Multivariate analysis of risk factors for predicting supplementary posterior instrumentation after anterolateral decompression and instrumentation in treating thoracolumbar burst fractures

Journal of Orthopaedic Surgery and Research

Chun-Xiao Bai¹  Jian Du¹  Chen-Ying Zheng¹  Jin-Yu Li¹  Qi Sun¹  Yu-Song Jia¹  Jiang Chen¹ 

[1] Department of Orthopaedics, Dongzhimen Hospital, University of Chinese Medicine, Beijing 100700, China

关键词: Risk factors;    Multivariate analysis;    Posterior instrumentation;    Anterolateral decompression;    Thoracolumbar burst fracture;   

Others  :  1144199
DOI  :  10.1186/s13018-015-0155-2

 received in 2014-10-11, accepted in 2015-01-03,  发布年份 2015

【 摘 要 】

Background

Although anterolateral decompression and instrumentation has several advantages in treating thoracolumbar burst fractures, the risk factors for supplementary posterior instrumentation are still unclear.

Methods

We retrospectively reviewed 238 patients who underwent anterolateral decompression and instrumentation for single-level thoracolumbar burst fractures from January 2010 and March 2012. The influences of several potential risk factors that might affect supplementary posterior instrumentation were assessed using univariate and multivariate analyses.

Results

Twenty seven patients who developed worsening back pain without neurological deterioration after the anterolateral approach treatment need further posterior instrumentation fixation. The univariate analysis showed that age, disruption of the posterior longitudinal ligament complex (PLC), and fracture level were the risk factors for supplementary posterior instrumentation. However, age and integrity of the PLC were the independent risk factors for supplementary posterior instrumentation by multivariate analyses.

Conclusions

Supplemental posterior instrumentation was necessary in 11.3% of cases following anterolateral decompression and instrumentation in the present study. Older age and disruption of the PLC were the independent risk factors in prediction of supplementary posterior instrumentation in treating thoracolumbar burst fractures.

