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.	张新胜, 崔力扬, 罗建平, 等. Ponté 截骨联合椎间隙颗粒骨打压植骨治疗陈旧性胸腰椎骨折后凸畸形. 中华骨科杂志, 2014, 34(5): 531-539.
3.	张锴, 高延征, 邢帅, 等. 改良后路单侧椎体次全切截骨矫形术治疗陈旧性胸腰椎骨折伴后凸畸形. 中华创伤杂志, 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.	徐冠华, 崔志明, 李卫东, 等. 后路截骨矫形手术治疗老年骨质疏松性陈旧胸腰椎骨折伴后凸畸形. 中国脊柱脊髓杂志, 2013, 23(2): 129-134.
6.	成茂华, 郑祖根, 张彩元, 等. 胸腰段骨折椎管内骨折块与脊髓损伤的关系. 中国脊柱脊髓杂志, 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.	张东辉, 郑璐, 杨波, 等. 退行性腰椎管狭窄症患者正确功能锻炼与保持良好习惯的重要性. 中国骨与关节损伤杂志, 2017, 32(11): 1191-1192.
12.	王琨, 杨操, 杨述华, 等. 陈旧性胸腰椎骨折伴后凸畸形的截骨矫形术式选择. 中国脊柱脊髓杂志, 2016, 26(1): 24-29.
13.	唐坤鹏, 杨函, 杨剑, 等. 后路椎间盘松解融合固定治疗陈旧性胸腰椎骨折后凸畸形. 中国矫形外科杂志, 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.	闫煌, 邱勇, 朱泽章, 等. 脊柱截骨矫形技术治疗成人复杂脊柱侧后凸畸形的疗效及安全性的前瞻性观察. 中国脊柱脊髓杂志, 2016, 26(1): 4-10.
17.	周喜宗, 汪厚军, 郭伦强, 等. 后路椎管270° 环形减压伤椎置钉内定治疗胸腰椎爆裂性骨折. 中华骨与关节外科杂志, 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. 后路椎弓根钉棒复位内固定+经伤椎椎弓根植骨治疗胸腰椎骨折. 中华骨与关节外科杂志, 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. 张新胜, 崔力扬, 罗建平, 等. Ponté 截骨联合椎间隙颗粒骨打压植骨治疗陈旧性胸腰椎骨折后凸畸形. 中华骨科杂志, 2014, 34(5): 531-539.
3. 张锴, 高延征, 邢帅, 等. 改良后路单侧椎体次全切截骨矫形术治疗陈旧性胸腰椎骨折伴后凸畸形. 中华创伤杂志, 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. 徐冠华, 崔志明, 李卫东, 等. 后路截骨矫形手术治疗老年骨质疏松性陈旧胸腰椎骨折伴后凸畸形. 中国脊柱脊髓杂志, 2013, 23(2): 129-134.
6. 成茂华, 郑祖根, 张彩元, 等. 胸腰段骨折椎管内骨折块与脊髓损伤的关系. 中国脊柱脊髓杂志, 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. 张东辉, 郑璐, 杨波, 等. 退行性腰椎管狭窄症患者正确功能锻炼与保持良好习惯的重要性. 中国骨与关节损伤杂志, 2017, 32(11): 1191-1192.
12. 王琨, 杨操, 杨述华, 等. 陈旧性胸腰椎骨折伴后凸畸形的截骨矫形术式选择. 中国脊柱脊髓杂志, 2016, 26(1): 24-29.
13. 唐坤鹏, 杨函, 杨剑, 等. 后路椎间盘松解融合固定治疗陈旧性胸腰椎骨折后凸畸形. 中国矫形外科杂志, 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. 闫煌, 邱勇, 朱泽章, 等. 脊柱截骨矫形技术治疗成人复杂脊柱侧后凸畸形的疗效及安全性的前瞻性观察. 中国脊柱脊髓杂志, 2016, 26(1): 4-10.
17. 周喜宗, 汪厚军, 郭伦强, 等. 后路椎管270° 环形减压伤椎置钉内定治疗胸腰椎爆裂性骨折. 中华骨与关节外科杂志, 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. 后路椎弓根钉棒复位内固定+经伤椎椎弓根植骨治疗胸腰椎骨折. 中华骨与关节外科杂志, 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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