Abstract
Aims: Aim of this prospective clinical study was to prove whether there are clinical differences between ms VTS with interposition of an autogenic tricortical bone graft alone and a consecutive dorso-ventral procedure for A 1.2 and A 3.1 fractures of the thoracic and lumbar spine.
Materials und Methods: From 01/2002 to 12/2003 298 pat. with traumatic fractures of the thoracic and lumbar spine were treated and had a prospective clinical and radiological follow-up according to the mc-study of the DGU. For 29 pat. (14 m, 15 f; mean age 33 y) ms VTS was performed either isolated (10) or consecutive after dorsal instrumentation (19). Over the post-OP course with a follow-up of 18 mo. the pat. underwent a questionnaire concerning the morbidity at the surgical approaches, the subjective back function and the Odom-score. The osseous integration of the graft and the resulting loss of correction were investigated within the follow-ups 3, 6, 12 and 18 mo. post-OP.
Results: Concerning the anterior column 83% of the pat. had type A 3.1.1 fractures. All pat. with type B and C injuries underwent consecutive dorso-ventral instrumentation in 2 sessions. In one case revision surgery with bisegmental replacement of the affected vertebral body by a distractible cage was performed due to osteolysis of the bone graft. The other 28 pat. had no intra- or post-OP complications associated with the autogenic bone graft. At the 12 mo. follow-up osseous integration of the bone graft was observed in 28/29 in the CT-scans. The dorsal instrumentation could be removed in 8 of the 19 pat. with a dorso-ventral procedure after a mean of 12,6 mo. The measurements of the CT-scans at 18 mo. showed an average loss of correction (bisegmental) of 1,5° in the isolated ventral group and of 2,7° in the dorso-ventral group (p < 0,05). After 18 mo. Odom-score and subjective back function increased by 49% respectively 57% compared to the post-OP values (p< 0,05). Concerning the morbidity at the surgical approaches the pat. stated a pain relief of up to 73%.
Conclusions: Ms VTS with interposition of an autogenic bone graft of the iliac crest is an appropriate and meanwhile standardized minimal-invasive procedure with a low morbidity at the surgical approach. In this study a high potential for graft integration with a low amount of loss of correction could be detected in both groups (p < 0,05). For the mentioned indications the isolated ventral technique can be seen equal to the dorso-ventral procedure in 2 sessions. However the indication for an isolated ventral procedure has to be reconsidered carefully concerning increasing age and level of osteoporosis.
Correspondence should be addressed to: EFORT Central Office, Technoparkstrasse 1, CH – 8005 Zürich, Switzerland. Email: office@efort.org