【 授权许可】

   
2015 Chen et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Bensch FV, Koivikko MP, Kiuru MJ, Koskinen SK: The incidence and distribution of burst fractures. Emerg Radiol 2006, 12(3):124-9.
• [2]Denis F: The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976) 1983, 8(8):817-31.
• [3]Bailey CS, Dvorak MF, Thomas KC, Boyd MC, Paquett S, Kwon BK, France J, Gurr KR, Bailey SI, Fisher CG: Comparison of thoracolumbosacral orthosis and no orthosis for the treatment of thoracolumbar burst fractures: interim analysis of a multicenter randomized clinical equivalence trial. J Neurosurg Spine 2009, 11(3):295-303.
• [4]Cantor JB, Lebwohl NH, Garvey T, Eismont FJ: Nonoperative management of stable thoracolumbar burst fractures with early ambulation and bracing. Spine (Phila Pa 1976) 1993, 18(8):971-6.
• [5]Dai LY. Remodeling of the spinal canal after thoracolumbar burst fractures. Clin Orthop Relat Res 2001(382):119–123.
• [6]Dai LY, Jiang LS, Jiang SD: Conservative treatment of thoracolumbar burst fractures: a long-term follow-up results with special reference to the load sharing classification. Spine (Phila Pa 1976) 2008, 33(23):2536-44.
• [7]Hitchon PW, Torner J, Eichholz KM, Beeler SN: Comparison of anterolateral and posterior approaches in the management of thoracolumbar burst fractures. J Neurosurg Spine 2006, 5(2):117-25.
• [8]Hitchon PW, Torner JC, Haddad SF, Follett KA: Management options in thoracolumbar burst fractures. Surg Neurol 1998, 49(6):619-26.
• [9]McCormack T, Karaikovic E, Gaines RW: The load sharing classification of spine fractures. Spine (Phila Pa 1976) 1994, 19(15):1741-4.
• [10]Mumford J, Weinstein JN, Spratt KF, Goel VK: Thoracolumbar burst fractures. The clinical efficacy and outcome of nonoperative management. Spine (Phila Pa 1976) 1993, 18(8):955-70.
• [11]Reid DC, Hu R, Davis LA, Saboe LA: The nonoperative treatment of burst fractures of the thoracolumbar junction. J Trauma 1988, 28(8):1188-94.
• [12]Siebenga J, Leferink VJ, Segers MJ, Elzinga MJ, Bakker FC, Haarman HJ, Rommens PM, Ten DH, Patka P: Treatment of traumatic thoracolumbar spine fractures: a multicenter prospective randomized study of operative versus nonsurgical treatment. Spine (Phila Pa 1976) 2006, 31(25):2881-90.
• [13]Tropiano P, Huang RC, Louis CA, Poitout DG, Louis RP: Functional and radiographic outcome of thoracolumbar and lumbar burst fractures managed by closed orthopaedic reduction and casting. Spine (Phila Pa 1976) 2003, 28(21):2459-65.
• [14]Vaccaro AR, Lehman RJ, Hurlbert RJ, Anderson PA, Harris M, Hedlund R, Harrop J, Dvorak M, Wood K, Fehlings MG, Fisher C, Zeiller SC, Anderson DG, Bono CM, Stock GH, Brown AK, Kuklo T, Oner FC: A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine (Phila Pa 1976) 2005, 30(20):2325-33.
• [15]Willen J, Anderson J, Toomoka K, Singer K: The natural history of burst fractures at the thoracolumbar junction. J Spinal Disord 1990, 3(1):39-46.
• [16]Wood K, Buttermann G, Mehbod A, Garvey T, Jhanjee R, Sechriest V: Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit. A prospective, randomized study. J Bone Joint Surg Am 2003, 85-A(5):773-81.
• [17]Wood KB, Bohn D, Mehbod A: Anterior versus posterior treatment of stable thoracolumbar burst fractures without neurologic deficit: a prospective, randomized study. J Spinal Disord Tech 2005, 18 Suppl:S15-23.
• [18]Dai LY, Jiang LS, Jiang SD: Posterior short-segment fixation with or without fusion for thoracolumbar burst fractures. a five to seven-year prospective randomized study. J Bone Joint Surg Am 2009, 91(5):1033-41.
• [19]Danisa OA, Shaffrey CI, Jane JA, Whitehill R, Wang GJ, Szabo TA, Hansen CA, Shaffrey ME, Chan DP: Surgical approaches for the correction of unstable thoracolumbar burst fractures: a retrospective analysis of treatment outcomes. J Neurosurg 1995, 83(6):977-83.
• [20]McLain RF, Sparling E, Benson DR: Early failure of short-segment pedicle instrumentation for thoracolumbar fractures. A preliminary report. J Bone Joint Surg Am 1993, 75(2):162-7.
• [21]McNamara MJ, Stephens GC, Spengler DM: Transpedicular short-segment fusions for treatment of lumbar burst fractures. J Spinal Disord 1992, 5(2):183-7.
• [22]Dai LY, Jiang LS, Jiang SD: Anterior-only stabilization using plating with bone structural autograft versus titanium mesh cages for two- or three-column thoracolumbar burst fractures: a prospective randomized study. Spine (Phila Pa 1976) 2009, 34(14):1429-35.
