anterior spondylodesis with or without posterior stabilization of unstable incomplete burst fractures of the thoracolumbar junction: a prospective cohort study |
| title_fullStr | Long-term results after thoracoscopic anterior spondylodesis with or without posterior stabilization of unstable incomplete burst fractures of the thoracolumbar junction: a prospective cohort study |
| title_full_unstemmed | Long-term results after thoracoscopic anterior spondylodesis with or without posterior stabilization of unstable incomplete burst fractures of the thoracolumbar junction: a prospective cohort study |
| title_short | Long-term results after thoracoscopic anterior spondylodesis with or without posterior stabilization of unstable incomplete burst fractures of the thoracolumbar junction: a prospective cohort study |
| title_sort | long term results after thoracoscopic anterior spondylodesis with or without posterior stabilization of unstable incomplete burst fractures of the thoracolumbar junction a prospective cohort study |
| topic | Thoracolumbar burst fractures Anterior thoracoscopic spondylodesis Long-term follow-up |
| url | http://link.springer.com/article/10.1186/s13018-020-01807-2 |
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