Impact of Sagittal Balance on Clinical Outcomes in Surgically Treated T12 and L1 Burst Fractures: Analysis of Long-Term Outcomes after Posterior-Only and Combined Posteroanterior Treatment.
Objective. Long-term radiological and clinical outcome retrospective study of surgical treatment for T12 and L1 burst fractures in perspective of sagittal balance measures.Methods. Patients with age of 16-60 years, complete radiographs, early surgical treatment surgery, and follow-up (F/U) > 18 months were included and strict exclusion criteria applied. Regional and thoracolumbar kyphosis angles (RKA and TLA) were measured preoperatively and at final F/U, as were parameters of the spinopelvic sagittal alignment. Clinical outcomes were assessed using validated measures.Results. 36 patients with age mean age of 39 years and F/U of 69 months were included. 61% of patients were treated with bisegmental posterior instrumentation (POST-I) and 39% with combined posteroanterior instrumented fusion (PA-F). At F/U, several indicators for clinical outcomes showed a significant correlation with radiographic measures in the overall cohort with inferior clinical outcomes corresponding with increasing residual deformity and sagittal malalignment. Statistical analysis failed to reach level of significance for the differences between POST-I and PA-F group at final F/U. Only a strong trend towards better restoration of the thoracolumbar alignment was observed for the PA-F group in terms of the RKA and TLA.Conclusions. Results in a surgically treated cohort of T12 and L1 burst fracture patients indicate that superior clinical outcomes depend on restoration of sagittal alignment.
Spinal Surgery Center, Schoen Clinic Nuernberg-Fuerth, Europa-Allee 1, 90763 Fürth, Germany.
M
0000-0002-2534-7268
M
Mayer
Department for Traumatology and Sports Injuries, Paracelsus Medical University Salzburg, Muellner Hauptstrasse 48, 5020 Salzburg, Austria.
R
R
Ortmaier
Spinal Surgery Center, Schoen Clinic Nuernberg-Fuerth, Europa-Allee 1, 90763 Fürth, Germany.
H
H
Koller
Spinal Surgery Center, Schoen Clinic Nuernberg-Fuerth, Europa-Allee 1, 90763 Fürth, Germany.
J
J
Koller
Research Office and Biostatistics, Paracelsus Medical University Salzburg, Strubergasse 21, 5020 Salzburg, Austria.
W
W
Hitzl
Department for Traumatology and Sports Injuries, Paracelsus Medical University Salzburg, Muellner Hauptstrasse 48, 5020 Salzburg, Austria.
A
A
Auffarth
Department for Traumatology and Sports Injuries, Paracelsus Medical University Salzburg, Muellner Hauptstrasse 48, 5020 Salzburg, Austria.
H
H
Resch
Department of Orthopaedic Surgery, Harvard Combined Orthopaedic Surgery Program, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
A
A
von Keudell
D000293:Adolescent; D000328:Adult; D003710:Demography; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000503:physiopathology / Q000601:surgery; D008159:Lumbar Vertebrae / Q000503:physiopathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D004856:Postural Balance; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D013904:Thoracic Vertebrae / Q000503:physiopathology* / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult