Effect of loss of correction on functional outcomes in thoracolumbar burst fractures treated with short segment posterior instrumentation

Abstract

Aim: Burst fractures are defined as vertebra fractures involving the anterior and middle columns and are associated with kyphotic deformity and retropulsion of bone fragment into the spinal canal. Although their treatment is controversial in the literature, use of transpedicular screws and short segment posterior instrumentation are increasingly common practices. The aim of this study is to investigate the radiological and functional outcomes of thoracolumbar vertebra burst fractures treated with short segment posterior instrumentation and to examine the effects of postoperative correction loss on these results.

Methods: Patients who were surgically treated for thoracolumbar burst fractures and prospectively followed-up between 2000-2003 were scanned retrospectively for this cohort study. 48 patients were included in the study, of which 18 were females (37.5%) and 30 were males (62.5%). Denis Pain Scale (DPS) and Denis Work Scale (DWS) were used for functional analysis. Cobb angles that were measured preoperatively, on the first postoperative day, and at the last follow-up visit were used for evaluation of radiological outcomes. Spinal stenosis and remodelization rates were also calculated by computerized tomography obtained preoperatively and at the last follow-up. One-way ANOVA and Pearson correlation tests were used for statistical analysis.

Results: No patient had any chronic pain complaints, and none were unable to work. The mean Cobb angles in the preoperative, early post-operative and final controls were measured as 23.2, 4.9, and 12.3 degrees, respectively. While preoperative mean Cobb angle and mean correction were positively correlated (r=0.85, P<0.001), there was no correlation between preoperative mean Cobb angle and loss of correction (r=0.27, P=0.43). There was a correlation between correction and loss of correction (r=0.38, P=0.008). Spinal stenosis, which was 35.7% preoperatively, reduced to 17.1% in the last follow-up. The mean remodelization was 51.3%, which was significant (P<0.001). Loss of correction was found significant in patients with poor DWS (P=0.003), and no such relationship was found in DPS. No correlation was found between the Cobb angle at the last follow-up, DPS and DWS. 

Conclusion: In conclusion, the loss of correction after short segment posterior instrumentation and fusion surgery is significantly higher in thoracolumbar burst fractures, especially when intraoperative correction exceeds 15 degrees. Denis Work Scale was significantly worse in patients with loss of correction above 10 degrees. The degree of loss of correction at the last follow-up is directly related to clinical and functional outcomes.

Keywords

• Cobb angle,Burst fractures,Kyphosis,Remodelization,Loss of correction,Short segment posterior instrumentation

Kısa segment posterior enstrümentasyon ile tedavi edilen torakolomber burst kırıklarında korreksiyon kaybının fonksiyonel sonuçlar üzerine etkisi

Abstract

Amaç: Burst kırıkları, ön ve orta kolonu içeren, kifotik deformite ve kemik fragmanının spinal kanala retropülsiyonu ile ilişkili vertebra kırıkları olarak tanımlanır. Tedavileri literatürde tartışmalı olsa da transpediküler vida ve kısa segment posterior enstrümentasyon oldukça sık uygulanmaktadır. Bu çalışmanın amacı kısa segment posterior enstrümentasyon ile tedavi edilen torakolomber vertebra burst kırıklarının radyolojik ve fonksiyonel sonuçlarını ve postoperatif korreksiyon kaybının bu sonuçlar üzerine etkisini incelemektir.

Yöntemler: 2000-2003 yılları arasında torakolomber burst kırığı nedeniyle cerrahi olarak tedavi edilen ve prospektif olarak takip edilen hastalar, bu retrospektif kohort çalışması için retrospektif olarak tarandı. Çalışmaya 18'i kadın (%37,5), 30'u erkek (%62,5) olan 48 hasta alındı. Fonksiyonel analiz için Denis Ağrı Skoru (DPS) ve Denis İş Skoru (DWS) kullanıldı. Radyolojik analiz için preoperatif, postoperatif ilk gün ve son takipte ölçülen Cobb açıları kullanıldı. Ayrıca preoperatif ve son takipte çekilen bilgisayarlı tomografi aracılığı ile spinal stenoz ve remodelizasyon oranları hesaplandı. İstatistiksel analiz için tek yönlü ANOVA ve Pearson korelasyon testleri kullanıldı.

Bulgular: Hiçbir hastada kronik ağrı ya da işe geri dönememe şikâyeti görülmedi. Hastaların ameliyat öncesi, sonrası ve son kontrollerde ortalama Cobb açıları sırası ile 23,2, 4,9 ve 12,3 derece olarak ölçüldü. Ameliyat öncesi ortalama Cobb açısı ile ortalama korreksiyon arasında anlamlı bir korelasyon saptanırken (r=0,85, P<0,001); korreksiyon kaybı ile arasında anlamlı ilişki bulunmadı (r=0,27, P=0,43). Korreksiyon ve korreksiyon kaybı arasında bir korelasyon tespit edildi (r=0,38, P=0,008). Ameliyat öncesi %35,7 olarak hesaplanan spinal darlığın, son takipte %17,1’e gerilediği görüldü. Ortalama remodelizasyon %51,3 olarak hesaplandı. Spinal kanal remodelizasyonu anlamlı bulundu (P<0,001). 10 dereceden fazla korreksiyon kaybı olan hastalar ile DWS arasında anlamlı ilişki bulundu (P=0,003). DPS'de böyle bir ilişki bulunamadı. Son takipte ölçülen Cobb açısı ile DPS ve DWS arasında ilişki saptanmadı.

Sonuç: Sonuç olarak, kısa segment posterior enstrümentasyon ve füzyon cerrahisi sonrası korreksiyon kaybı, torakolomber burst kırıklarında, özellikle intraoperatif korreksiyon 15 dereceyi aştığında, belirgin olarak daha yüksektir. DWS, 10 derecenin üzerinde korreksiyon kaybı olan hastalarda anlamlı olarak daha kötüdür. Son takipteki korreksiyon kaybının derecesi doğrudan klinik ve fonksiyonel sonuçlarla ilgilidir.

Keywords

• Burst kırıkları,Kifoz,Cobb açısı,Remodelizasyon,Korreksiyon kaybı,Kısa segment posterior enstrümentasyon

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