Relation between sagittal pelvic and thoracolumbar parameters in supine position - Pelvic parameters and their predictive value for spinal Cobb angles.

Introduction: Predicting the pre-morbid sagittal profile of the spine or segmental angles could enhance the process of planning the extent of fracture reduction. There is evidence that spinopelvic parameters may be suitable for this purpose. Research question: Is it possible to determine the inflection point and the mono- and bi-segmental endplate angles (EPA) in the thoracolumbar transition (from Th9 to L2) based on age, gender, spinopelvic parameters, and the adjacent EPA in the supine position? Material and methods: Based on Polytrauma CT scans in the supine position, the following spinopelvic parameters were measured using non-fractured spines: pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), and the apex of the LL. Results: In this study, a total of 287 patients with a mean age of 42±16 years were included. Age-related changes were observed, where LL, thoracic kyphosis (TK), and PI increase with age. Gender-related comparisons showed that females had a more pronounced LL and reduced TK. Significant correlations between IP and spinopelvic parameters, with the apex of LL providing the best prediction, were found. However, the overall model quality remained low. Predicting mEPA and bEPA showed positive correlations. The prediction for mEPA L2/3 demonstrated the highest correlation. For bisegmental angles, the most caudal bEPA (L2) exhibited the highest correlation, albeit with some notable absolute differences in the values between measured and predicted values. Discussion and conclusion: While this study highlights the complexity of the relationship between the pelvis and thoracolumbar parameters, finding a predictive tool for thoracolumbar reduction and stabilization was not possible.

Percutaneous reduction of thoracolumbar fractures using monoaxial screws: Comparison of two instruments based on initial reduction and loss of reduction.

Introduction: Percutaneous techniques for the surgical treatment of vertebral fractures are constantly progressing. There are different biomechanics involved. Research question: Two percutaneous, monoaxial fixation systems with different reduction tools were analyzed in relation to their reduction capacity. Additionally, the impact of anterior fusion, fracture severity and bone quality on reduction and loss of reduction were examined. Material and methods: 117 cases were retrospectively included in the monocentric study. The subsample (N = 53) with complete data at follow-up times was used to analyze the influence of anterior fusion. The dependencies on fracture severity and bone quality were determined using Spearman and Pearson correlation. Results: Both systems achieved equally good reduction (9° mean, 95%-CI: 8°-11°, p < 0.001). Anterior fused patients showed not significant (p = 0.057) less loss of reduction over time. Fracture severity had neither an influence on reduction or loss of reduction. Bone quality was positively correlated with greater amount of reduction and less loss of reduction. Early reduction within two days correlated with a greater amount of reduction (p = 0.006). Screw diameters and the patient's weight had no influence on loss of reduction. Complications occurred only in "V2" group. Discussion and conclusion: Both systems are equivalent in reduction ability. The additional anterior fusion did not result in significantly lower reduction losses. The subsample being small, is a limitation. Good bone quality correlates with better initial reduction and less reduction loss. A preoperative bone density measurement can lead to optimization of surgical techniques.

Muscle activity and rehabilitation in spinal stenosis (MARSS) after conservative therapy and surgical decompression with or without fusion: Protocol for a partially randomized patient preference trial on rehabilitation timing.

Background: Patients affected by lumbar spinal stenosis (LSS) suffer from a multifactorial degeneration of the lumbar spine resulting in narrowing of the neuroforamina and spinal canal, leading to various functional limitations. It remains unclear whether LSS patients after surgery would benefit from early post-operative rehabilitation, or if a delayed rehabilitation would be more advantageous. The purpose of this partially randomized patient preference trial is to evaluate the impact of post-operative rehabilitation timing as well as surgical intervention type on psychometric properties and functional outcomes in patients with LSS. Methods: Data for this patient preference trial are collected before and after surgical (decompression only or decompression and fusion) and rehabilitative interventions as well as six, 12 and 24 months after completing rehabilitation. The study participants are patients diagnosed with LSS who are at least 18 years old. After a medical check-up, participants will complete patient-reported outcome measures (PAREMO-20, SIBAR, FREM-8, SF-12, SFI, ODI) and different functional assessments (functional reach test, loaded reach test, handgrip strength, standing balance control, 6-min walk test). Ethics and dissemination: The results of this study will be published through peer-reviewed publications and scientific contributions at national and international conferences. This research has been approved by the Institutional Review Board of Martin Luther University Halle-Wittenberg (reference number: 2022-128).

