Vertebral body cage use in thoracolumbar fractures: Outcomes in a prospective series of 23 cases at 2 years’ follow-up

Doi : 10.1016/j.otsr.2011.05.003

N. Salas , R. Prébet, B. Guenoun, L.-E. Gayet, P. Pries

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Summary

Introduction

One objective of surgery in thoracolumbar spine fracture is to restore correct and lasting spinal statics. This may involve vertebral body replacement using an anterior approach. We here report results on a prospective series of 23 trauma patients managed by vertebral body replacement using an expandable cage.

Patients and methods

The sex ratio was 2.28. Fifteen cases involved primary treatment of recent fracture and eight secondary surgery for non-union or malunion. In 12 cases, posterior osteosynthesis was associated. Six patients were operated on using a classical approach and 17 using a video-assisted minimally invasive approach. Pre- and perioperative data were recorded, with clinical scores (VAS and Oswestry) at 6weeks, 3months, 6months, 1year and 2years. Radiologic follow-up assessed regional traumatic kyphosis (RTK), enabling calculation of regional traumatic angulation (RTA), with control CT to check fusion.

Results

Minimum follow-up was 2years. There were no cases of postoperative neurological deterioration. There were three major postoperative complications: one hemothorax, one adhesive bowel occlusion, and one bilateral pneumothorax at 1month. Mean Oswestry score at 6months was 20%, and mean VAS score at 2years was 0.36. Postoperative RTA showed a mean 7.34° improvement. Mean RTA reduction loss was 1.95° at 3months, subsequently unchanged. All arthrodeses showed fusion at 6months.

Conclusion

Results were satisfactory with this technique, comparable to those reported in the literature. The development of minimally invasive approaches and improved instrumentation procedures optimize surgery and enhance anterior reconstruction tolerance. Lasting restoration of sagittal spinal curvature improves trauma patients’ functional recovery.