title: Circumferential management of unstable thoracolumbar fractures using an anterior expandable cage, as an alternative to an iliac crest graft, combined with a posterior screw fixation: results of a series of 85 patients.
abstract: OBJECTIVE
  The optimal management of unstable thoracolumbar fractures remains unclear. The objective of the present study was to evaluate the results of using an expandable prosthetic vertebral body cage (EPVBC) in the management of unstable thoracolumbar fractures.
  
  
  METHODS
  Eighty-five patients with unstable T7-L4 thoracolumbar fractures underwent implantation of an EPVBC via an anterior approach combined with posterior fixation. Long-term functional outcomes, including visual analog scale and Oswestry disability index scores, were evaluated.
  
  
  RESULTS
  In a mean follow-up period of 16 months, anterior fixation led to a significant increase in vertebral body height, with an average gain of 19%. However, the vertebral regional kyphosis angle was not significantly increased by anterior fixation alone. No significant difference was found between early postoperative, 3-month, and 1-year postoperative regional kyphosis angle and vertebral body height. Postoperative impaction of the prosthetic cage in adjacent endplates was observed in 35% of the cases, without worsening at last follow-up. Complete fusion was observed at 1 year postoperatively and no cases of infections or revisions were observed in relation to the anterior approach.
  
  
  CONCLUSIONS
  The use of EPVBCs for unstable thoracolumbar fractures is safe and effective in providing long-term vertebral body height restoration and kyphosis correction, with a moderate surgical and sepsis risk. Anterior cage implantation is an alternative to iliac bone graft fusion and is a viable option in association with a posterior approach, in a single operation without additional risks.
authors: Department of Spine Surgery, Aix-Marseille University;
authors: Thomas
authors: T
authors: Graillon
authors: Patrick
authors: P
authors: Rakotozanany
authors: Benjamin
authors: B
authors: Blondel
authors: Tarek
authors: T
authors: Adetchessi
authors: Henry
authors: H
authors: Dufour
authors: Stéphane
authors: S
authors: Fuentes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001863:Bone Screws; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007738:Kyphosis / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D019651:Plastic Surgery Procedures / Q000295:instrumentation* / Q000379:methods*; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000145:classification / Q000150:complications / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: VAS = visual analog scale; expandable cage; fusion; iliac crest graft; kyphosis; thoracolumbar fracture