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Instrumented Circumferential Fusion in Two Stages for Instable Lumbar Fracture: Long-Term Results of a Series of 74 Patients on Sagittal Balance and Functional Outcomes
- Source :
- World Neurosurgery. 103:303-309
- Publication Year :
- 2017
- Publisher :
- Elsevier BV, 2017.
-
Abstract
- To report the radiologic and functional results of a multicenter, prospective case series of patients with comminuted lumbar fractures treated with 2-stage circumferential arthrodesis.A multicenter prospective case series of 74 patients with comminuted lumbar fractures was analyzed. The strategy entailed initial posterior osteosynthesis, followed by physical replacement with an expandable titanium cage filled with autologous bone via retroperitoneal lumbotomy. The mechanism of lesion formation and epidemiologic characteristics were recorded. Clinical and quality-of-life analyses (visual analog scale [VAS], Oswesty Disability Index [ODI], Short Form 12 [SF-12]) were performed over a minimum observation period of 1 year. Radiologic parameters, including deformity measurements, were recorded at each evaluation. Fusion was analyzed by means of a 1-year monitoring scan.The mean patient age was 38.1 years, and median duration of follow-up was 2.1 years (interquartile range, 1.3-2.9). The distribution of fractures according to the Magerl classification scheme was as follows: A, 64.8%; B, 16.7%; C, 18.5%. At the last follow-up, fusion was considered certain in 57 cases (77%). The mean VAS score was 2.1 ± 1.3, mean ODI was 14.7 ± 8.0, mean SF-12 Physical Component Summary score was 43.2 ± 9.3, and mean SF-12 Mental Component Summary score was 50.8 ± 5.9. Correction of the regional sagittal deformity was significant during the postoperative period, with a mean increase in lordosis of 9.0° (P0.0001). The loss of mean correction at the last follow-up (-2.9°) was not significant.Circumferential arthrodesis, including posterior osteosynthesis and physical replacement with an expandable cage and autologous graft, is applicable to the treatment of comminuted lumbar fractures. A high rate of fusion was obtained with significant and long-lasting correction of the sagittal deformity. Functional scores measured at 1 year suggest mild disability. The ODI, SF-12, and VAS scores were positively correlated with fusion at the last follow-up.
- Subjects :
- Adult
Joint Instability
Male
medicine.medical_specialty
Visual Analog Scale
Visual analogue scale
Arthrodesis
medicine.medical_treatment
Lumbar vertebrae
Young Adult
03 medical and health sciences
0302 clinical medicine
Lumbar
medicine
Deformity
Humans
Prospective Studies
Postural Balance
Fractures, Comminuted
Aged
030222 orthopedics
Bone Transplantation
Lumbar Vertebrae
Osteosynthesis
business.industry
Accidents, Traffic
Middle Aged
Sagittal plane
Surgery
Spinal Fusion
Treatment Outcome
medicine.anatomical_structure
Fractures, Ununited
Spinal fusion
Multivariate Analysis
Quality of Life
Spinal Fractures
Accidental Falls
Female
Neurology (clinical)
medicine.symptom
Autolysis
Tomography, X-Ray Computed
business
030217 neurology & neurosurgery
Follow-Up Studies
Subjects
Details
- ISSN :
- 18788750
- Volume :
- 103
- Database :
- OpenAIRE
- Journal :
- World Neurosurgery
- Accession number :
- edsair.doi.dedup.....ddf7a33c05f4a0eb5f4ba91b1a34f8bc
- Full Text :
- https://doi.org/10.1016/j.wneu.2017.04.074