Radiological and mid- to long-term patient-reported outcome after stabilization of traumatic thoraco-lumbar spinal fractures using an expandable vertebral body replacement implant

URN to cite this document:: urn:nbn:de:bvb:355-epub-450831
DOI to cite this document:: 10.5283/epub.45083

Lang, Siegmund

; Neumann, Carsten ; Schwaiger, Christina ; Voss, Andreas ; Alt, Volker ; Loibl, Markus ; Kerschbaum, Maximilian

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Date of publication of this fulltext: 21 Feb 2022 12:21

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Background For the treatment of unstable thoraco-lumbar burst fractures, a combined posterior and anterior stabilization instead of a posterior-only instrumentation is recommend in the current literature due to the instability of the anterior column. Data on restoring the bi-segmental kyphotic endplate angle (BKA) with expandable vertebral body replacements (VBR) and on the mid- to long-term patient-reported outcome measures (PROM) is sparse. Methods A retrospective cohort study of patients with traumatic thoraco-lumbar spinal fractures treated with an expandable VBR implant (Obelisc (TM), Ulrich Medical, Germany) between 2001 and 2015 was conducted. Patient and treatment characteristics were evaluated retrospectively. Radiological data acquisition was completed pre- and postoperatively, 6 months and at least 2 years after the VBR surgery. The BKA was measured and fusion-rates were assessed. The SF-36, EQ-5D and ODI questionnaires were evaluated prospectively. Results Ninety-six patients (25 female, 71 male; age: 46.1 +/- 12.8 years) were included in the study. An AO Type A4 fracture was seen in 80/96 cases (83.3%). Seventy-three fractures (76.0%) were located at the lumbar spine. Intraoperative reduction of the BKA in n = 96 patients was 10.5 +/- 9.4 degrees (p < 0.01). A loss of correction of 1.0 +/- 2.8 degrees at the first follow-up (t1) and of 2.4 +/- 4.0 degrees at the second follow-up (t2) was measured (each p < 0.05). The bony fusion rate was 97.9%. The total revision rate was 4.2%. Fifty-one patients (53.1% of included patients; age: 48.9 +/- 12.4 years) completed the PROM questionnaires after 106.4 +/- 44.3 months and therefore were assigned to the respondent group. The mean ODI score was 28.2 +/- 18.3%, the mean EQ-5D VAS reached 60.7 +/- 4.1 points. Stratified SF-36 results (ISS < and >= 16) were lower compared to a reference population. Conclusion The treatment of traumatic thoraco-lumbar fractures with an expandable VBR implant lead to a high rate of bony fusion. A significant correction of the BKA could be achieved and no clinically relevant loss of reduction occurred during the follow-up. Even though health related quality of life did not reach the normative population values, overall satisfactory results were reported.

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