Instrumented circumferential fusion in two stages for instable lumbar fracture Long-term results of a series of 74 patients on sagittal balance and functional outcomes.

Instrumented circumferential fusion in two stages for instable lumbar fracture Long-term results of a series of 74 patients on sagittal balance and functional outcomes.

World Neurosurg. 2017 Apr 19;:

Authors: Ould-Slimane M, Damade C, Lonjon G, Gilibert A, Cochereau J, Gauthé R, Lonjon N

Abstract
AIM: To report the radiological and functional results of a multicentre, prospective case series of patients with comminuted lumbar fractures treated with two-stage circumferential arthrodesis.
METHODS: A multicentre, prospective case series of 74 patients with comminuted lumbar fractures was analyzed. The strategy entailed initial posterior osteosynthesis then physical replacement with an expandable titanium cage filled with autologous bone, via retroperitoneal lumbotomy. The mechanism of lesion formation and the epidemiological characteristics were recorded. Clinical and quality-of-life analyses (VAS, ODI, SF12) were performed over a minimum observation period of one year. Radiological parameters including deformity measurements were recorded at each evaluation. Fusion was analyzed by means of a 1-year monitoring scan.
RESULTS: The mean age of the patients was 38.1 and median follow-up time was 2.1 years [1.3-2.9]. The fracture distribution according to the Magerl classification is as follows: A (64.8%), B (16.7%) and C (18.5%). At the last follow-up, fusion was considered certain in 57 cases (77%). Mean VAS was 2.1 (+/- 1.3), ODI 14.7 (+/- 8.0), SF12 PCS 43.2 (+/- 9.3) and SF12 MCS 50.8 (+/- 5.9). Correction of the regional sagittal deformity was significant during the post-operative period with a mean increase in lordosis of 9.0° (p < 0.0001). The loss of mean correction at the last follow-up (-2.9º) was not significant.
CONCLUSION: Circumferential arthrodesis including posterior osteosynthesis and physical replacement with an expandable cage and autologous graft is applicable to treatment of comminuted lumbar fractures. A high rate of fusion was obtained with significant and long-lasting correction of the sagittal deformity. Functional scores measured at one year suggest mild disability. The ODI, SF-12 and VAS scores were positively correlated to fusion at last follow-up.

PMID: 28433848 [PubMed - as supplied by publisher]

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