Gianoli Daniele, Bättig Linda, Bertulli Lorenzo, Forster Thomas, Martens Benjamin, Stienen Martin N
Spine Center of Eastern Switzerland, Kantonsspital St. Gallen & St. Gallen Medical School, St. Gallen, Switzerland.
Department of Orthopedic Surgery, Kantonsspital St. Gallen & St. Gallen Medical School, St. Gallen, Switzerland.
N Am Spine Soc J. 2024 Jul 27;19:100534. doi: 10.1016/j.xnsj.2024.100534. eCollection 2024 Sep.
Pain, disability and progressive kyphosis is a common problem after traumatic injury of the thoracolumbar (TL-) junction. Surgical treatment may include long-segment posterior or short-segment anterior-posterior fusion. We aim to report our experience with the application of short-segment posterior instrumented fusion with anterior column support using lateral lumbar or thoracic interbody (LLIF) cages.
In this retrospective, single-center observational cohort study we included consecutive patients treated surgically for traumatic injury of the TL-junction (Th10/11-L2/3) by posterior instrumentation/fusion and LLIF. We measured segmental kyphosis, complications, and outcomes until last follow-up (about 3 years postoperative).
We identified 61 patients (mean age 39.0 years [SD 13.3]; 23 females [37.7%]) with A3 fractures without (n=48; 78.7%) or with additional sagittal split component n=11; 18.0%. Additional posterior tension band injury was present in n=26 (42.6%). The affected levels of injury were Th12/L1 in n=25 (41.0%) and Th11/12 in n=22 (36.1%). The segmental kyphotic angle was 14.6° (6.7°) preoperative and remained significantly reduced at all times of follow-up at discharge (5.4°±5.5°; p<.001), at 90 days (7.2°±5.5°; p<.001), after partial hardware removal (7.2°±6.0°; p<.001) and at last follow-up (8.1°±6.3°; p<.001). We noticed a tendency for less progression of kyphosis in the group with 2-staged, compared to single-staged bisegmental surgery (mean difference (MD) 3.1° after partial hardware removal, p=.064). During follow-up, n=11 experienced complications (18%), n=58 (95.1%) had an excellent or good outcome and solid fusion was noticed in n=60 (98.4%).
"Trauma LLIF" should be considered as possibility for short-segment anterior-posterior fusion for injuries of the TL- junction. We observed most reproducible and long-lasting kyphosis reduction with a temporary bisegmental, 2-staged procedure resulting in monosegmental fusion (posterior instrumentation/fusion with delayed LLIF and partial hardware removal to release the noninjured caudal motion segment).
疼痛、功能障碍和进行性脊柱后凸是胸腰段（TL）交界处创伤性损伤后的常见问题。手术治疗可能包括长节段后路或短节段前后路融合。我们旨在报告应用短节段后路器械融合并使用腰椎或胸椎侧方椎间融合器（LLIF）进行前柱支撑的经验。
在这项回顾性单中心观察性队列研究中，我们纳入了通过后路器械固定/融合和LLIF手术治疗TL交界处（胸10/11 - 腰2/3）创伤性损伤的连续患者。我们测量了节段性脊柱后凸、并发症和直至最后随访（术后约3年）的结果。
我们确定了61例患者（平均年龄39.0岁[标准差13.3]；23例女性[37.7%]），其中A3型骨折患者，无矢状面劈裂成分的有48例（78.7%），伴有矢状面劈裂成分的有11例（18.0%）。另外有26例（42.6%）存在后方张力带损伤。损伤累及节段为胸12/腰1的有25例（41.0%），胸11/12的有22例（36.1%）。术前节段性脊柱后凸角度为14.6°（6.7°），在出院时的所有随访时间（5.4°±5.5°；p<0.001）、90天时（7.2°±5.5°；p<0.001）、部分内固定取出后（7.2°±6.0°；p<0.001）以及最后随访时（8.1°±6.3°；p<0.001）均显著减小。我们注意到，与单阶段双节段手术相比，两阶段手术组的脊柱后凸进展趋势较小（部分内固定取出后平均差值（MD）为3.1°，p = 0.064）。随访期间，11例（18%）出现并发症，58例（95.1%）预后为优或良，60例（98.4%）实现了牢固融合。
“创伤性LLIF”应被视为TL交界处损伤进行短节段前后路融合的一种选择。我们观察到，采用临时双节段两阶段手术实现单节段融合（后路器械固定/融合，延迟行LLIF并部分取出内固定以释放未受伤的尾侧活动节段）可最有效地且持久地减少脊柱后凸。
