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. 2022 Jun;12(5):801-811.
doi: 10.1177/2192568220964453. Epub 2020 Oct 14.

Single-Stage Posterior Vertebral Column Resection With Circumferential Reconstruction for Thoracic/Thoracolumbar Burst Fractures With or Without Neurological Deficit: Clinical Neurological and Radiological Outcomes

Azmi Hamzaoglu  1 , Mustafa Elsadig  1 , Selhan Karadereler  1 , Ayhan Mutlu  1 , Yunus Emre Akman  2 , Huseyin Ozturk  1 , Okan Aslantürk  3 , Tunay Sanlı  1 , Sinan Kahraman  2 , Meric Enercan  1
Affiliations

Single-Stage Posterior Vertebral Column Resection With Circumferential Reconstruction for Thoracic/Thoracolumbar Burst Fractures With or Without Neurological Deficit: Clinical Neurological and Radiological Outcomes

Azmi Hamzaoglu et al. Global Spine J. 2022 Jun.

Abstract

Study design: Retrospective study.

Objective: The aim of this study is to evaluate the clinical, neurological, and radiological outcomes of posterior vertebral column resection (PVCR) technique for treatment of thoracic and thoracolumbar burst fractures.

Methods: Fifty-one patients (18 male, 33 female) with thoracic/thoracolumbar burst fractures who had been treated with PVCR technique were retrospectively reviewed. Preoperative and most recent radiographs were evaluated and local kyphosis angle (LKA), sagittal and coronal spinal parameters were measured. Neurological and functional results were assessed by the American Spinal Injury Association (ASIA) Impairment Scale, visual analogue scale score, Oswestry Disability Index, and Short Form 36 version 2.

Results: The mean age was 49 years (range 22-83 years). The mean follow-up period was 69 months (range 28-216 months). Fractures were thoracic in 16 and thoracolumbar in 35 of the patients. AO spine thoracolumbar injury morphological types were as follows: 1 type A3, 15 type A4, 4 type B1, 23 type B2, 8 type C injuries. PVCR was performed in a single level in 48 of the patients and in 2 levels in 3 patients. The mean operative time was 434 minutes (range 270-530 minutes) and mean intraoperative blood loss was 520 mL (range 360-1100 mL). The mean LKA improved from 34.7° to 4.9° (85.9%). For 27 patients, the initial neurological deficit (ASIA A in 8, ASIA B in 3, ASIA C in 5, and ASIA D in 11) improved at least 1 ASIA grade (1-3 grades) in 22 patients (81.5%). Solid fusion, assessed with computed tomography at the final follow-up, was achieved in all patients.

Conclusion: Single-stage PVCR provides complete spinal canal decompression, ideal kyphosis correction with gradual lengthening of anterior column together with sequential posterior column compression. Anterior column support, avoidance of the morbidity of anterior approach and improvement of neurological deficit are the other advantages of the single stage PVCR technique in patients with thoracic/thoracolumbar burst fractures.

Keywords: PVCR; burst fracture; thoracic/thoracolumbar.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
(A, B) Preoperative computed tomography (CT) and magnetic resonance images a of 46-year-old male patient with T12 burst fracture. (C) Postoperative anteroposteior and lateral standing radiographs. (D) Postoperative CT image confirmed the solid union after 18 months.
Figure 2.
Figure 2.
(A) Correction of kyphotic deformity with sequential posterior compression and simultaneous anterior column lengthening technique. (B) Placement of initial temporal rod, resection of the fractured vertebral body with preservation of anterior longitudinal ligament and anterior cortex. (C, D) Gradual anterior column lengthening using a spreader and expandable cage. (E, F) Simultaneous posterior column compression.
Figure 3.
Figure 3.
(A) H-shaped femoral strut allograft and the laminectomy defect following posterior vertebral column resection. (B, C) Anteroposterior and lateral view of the H-shaped strut allograft stabilized in place by rod-cross links and autograft in upper and lower ends.
Figure 4.
Figure 4.
(A) Preoperative computed tomography and magnetic resonance images of a 37-year-old male patient with T11 burst fracture. (B) Postoperative anteroposterior and lateral Standing radiographs after T11 posterior vertebral column resection using an expandable cage.
Figure 5.
Figure 5.
(A, B) Preoperative computed tomography and magnetic resonance images of a 24-year-old female patient with T7 burst fracture. (C) Postoperative anteroposterior and lateral standing radiographs after T7 posterior vertebral column resection using a mesh cage.
Figure 6.
Figure 6.
(A, B) Preoperative radiographs, computed tomography scans, and magnetic resonance images of a 27-year-old female patient with L2 burst fracture. (C) Postoperative anteroposterior and lateral standing radiographs after L2 posterior vertebral column resection using an expandable cage.
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