Comparative results of surgical treatment of patients with spinal cord injury of the thoracolumbar spine
https://doi.org/10.56618/2071-2693_2024_16_1_98
EDN: CMQTWB
Abstract
The results of surgical treatment of patients with single-level spinal cord injury (PSMT) of the thoracolumbar spine in two groups of 35 people are presented. Clinical and X-ray examination was performed in representative groups. According to spiral computed tomography data, the effect of the calculated initial sizes of interbody gaps and the angle of deformation on the restoration of the size of the damaged vertebral body and closed decompression of the contents of the spinal canal was evaluated. In the main group, the developed method of preoperative planning was used for treatment, in which they tried to reproduce the calculated dimensions, and an improved method of spinal reposition. In the control group, the achieved sizes were retrospectively studied. The restoration of the calculated sizes of interbody gaps and the angle of deformation during surgery contributed to the restoration of the anterior and posterior dimensions of the bodies of damaged vertebrae with maximum decompression of the contents of the spinal canal, increased stability of osteosynthesis and reduced the number of complications. A comparison of long-term treatment outcomes to assess pain, economic and functional status on the R.G. Watkins scale showed the best treatment results for patients with thoracolumbar PSMT in the main group.
About the Authors
V. S. Kuftov
Bryansk City Hospital No. 1
Russian Federation
Russian Federation
Kuftov Vladimir Sergeevich,
11, Kamozina street, Bryansk, 241035.
V. D. Usikov
MTF “Sintez”
Russian Federation
Russian Federation
Usykov Vladimir Dmitrievich,
1B, Tsentralnaya street, Penza, 440004.
A. Yu. Ulitin
Polenov Neurosurgery Institute – the branch of Almazov National Medical Research Centre; I. I.Mechnikov Northwestern State Medical University
Russian Federation
Russian Federation
Ulitin Alexey Yurievich
12, Mayakovskogo street, St. Petersburg, 191025;
41, Kirochnaya street, St. Petersburg, 191015.
D. N. Monashenko
National Medical Research Center of Traumatology and Orthopedics named after R. R. Vreden
Russian Federation
Russian Federation
Monashenko Dmitry Nikolaevich,
8, Baykova street, St. Petersburg, 195427.
References
1. Piccone L., Cipolloni V., Nasto L. A., Pripp C., Tamburrelli F. C., Maccauro G, et al. Thoracolumbar burst fractures associated with incomplete neurological deficit in patients under the age of 40:Is the posterior approach enough? Surgical treatment and results in a case series of 10 patients with a minimum follow-up of 2 years. Injury. 2020;51(2):312–316. https://doi.org/10.1016/j.injury.2019.12.031.
2. Diotalevi L., Bailly N., Wagnac É., Mac-Thiong J. M., Goulet J., Petit Y. Dynamics of spinal cord compression with different patterns of thoracolumbar burst fractures: Numerical simulations using finite element modelling. Clin Biomech (Bristol, Avon). 2020;72:186–194. https://doi.org/10.1016/j.clinbiomech.2019.12.023.
3. Vaccaro A. R., Oner C., Kepler C. K., Dvorak M., Schnake K., Bellabarba C., Reinhold M., Aarabi B., Kandziora F., Chapman J., Shanmuganathan R., Fehlings M., Vialle L. AOSpine Spinal Cord Injury & Trauma Knowledge Forum. AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine (Phila Pa 1976). 2013;38(23):2028–2037. https://doi.org/10.1097/BRS.0b013e3182a8a381.
4. Крылов В. В., Гринь А. А., Кайков А. К. и др. Современные принципы в хирургии травм и заболеваний позвоночника // Неотложная мед. помощь: Журнал им. Н. В. Склифосовского. 2014. № 4. С. 36–41. [Krylov V. V., Grin A. A., Kaykov A. K., Oschepkov S. K., Lvov I. S. Modern principles in surgery of injuries and diseases of the spine. Neotlozhnaya meditsinskaya pomoshch: Zhurnal im. N.V. Sklifosovskogo. 2014;(4):36–41. (In Russ.)]. EDN: https://elibrary.ru/tgoisj.
