Title : Radiological Outcome of Operative Treatment with Posterior Approach in Patients with Thoracolumbar Junction Traumatic Injuries: A Single-Center Pilot Study in a Developing Country
Abstract:
Introduction: The thoracolumbar junction represents a transition zone of the spine that leads to a high incidence of fractures. The treatment of burst fractures remains controversial regarding the ideal management. This study assessed the postoperative radiological outcome of thoracolumbar junction (TLJ) fixation in patients with TLJ injuries who underwent surgery.
Material and methods: All traumatic patients with TLJ injuries who were referred to the Khatam hospital of Zahedan between 2015-2020, with their thoracolumbar injury classification and severity score (TLICS) of four or more and who underwent surgery, were included in this study. The patients who entered the study were called for a follow-up examination. The degree of kyphosis, proximal junctional kyphosis (PJK), and fusion were assessed in these patients.
Results: Among 273 patients, the average age was 43.5±12.3 (21-73) years. One hundred ninety-eight patients (72.5%) had no neurological symptoms at admission. Based on the above criteria, the kyphosis angle of these patients was calculated before surgery, which in 46 patients (16.8%), the kyphosis angle was more than 25 degrees. Pre-operation kyphosis was significantly associated with follow-up kyphosis (p <0.001). Evidence of no fusion was also observed in 22 patients (8.1%). According to the Chi-Square test, no association was observed between preoperative kyphosis and postoperative complications, including PJK and fusion (p> 0.05).
Conclusions: According to our study, the posterior spinal fixation procedure is a low-complication method with an acceptable radiological outcome. Although kyphosis before surgery is a factor in developing long-term kyphosis, it is not associated with nonfusion and PJK.
What will audience learn from your presentation?
- Most spinal fractures are stable, do not require surgery, and are often cured with proper braces or hyperextension. The benefits of spinal fracture surgery include better correction of kyphotic deformity, greater stability, the possibility of direct and indirect decompression of neural elements, less need to use external immobilization, and faster return to work.
- According to previous studies, surgical indications based on the presence of canal compromise, neurological defects, reduction in body height, and the presence of kyphosis were used relatively. In a study by Reid et al., the researchers concluded that patients harboring burst fracture with neurological defect or kyphosis angle greater than 35 degrees had to undergo surgery.
- In 2005, Vacarro et al. introduced a new classification for thoracolumbar fractures called thoracolumbar injury classification and severity score (TLICS). According to this classification, patients who receive a score of 3 or less do not need surgery; however, patients with a score of 5 or higher must undergo surgery. In cases where the patient's score is 4, the type of treatment is based on the surgeon's judgment.
- Krompinger et al. found that about 36 percent of burst fractures in their follow-up examinations had changed more than 10 degrees. This study also showed that a significant portion of patients has an increase in kyphosis during follow-up examinations, which highlights the importance of examining patients in the long term. Siebenga et al. showed that regardless of the clinical consequences, surgery is more cost-effective than conservative treatment in the burst fractures TLJ
- Based on the results of previous studies, in TLJ traumatic injuries, conservative treatment is associated with significant complications such as prolonged immobility, delayed return to work, higher chances of developing kyphosis, and less spinal stabilization.
- According to the general results and radiological studies of follow-up in our study, it can be concluded that the posterior spinal fixation procedure is a low-complication method and with an acceptable radiological outcome. Although kyphosis before surgery is a factor in developing long-term kyphosis, it is not associated with nonfusion and PJK.