• [23]Heary RF, Kheterpal A, Mammis A, Kumar S: Stackable carbon fiber cages for thoracolumbar interbody fusion after corpectomy: long-term outcome analysis. Neurosurgery 2011, 68(3):810-8.
• [24]Kaneda K, Taneichi H, Abumi K, Hashimoto T, Satoh S, Fujiya M: Anterior decompression and stabilization with the Kaneda device for thoracolumbar burst fractures associated with neurological deficits. J Bone Joint Surg Am 1997, 79(1):69-83.
• [25]McAfee PC. Complications of anterior approaches to the thoracolumbar spine. Emphasis on Kaneda instrumentation. Clin Orthop Relat Res 1994;(306):110–119
• [26]McDonough PW, Davis R, Tribus C, Zdeblick TA: The management of acute thoracolumbar burst fractures with anterior corpectomy and Z-plate fixation. Spine (Phila Pa 1976) 2004, 29(17):1901-8. 1909
• [27]Sasso RC, Renkens K, Hanson D, Reilly T, McGuire RJ, Best NM: Unstable thoracolumbar burst fractures: anterior-only versus short-segment posterior fixation. J Spinal Disord Tech 2006, 19(4):242-8.
• [28]Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S: A comprehensive classification of thoracic and lumbar injuries. Eur Spine J 1994, 3(4):184-201.
• [29]Patel AA, Vaccaro AR: Thoracolumbar spine trauma classification. J Am Acad Orthop Surg 2010, 18(2):63-71.
• [30]Rihn JA, Anderson DT, Harris E, Lawrence J, Jonsson H, Wilsey J, Hurlbert RJ, Vaccaro AR: A review of the TLICS system: a novel, user-friendly thoracolumbar trauma classification system. Acta Orthop 2008, 79(4):461-6.
• [31]Emery SE, Pathria MN, Wilber RG, Masaryk T, Bohlman HH: Magnetic resonance imaging of posttraumatic spinal ligament injury. J Spinal Disord 1989, 2(4):229-33.
• [32]Haba H, Taneichi H, Kotani Y, Terae S, Abe S, Yoshikawa H, Abumi K, Minami A, Kaneda K: Diagnostic accuracy of magnetic resonance imaging for detecting posterior ligamentous complex injury associated with thoracic and lumbar fractures. J Neurosurg 2003, 99(1 Suppl):20-6.
• [33]Lee HM, Kim HS, Kim DJ, Suk KS, Park JO, Kim NH: Reliability of magnetic resonance imaging in detecting posterior ligament complex injury in thoracolumbar spinal fractures. Spine (Phila Pa 1976) 2000, 25(16):2079-84.
• [34]Oner FC, van Gils AP, Faber JA, Dhert WJ, Verbout AJ: Some complications of common treatment schemes of thoracolumbar spine fractures can be predicted with magnetic resonance imaging: prospective study of 53 patients with 71 fractures. Spine (Phila Pa 1976) 2002, 27(6):629-36.
• [35]Radcliff K, Kepler CK, Rubin TA, Maaieh M, Hilibrand AS, Harrop J, Rihn JA, Albert TJ, Vaccaro AR: Does the load-sharing classification predict ligamentous injury, neurological injury, and the need for surgery in patients with thoracolumbar burst fractures?: Clinical article. J Neurosurg Spine 2012, 16(6):534-8.
• [36]Radcliff K, Su BW, Kepler CK, Rubin T, Shimer AL, Rihn JA, Harrop JA, Albert TJ, Vaccaro AR: Correlation of posterior ligamentous complex injury and neurological injury to loss of vertebral body height, kyphosis, and canal compromise. Spine (Phila Pa 1976) 2012, 37(13):1142-50.
• [37]Burns S, Biering-Sorensen F, Donovan W, Graves DE, Jha A, Johansen M, Jones L, Krassioukov A, Kirshblum S, Mulcahey MJ, Read MS, Waring W: International standards for neurological classification of spinal cord injury, revised 2011. Top Spinal Cord Inj Rehabil 2012, 18(1):85-99.
• [38]Brodke DS, Gollogly S, Bachus KN, Alexander MR, Nguyen BK: Anterior thoracolumbar instrumentation: stiffness and load sharing characteristics of plate and rod systems. Spine (Phila Pa 1976) 2003, 28(16):1794-801.
• [39]Kallemeier PM, Beaubien BP, Buttermann GR, Polga DJ, Wood KB: In vitro analysis of anterior and posterior fixation in an experimental unstable burst fracture model. J Spinal Disord Tech 2008, 21(3):216-24.
• [40]Maiman DJ, Pintar F, Yoganandan N, Reinartz J: Effects of anterior vertebral grafting on the traumatized lumbar spine after pedicle screw-plate fixation. Spine (Phila Pa 1976) 1993, 18(16):2423-30.
• [41]Khosla S, Riggs BL: Pathophysiology of age-related bone loss and osteoporosis. Endocrinol Metab Clin North Am 2005, 34(4):1015-30.
• [42]Riggs BL, Melton ILR, Robb RA, Camp JJ, Atkinson EJ, Peterson JM, Rouleau PA, McCollough CH, Bouxsein ML, Khosla S: Population-based study of age and sex differences in bone volumetric density, size, geometry, and structure at different skeletal sites. J Bone Miner Res 2004, 19(12):1945-54.