title: Anterior approach with expandable cage implantation in management of unstable thoracolumbar fractures: Results of a series of 93 patients.
abstract: BACKGROUND
  Anterior approach indications in unstable thoracolumbar fractures (UTLF) are debated. The aim of this study was to evaluate the results of anterior fixation and expandable prosthetic vertebral body cage (EPVBC) implantation alone or combined with a posterior approach in the management of UTLF.
  
  
  METHODS
  Ninety-three patients underwent anterior fixation with implantation of an EPVBC for UTLF from T7 to L5. Long-term kyphosis and vertebral height loss reduction, functional outcomes including visual analogical scale and Oswestry disability index were evaluated.
  
  
  RESULTS
  Anterior fixation led to a significant increase of vertebral body height with a gain of 13% after a previous posterior approach, 38% after a single anterior approach and 65% after combined posterior and anterior approaches (P=0.0001). However, anterior fixation did not significantly enhance the vertebral regional kyphosis angle (P=0.08), except in cases of single anterior approach for thoracic fractures (P=0.03). No significant difference was found between early, 3 months and 1 year postoperative vertebral regional kyphosis angle and vertebral body height (P=0.6). Complete fusion was routinely observed at 1 year postoperatively. rhBMP2 implantation in selected cases appears to be a safe and reliable strategy. No infections or surgical revisions were observed after the anterior approach.
  
  
  CONCLUSIONS
  Anterior approach and EPVBC implantation, in UTLF, is a safe and effective procedure, providing long-term vertebral body height and kyphosis correction. Adverse effects of anterior approach remain acceptable. Single anterior fixation is a reliable surgical alternative in thoracic fractures without posterior spine segment injury or spinal cord compression. These results prompted us to extend anterior approach indications in oncology and infectious diseases.
authors.affiliation: Aix-Marseille Université, 13284 Marseille, France; AP-HM, Hôpital Timone, Service de Neurochirurgie, 13005 Marseille, France. Electronic address: Thomas.Graillon@ap-hm.fr.
authors.forename: T
authors.initials: T
authors.lastname: Graillon
authors.affiliation: Aix-Marseille Université, 13284 Marseille, France; AP-HM, Hôpital Timone, Service de Neurochirurgie, 13005 Marseille, France.
authors.forename: K
authors.initials: K
authors.lastname: Farah
authors.affiliation: Aix-Marseille Université, 13284 Marseille, France; AP-HM, Hôpital Timone, Service de Neurochirurgie, 13005 Marseille, France.
authors.forename: P
authors.initials: P
authors.lastname: Rakotozanany
authors.affiliation: Aix-Marseille Université, 13284 Marseille, France; AP-HM, Hôpital Timone, Service d'Orthopédie, 13005 Marseille, France.
authors.forename: B
authors.initials: B
authors.lastname: Blondel
authors.affiliation: Aix-Marseille Université, 13284 Marseille, France; AP-HM, Hôpital Timone, Service de Neurochirurgie, 13005 Marseille, France.
authors.forename: T
authors.initials: T
authors.lastname: Adetchessi
authors.affiliation: Aix-Marseille Université, 13284 Marseille, France; AP-HM, Hôpital Timone, Service de Neurochirurgie, 13005 Marseille, France.
authors.forename: H
authors.initials: H
authors.lastname: Dufour
authors.affiliation: Aix-Marseille Université, 13284 Marseille, France; AP-HM, Hôpital Timone, Service de Neurochirurgie, 13005 Marseille, France.
authors.forename: S
authors.initials: S
authors.lastname: Fuentes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001416:Back Pain / Q000209:etiology / Q000517:prevention & control; D055396:Bone Morphogenetic Protein 2 / Q000627:therapeutic use; D016025:Bone Transplantation; D003131:Combined Modality Therapy; D004185:Disability Evaluation; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D016268:Internal Fixators; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control / Q000601:surgery; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011542:Pseudarthrosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: C525718:BMP2 protein, human; D055396:Bone Morphogenetic Protein 2; D011994:Recombinant Proteins
keywords: Cage extensive; Cyphose; Expendable cage; Fractures thoracolombaires; Fusion; Greffon iliaque; Iliac crest graft; Kyphosis; Thoracolumbar fractures; rhBMP2