The online version of this article (https://doi.org/10.1007/s00586-020-06321-x) contains supplementary material, which is available to authorized users.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
In management of traumatic thoracolumbar burst fractures, short-segment pedicle screw fixation with balloon-assisted endplate reduction (BAER) and cement injection is a safe, feasible, and effective technique to maintain radiological alignment with minimum spinal segments involved. However, 20% of patients report daily discomfort despite good spinal alignment and fusion after this technique. This study provides clinical, radiological, and patient-reported outcomes after a minimum 13 years of follow-up.
Eighteen patients were invited at the outpatient clinic for clinical/radiological examinations. The cohort (originally 20 patients) was treated 13–14 years earlier with pedicle screw fixation, BAER, and cement injection for traumatic thoracolumbar burst fractures. Patient-reported outcome measures were obtained at time of examinations. Current data were compared with data obtained at 6 years of follow-up.
Seventeen patients (median age 50; range 32–80) cooperated. No/minimal back pain was reported by 15 patients, and 12 patients returned to their previous heavy labor work. Median visual analog score of health (80%; 50–100%) was similar to results at 6 years (80%; 60–100% p = 0.259). An Oswestry Disability Index score of less than 20% (reflecting minimal disability) was reported by 14 patients, compared with 15 patients at 6 years of follow-up. No significant differences were found in wedge or Cobb angle between the time points. Intravertebral cement resorption was not observed.
Results from this study suggest that, 13 years after pedicle screw fixation with BAER and cement injection for traumatic thoracolumbar burst fractures, functional performance, pain and radiological outcomes of the current cohort were stable or had slightly improved.
These slides can be retrieved under Electronic Supplementary Material.
Denis F (1984) Spinal instability as defined by the three-column spine concept in acute spinal trauma. Clin Orthop Relat Res 189:65–76
Schoenfeld AJ, Wood KB, Fisher CF, Fehlings M, Oner FC, Bouchard K et al (2010) Posttraumatic kyphosis: current state of diagnosis and treatment: results of a multinational survey of spine trauma surgeons. J Spinal Disord Tech 23:e1–e8. https://doi.org/10.1097/BSD.0b013e3181c03517 CrossRefPubMed
Verlaan JJ, Diekerhof CH, Buskens E, van der Tweel I, Verbout AJ, Dhert WJA et al (2004) Surgical treatment of traumatic fractures of the thoracic and lumbar spine: a systematic review of the literature on techniques, complications, and outcome. Spine (Phila Pa 1976) 29:803–814. https://doi.org/10.1097/01.brs.0000116990.31984.a9 CrossRef
Verlaan J-J, Dhert WJA, Verbout AJ, Oner FC (2005) Balloon vertebroplasty in combination with pedicle screw instrumentation: a novel technique to treat thoracic and lumbar burst fractures. Spine (Phila Pa 1976) 30:E73–E79. https://doi.org/10.1097/01.brs.0000152162.64015.fb CrossRef
Verlaan JJ, Somers I, Dhert WJA, Oner FC (2015) Clinical and radiological results 6 years after treatment of traumatic thoracolumbar burst fractures with pedicle screw instrumentation and balloon assisted endplate reduction. Spine J 15:1172–1178. https://doi.org/10.1016/j.spinee.2013.11.044 CrossRefPubMed
McCormack T, Karaikovic E, Gaines RW (1994) The load sharing classification of spine fractures. Spine (Phila Pa 1976) 19:1741–1744. https://doi.org/10.1097/00007632-199408000-00014 CrossRef
Verlaan JJ, van Helden WH, Oner FC, Verbout AJ, Dhert WJA (2002) Balloon vertebroplasty with calcium phosphate cement augmentation for direct restoration of traumatic thoracolumbar vertebral fractures. Spine (Phila Pa 1976) 27:543–548. https://doi.org/10.1097/00007632-200203010-00021 CrossRef
Denis F, Armstrong GW, Searls K, Matta L (1984) Acute thoracolumbar burst fractures in the absence of neurologic deficit. A comparison between operative and nonoperative treatment. Clin Orthop Relat Res 189:142–149. https://doi.org/10.1097/00003086-198410000-00015 CrossRef
