Surgical treatment of delayed spinal cord injury caused by atypical compression of old thoracolumbar fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 ZHANG Ganggang ¹ , PING Ansong ² , LI Pengfei ³ , ZHANG Yi ¹ , DUAN Yongzhuang ¹ , WANG Jihai ¹ , WANG Peixia ¹

1. Departement of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052, P.R.China;
2. Departement of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan Hubei, 430071, P.R.China;
3. Departement of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou Guangdong, 510000, P.R.China;

Corresponding?author：

ZHANG Ganggang, Email: zhang_orthop@163.com

Keywords：

Thoracolumbar fracture; spinal cord injury; kyphosis; vertebral canal occupying; ring decompression

DOI：

10.7507/1002-1892.202101112

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Objective To explore the clinical characteristics and surgical treatment strategies of delayed spinal cord injury (SCI) caused by atypical compression of old thoracolumbar fracture.Methods Between January 2011 and June 2018, 32 patients with delayed SCI caused by atypical compression of old thoracolumbar fracture who met the inclusion criteria were admitted and divided into group A (20 cases, underwent anterior subtotal vertebral body resection+titanium mesh reconstruction+screw rod internal fixation) and group B (12 cases, underwent posterior 270° ring decompression of vertebral canal+titanium mesh reconstruction+screw rod internal fixation) according to the different operation approaches. There was no significant difference between the two groups in age, gender, cause of injury, fracture segment, disease duration, preoperative American Spinal Injury Association (ASIA) classification, and preoperative back pain visual analogue scale (VAS) score, lumbar Japanese Orthopaedic Association (JOA) score, kyphosis angle, and vertebral canal occupational ratio (P>0.05). The incision length, operation time, intraoperative blood loss, complications, and bone fusion time of reconstructed vertebrae were recorded and compared between the two groups; the kyphosis angle, back pain VAS score, and lumbar JOA score were used to evaluate the effectiveness.Results Except that the incision length in group A was significantly shorter than that in group B (t=?4.865, P=0.000), there was no significant difference in intraoperative blood loss and operation time between the two groups (P>0.05). There was no deaths or postoperative paraplegia cases in the two groups, and no deep infection or skin infection occurred. There was 1 case of cerebrospinal fluid leakage, 1 case of inferior vena cava injury, and 1 case of chyle leakage in group A. No serious complications occurred in group B. There was no significant difference in the incidence of complications between the two groups (P=0.274). All 32 patients were followed up 12-61 months, with an average of 20.8 months. The follow-up time for groups A and B were (19.35±5.30) months and (23.25±12.20) months respectively, and the difference was not significant (t=?1.255, P=0.219). The reconstructed vertebrae in all cases obtained bony fusion postoperatively. The fusion time of groups A and B were (8.85±2.27) months and (8.50±2.50) months respectively, and the difference was not significant (t=0.406, P=0.688). The kyphosis angle, back pain VAS score, and lumbar JOA score of the two groups at each time point after operation and last follow-up were significantly improved when compared with preoperatively (P<0.05); the lumbar JOA score was further improved with time postoperatively (P<0.05), while the kyphosis angle and the VAS score of back pain remained similarly (P>0.05). Comparison of kyphosis angle, back pain VAS score, and lumbar JOA score between the two groups at various time points postoperatively showed no significant difference (P>0.05). At last follow-up, the JOA score improvement rate in groups A and B were 83.87%±0.20% and 84.50%±0.14%, respectively, and the difference was not significant (t=–0.109, P=0.914); the surgical treatment effects of the two groups were judged to be significant.Conclusion In the later stage of treatment of old thoracolumbar fractures, even mild kyphosis and spinal canal occupying may induce delayed SCI. Surgical correction and decompression can significantly promote the recovery of damaged spinal cord function. Compared with anterior approach surgery, posterior approach surgery has the advantages of less trauma, convenient operation, and fewer complications, so it can be preferred.

Citation： ZHANG Ganggang, PING Ansong, LI Pengfei, ZHANG Yi, DUAN Yongzhuang, WANG Jihai, WANG Peixia. Surgical treatment of delayed spinal cord injury caused by atypical compression of old thoracolumbar fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(8): 1014-1020. doi: 10.7507/1002-1892.202101112 Copy

