General Session: Tumor, Trauma, and Infection

Presented by: S-H Kim - View Audio/Video Presentation (Members Only)

Author(s):

S.-H. Kim(1), S.-H. Lee(1), S.-W. Jin(1), W.-H. Kim(1), B.-J. Kim(1), S.-D. Kim(1), S.-K. Ha(1), D.-J. Lim(1)

(1) Korea University Ansan Hospital, Department of Neurosurgery, Ansan, Korea, Republic of

Abstract

Objectives: Patients with unstable thoracolumbar spine fractures require surgical treatment to relieve pain, address paralysis, and stabilize the spine to prevent further segmental deformity. Optimal surgical treatment, however, still remains controversial. The purpose of this study is to examine the efficacy and safety of vertebrectomy and reconstruction of vertebral body using an expandable cage via a single-stage posterior approach for trauma-related unstable thoracolumbar spine fractures.

Materials and Methods: Thirty patients underwent single-stage posterior-only vertebral column resection and vertebral body reconstruction using an expandable cage. The spinal levels affected were T12 in 6 patients, L1 in 9, L2 in 4, L3 in 7, L4 in 3, and L5 in 1. Neurologic status was classified using the ASIA Impairment Scale, while functional outcome was analyzed using a VAS 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 neurologic status was ASIA grade E in 6 patients, grade D in 13 patients, grade C in 5 patients, and grade B in 6 patients. Postoperatively, neurologic stability was demonstrated in 8 patients (26.7%), and 22 (73.3%) showed improvement in the ASIA grade. The mean preoperative VAS score was 8.6, which decreased to 4.3 postoperatively, and to 1.7 at the final follow-up. The mean preoperative segmental lordotic angle was 8.9°, which increased to 17.4° postoperatively, and decreased to 16.1° at the last follow-up. Regarding surgical complications, an intraoperative dural tear occurred in two patients and cage subsidence in three osteoporotic patients.

Conclusions: The results of our series suggest the feasibility, efficacy, and safety of this surgical option for unstable thoracolumbar spine fractures. This technique from a single posterior approach offers several advantages over traditional anterior or anterior-posterior combined approaches using strut graft or nonexpandable implants.

Keywords: expandable cage, unstable thoracolumbar spine fracture, transpedicular vertebrectomy, posterior approach