Comparison of combined posterior and anterior spondylodesis versus hybrid stabilization in unstable burst fractures at the thoracolumbar spine in patients between 60 and 70 years of age

• Published in: Archives of orthopaedic and trauma surgery 2018-10, Vol.138 (10), p.1407-1414
• Main Authors: Spiegl, Ulrich J., Devitt, Brian M., Kasivskiy, Ihor, Jarvers, Jan-Sven, Josten, Christoph, Heyde, Christoph-Eckhard, Fakler, Hannes M.
• Format: Article
• Language: English
• Subjects: Age; Aged; Disability Evaluation; Female; Follow-Up Studies; Fracture Fixation, Internal - methods; Fractures, Compression - diagnostic imaging; Fractures, Compression - surgery; Humans; Kyphoplasty; Length of Stay; Lumbar Vertebrae - diagnostic imaging; Lumbar Vertebrae - surgery; Male; Medicine; Medicine & Public Health; Older people; Operative Time; Orthopedics; Patient Satisfaction; Reoperation; Retrospective Studies; Spinal Fractures - diagnostic imaging; Spinal Fractures - surgery; Spinal Fusion - methods; Thoracic Vertebrae - diagnostic imaging; Thoracic Vertebrae - surgery; Trauma; Trauma Surgery; Visual Analog Scale
• ISSN: 0936-8051; 1434-3916
• DOI: 10.1007/s00402-018-2993-y

Introduction Surgical treatment of unstable burst fractures of the thoracolumbar spine in the elderly population is highly variable with combined posterior and anterior stabilization (CPAS) and posterior augmented stabilization with cementation of the vertebral body (hybrid) being two commonly used techniques. The aim of this study was to compare the clinical and radiographic outcomes of CPAS versus hybrid stabilization for the treatment of unstable burst fractures of the thoracolumbar spine in patients aged between 60 and 70 years. Materials and methods A retrospective analysis was performed of all thoracolumbar burst fractures treated surgically in a single level I trauma center between June 2013 and February 2015. Two commonly used strategies of surgical stabilization were compared; the first consisted of initial posterior reduction and bisegmental stabilization, followed by additional anterior spondylodesis (CPAS); the second method comprised a hybrid technique with a posterior cement augmented bisegmental minimally invasive stabilization and kyphoplasty of the fractured vertebral body. Patients were evaluated clinically after a minimum follow-up of 18 months. The primary endpoint was the Oswestry Disability Index (ODI) at the latest follow-up. Secondary parameters of interest were length of in-hospital stay (LIHS), duration of surgery (DS), surgical revisions (SR), pain level (P-VAS), satisfaction level and the SF-36 score (PSC, MSC), the bisegmental postoperative Cobb angle, the reduction loss (RL), and all alignment parameters (pelvic tilt, pelvic incidence, sacral slope, lumbar lordosis, C7 plumb line). Results A total of 29 patients were included (17 females, 12 males, mean age 65.6 years ± 3.4 years). The following vertebral bodies were fractured: thoracic level (T) 12: n  = 6; lumbar (L) 1: n  = 14; L 2: n  = 6; L 3: n  = 3. CPAS was performed in 10 patients (34%), whereas the hybrid was carried out in 19 patients (66%). There were no statistical significant differences between both study groups regarding age, gender, trauma energy, fracture level, and fracture morphology. The latest follow-up was performed after a mean of 27 months (range 18–53 months). The LIHS between the treatment methods was statistically significant ( p