Prospective randomized controlled comparison of posterior vs. posterior–anterior stabilization of thoracolumbar incomplete cranial burst fractures in neurological intact patients: the RASPUTHINE pilot study

Oct 27, 2017European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society

Comparing Back-Only and Back-Plus-Front Stabilization for Partial Upper Spine Burst Fractures in Patients without Nerve Damage

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Abstract

21 patients were randomly assigned to either the posterior-anterior or posterior-only stabilization groups.

The clinical outcome, measured by the Oswestry Disability Index, indicated less but statistically insignificant disability (13.3% vs. 19.3%, p = 0.67) for the posterior-anterior group compared to the posterior-only group.
A crossover occurred in one patient from the posterior-only group, who required additional anterior stabilization due to severe initial loss of correction.
The control group experienced a worsening in bisegmental kyphosis from 10.7° to 15.6°, while the interventional group showed an improvement from 11° to 8.3°.
Results suggest better restoration of the sagittal profile for the posterior-anterior stabilization method.
To detect a clinically significant difference in the multicentre trial, a total of 266 patients is necessary, accounting for a 20% loss to follow-up.

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PURPOSE: If surgery for thoracolumbar incomplete cranial burst fractures (Magerl A3.1.1) is necessary, the ideal stabilization strategy still remains undetermined. To justify posterior-anterior stabilization, which generates higher costs and potentially higher morbidity vs. posterior-only stabilization, clinical trials with sufficient power and adequate methodology are required. This prospective randomized single-centre pilot trial was designed to enable sufficient sample-size calculation for a randomized multicentre clinical trial (RASPUTHINE).

METHODS: Patients with a traumatic thoracolumbar (Th11-L2) incomplete burst fracture (Magerl A3.1.1) were randomly assigned either to the interventional group (posterior-anterior) or to the control group (posterior-only). Primary endpoint of the study was the clinical outcome measured using the Oswestry Disability Index (ODI) at 24 months. Radiological outcome was assessed as secondary endpoint by evaluation of mono- and bisegmental kyphotic angulation and monosegmental fusion.

RESULTS: 21 patients were randomly assigned to interventional group (n = 9) or control group (n = 12). One posterior-only treated patient showed a severe initial loss of correction resulting in a crossover to additional anterior bisegmental fusion. The ODI measures at the primary study endpoint showed less but insignificant (p = 0.67) disability for the interventional group over the control group (13.3 vs. 19.3%). Comparison of preoperative bisegmental kyphosis in supine position with the bisegmental kyphosis at 24-month FU in upright position showed a worsened kyphosis for the control group (10.7° → 15.6°), whereas an improved kyphosis (11° → 8.3°) was detectable for the interventional group.

CONCLUSION: The results of this pilot RCT showed less disability for the posterior-anterior group linked with a significant better restoration of the sagittal profile in comparison with the posterior-only group. To detect a clinically significant difference using the ODI and assuming a 20% loss of FU rate, a total of 266 patients have to be studied in the multicentre trial.

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Prospective randomized controlled comparison of posterior vs. posterior–anterior stabilization of thoracolumbar incomplete cranial burst fractures in neurological intact patients: the RASPUTHINE pilot study

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