Single-stage Transpedicular Vertebrectomy and Expandable Cage Placement for Treatment of Unstable Mid and Lower Lumbar Burst Fractures

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Abstract

Study Design: Retrospective clinical and radiographic study. Objective: To examine the efficacy and safety of vertebrectomy and expandable cage placement by a single-stage posterior approach for unstable mid and lower lumbar burst fractures (below the L3). Summary of Background Data: Patients with unstable mid and lower lumbar burst fractures require surgical treatment to relieve pain, address paralysis, and stabilize the spine to prevent further segmental deformity. However, controversy remains regarding the optimal surgical treatment. Materials and Methods: Eleven patients underwent single-stage posterior-only vertebral column resection and vertebral body reconstruction using an expandable cage. Neurological status was classified using the American Spinal Injury Association (ASIA) Impairment Scale, whereas functional outcome was analyzed using a visual analog scale for back pain. Segmental Cobb angles were measured above and below the fractured vertebral body preoperatively, immediate postoperatively, and at the last follow-up. Results: The preoperative neurological status was ASIA grade E in 2 patients, grade D in 5 patients, grade C in 2 patients, and grade B in 2 patients. Postoperatively, neurological stability was demonstrated in 3 patients (27%), and 8 (73%) showed improvement in the ASIA grade. The mean preoperative visual analog scale score was 8.3, which decreased to 4.5 postoperatively, and to 1.8 at the final follow-up. The mean preoperative segmental lordotic angle was 9.2 degrees, which increased to 16.9 degrees postoperatively, and decreased to 15.1 degrees at the last follow-up. The mean operating time was 208.8 minutes, and the mean blood loss was 1006.3 mL. Regarding surgical complications, 1 patient experienced a dural tear and 1 patient demonstrated cage subsidence. Conclusions: The results of this small series suggest the feasibility, efficacy, and safety of this surgical option for unstable mid and lower lumbar burst fractures. This technique from a single posterior approach offers several advantages over traditional anterior or combined approaches using strut graft or nonexpandable implants.

Original languageEnglish
Pages (from-to)E257-E264
JournalClinical Spine Surgery
Volume30
Issue number3
DOIs
Publication statusPublished - 2017 Jan 1

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Spinal Injuries
Therapeutics
Visual Analog Scale
Spine
Safety
Back Pain
Tears
Paralysis
Retrospective Studies
Transplants
Pain
Clinical Studies

Keywords

  • expandable cage
  • posterior approach
  • transpedicular vertebrectomy
  • unstable lumbar burst fracture

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

@article{38cf6ce619ac4c3aaf08b3c0d096ae3b,
title = "Single-stage Transpedicular Vertebrectomy and Expandable Cage Placement for Treatment of Unstable Mid and Lower Lumbar Burst Fractures",
abstract = "Study Design: Retrospective clinical and radiographic study. Objective: To examine the efficacy and safety of vertebrectomy and expandable cage placement by a single-stage posterior approach for unstable mid and lower lumbar burst fractures (below the L3). Summary of Background Data: Patients with unstable mid and lower lumbar burst fractures require surgical treatment to relieve pain, address paralysis, and stabilize the spine to prevent further segmental deformity. However, controversy remains regarding the optimal surgical treatment. Materials and Methods: Eleven patients underwent single-stage posterior-only vertebral column resection and vertebral body reconstruction using an expandable cage. Neurological status was classified using the American Spinal Injury Association (ASIA) Impairment Scale, whereas functional outcome was analyzed using a visual analog scale for back pain. Segmental Cobb angles were measured above and below the fractured vertebral body preoperatively, immediate postoperatively, and at the last follow-up. Results: The preoperative neurological status was ASIA grade E in 2 patients, grade D in 5 patients, grade C in 2 patients, and grade B in 2 patients. Postoperatively, neurological stability was demonstrated in 3 patients (27{\%}), and 8 (73{\%}) showed improvement in the ASIA grade. The mean preoperative visual analog scale score was 8.3, which decreased to 4.5 postoperatively, and to 1.8 at the final follow-up. The mean preoperative segmental lordotic angle was 9.2 degrees, which increased to 16.9 degrees postoperatively, and decreased to 15.1 degrees at the last follow-up. The mean operating time was 208.8 minutes, and the mean blood loss was 1006.3 mL. Regarding surgical complications, 1 patient experienced a dural tear and 1 patient demonstrated cage subsidence. Conclusions: The results of this small series suggest the feasibility, efficacy, and safety of this surgical option for unstable mid and lower lumbar burst fractures. This technique from a single posterior approach offers several advantages over traditional anterior or combined approaches using strut graft or nonexpandable implants.",
keywords = "expandable cage, posterior approach, transpedicular vertebrectomy, unstable lumbar burst fracture",
author = "Choi, {Jong Il} and Bum-Joon Kim and Sung-Kon Ha and Sang-Dae Kim and Lim, {Dong Jun} and Se-Hoon Kim",
year = "2017",
month = "1",
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doi = "10.1097/BSD.0000000000000232",
language = "English",
volume = "30",
pages = "E257--E264",
journal = "Clinical Spine Surgery",
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T1 - Single-stage Transpedicular Vertebrectomy and Expandable Cage Placement for Treatment of Unstable Mid and Lower Lumbar Burst Fractures

