Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Von Martius, A.
Posttraumatic disc injuries after burst fractures of vertebral bodies in the thoracolumbar transition zone
Humanmedizin; [ Diplomarbeit ] ; 2014. pp. 98
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Gumpert Rainer
- Altmetrics:
- Abstract:
- During the last 20 years, a remarkable increase in relevant spine injuries has been seen. This paper deals with traumatic burst fractures, type A3-lesions, in the thoracolumbar transition zone in younger patients. Fractures are often sustained in this zone because of the composition of the human spine; it is in this area that there is a change in the physiological curve from the thoracic kyphosis to the lumbar lordosis and additionally, there is no stabilizing ribcage present. These fractures are also typically accompanied by a loss of height of the fractured vertebral body and an in- or decrease in the distance between the adjacent pedicles. There are several therapy options available for these injuries: conservative treatment, balloon kyphoplasty with calcium phosphate cement or an anterior, antero- posterior or posterior stabilization combined with or without balloon assisted kyphoplasty. Nowadays, in Graz, the trend is towards the surgical approach in the form of CaP-balloon kyphoplasty with percutaneous dorsal instrumentation. This option is minimally invasive, causes little pain and blood loss and facilitates a faster mobilization. After a stabilization procedure, it must be decided whether or not to remove the metallic implant. Due to the close spatial proximity of the intervertebral disc to the vertebral body, the disc is affected in almost every process of the vertebral body. Thus, it would be interesting to review what happens to the disc following a fracture, balloon kyphoplasty and dorsal instrumentation and also after the removal of metalwork in cases where full recovery has been made. Methods: All patients included in this study previously suffered an A3-fracture and underwent a balloon assisted endplate reduction with CaP-cement and a minimally invasive percutaneous dorsal instrumentation. Metal removal can be performed after at least six to eight months after initial surgery, however, our cases show an average time of 11.8 months. Medical imaging was also performed and preoperative, postoperative, follow-up x-rays and CT scans were taken on three occasions to classify the fracture, to measure the two vertebral edges and the intervertebral disc space and also to determine the Cobb angle. After the removal of metalwork, follow-up MRI scans showed the hydration of the discs, the loss of height in the intervertebral disc space and any damage or signs of degeneration. With these follow-up MRI images, the Oner and Pfirrmann classifications were used to classify the post-traumatic discs and disc spaces. In addition to that, patients were interviewed and rated according to different pain and activity score profiles (VAS, RMDS, Return to Work). Furthermore, a literature review based on Medical databases such as PubMed, Google Scholar and Ovid was completed and related articles were chosen. Results: We expect that some of the patients will show minimal loss of correction. This would include varying degrees of change in the structure of the disc, its morphology, liquid content and/or a slight reduction in the intervertebral disc space height. All in all, our results show that these changes do not result in serious limitations such as the restriction of motion. It is also evident, that the removal of implants does not lead to an additional significant loss of height of the intervertebral disc space. A certain amount of disc involvement after burst fracture is definitely visible however it is not as severe as one might expect. Conclusion: This present study shows that, after an A3-fracture and the treatment performed at the LKH Graz changes can be noticed within the vertebral disc, the vertebral body itself or the intervertebral disc space. These changes, however, do not lead to major shortcomings for patients. This type of therapy, therefore, in combination with good aftercare is shown to produce very satisfactory long-term results.