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CC BY 4.0 · J Neurol Surg A Cent Eur Neurosurg
DOI: 10.1055/a-2331-2466
Original Article

Radiologic Outcomes after Operative Management of Traumatic Spine Fractures: Stand-Alone Posterior Stabilization versus Combined Anteroposterior Approach

Ali Mulhem 
1   Department for Continuing Education, University of Oxford, Oxford, United Kingdom of Great Britain and Northern Ireland
,
Ziad Omran
2   Department of Neurosurgery, Vivantes Klinikum im Friedrichshain, Berlin, Germany
,
Stefanie Hammersen
2   Department of Neurosurgery, Vivantes Klinikum im Friedrichshain, Berlin, Germany
,
Sven Rainer Kantelhardt
2   Department of Neurosurgery, Vivantes Klinikum im Friedrichshain, Berlin, Germany
› Author Affiliations Funding None.
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Abstract

Background Previous research emphasizes correcting deformities resulting from spine fractures by restoring sagittal alignment and vertebral height. This study aims to compare radiologic outcomes, including sagittal index (SI) and loss of vertebral body height (LVBH), between stand-alone posterior stabilization (group I) and the posteroanterior/combined approach (group II) in the operative management of traumatic thoracic or lumbar spine fractures.

Methods In this retrospective single-center study, all patients with traumatic spine fractures (T1–L5) undergoing surgical stabilization between January 1, 2015, and May 31, 2021, were included. Two spine surgeons independently assessed imaging, recording the SI and LVBH values at baseline, after each surgical intervention, and during follow-up (at least 3 months posttreatment). The mean SI and LVBH values between the assessing surgeons were utilized. Linear mixed-effects regression models, adjusted to baseline values, compared the SI and the LVBH values between the two groups.

Results In all, 71 patients (42 men), with the median age of 38 years (interquartile range [IQR]: 28–54) and median follow-up of 4 months (IQR: 3–17), were included. Thirty-two patients were in group I and 39 patients were in group II. Forty fractures included the thoracolumbar junction (T12 or L1), 15 affected the thoracic spine, and 14 the lumbar spine. The regression model revealed superior sagittal alignment in group II, with an adjusted mean difference for SI of –4.24 (95% confidence interval [CI]: –7.13 to –1.36; p = 0.004), and enhanced restoration of vertebral body height with an adjusted mean difference for LVBH of 0.11 in the combined approach (95% CI: 0.02–0.20; p = 0.02). Nine postoperative complications occurred in the entire cohort (4 in group I and 5 in group II).

Conclusions Combined posteroanterior stabilization for spine fractures improves deformities by enhancing sagittal alignment and increasing vertebral body height, with acceptable morbidity compared with the stand-alone posterior approach.

Keywords

spine fracture - sagittal alignment - vertebral height - comparative study - surgical approach

Availability of Data and Material

All data and material used in this study are available for sharing with researchers.


Ethical Approval

Ethical approval was waived in this retrospective cohort study with anonymous data.




Publication History

Received: 05 December 2023

Accepted: 27 March 2024

Accepted Manuscript online:
22 May 2024

Article published online:
21 June 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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