5. Wang T., Wang Z., Ji P., Zhang J., Zhang C., Zhang L.. The efficacy and safety of anterior versus posterior approach for the treatment of thoracolumbar burst fractures: a systematic review and meta-analysis. Ann Transl Med. 2022;10(6):309. https://doi.org/10.21037/atm-22-903.
6. Kumar S., Patralekh M. K., Boruah T., Kareem S. A., Kumar A., Kumar R. Thoracolumbar fracture dislocation (AO type C injury): A systematic review of surgical reduction techniques. J Clin Orthop Trauma. 202011(5):730–741. Doi: https://doi.org/10.1016/j.jcot.2019.09.016.
7. Lafage R., Steinberger J., Pesenti S., Assi A., Elysee J. C., Iyer S., Lenke L. G., Schwab F. J., Kim H. J., Lafage V. Understanding Thoracic Spine Morphology, Shape, and Proportionality. Spine (Phila Pa 1976). 2020;45(3):149– 157. https://doi.org/10.1097/BRS.0000000000003227.
8. Machino M., Morita D., Ando K., Kobayashi K., Nakashima H., Kanbara S.., Ito S, Inoue T., Koshimizu H., Ito K., Kato F., Imagama S. Dynamic changes in longitudinal stretching of the spinal cord in thoracic spine: Focus on the spinal cord occupation rate of dural sac. Clin Neurol Neurosurg. 2020;(198):106225. https://doi.org/10.1016/j.clineuro.2020.106225.
9. Kunkel M. E., Herkommer A., Reinehr M., Böckers T. M., Wilke H. J. Morphometric analysis of the relationships between intervertebral disc and vertebral body heights: an anatomical and radiographic study of the human thoracic spine. J Anat. 2011;219(3):375–387. https://doi.org/10.1111/j.1469-7580.2011.01397.x.
10. Математические расчеты по моделированию поврежденного тела позвонка со смежными дисками и сагиттального угла на грудном и поясничном отделах / В. Д. Усиков, В. С. Куфтов, Д. Н. Монашенко, А. А. Долгушин // Росс. нейрохирург. журна. им. проф. А. Л. Поленова. 2022. Т. 14, № 4. С. 98–110. [Usikov V. D., Kuftov V. S., Monashenko D. N., Dolgushin A. A. Mathematical calculations for modeling the damaged vertebral body with adjacent discs and the sagittal angle in the thoracic and lumbar regions. Rossiiskii neirokhirurgicheskii zhurnal imeni professora A. L. Polenova. 2022;14(4):98– 110. (In Russ.).] https://doi.org/10.56618/20712693_2022_14_4_98 EDN: https://elibrary.ru/gvfzzv.
11. Sherrod B., Karsy M., Guan J., Mortenson J., Flis A., Rosenbluth J. P., Bisson E., Dailey A. Cost Analysis of Inpatient Rehabilitation after Spinal Injury: A Retrospective Cohort Analysis. Cureus. 2019;11(9):e5747. https://doi.org/10.7759/cureus.5747.
12. Yuksel M. O., Gurbuz M. S., Is M., Somay H. Is the Thoracolumbar Injury Classification and Severity Score (TLICS) Superior to the AO Thoracolumbar Injury Classification System for Guiding the Surgical Management of Unstable Thoracolumbar Burst Fractures without Neurological Deficit?. Turk Neurosurg. 2018;28(1):94–98. https://doi.org/10.5137/1019-5149.JTN.19094-16.2.
13. Wong C. E., Hu H. T., Tsai C. H., Li J. L., Hsieh C. C., Huang K. Y. Comparison of Posterior Fixation Strategies for Thoracolumbar Burst Fracture: A Finite Element Study. J Biomech Eng. 2021;143(7):071007. https:// doi.org/10.1115/1.4050537.
