The late-term results in our patients operated for lumbar spine fractures

Year 2023, Volume: 6 Issue: 2, 519 - 525, 27.03.2023

Emir İzci , Oguzhan Pekince , Fatih Keskin

https://doi.org/10.32322/jhsm.1250055

Abstract

Aim: The current study aimed to evaluate the late-term results of patients operated for lumbar spine fractures in our clinic.
Material and Method: 134 patients from January 2012 to January 2020 were treated with “short-segment pedicle instrumentation” for lumbar fractures in our neurosurgery department. Patients with a burst fracture of a single lumbar vertebra were included. The final sample consisted of 67 patients who were followed up over the years with radiographs before and after surgery and CT scans at the final follow-up.
Results: The results showed that 60% of the patients were rated as Denis P1, 35% as P2, and 5% as P3. Screw breakage was observed in seven patients, and 67 patients underwent revision surgery. Furthermore, the fractured vertebral body’s height was improved at the final follow-up stage, and an increase was witnessed from the preoperative figure of 16.4 mm to 25.8 at the final follow-up. At the final follow-up, the average Cobb angle was -11.6° preoperatively, and 6.3° after the operation and the correction loss was 12.1° which was severe in the middle part of the vertebra. By the final follow-up, disc spaces were narrowed below and above the fractured vertebra, and no correlation was found between clinical outcomes and adjacent disc degeneration.
Conclusion: We concluded that short-segment pedicle instrumentation produced satisfactory long-term results for lumbar fractures. To achieve adequate outcomes, correct management of complications and evaluation of various factors must be focused on.

