Sulpis Benoit, Neri Thomas, Klasan Antonio, Castel Xavier, Vassal François, Tetard Marie Charlotte
Jacques Lisfranc Faculty of Medicine, Jean Monnet University, 10 Rue de la Marandière, 42270 Saint-Priest-en-Jarez, France - Department of Neuro Surgery, University Hospital of Saint Etienne, Hôpital Nord, 42055 Saint-Étienne Cedex 2, France - Department of Orthopaedic Surgery, University Hospital of Saint Etienne, Saint Etienne, France.
Department of Orthopaedic Surgery, University Hospital of Saint Etienne, Saint Etienne, France - EA 7424 - Inter-University Laboratory of Human Movement Science, University of Lyon - Jean Monnet University, Saint-Étienne Cedex 2, France.
SICOT J. 2024;10:26. doi: 10.1051/sicotj/2024022. Epub 2024 Aug 9.
Fractures in ankylosing spine disorders (ASD) are associated with high complication and mortality rates. During the posterior stabilization of these fractures, reduction is often partial, resulting in the persistence of a significant anterior diastasis. Our objective was to evaluate the safety and efficiency of isolated posterior stabilization in elderly ASD patients, without direct reduction of the anterior diastasis, in terms of clinical and radiological outcomes, complications, and mortality.
This retrospective study included 46 patients, mean age 79.3 years, with ASD, who underwent isolated posterior stabilization, open or percutaneous, for thoracolumbar fractures. The average follow-up was 21.7 months, with a minimum follow-up of 6 months. Autonomy (Parker score) and radiological results (lordotic angulation) were analyzed pre-and post-operatively.
Autonomy was maintained at the last follow-up, with no significant difference in Parker's score. The consolidation rate was 94.6%. No implant failure was recorded. Despite the absence of an anterior procedure, lordotic angulation was significantly reduced by 2.6° at 6 months (p = 0.02). The rate of surgical complications following open surgeries was 10.9% (n = 5), of which 6.5% were infections. No surgical complications were reported in percutaneous surgeries. The rate of medical complications was 67.4% (n = 31), with a rate of 88.2% in the open surgery group, compared to 55.2% in the percutaneous surgery group. An open approach was associated with a five-fold higher risk of complications (p = 0.049). Nine patients died during follow-up (19.6%).
Isolated posterior stabilization in the treatment of thoracolumbar spine fractures in elderly ASD patients is a safe technique promoting autonomy preservation, and high radiological bony healing with acceptable complication and mortality rates. The persistent anterior gap is partially reduced when the spine is loaded and does not seem to require an anterior procedure, thus decreasing complications. Percutaneous surgery should be the technique of choice to reduce surgical complications.
强直性脊柱炎相关疾病（ASD）中的骨折与高并发症和死亡率相关。在这些骨折的后路稳定手术中，复位往往不完全，导致显著的前方分离持续存在。我们的目的是从临床和影像学结果、并发症及死亡率方面评估老年ASD患者单纯后路稳定手术（不直接复位前方分离）的安全性和有效性。
这项回顾性研究纳入了46例平均年龄79.3岁的ASD患者，他们因胸腰椎骨折接受了单纯后路开放或经皮稳定手术。平均随访时间为21.7个月，最短随访时间为6个月。术前和术后分析了自主性（帕克评分）和影像学结果（腰椎前凸角度）。
在最后一次随访时自主性得以维持，帕克评分无显著差异。骨愈合率为94.6%。未记录到植入物失败情况。尽管未进行前路手术，但在6个月时腰椎前凸角度显著减小了2.6°（p = 0.02）。开放手术的手术并发症发生率为10.9%（n = 5），其中6.5%为感染。经皮手术未报告手术并发症。医疗并发症发生率为67.4%（n = 31），开放手术组为88.2%，经皮手术组为55.2%。开放手术的并发症风险高出五倍（p = 0.049）。9例患者在随访期间死亡（19.6%）。
老年ASD患者胸腰椎骨折的单纯后路稳定手术是一种安全的技术，可促进自主性的保留，实现高影像学骨愈合率，并发症和死亡率可接受。当脊柱负重时，持续存在的前方间隙会部分减小，似乎不需要前路手术，从而减少并发症。经皮手术应作为减少手术并发症的首选技术。
