Anterior approach with expandable cage implantation in management of unstable thoracolumbar fractures: Results of a series of 93 patients

May 2, 2016Neuro-Chirurgie

Using a front-side expandable cage to treat unstable fractures in the middle and lower back: Results from 93 patients

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Abstract

Anterior fixation with expandable prosthetic vertebral body cage implantation resulted in a 65% increase in vertebral body height when combined with a posterior approach.

Vertebral height gain was 13% after a previous posterior approach and 38% after a single anterior approach.
Anterior fixation did not significantly improve the vertebral regional kyphosis angle overall, with a notable exception for thoracic fractures treated with a single anterior approach.
Complete fusion was consistently observed one year after the procedure.
No infections or surgical revisions occurred following the anterior approach.
The safety and effectiveness of anterior fixation may support its expanded use in treating certain oncology and infectious disease cases.

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INTRODUCTION: Anterior approach indications in unstable thoracolumbar fractures (UTLF) are debated. The aim of this study was to evaluate the results of anterior fixation and expandable prosthetic vertebral body cage (EPVBC) implantation alone or combined with a posterior approach in the management of UTLF.

MATERIALS AND METHODS: Ninety-three patients underwent anterior fixation with implantation of an EPVBC for UTLF from T7 to L5. Long-term kyphosis and vertebral height loss reduction, functional outcomes including visual analogical scale and Oswestry disability index were evaluated.

RESULTS: Anterior fixation led to a significant increase of vertebral body height with a gain of 13% after a previous posterior approach, 38% after a single anterior approach and 65% after combined posterior and anterior approaches (P=0.0001). However, anterior fixation did not significantly enhance the vertebral regional kyphosis angle (P=0.08), except in cases of single anterior approach for thoracic fractures (P=0.03). No significant difference was found between early, 3 months and 1 year postoperative vertebral regional kyphosis angle and vertebral body height (P=0.6). Complete fusion was routinely observed at 1 year postoperatively. rhBMP2 implantation in selected cases appears to be a safe and reliable strategy. No infections or surgical revisions were observed after the anterior approach.

CONCLUSION: Anterior approach and EPVBC implantation, in UTLF, is a safe and effective procedure, providing long-term vertebral body height and kyphosis correction. Adverse effects of anterior approach remain acceptable. Single anterior fixation is a reliable surgical alternative in thoracic fractures without posterior spine segment injury or spinal cord compression. These results prompted us to extend anterior approach indications in oncology and infectious diseases.

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Anterior approach with expandable cage implantation in management of unstable thoracolumbar fractures: Results of a series of 93 patients

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