Reinhold M, Knop C, Beisse R, Audigé L, Kandziora F, Pizanis A et al (2010) Operative treatment of 733 patients with acute thoracolumbar spinal injuries: comprehensive results from the second, prospective, internet-based multicenter study of the Spine Study Group of the German Association of Trauma Surgery. Eur Spine J 19:1657–1676. https://doi.org/10.1007/s00586-010-1451-5 CrossRefPubMedPubMedCentral
Asia-Spinalsurgery.org [Internet]. No Title n.d. http://asia-spinalinjury.org/
Clement RC, Welander A, Stowell C, Cha TD, Chen JL, Davies M et al (2015) A proposed set of metrics for standardized outcome reporting in the management of low back pain. Acta Orthop 86:1–11. https://doi.org/10.3109/17453674.2015.1036696 CrossRef
Jamison RN, Raymond SA, Slawsby EA, McHugo GJ, Baird JC (2006) Pain assessment in patients with low back pain: comparison of weekly recall and momentary electronic data. J Pain 7:192–199. https://doi.org/10.1016/j.jpain.2005.10.006 CrossRefPubMed
EuroQol Group (1990) EQ-5D-3L. www.euroqol.org
Häkkinen A, Kautiainen H, Järvenpää S, Arkela-Kautiainen M, Ylinen J (2007) Changes in the total Oswestry Index and its ten items in females and males pre- and post-surgery for lumbar disc herniation: a 1-year follow-up. Eur Spine J 16:347–352. https://doi.org/10.1007/s00586-006-0187-8 CrossRefPubMed
van Hooff ML, Spruit M, Fairbank JCT, van Limbeek J, Jacobs WCH (2015) The Oswestry disability index (version 2.1a): validation of a Dutch language version. Spine (Phila Pa 1976) 40:E83–E90. https://doi.org/10.1097/brs.0000000000000683 CrossRef
Fairbank JC, Pynsent PB (2000) The Oswestry disability index. Spine (Phila Pa 1976) 25:2940–2952. Discussion 2952. https://doi.org/10.1097/00007632-200011150-00017 CrossRef
Konig HH, Bernert S, Angermeyer MC, Matschinger H, Martinez M, Vilagut G et al (2009) Comparison of population health status in six european countries: results of a representative survey using the EQ-5D questionnaire. Med Care 47:255–261. https://doi.org/10.1097/MLR.0b013e318184759e CrossRefPubMed
Wood KB, Buttermann GR, Phukan R, Harrod CC, Mehbod A, Shannon B et al (2015) Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit: a prospective randomized study with follow-up at sixteen to twenty-two years. J Bone Joint Surg Am 97:3–9. https://doi.org/10.2106/JBJS.N.00226 CrossRefPubMed
Aono H, Tobimatsu H, Ariga K, Kuroda M, Nagamoto Y, Takenaka S et al (2016) Surgical outcomes of temporary short-segment instrumentation without augmentation for thoracolumbar burst fractures. Injury 47:1337–1344. https://doi.org/10.1016/j.injury.2016.03.003 CrossRefPubMed
Verlaan J-J, van de Kraats EB, Oner FC, van Walsum T, Niessen WJ, Dhert WJA (2005) The reduction of endplate fractures during balloon vertebroplasty: a detailed radiological analysis of the treatment of burst fractures using pedicle screws, balloon vertebroplasty, and calcium phosphate cement. Spine (Phila Pa 1976) 30:1840–1845 CrossRef
Ooms EM, Wolke JGC, Van de Heuvel MT, Jeschke B, Jansen JA (2003) Histological evaluation of the bone response to calcium phosphate cement implanted in cortical bone. Biomaterials 24:989–1000. https://doi.org/10.1016/S0142-9612(02)00438-6 CrossRefPubMed
Korovessis P, Vardakastanis K, Repantis T, Vitsas V (2014) Less invasive reduction and fusion of fresh A2 and A3 traumatic L1–L4 fractures with a novel vertebral body augmentation implant and short pedicle screw fixation and fusion. Eur J Orthop Surg Traumatol 24:297–304. https://doi.org/10.1007/s00590-013-1339-2 CrossRefPubMed
Korovessis P, Vardakastanis K, Repantis T, Vitsas V (2014) Transpedicular vertebral body augmentation reinforced with pedicle screw fixation in fresh traumatic A2 and A3 lumbar fractures: Comparison between two devices and two bone cements. Eur J Orthop Surg Traumatol 24:183–191. https://doi.org/10.1007/s00590-013-1296-9 CrossRef
Lee JK, Jang JW, Kim TW, Kim TS, Kim SH, Moon SJ (2013) 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). https://doi.org/10.1007/s00701-013-1859-x CrossRef
- Clinical, radiological, and patient-reported outcomes 13 years after pedicle screw fixation with balloon-assisted endplate reduction and cement injection
Erin E. A. De Gendt
Jonneke S. Kuperus
F. Cumhur Oner
- Springer Berlin Heidelberg
European Spine Journal
Print ISSN: 0940-6719
Elektronische ISSN: 1432-0932
Neu im Fachgebiet Orthopädie und Unfallchirurgie
Mail Icon II