1.	Mariotti AJ, Diwan AD. Current concepts in anterior surgery for thoracolumbar trauma. Orthop Clin North Am, 2002, 33(2): 403-412.
2.	張新勝, 崔力揚, 羅建平, 等. Ponté 截骨聯合椎間隙顆粒骨打壓植骨治療陳舊性胸腰椎骨折后凸畸形. 中華骨科雜志, 2014, 34(5): 531-539.
3.	張鍇, 高延征, 邢帥, 等. 改良后路單側椎體次全切截骨矯形術治療陳舊性胸腰椎骨折伴后凸畸形. 中華創傷雜志, 2019, 35(8): 708-715.
4.	Gao R, Wu J, Yuan W, et al. Modified partial pedicle subtraction osteotomy for the correction of post-traumatic thoracolumbar kyphosis. Spine J, 2015, 15(9): 2009-2015.
5.	徐冠華, 崔志明, 李衛東, 等. 后路截骨矯形手術治療老年骨質疏松性陳舊胸腰椎骨折伴后凸畸形. 中國脊柱脊髓雜志, 2013, 23(2): 129-134.
6.	成茂華, 鄭祖根, 張彩元, 等. 胸腰段骨折椎管內骨折塊與脊髓損傷的關系. 中國脊柱脊髓雜志, 2001, 11(5): 275-277.
7.	Joaquim AF, Patel AA, Schroeder GD, et al. A simplified treatment algorithm for treating thoracic and lumbar spine trauma. J Spinal Cord Med, 2019, 42(4): 416-422.
8.	Mumford J, Weinstein JN, Spratt KF, et al. Thoracolumbar burst fractures. The clinical efficacy and outcome of nonoperative management. Spine (Phila Pa 1976), 1993, 18(8): 955-970.
9.	Ohtori S, Ito T, Yamashita M, et al. Evaluation of low back pain using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire for lumbar spinal disease in a multicenter study: differences in scores based on age, sex, and type of disease. J Orthop Sci, 2010, 15(1): 86-91.
10.	Fujimori T, Okuda S, Iwasaki M, et al. Validity of the Japanese Orthopaedic Association scoring system based on patient-reported improvement after posterior lumbar interbody fusion. Spine J, 2016, 16(6): 728-736.
11.	張東輝, 鄭璐, 楊波, 等. 退行性腰椎管狹窄癥患者正確功能鍛煉與保持良好習慣的重要性. 中國骨與關節損傷雜志, 2017, 32(11): 1191-1192.
12.	王琨, 楊操, 楊述華, 等. 陳舊性胸腰椎骨折伴后凸畸形的截骨矯形術式選擇. 中國脊柱脊髓雜志, 2016, 26(1): 24-29.
13.	唐坤鵬, 楊函, 楊劍, 等. 后路椎間盤松解融合固定治療陳舊性胸腰椎骨折后凸畸形. 中國矯形外科雜志, 2019, 27(23): 2125-2128.
14.	Li S, Li Z, Hua W, et al. Clinical outcome and surgical strategies for late post-traumatic kyphosis after failed thoracolumbar fracture operation: Case report and literature review. Medicine (Baltimore), 2017, 96(49): e8770. doi: 10.1097/MD.0000000000008770.
15.	Buchowski JM, Kuhns CA, Bridwell KH, et al. Surgical management of posttraumatic thoracolumbar kyphosis. Spine J, 2008, 8(4): 666-677.
16.	閆煌, 邱勇, 朱澤章, 等. 脊柱截骨矯形技術治療成人復雜脊柱側后凸畸形的療效及安全性的前瞻性觀察. 中國脊柱脊髓雜志, 2016, 26(1): 4-10.
17.	周喜宗, 汪厚軍, 郭倫強, 等. 后路椎管270° 環形減壓傷椎置釘內定治療胸腰椎爆裂性骨折. 中華骨與關節外科雜志, 2018, 11(5): 330-333.
18.	Muratore M, Allasia S, Viglierchio P, et al. Surgical treatment of traumatic thoracolumbar fractures: a retrospective review of 101 cases. Musculoskelet Surg, 2021, 105(1): 49-59.
19.	Pneumaticos SG, Karampinas PK, Triantafilopoulos G, et al. Evaluation of TLICS for thoracolumbar fractures. Eur Spine J, 2016, 25(4): 1123-1127.
20.	Kanna RM, Shetty AP, Rajasekaran S. Posterior fixation including the fractured vertebra for severe unstable thoracolumbar fractures. Spine J, 2015, 15(2): 256-264.
21.	Wood KB, Buttermann GR, Phukan R, et al. Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit: a prospective randomized study with follow-up at sixteen to twenty-two years. J Bone Joint Surg (Am), 2015, 97(1): 3-9.
22.	曹杰, 于海洋, 梁成民, 等. 后路椎弓根釘棒復位內固定+經傷椎椎弓根植骨治療胸腰椎骨折. 中華骨與關節外科雜志, 2016, 9(5): 381-385.
23.	Liao JC, Fan KF, Keorochana G, et al. Transpedicular grafting after short-segment pedicle instrumentation for thoracolumbar burst fracture: calcium sulfate cement versus autogenous iliac bone graft. Spine (Phila Pa 1976), 2010, 35(15): 1482-1488.

