Sat., 10/16/10 Pelvis & Spine, Paper #84, 4:22 pm OTA-2010
Percutaneous Posterior Instrumentation after Unstable Thoracolumbar Fractures: Prospective Analysis of Two Systems (FDA=Non-U.S. research conducted within guidelines of my country)
Oliver Gonschorek, MD; Stefan Hauck, MD; Thomas Weiß, MD; Volker Bühren, MD;
Department of Spine Surgery, BGU Murnau, Murnau, Germany
Purpose: Posterior instrumentation is a common operative therapy to reduce and stabilize unstable thoracolumbar fracture types A3 and B according to the OTA classification. Percutaneous systems may reduce the morbidity and blood loss, but until now the reduction tools were poor. In this study, two new percutaneous systems are presented and compared.
Methods: Between January and December 2008, 54 patients with A3- and B-type fractures were treated with a percutaneous internal fixator from posterior and prospectively recorded. Fractures were classified according to the OTA classification. Clinical and radiological controls were performed postoperatively, after 3, 6, and 12 months. End-plate angle measurements were performed to determine initial reduction and loss of reduction after 1 year. Inclusion criteria were A3-type and B-type fractures according to the OTA classification. Exclusion criteria were age <18 years and metastatic fractures.
Results: 54 patients were included in the study. They were treated with the S4FRI system (Aesculap; n = 33, group A) and the Longitude system (Medtronic; n = 21, group B), respectively. Fractured vertebrae were from T4 to L3. There was no significant difference in both groups concerning age (mean age in group A, 47 years; in group B, 45 years), gender, operating time (A, 90 minutes; B, 92 minutes), and blood loss (A, 82 mL; B, 78 mL). Posttraumatic endplate angle was 12° in both groups (A, 0°-21°; B, 4°-30°). Significant reduction was obtained in both groups to an end-plate angle of 6° (P < 0.001) without significant difference between groups A and B. After 1 year, we observed a loss of reduction in 14 patients (A, n = 8; B, n = 6), with a mean of 7° (end-plate angle: A, 7.2°; B, 6.6°). 12 of 14 patients were treated with polyaxial screws; none of them received reconstruction of the anterior column.
Conclusion: Percutaneous instrumentation is a safe method to treat unstable spine fractures of the thoracolumbar region. The new systems even provide reduction tools. However, there was a significant loss of reduction after 1 year if polyaxial screws were used and no anterior reconstruction was performed. Further analysis has to be performed for the combination of combined posterior and anterior spine reconstruction using minimal invasive methods (percutaneous posterior and thoracoscopical anterior).
Alphabetical Disclosure Listing (292K PDF)
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.