Short-segment posterior instrumentation combined with anterior spondylodesis using an autologous rib graft in thoracolumbar burst fractures

Dec 24, 2013Acta orthopaedica

Using short back support and front bone graft from the ribs to treat mid-lower spine burst fractures

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Abstract

Segmental kyphosis at the fracture site was corrected from a median of -20° to -1.0° postoperatively.

A median correction loss of 2.0° was observed one year after surgery.
All patients achieved successful fusion of the spondylodesis, indicated by rib graft incorporation and remodeling.
The median correction loss after implant removal was 0.0°.
At the 2-year follow-up, 26 of 32 patients reported no back complaints.
One patient experienced intercostal neuralgia, while five patients reported mild to moderate back pain.

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BACKGROUND AND PURPOSE: There are very few data concerning the outcome after short-segment posterior stabilization and anterior spondylodesis with rib grafts in patients suffering from unstable thoracolumbar burst fractures. We have therefore investigated the clinical and radiographic outcome after posterior bisegmental instrumentation and monosegmental anterior spondylodesis using an autologous rib graft for unstable thoracolumbar burst fractures.

PATIENTS AND METHODS: This was a retrospective analysis of 32 consecutive patients at a single center. The monosegmental Cobb angle was measured preoperatively, postoperatively, then 6 and 12 months postoperatively, and also after implant removal. Anterior vertebral fusion was graded on conventional radiographs according to the criteria proposed by Molinari.

RESULTS: Segmental kyphosis at the fracture site was corrected from a median of -20° (95% CI: -21.2 to -18.8) to -1.0° (95% CI: -2.7 to 0.7) postoperatively. 1 year after surgery, the segmental angle had decreased by a median of 2.0° (95% CI: 0.2 to 2.8). The spondylodesis fused in all patients, which was evident from incorporation and remodeling of the rib grafts. The median correction loss after implant removal was 0.0° (95% CI: -0.5 to 0.5). 26 of the 32 patients reported having no back complaints at the last follow-up (2 years postoperatively). 1 patient suffered from intercostal neuralgia, and 5 patients reported mild to moderate back pain.

INTERPRETATION: Short-segment posterior instrumentation and anterior spondylodesis using an autologous rib graft resulted in sufficient correction of posttraumatic segmental kyphosis. There was no clinically relevant correction loss, and the majority of patients had no back complaints at the 2-year follow-up.

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Short-segment posterior instrumentation combined with anterior spondylodesis using an autologous rib graft in thoracolumbar burst fractures

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