title: Fracture reduction by postoperative mobilisation for the treatment of hyperextension injuries of the thoracolumbar spine in patients with ankylosing spinal disorders.
abstract: BACKGROUND
  The aim of this study was to evaluate results of surgical stabilisation of hyperextension injuries of the thoracolumbar spine in patients with ankylosing spinal disorders using two different treatment strategies: the conventional open rigid posterior instrumentation and percutaneous less rigid posterior instrumentation. Surgical and non-surgical complications, the postoperative radiological course, and clinical outcome at final follow-up were comparatively assessed. Moreover, we sought to discuss important biomechanical and surgical aspects specific to posterior instrumentation of the ankylosed thoracolumbar spine as well as to elaborate on the advantages and limitations of the proposed new treatment strategy involving percutaneous less rigid stabilisation and fracture reduction by postoperative mobilisation.
  
  
  METHODS
  Between January 2006 and June 2012, a consecutive series of 20 patients were included in the study. Posterior instrumentation was performed either using an open approach with rigid 6.0 mm bars (open rigid (OR) group) or via a percutaneous approach using softer 5.5 mm bars (percutaneous less rigid (PLR) group). Complications as well as the radiological course were retrospectively assessed, and patient outcome was evaluated at final follow-up using validated outcome scores (VAS Spine Score, ODI, RMDQ, Parker Mobility Score, Barthel Score and WHOQOL-BREF).
  
  
  RESULTS
  Surgical complications occurred more frequently in the OR group requiring revision surgery in two patients, while there was no revision surgery in the PLR group. The rate of postoperative complications was lower in the PLR group as well (0.7 vs. 1.3 complications per patient, respectively). Fracture reduction and restoration of pre-injury sagittal alignment by postoperative mobilisation occurred within the first 3 weeks in the PLR group, and within 6 months in the OR group. The clinical outcome at final follow-up was very good in both groups with no relevant loss in VAS Spine Score (pain and function), Parker Mobility Score (mobility), and Barthel Index (social independency) compared to pre-operative values.
  
  
  CONCLUSIONS
  This study indicates that the proposed treatment concept involving percutaneous less rigid posterior instrumentation and fracture reduction by postoperative mobilisation is feasible, seems to facilitate adequate reduction and restoration of pre-injury sagittal alignment, and might have the potential to reduce the rate of complications in the management of hyperextension injuries of the ankylosed thoracolumbar spine.
authors.affiliation: Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Lindtner
authors.affiliation: Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Kammerlander
authors.affiliation: Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Goetzen
authors.affiliation: Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
authors.forename: Alexander
authors.initials: A
authors.lastname: Keiler
authors.affiliation: Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
authors.forename: Davud
authors.initials: D
authors.lastname: Malekzadeh
authors.affiliation: Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria. dietmar@krappinger.eu.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Krappinger
authors.affiliation: Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
authors.forename: Rene
authors.initials: R
authors.lastname: Schmid
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain; D005260:Female; D005592:Fracture Fixation / Q000379:methods*; D006801:Humans; D004057:Hyperostosis, Diffuse Idiopathic Skeletal / Q000150:complications; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D011859:Radiography; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D013124:Spinal Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D013167:Spondylitis, Ankylosing / Q000150:complications; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
keywords: Ankylosing spinal disorders; Ankylosing spondylitis; Diffuse idiopathic skeletal hyperostosis; Extension distraction injuries; Fracture reduction; Hyperextension injury; Outcomes; Percutaneous fixation; Posterior instrumentation; Spinal fractures; Thoracolumbar spine