Improvement of vertebral body fracture reduction utilizing a posterior reduction tool: a single-center experience

Improvement of vertebral body fracture reduction utilizing a posterior reduction tool: a single-center experience

Extensive research regarding instabilities and prevention of kyphotic malalignment in the thoracolumbar spine exists. Keystones of this treatment are posterior instrumentation and anterior vertebral height restoration. Anterior column reduction via a single-stage procedure seems to be advantageous r...

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Bibliographic Details
Published in:Journal of orthopaedic surgery and research 2023-04, Vol.18 (1), p.321-321, Article 321
Main Authors: Hoffmann, Martin F, Kuhlmann, Kristina, Schildhauer, Thomas A, Wenning, Katharina E
Format: Article
Language:eng
Subjects:
Adult
Closed reduction
Comorbidity
Emergency medical services
Female
Fracture Fixation - adverse effects
Fracture Fixation, Internal - methods
Fractures
Fractures, Bone - complications
Humans
Immunoglobulins
Kyphosis
Kyphosis - diagnostic imaging
Kyphosis - prevention & control
Kyphosis - surgery
Lumbar Vertebrae - surgery
Medical imaging
Middle Aged
Orthopedics
Patients
Posterior surgical treatment
Questionnaires
Reduction tool
Retrospective Studies
Spinal Fractures - complications
Spinal Fractures - diagnostic imaging
Spinal Fractures - surgery
Spine
Statistical analysis
Thoracic Vertebrae - diagnostic imaging
Thoracic Vertebrae - injuries
Thoracic Vertebrae - surgery
Thoracolumbar spine
Trauma
Treatment Outcome
Vertebrae
Vertebral Body
Vertebral fracture
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Summary:Extensive research regarding instabilities and prevention of kyphotic malalignment in the thoracolumbar spine exists. Keystones of this treatment are posterior instrumentation and anterior vertebral height restoration. Anterior column reduction via a single-stage procedure seems to be advantageous regarding complication, blood loss, and OR-time. Mechanical elevation of the anterior cortex of the vertebra may prevent the necessity of additional anterior stabilization or vertebral body replacement. The purpose of this study was to examine (1) if increased bony reduction in the anterior vertebral cortex could be achieved by utilization of an additional reduction tool, (2) if postoperative loss of vertebral height could be reduced, and (3) if anterior column reduction is related to clinical outcome. From one level I trauma center, 173 patients underwent posterior stabilization for fractures of the thoracolumbar region between 2015 and 2020. Reduction in the vertebral body was performed via intraoperative lordotic positioning or by utilization of an additional reduction tool (Nforce, Medtronic). The reduction tool was mounted onto the pedicle screws and removed after tightening of the locking screws. To assess bony reduction, the sagittal index (SI) and vertebral kyphosis angle (VKA) were measured on X-rays and CT images at different time points ((1) preoperative, (2) postoperative, (3) ≥ 3 months postoperative). Clinical outcome was assessed utilizing the Ostwestry Disability Index (ODI). Bisegmental stabilization of AO/OTA type A3/A4 vertebral fractures was performed in 77 patients. Thereof, reduction was performed in 44 patients (females 34%) via intraoperative positioning alone (control group), whereas 33 patients (females 33%) underwent additional reduction utilizing a mechanical reduction tool (instrumentation group). Mean age was 41 ± 13 years in the instrumentation group (IG) and 52 ± 12 years in the control group (CG) (p 
ISSN:1749-799X
1749-799X