14. Томилов А. Б., Кузнецова Н. Л. Ортопедическая коррекция посттравматических деформаций позвоночника // Гений ортопедии. 2012. № 1. С. 60–63. [Tomilov A. B., Kuznetsova N. L. Orthopedic correction of posttraumatic spinal deformities. Genij Ortopedii. 2012;(1):60–63. (In Russ.)]. EDN: https://elibrary.ru/pbxiuh.
15. Olivares O. B., Carrasco M. V., Pinto G. I., Tonda F. N., Riera Martínez J. A., González A. S. Preoperative and Postoperative Sagittal Alignment and Compensatory Mechanisms in Patients With Posttraumatic Thoracolumbar Deformities Who Undergo Corrective Surgeries. Int J Spine Surg. 2021;15(3):585–590. https://doi.org/10.14444/8079.
16. Клинические аспекты сагиттального баланса у взрослых / А. В. Бурцев, С. О. Рябых, А. О. Котельников, А. В. Губин // Гений ортопедии. 2017. Т. 23, № 2. С. 228– 235. [Burtsev A. V., Ryabykh S. O., Kotelnikov A. O., Gubin A. V. Clinical issues of the sagittal balance in adults. Genij Ortopedii. 2017;23(2):228–235. (In Russ.)]. https://doi.org/10.18019/1028-4427-2017-23-2-228-235. EDN: https://elibrary.ru/yudvzb
17. Lee J. C., Choi S. W. Adjacent Segment Pathology after Lumbar Spinal Fusion. Asian Spine J. 2015;9(5):807–17. https://doi.org/10.4184/asj.2015.9.5.807.
18. Дулаев А. К., Кутянов Д. И., Мануковский В. А. и др. Выбор тактики и технологии инструментальной фиксации при изолированных неосложненных взрывных переломах грудных и поясничных позвонков // Хирургия позвоночника. 2019. Т. 16, № 2. С. 7–17. [Dulaev A. K., Kutyanov D. I., Manukovskiy V. A., Parshin M. S., Iskrovskiy S. V., Zhelnov P. V. Decisionmaking and technical choice in instrumental fixation for neurologically uncomplicated isolated burst fractures of the thoracic and lumbar vertebrae. Khirurgiya Pozvonochnika. 2019;16(2):7–17. (In Russ.)]. https://doi.org/10.14531/ss2019.2.7-17. EDN: https://elibrary.ru/ugwozk.
19. Mayer M., Ortmaier R., Koller H., Koller J., Hitzl W., Auffarth A., Resch H., von Keudell A. Impact of Sagittal Balance on Clinical Outcomes in Surgically Treated T12 and L1 Burst Fractures: Analysis of Long-Term Outcomes after Posterior-Only and Combined Posteroanterior Treatment. Biomed Res Int. 2017;(2017):1568258. https://doi.org/10.1155/2017/1568258.
20. Pesenti S., Lafage R., Stein D., Elysee J. C., Lenke L. G., Schwab F. J., Kim H. J., Lafage V. The Amount of Proximal Lumbar Lordosis Is Related to Pelvic Incidence. Clin Orthop Relat Res. 2018;476(8):1603–1611. https://doi.org/10.1097/CORR.0000000000000380.
21. Koller H., Acosta F., Hempfing A., Rohrmüller D., Tauber M., Lederer S., Resch H., Zenner J., Klampfer H., Schwaiger R., Bogner R., Hitzl W. Long-term investigation of nonsurgical treatment for thoracolumbar and lumbar burst fractures: an outcome analysis in sight of spinopelvic balance. Eur Spine J. 2008;17(8):1073–1095. https://doi.org/10.1007/s00586-008-0700-3.