1. Mariotti AJ, Diwan AD. Current concepts in anterior surgery for thoracolumbar trauma. Orthop Clin North Am, 2002, 33(2): 403-412.
2. 張新勝, 崔力揚, 羅建平, 等. Ponté 截骨聯合椎間隙顆粒骨打壓植骨治療陳舊性胸腰椎骨折后凸畸形. 中華骨科雜志, 2014, 34(5): 531-539.
3. 張鍇, 高延征, 邢帥, 等. 改良后路單側椎體次全切截骨矯形術治療陳舊性胸腰椎骨折伴后凸畸形. 中華創傷雜志, 2019, 35(8): 708-715.
4. Gao R, Wu J, Yuan W, et al. Modified partial pedicle subtraction osteotomy for the correction of post-traumatic thoracolumbar kyphosis. Spine J, 2015, 15(9): 2009-2015.
5. 徐冠華, 崔志明, 李衛東, 等. 后路截骨矯形手術治療老年骨質疏松性陳舊胸腰椎骨折伴后凸畸形. 中國脊柱脊髓雜志, 2013, 23(2): 129-134.
6. 成茂華, 鄭祖根, 張彩元, 等. 胸腰段骨折椎管內骨折塊與脊髓損傷的關系. 中國脊柱脊髓雜志, 2001, 11(5): 275-277.
7. Joaquim AF, Patel AA, Schroeder GD, et al. A simplified treatment algorithm for treating thoracic and lumbar spine trauma. J Spinal Cord Med, 2019, 42(4): 416-422.
8. Mumford J, Weinstein JN, Spratt KF, et al. Thoracolumbar burst fractures. The clinical efficacy and outcome of nonoperative management. Spine (Phila Pa 1976), 1993, 18(8): 955-970.
9. Ohtori S, Ito T, Yamashita M, et al. Evaluation of low back pain using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire for lumbar spinal disease in a multicenter study: differences in scores based on age, sex, and type of disease. J Orthop Sci, 2010, 15(1): 86-91.
10. Fujimori T, Okuda S, Iwasaki M, et al. Validity of the Japanese Orthopaedic Association scoring system based on patient-reported improvement after posterior lumbar interbody fusion. Spine J, 2016, 16(6): 728-736.
11. 張東輝, 鄭璐, 楊波, 等. 退行性腰椎管狹窄癥患者正確功能鍛煉與保持良好習慣的重要性. 中國骨與關節損傷雜志, 2017, 32(11): 1191-1192.
12. 王琨, 楊操, 楊述華, 等. 陳舊性胸腰椎骨折伴后凸畸形的截骨矯形術式選擇. 中國脊柱脊髓雜志, 2016, 26(1): 24-29.
13. 唐坤鵬, 楊函, 楊劍, 等. 后路椎間盤松解融合固定治療陳舊性胸腰椎骨折后凸畸形. 中國矯形外科雜志, 2019, 27(23): 2125-2128.
14. Li S, Li Z, Hua W, et al. Clinical outcome and surgical strategies for late post-traumatic kyphosis after failed thoracolumbar fracture operation: Case report and literature review. Medicine (Baltimore), 2017, 96(49): e8770. doi: 10.1097/MD.0000000000008770.
15. Buchowski JM, Kuhns CA, Bridwell KH, et al. Surgical management of posttraumatic thoracolumbar kyphosis. Spine J, 2008, 8(4): 666-677.
16. 閆煌, 邱勇, 朱澤章, 等. 脊柱截骨矯形技術治療成人復雜脊柱側后凸畸形的療效及安全性的前瞻性觀察. 中國脊柱脊髓雜志, 2016, 26(1): 4-10.
17. 周喜宗, 汪厚軍, 郭倫強, 等. 后路椎管270° 環形減壓傷椎置釘內定治療胸腰椎爆裂性骨折. 中華骨與關節外科雜志, 2018, 11(5): 330-333.
18. Muratore M, Allasia S, Viglierchio P, et al. Surgical treatment of traumatic thoracolumbar fractures: a retrospective review of 101 cases. Musculoskelet Surg, 2021, 105(1): 49-59.
19. Pneumaticos SG, Karampinas PK, Triantafilopoulos G, et al. Evaluation of TLICS for thoracolumbar fractures. Eur Spine J, 2016, 25(4): 1123-1127.
20. Kanna RM, Shetty AP, Rajasekaran S. Posterior fixation including the fractured vertebra for severe unstable thoracolumbar fractures. Spine J, 2015, 15(2): 256-264.
21. Wood KB, Buttermann GR, Phukan R, et al. Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit: a prospective randomized study with follow-up at sixteen to twenty-two years. J Bone Joint Surg (Am), 2015, 97(1): 3-9.
22. 曹杰, 于海洋, 梁成民, 等. 后路椎弓根釘棒復位內固定+經傷椎椎弓根植骨治療胸腰椎骨折. 中華骨與關節外科雜志, 2016, 9(5): 381-385.
23. Liao JC, Fan KF, Keorochana G, et al. Transpedicular grafting after short-segment pedicle instrumentation for thoracolumbar burst fracture: calcium sulfate cement versus autogenous iliac bone graft. Spine (Phila Pa 1976), 2010, 35(15): 1482-1488.

Chinese Journal of Reparative and Reconstructive Surgery

Surgical treatment of delayed spinal cord injury caused by atypical compression of old thoracolumbar fractures

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