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Efficacy of Titanium Mesh Cages for Anterior Column Reconstruction after Thoracolumbar Corpectomy.

Abdeen K - Asian Spine J (2016)

Bottom Line: Of the 6 patients with Frankel grade C, three improved one grade and the other three improved two grades.The sagittal alignment of the fractured segment was restored immediately after surgery as a significant decrease in the local kyphotic angle.Anterior instrumentation is an effective and safe treatment for thoracolumbar instability with satisfactory clinical and radiological outcomes.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt.

ABSTRACT

Study design: This retrospective study was conducted to determine the safety and efficacy of titanium cage reconstruction and anterior plating after thoracolumbar corpectomy.

Purpose: To study the clinical and radiological outcome of anterior column reconstruction after thoracolumbar corpectomy.

Overview of literature: Anterior column reconstruction aims to optimize neural decompression with adequate stabilization.

Methods: A series of 16 patients underwent reconstruction after thoracolumbar corpectomy to treat injury due to trauma (n=10), tuberculosis (n=3), and tumor (n=3). The average duration of follow-up was 18 months (range, 8-58 months). The degree of kyphosis, construct height, and the subsidence of the cage in relation to the vertebral endplates were measured. The approach was thoracoabdominal in 10 cases and retroperitoneal in 6 cases.

Results: Four patients were neurologically intact with Frankel grade E on admission, and all remained intact postoperatively. Of the 6 patients with Frankel grade D, all fully recovered full motor and sensory functions. Of the 6 patients with Frankel grade C, three improved one grade and the other three improved two grades. The mean height of the vertebra before surgery was 41 mm and the mean construct height immediately after surgery and at follow-up was 47 mm and 44 mm, respectively. Solid fusion was observed in all patients. The sagittal alignment of the fractured segment was restored immediately after surgery as a significant decrease in the local kyphotic angle.

Conclusions: Anterior instrumentation is an effective and safe treatment for thoracolumbar instability with satisfactory clinical and radiological outcomes.

No MeSH data available.


Related in: MedlinePlus

(A, B) Anterior column reconstruction after L1 fracture.
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Figure 8: (A, B) Anterior column reconstruction after L1 fracture.

Mentions: This study included 16 patients: 10 with traumatic thoracolumbar instability (Figs. 3, 4), 3 with tuberculous spondylitis, 2 with metastatic deposits (Fig. 5) and one case with myeloma (Fig. 6). The level was L1 in 6 cases, D12 in 4 cases and L2 in 6 cases. The average extent of canal encroachment was 55% (range, 40%–75%) according to axial CT measurements of the compromised vertebra. The mean preoperative kyphotic deformity was 13 degrees (range, 5–16 degrees). Four patients were neurologically intact, with Frankel grade E on admission. All these patients remained intact postoperatively. Of the six patients with Frankel D on admission, all recovered full motor and sensory functions. Of the six patients with Frankel C on admission, three improved one grade and the other three improved two grades (Table 1). The mean±standard deviation preoperative kyphosis was 2.0±13.5 degrees. The mean kyphosis immediately after surgery was –2.6±14.5 degrees. The mean kyphosis at final follow-up was 3.4±13.5 degrees. There was no significant difference between the postoperative and final kyphosis measurements. The mean height of the involved vertebra before surgery was 41 mm and the mean construct height immediate after surgery and at follow-up was 47 mm and 44 mm, respectively (Figs. 7, 8). No case of severe collapse or signifi-cant recurrence of the deformity was evident. All patients achieved solid fusion with significant neurological im-provement and no significant correction loss. Two pa-tients developed intercostal neuralgia that was improved after intercostal nerve block and medical treatment, postoperative pneumonia (n=1) and superficial wound infection (n=4) (Table 2). There were no intraoperative or late vascular injuries. No case displayed a complication directly attributable to the use of titanium mesh cage.


Efficacy of Titanium Mesh Cages for Anterior Column Reconstruction after Thoracolumbar Corpectomy.

Abdeen K - Asian Spine J (2016)

(A, B) Anterior column reconstruction after L1 fracture.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4764546&req=5

Figure 8: (A, B) Anterior column reconstruction after L1 fracture.
Mentions: This study included 16 patients: 10 with traumatic thoracolumbar instability (Figs. 3, 4), 3 with tuberculous spondylitis, 2 with metastatic deposits (Fig. 5) and one case with myeloma (Fig. 6). The level was L1 in 6 cases, D12 in 4 cases and L2 in 6 cases. The average extent of canal encroachment was 55% (range, 40%–75%) according to axial CT measurements of the compromised vertebra. The mean preoperative kyphotic deformity was 13 degrees (range, 5–16 degrees). Four patients were neurologically intact, with Frankel grade E on admission. All these patients remained intact postoperatively. Of the six patients with Frankel D on admission, all recovered full motor and sensory functions. Of the six patients with Frankel C on admission, three improved one grade and the other three improved two grades (Table 1). The mean±standard deviation preoperative kyphosis was 2.0±13.5 degrees. The mean kyphosis immediately after surgery was –2.6±14.5 degrees. The mean kyphosis at final follow-up was 3.4±13.5 degrees. There was no significant difference between the postoperative and final kyphosis measurements. The mean height of the involved vertebra before surgery was 41 mm and the mean construct height immediate after surgery and at follow-up was 47 mm and 44 mm, respectively (Figs. 7, 8). No case of severe collapse or signifi-cant recurrence of the deformity was evident. All patients achieved solid fusion with significant neurological im-provement and no significant correction loss. Two pa-tients developed intercostal neuralgia that was improved after intercostal nerve block and medical treatment, postoperative pneumonia (n=1) and superficial wound infection (n=4) (Table 2). There were no intraoperative or late vascular injuries. No case displayed a complication directly attributable to the use of titanium mesh cage.

Bottom Line: Of the 6 patients with Frankel grade C, three improved one grade and the other three improved two grades.The sagittal alignment of the fractured segment was restored immediately after surgery as a significant decrease in the local kyphotic angle.Anterior instrumentation is an effective and safe treatment for thoracolumbar instability with satisfactory clinical and radiological outcomes.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt.

ABSTRACT

Study design: This retrospective study was conducted to determine the safety and efficacy of titanium cage reconstruction and anterior plating after thoracolumbar corpectomy.

Purpose: To study the clinical and radiological outcome of anterior column reconstruction after thoracolumbar corpectomy.

Overview of literature: Anterior column reconstruction aims to optimize neural decompression with adequate stabilization.

Methods: A series of 16 patients underwent reconstruction after thoracolumbar corpectomy to treat injury due to trauma (n=10), tuberculosis (n=3), and tumor (n=3). The average duration of follow-up was 18 months (range, 8-58 months). The degree of kyphosis, construct height, and the subsidence of the cage in relation to the vertebral endplates were measured. The approach was thoracoabdominal in 10 cases and retroperitoneal in 6 cases.

Results: Four patients were neurologically intact with Frankel grade E on admission, and all remained intact postoperatively. Of the 6 patients with Frankel grade D, all fully recovered full motor and sensory functions. Of the 6 patients with Frankel grade C, three improved one grade and the other three improved two grades. The mean height of the vertebra before surgery was 41 mm and the mean construct height immediately after surgery and at follow-up was 47 mm and 44 mm, respectively. Solid fusion was observed in all patients. The sagittal alignment of the fractured segment was restored immediately after surgery as a significant decrease in the local kyphotic angle.

Conclusions: Anterior instrumentation is an effective and safe treatment for thoracolumbar instability with satisfactory clinical and radiological outcomes.

No MeSH data available.


Related in: MedlinePlus