Keywords

Lumbar, Spinal Fractures, Spinal Surgery, Turkey

References

• Kumar R, Lim J, Mekary RA, et al. Traumatic spinal injury: global epidemiology and worldwide volume. World Neurosurg 2018; 113: 345-63.
• WorldOMeters. Turkey Population 2020. Available online: https://www.worldometers.info/world-population/turkey-population/
• Taşoğlu Ö, Koyuncu E, Daylak R, et al. Demographic and clinical characteristics of persons with spinal cord injury in Turkey: One-year experience of a primary referral rehabilitation center. J Spinal Cord Med 2018; 41: 157-64.
• Venkatesh K, Ghosh SK, Mullick M, Manivasagam G, Sen D. Spinal cord injury: pathophysiology, treatment strategies, associated challenges, and future implications. Cell Tissue Res 2019; 377: 125-51.
• Wang H, Lv B, Zhang Z, Wang S, Ding W. Prevalence and predictors for preoperative deep vein thrombosis in patients with thoracolumbar fractures caused by high-energy injuries. World Neurosurg 2020; 141: 431-6.
• Niemi-Nikkola V, Saijets N, Ylipoussu H, et al. Long-term posttraumatic survival of spinal fracture patients in northern Finland. Spine (Phila Pa 1976) 2018; 43: 1657-63.
• Alswat KA. Gender disparities in osteoporosis. J Clin Med Res 2017; 9: 382-7.
• Wakim J, Rajan T, Beschloss A, Albayar A, Ozturk A, Saifi C. Etiologies, incidence, and demographics of lumbar vertebral fractures in U.S. emergency departments. J Spine Surg 2022; 8: 21-8.
• Baidwan NK, Naranje SM. Epidemiology and recent trends of geriatric fractures presenting to the emergency department for United States population from year 2004-2014. Public Health 2017; 142: 64-9.
• Burke D, Lennon O, Fullen BM. Quality of life after spinal cord injury: the impact of pain. Eur J Pain 2018; 22: 1662-72.
• Wood KB, Li W, Lebl DR, Ploumis A. Management of thoracolumbar spine fractures [published correction appears in Spine J 2014 Aug 1; 14(8): A18. Lebl, Darren S [corrected to Lebl, Darren R]]. Spine J 2014; 14: 145-64.
• Malçok Ü. A. , Akar A. Distribution of traumatic spinal injuries in Turkey in accordance with ICD-10 codes between the years 2015 and 2019. Eskisehir Med J 2021; 2: 68-73.
• Pannu CD, Farooque K, Sharma V, Singal D. Minimally invasive spine surgeries for treatment of thoracolumbar fractures of spine: A systematic review. J Clin Orthop Trauma 2019; 10: 147-55.
• McAnany SJ, Overley SC, Kim JS, Baird EO, Qureshi SA, Anderson PA. Open versus minimally invasive fixation techniques for thoracolumbar trauma: a meta-analysis. Global Spine J 2016; 6: 186-94.
• Seo JY, Kwon YS, Kim KJ, Shin JY, Kim YH, Ha KY. Clinical importance of posterior vertebral height loss on plain radiography when conservatively treating osteoporotic vertebral fractures. Injury 2017; 48: 1503-9.
• Spiegl U, Bork H, Grüninger S, et al. Osteoporotic fractures of the thoracic and lumbar vertebrae: diagnosis and conservative treatment. Dtsch Arztebl Int 2021; 118: 670-7.
• Agarwal A, Kelkar A, Agarwal AG, et al. Implant retention or removal for management of surgical site infection after spinal surgery. Global Spine J 2020; 10: 640-6.
• Wen Z, Mo X, Zhao S, et al. Comparison of percutaneous kyphoplasty and pedicle screw fixation for treatment of thoracolumbar severe osteoporotic vertebral compression fracture with kyphosis. World Neurosurg 2021; 152: 589-96.
• Invernizzi M, de Sire A, Fusco N. Rethinking the clinical management of volumetric muscle loss in patients with spinal cord injury: Synergy among nutritional supplementation, pharmacotherapy, and rehabilitation. Curr Opin Pharmacol 2021; 57: 132-9.
• Joaquim AF, Makhni MC, Riew KD. Post-operative nerve injuries after cervical spine surgery. Int Orthop 2019; 43: 791-5.
• Kato S, Demura S, Kurokawa Y, et al. Correlation between osteoporotic vertebral fracture and abdominal trunk muscle strength in middle-aged and older women. Arch Osteoporos 2019; 14: 106.
• Genev IK, Tobin MK, Zaidi SP, Khan SR, Amirouche FML, Mehta AI. Spinal compression fracture management: a review of current treatment strategies and possible future avenues. Global Spine J 2017; 7: 71-82.
• Fontana MA, Islam W, Richardson MA, et al. Presenteeism and absenteeism before and after single-level lumbar spine surgery. Spine J 2022; 22: 776-86.
• Lin I, Wiles L, Waller R, et al. What does best practice care for musculoskeletal pain look like? eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. Br J Sports Med 2020; 54: 79-86.
• Lubelski D, Feghali J, Nowacki AS, et al. Patient-specific prediction model for clinical and quality-of-life outcomes after lumbar spine surgery. J Neurosurg Spine 2021; 34: 580-8.
• Mimura M, Panjabi MM, Oxland TR, Crisco JJ, Yamamoto I, Vasavada A. Disc degeneration affects the multidirectional flexibility of the lumbar spine. Spine (Phila Pa 1976) 1994; 19: 1371-80.
• Kim DC, Carlson BC, Shafa E, Mehbod AA. Vacuum-assisted wound closure management for posterior lumbar spine infections. J Am Acad Orthop Surg 2022; 30: 395-9.
• Li J, Zhang H, Li Q, et al. Treating lumbar fracture using the mixed reality technique. Biomed Res Int 2021; 2021: 6620746.
• Verlaan JJ, Diekerhof CH, Buskens E, et al. 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) 2004; 29: 803-14.
• An HS, Simpson JM, Ebraheim NA, Jackson WT, Moore J, O'Malley NP. Low lumbar burst fractures: comparison between conservative and surgical treatments. Orthopedics 1992; 15: 367-73.
• Smith WD, Dakwar E, Le TV, Christian G, Serrano S, Uribe JS. Minimally invasive surgery for traumatic spinal pathologies: a mini-open, lateral approach in the thoracic and lumbar spine. Spine (Phila Pa 1976) 2010; 35: 338-46.
• Gelb D, Ludwig S, Karp JE, et al. Successful treatment of thoracolumbar fractures with short-segment pedicle instrumentation. J Spinal Disord Tech 2010; 23: 293-301.
• Wang L, Li J, Wang H, et al. Posterior short segment pedicle screw fixation and TLIF for the treatment of unstable thoracolumbar/lumbar fracture. BMC Musculoskelet Disord 2014; 15: 40.
• Moawad CM, Arzi H, Naik A, Bashir R, Arnold PM. Short-segment pedicle fixation of traumatic low lumbar fractures (l3-l5): report of 36 cases. Clin Spine Surg 2022; 35: 590-5.
• Mak S-YJ, Siu Y-C, Chau W-W, Lo C-Y, Ma C-M. Long segment versus short segment stabilization in thoracolumbar spine fracture: A retrospective clinical and radiological analysis. Journal of Orthopaedics, Trauma and Rehabilitation 2023; 30.
• Doğu H, Çinar İ Thoracic and lumbar spine fractures: a retrospective study. J Turk Spinal Surg 2019; 30: 133-8.
• Brown MD, Seltzer DG. Perioperative care in lumbar spine surgery. Orthop Clin North Am 1991; 22: 353-8.
• Xu BS, Tang TS, Yang HL. Long-term results of thoracolumbar and lumbar burst fractures after short-segment pedicle instrumentation, with special reference to implant failure and correction loss. Orthop Surg 2009; 1: 85-93.