[Vertebral body replacement with Synex in combined posteroanterior surgery for treatment of thoracolumbar injuries].
OBJECTIVE
Reduction and stabilization of unstable spinal injuries with reconstruction of the anterior column resulting in a permanent restitution of the physiologic spinal alignment, stability and load-bearing capacity.


METHODS
Unstable injuries and lesions of the spine from T4 to L5 resulting in a reduced load-bearing capacity of the anterior spinal column caused by vertebral fractures and injury of the intervertebral disks, posttraumatic kyphotic deformities, pathologic fractures, tumors. Relative indications: younger patients with monosegmental injuries; patients with severe osteoporosis.


METHODS
Concomitant serious thoracic injuries or preexisting cardiopulmonary disease precluding anterior intervention.


METHODS
Combined posteroanterior treatment with (1) posterior reduction and stabilization with an internal fixator and interlaminar fusion with autogenous bone grafts; (2) thoracoscopic anterior approach with reconstruction of the anterior column with a distractible titanium implant for vertebral body replacement (Synex), interbody fusion with autogenous bone grafts and/or beta-tricalciumphosphate.


RESULTS
50 consecutive patients (29 men, 21 women) with an average age of 43 years (20-77 years) were treated with Synex. The most frequent indication was acute injury (n = 36). A bisegmental reconstruction was performed in 30 patients, a monosegmental in 20. Mean follow-up 19.5 months (14-31 months) in 41 patients. 18/33 patients returned to their previous occupation, and 32/41 resumed their recreational activities. At follow-up, 32/41 were free of symptoms or complained of only occasional pain, eight reported marked pain and one severe pain. A VAS spine score (0-100 points, visual analog scale, 19 items) was used for assessment; the preoperative score amounted to 83.1 +/- 20.2 (21-100), the postoperative score to 63.8 +/- 19.5 (25-99). The mean decrease in VAS spine score was 19.3 +/- 22.3. The average degree of correction measured radiologically for patients with fresh injuries or posttraumatic malalignment was 18.6 degrees +/- 10 degrees and the loss of correction 2.1 degrees +/- 2.9 degrees . No implant-related complications were observed.
Knop
Christian
C
Universitätsklinik für Unfallchirurgie und Sporttraumatologie, Medizinische Universität Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria. christian.knop@uibk.ac.at
Lange
Uta
U
Reinhold
Maximilian
M
Blauth
Michael
M
D000328:Adult; D000368:Aged; D018786:Bone Substitutes / Q000627:therapeutic use; D016025:Bone Transplantation / Q000379:methods; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007796:Laminectomy / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods; D013119:Spinal Cord Injuries / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013904:Thoracic Vertebrae / Q000293:injuries* / Q000601:surgery*; D016896:Treatment Outcome
D018786:Bone Substitutes