22. Hou G. J., Zhou F., Tian Y., Ji H. Q., Zhang Z. S., Guo Y., Lv Y., Yang Z. W., Zhang Y. W. [Risk factors of recurrent kyphosis in thoracolumbar burst fracture patients treated by short segmental pedicle screw fixation]. Beijing Da XueXueBao Yi Xue Ban. 2020;53(1):167–174. https:// doi.org/10.19723/j.issn.1671-167X.2021.01.025.
23. Zappalá M., Lightbourne S., Heneghan N. R. The relationship between thoracic kyphosis and age, and normative values across age groups: a systematic review of healthy adults. J Orthop Surg Res. 2021;16(1):447. https://doi.org/10.1186/s13018-021-02592-2.
24. Hipp J. A., Grieco T. F., Newman P., Reitman C. A. Definition of Normal Vertebral Morphometry Using NHANES-II Radiographs. JBMR Plus. 2022;6(10):e10677. https://doi.org/10.1002/jbm4.10677.
25. Farcy J. P., Weidenbaum M., Glassman S. D. Sagittal index in management of thoracolumbar burst fractures. Spine (Phila Pa 1976). 1990;15(9):958–965. https://doi.org/10.1097/00007632-199009000-00022.
26. Voinea G. D., Butnariu S., Mogan G. Measurement and Geometric Modelling of Human Spine Posture for Medical Rehabilitation Purposes Using a Wearable Monitoring System Based on Inertial Sensors. Sensors (Basel). 2016;17(1):3. https://doi.org/10.3390/s17010003.
27. Орлов С. В., Каныкин А. Ю., Москалев В. П. и др. Математический расчет прочности позвоночного столба при хирургическом лечении нестабильных переломов позвоночника // Вестник хирургии им. И. И. Грекова. 2009. Т. 168, № 2. С. 61–64. [Orlov S.V., Kanykin A. Yu., Moskalev V. P., Shchedrenok V. V., Sedov R. L. Mathematical calculation of the strength of the spinal column in the surgical treatment of unstable spinal fractures. Vestnik khirurgii im. I. I. Grekova. 2009;168(2):61–64. (In Russ.)]. EDN: https://elibrary.ru/kugyyz .
28. Benek H. B., Akcay E., Yilmaz H., Yurt A. Efficiency of Distraction and Ligamentotaxis in Posterior Spinal Instrumentation of Thoracolumbar Retropulsed Fractures. Turk Neurosurg. 2021;31(6):973–979. https://doi.org/10.5137/1019-5149.JTN.34860-21.3.
29. Афаунов А. А., Кузьменко А. В. Транспедикулярная фиксация при повреждениях грудного и поясничного отделов позвоночника, сопровождающихся травматическим стенозом позвоночного канала // Хирургия позвоночника. 2011. Т. 4. С. 008–017. [Afaunov A. A., Kuzmenko A. V. Тranspedicular fixation for thoracic and lumbar spine injury with post-traumatic spinal stenosis. Khirurgiya Pozvonochnika. 2011;(4):008–017. (In Russ.)]. https://doi.org/10.14531/ss2011.4.8-17. EDN: https://elibrary.ru/onttib.
30. Leferink V. J., Nijboer J. M., Zimmerman K. W., Veldhuis E. F., ten Vergert E. M., ten Duis H. J. Burst fractures of the thoracolumbar spine: changes of the spinal canal during operative treatment and follow-up. Eur Spine J. 2003;12(3):255–260. https://doi.org/10.1007/s00586-002-0499-2.
31.
Review
For citations:
Kuftov V.S., Usikov V.D., Ulitin A.Yu., Monashenko D.N. Comparative results of surgical treatment of patients with spinal cord injury of the thoracolumbar spine. Russian Neurosurgical Journal named after Professor A. L. Polenov. 2024;16(1):98-108. (In Russ.) https://doi.org/10.56618/2071-2693_2024_16_1_98. EDN: CMQTWB
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