AU - Choi, Jong Il

AU - Kim, Bum-Joon

AU - Ha, Sung-Kon

AU - Kim, Sang-Dae

AU - Lim, Dong Jun

AU - Kim, Se-Hoon

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Study Design: Retrospective clinical and radiographic study. Objective: To examine the efficacy and safety of vertebrectomy and expandable cage placement by a single-stage posterior approach for unstable mid and lower lumbar burst fractures (below the L3). Summary of Background Data: Patients with unstable mid and lower lumbar burst fractures require surgical treatment to relieve pain, address paralysis, and stabilize the spine to prevent further segmental deformity. However, controversy remains regarding the optimal surgical treatment. Materials and Methods: Eleven patients underwent single-stage posterior-only vertebral column resection and vertebral body reconstruction using an expandable cage. Neurological status was classified using the American Spinal Injury Association (ASIA) Impairment Scale, whereas functional outcome was analyzed using a visual analog scale for back pain. Segmental Cobb angles were measured above and below the fractured vertebral body preoperatively, immediate postoperatively, and at the last follow-up. Results: The preoperative neurological status was ASIA grade E in 2 patients, grade D in 5 patients, grade C in 2 patients, and grade B in 2 patients. Postoperatively, neurological stability was demonstrated in 3 patients (27%), and 8 (73%) showed improvement in the ASIA grade. The mean preoperative visual analog scale score was 8.3, which decreased to 4.5 postoperatively, and to 1.8 at the final follow-up. The mean preoperative segmental lordotic angle was 9.2 degrees, which increased to 16.9 degrees postoperatively, and decreased to 15.1 degrees at the last follow-up. The mean operating time was 208.8 minutes, and the mean blood loss was 1006.3 mL. Regarding surgical complications, 1 patient experienced a dural tear and 1 patient demonstrated cage subsidence. Conclusions: The results of this small series suggest the feasibility, efficacy, and safety of this surgical option for unstable mid and lower lumbar burst fractures. This technique from a single posterior approach offers several advantages over traditional anterior or combined approaches using strut graft or nonexpandable implants.

AB - Study Design: Retrospective clinical and radiographic study. Objective: To examine the efficacy and safety of vertebrectomy and expandable cage placement by a single-stage posterior approach for unstable mid and lower lumbar burst fractures (below the L3). Summary of Background Data: Patients with unstable mid and lower lumbar burst fractures require surgical treatment to relieve pain, address paralysis, and stabilize the spine to prevent further segmental deformity. However, controversy remains regarding the optimal surgical treatment. Materials and Methods: Eleven patients underwent single-stage posterior-only vertebral column resection and vertebral body reconstruction using an expandable cage. Neurological status was classified using the American Spinal Injury Association (ASIA) Impairment Scale, whereas functional outcome was analyzed using a visual analog scale for back pain. Segmental Cobb angles were measured above and below the fractured vertebral body preoperatively, immediate postoperatively, and at the last follow-up. Results: The preoperative neurological status was ASIA grade E in 2 patients, grade D in 5 patients, grade C in 2 patients, and grade B in 2 patients. Postoperatively, neurological stability was demonstrated in 3 patients (27%), and 8 (73%) showed improvement in the ASIA grade. The mean preoperative visual analog scale score was 8.3, which decreased to 4.5 postoperatively, and to 1.8 at the final follow-up. The mean preoperative segmental lordotic angle was 9.2 degrees, which increased to 16.9 degrees postoperatively, and decreased to 15.1 degrees at the last follow-up. The mean operating time was 208.8 minutes, and the mean blood loss was 1006.3 mL. Regarding surgical complications, 1 patient experienced a dural tear and 1 patient demonstrated cage subsidence. Conclusions: The results of this small series suggest the feasibility, efficacy, and safety of this surgical option for unstable mid and lower lumbar burst fractures. This technique from a single posterior approach offers several advantages over traditional anterior or combined approaches using strut graft or nonexpandable implants.

KW - expandable cage

KW - posterior approach

KW - transpedicular vertebrectomy

KW - unstable lumbar burst fracture

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