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Open versus minimally invasive fixation of thoracic and lumbar spine fractures in patients with ankylosing spinal diseases

PURPOSE: Posterior multilevel fixation of traumatic instability in ankylosing spinal disease (ASD) can be performed by open surgery (OS) or minimally invasive surgery (MIS). We investigated whether both methods differ based on the reduction results and perioperative parameters. METHODS: In this retr...

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Autores principales: Kohler, Felix C., Schenk, P., Bechstedt-Schimske, M., Ullrich, B. W., Klauke, F., Hofmann, G. O., Mendel, T.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9192405/
https://www.ncbi.nlm.nih.gov/pubmed/34357408
http://dx.doi.org/10.1007/s00068-021-01756-3
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author Kohler, Felix C.
Schenk, P.
Bechstedt-Schimske, M.
Ullrich, B. W.
Klauke, F.
Hofmann, G. O.
Mendel, T.
author_facet Kohler, Felix C.
Schenk, P.
Bechstedt-Schimske, M.
Ullrich, B. W.
Klauke, F.
Hofmann, G. O.
Mendel, T.
author_sort Kohler, Felix C.
collection PubMed
description PURPOSE: Posterior multilevel fixation of traumatic instability in ankylosing spinal disease (ASD) can be performed by open surgery (OS) or minimally invasive surgery (MIS). We investigated whether both methods differ based on the reduction results and perioperative parameters. METHODS: In this retrospective cohort study, OS and MIS groups were investigated. The bisegmental Cobb angles and dislocation angles were measured using pre- and postoperative CT images, and the initial malalignment and achieved reduction were calculated. Cut-seam time, calculated blood loss, transfusion number, fluoroscopy time, pedicle screw placement accuracy, duration of ICU stay, in-patient stay, and complications (bleeding, postoperative thrombosis and embolism, and postoperative mortality) were recorded. RESULTS: Seventy-five ASD patients with spine fractures (Ø 75 ± 11 years, male: 52, female: 23) (MIS: 48; OS: 27) were included in this study. The extent of reduction did not differ in the OS and MIS groups (p = 0.465; MIS:− 1 ± 3°, OS:−2 ± 6°). The residual postoperative malalignment angle was not significantly different (p = 0.283). Seventy-eight of the implanted screws (11%) showed malpositioning. No difference was found between OS and MIS (MIS, 37 [7%]; OS, 41 [16%]; p = 0.095). MIS was associated with less blood loss (OS: 1.28 ± 0.78 l, MIS: 0.71 ± 0.57 l, p = 0.001), cut-seam time (MIS: 98 ± 44 min, OS: 166 ± 69 min, p < 0.001), and hospital stay (MIS: Ø14 ± 16 d, OS: Ø38 ± 49 d, p = 0.02) than OS. CONCLUSION: OS and MIS show equally limited performance in terms of the fracture reduction achieved. The MIS technique was superior to OS based on the perioperative outcome. Therefore, MIS should be preferred over OS for unstable spinal injuries, excluding C-type fractures, in ASD patients without neurological impairment.
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spelling pubmed-91924052022-06-15 Open versus minimally invasive fixation of thoracic and lumbar spine fractures in patients with ankylosing spinal diseases Kohler, Felix C. Schenk, P. Bechstedt-Schimske, M. Ullrich, B. W. Klauke, F. Hofmann, G. O. Mendel, T. Eur J Trauma Emerg Surg Original Article PURPOSE: Posterior multilevel fixation of traumatic instability in ankylosing spinal disease (ASD) can be performed by open surgery (OS) or minimally invasive surgery (MIS). We investigated whether both methods differ based on the reduction results and perioperative parameters. METHODS: In this retrospective cohort study, OS and MIS groups were investigated. The bisegmental Cobb angles and dislocation angles were measured using pre- and postoperative CT images, and the initial malalignment and achieved reduction were calculated. Cut-seam time, calculated blood loss, transfusion number, fluoroscopy time, pedicle screw placement accuracy, duration of ICU stay, in-patient stay, and complications (bleeding, postoperative thrombosis and embolism, and postoperative mortality) were recorded. RESULTS: Seventy-five ASD patients with spine fractures (Ø 75 ± 11 years, male: 52, female: 23) (MIS: 48; OS: 27) were included in this study. The extent of reduction did not differ in the OS and MIS groups (p = 0.465; MIS:− 1 ± 3°, OS:−2 ± 6°). The residual postoperative malalignment angle was not significantly different (p = 0.283). Seventy-eight of the implanted screws (11%) showed malpositioning. No difference was found between OS and MIS (MIS, 37 [7%]; OS, 41 [16%]; p = 0.095). MIS was associated with less blood loss (OS: 1.28 ± 0.78 l, MIS: 0.71 ± 0.57 l, p = 0.001), cut-seam time (MIS: 98 ± 44 min, OS: 166 ± 69 min, p < 0.001), and hospital stay (MIS: Ø14 ± 16 d, OS: Ø38 ± 49 d, p = 0.02) than OS. CONCLUSION: OS and MIS show equally limited performance in terms of the fracture reduction achieved. The MIS technique was superior to OS based on the perioperative outcome. Therefore, MIS should be preferred over OS for unstable spinal injuries, excluding C-type fractures, in ASD patients without neurological impairment. Springer Berlin Heidelberg 2021-08-06 2022 /pmc/articles/PMC9192405/ /pubmed/34357408 http://dx.doi.org/10.1007/s00068-021-01756-3 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Article
Kohler, Felix C.
Schenk, P.
Bechstedt-Schimske, M.
Ullrich, B. W.
Klauke, F.
Hofmann, G. O.
Mendel, T.
Open versus minimally invasive fixation of thoracic and lumbar spine fractures in patients with ankylosing spinal diseases
title Open versus minimally invasive fixation of thoracic and lumbar spine fractures in patients with ankylosing spinal diseases
title_full Open versus minimally invasive fixation of thoracic and lumbar spine fractures in patients with ankylosing spinal diseases
title_fullStr Open versus minimally invasive fixation of thoracic and lumbar spine fractures in patients with ankylosing spinal diseases
title_full_unstemmed Open versus minimally invasive fixation of thoracic and lumbar spine fractures in patients with ankylosing spinal diseases
title_short Open versus minimally invasive fixation of thoracic and lumbar spine fractures in patients with ankylosing spinal diseases
title_sort open versus minimally invasive fixation of thoracic and lumbar spine fractures in patients with ankylosing spinal diseases
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9192405/
https://www.ncbi.nlm.nih.gov/pubmed/34357408
http://dx.doi.org/10.1007/s00068-021-01756-3
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