1Neurosurgery Unit, Cardinale G. Panico Hospital, Tricase; and.
2NESMOS Department, "Sapienza" University of Rome, Sant'Andrea Hospital, Rome, Italy.
Neurosurg Focus. 2021 Oct;51(4):E8. doi: 10.3171/2021.7.FOCUS21308.
The typical traumatic thoracolumbar (TL) fracture in patients with ankylosing spondylitis (AS) is a hyperextension injury involving all three spinal columns, which is associated with unfavorable outcomes. Although a consensus on the management of these highly unstable injuries is missing, minimally invasive surgery (MIS) has been progressively accepted as a treatment option, since it is related to lower morbidity and mortality rates. This study aimed to evaluate clinical and radiological outcomes after percutaneous instrumentation with cement augmentation for hyperextension TL fractures in patients with AS at a single institution.
This cohort study was completed retrospectively. Back pain was assessed at preoperative, postoperative, and final follow-up visits using the visual analog scale (VAS). Patient-reported outcomes via the Oswestry Disability Index (ODI) and the new mobility score (NMS) were obtained to assess disability and mobility during follow-up. Radiological outcomes included the Cobb angle, sagittal index (SI), union rate, and implant failure. Intra- and postoperative complications were recorded.
A total of 22 patients met inclusion criteria. The mean patient age was 74.2 ± 7.3 years with a mean follow-up of 39.2 ± 17.4 months. The VAS score for back pain significantly improved over the follow-up period (from 8.4 ± 1.1 to 2.8 ± 0.8, p < 0.001). At the last follow-up, all patients had minor disability (mean ODI score 24.4 ± 6.1, p = 0.003) and self-sufficiency of mobility (mean NMS 7.5 ± 1.6, p = 0.02). The Cobb angle (5.2° ± 2.9° preoperatively to 4.4° ± 3.3° at follow-up) and SI (7.9° ± 4.2° to 8.8° ± 5.1°) were maintained at follow-up, showing no loss of segmental kyphosis. Bone union was observed in all patients. The overall complication rate was 9.1%, while the reoperation rate for implant failure was 4.5%.
Percutaneous instrumentation with cement augmentation for traumatic hyperextension TL fractures in AS demonstrated good clinical and radiological outcomes, along with a high bone union level and low reoperation rate. Accordingly, MIS reduced the complication rate in the management of these injuries of the ankylosed spine.
强直性脊柱炎（AS）患者的典型创伤性胸腰椎（TL）骨折是涉及三个脊柱柱的过伸损伤，其结果通常不佳。尽管对于这些高度不稳定损伤的管理尚未达成共识，但微创外科（MIS）已逐渐被接受为一种治疗选择，因为它与较低的发病率和死亡率相关。本研究旨在评估单中心接受经皮骨水泥强化内固定治疗的 AS 患者过伸性 TL 骨折的临床和影像学结果。
这是一项回顾性队列研究。使用视觉模拟量表（VAS）在术前、术后和最终随访时评估背痛。通过 Oswestry 残疾指数（ODI）和新活动评分（NMS）获得患者报告的结果，以评估随访期间的残疾和活动能力。影像学结果包括 Cobb 角、矢状指数（SI）、愈合率和植入物失败。记录术中及术后并发症。
共纳入 22 例符合条件的患者。患者平均年龄为 74.2 ± 7.3 岁，平均随访时间为 39.2 ± 17.4 个月。随访期间，VAS 背痛评分显著改善（从 8.4 ± 1.1 降至 2.8 ± 0.8，p < 0.001）。末次随访时，所有患者均有轻度残疾（平均 ODI 评分 24.4 ± 6.1，p = 0.003）和移动能力的自理（平均 NMS 7.5 ± 1.6，p = 0.02）。Cobb 角（术前 5.2° ± 2.9°至随访时 4.4° ± 3.3°）和 SI（术前 7.9° ± 4.2°至随访时 8.8° ± 5.1°）在随访时保持不变，未见节段性后凸丢失。所有患者均观察到骨愈合。总体并发症发生率为 9.1%，植入物失败的再次手术率为 4.5%。
对于 AS 过伸性 TL 骨折，经皮骨水泥强化内固定治疗具有良好的临床和影像学结果，且骨愈合水平高，再次手术率低。因此，MIS 降低了僵硬脊柱损伤的治疗并发症发生率。