Bone density of the cervical, thoracic and lumbar spine measured using Hounsfield units of computed tomography - results of 4350 vertebras.

INTRODUCTION: The assessment of bone density has gained significance in recent years due to the aging population. Accurate assessment of bone density is crucial when deciding on the appropriate treatment plan for spinal stabilization surgery. The objective of this work was to determine the trabecular bone density values of the subaxial cervical, thoracic and lumbar spine using Hounsfield units. MATERIAL AND METHODS: Data from 200 patients who underwent contrast-enhanced polytrauma computed tomography at a maximum care hospital over a two-year period were retrospectively analyzed. HUs were measured with an elliptical measurement field in three different locations within the vertebral body: below the upper plate, in the middle of the vertebral body, and above the base plate. The measured Hounsfield units were converted into bone density values using a validated formula. RESULTS: The mean age of the patient collective was 47.05 years. Mean spinal bone density values decreased from cranial to caudal (C3: 231.79 mg/cm3; L5: 155.13 mg/cm3; p < 0.001), with the highest values in the upper cervical spine. Bone density values generally decreased with age in all spinal segments. There was a clear decrease in values after age 50 years (p < 0.001). CONCLUSIONS: In our study, bone density decreased from cranial to caudal with higher values in the cervical spine. These data from the individual spinal segments may be helpful to comprehensively evaluate the status of the spine and to design a better preoperative plan before instrumentation.

Standardized analysis of syndesmosis stability in ankle trauma with an innovative syndesmosis-test-tool: a biomechanical study.

When treating ankle fractures, the question of syndesmosis complex involvement often arises. So far, there is no standardized method to reliably detect syndesmosis injuries in the surgical treatment of ankle fractures. For this reason, an intraoperative syndesmosis-test-tool (STT) was developed and compared to the recommended and established hook-test (HT). Tests were performed on cadaveric lower legs (n = 20) and the diastasis was visualized by 3D camera. Tests were performed at 50, 80, and 100 N in native conditions and four instability levels. Instability was induced from anterior to posterior and the reverse on the opposite side. The impact on diastasis regarding the direction, the force level, the instability level, and the device used was checked using a general linear model for repeated measurement. The direction of the induced instability showed no influence on the diastasis during the stability tests. The diastasis measured with the STT increased from 0.5 to 3.0 mm depending on the instability, while the range was lower with the HT (1.1 to 2.3 mm). The results showed that the differentiation between the instability levels was statistically significantly better for the developed STT. The last level of maximum instability was significantly better differentiable with the STT compared to the HT. An average visualizable diastasis of more than 2 mm could only be achieved at maximum instability. In conclusion, the newly developed STT was superior to the commonly used HT to detect instability.

The Halofixator for the Treatment of Unstable Fractures of the Upper Cervical Spine - Our Own Experience and Narrative Review. / Der Halofixateur zur Therapie von instabilen Frakturen der oberen Halswirbelsäule ­ eigene Erfahrungen und narratives Review.

INTRODUCTION: In the treatment of upper cervical spine injuries, the semiconservative procedure of the halofixator is now of only secondary importance. Older studies from the 2000 s showed unsatisfactory rates of consolidation as well as high rates of complications. However, due to current data on therapy effectiveness, the literature is inconsistent. The aim of this work is to compare our own experiences and results of treatment with the current literature and to help to clarify the role of the halofixator. MATERIAL AND METHODS: In a monocentric retrospective cohort study, patients with unstable injuries of the axial cervical spine who were to be treated in the halofixator were investigated. Individual variables (sex, age, concomitant diseases, Charlson Comorbidity Index) and treatment characteristics (duration of treatment, consolidation status, complications) were recorded using the electronic medical record. Injuries were classified based on CT data at the time of the accident and at the end of treatment, using common classification systems, and assessed with respect to the rate of consolidation. Possible factors influencing bony consolidation as well as complications were statistically analysed. RESULTS: A total of 54 patients met the inclusion criteria. The median duration of treatment was 83 days. The most common injuries were isolated atlas fracture type III (7; 13%) and isolated dens fracture type III (24; 44%). Bony consolidation was demonstrated in 34 cases (63%) and tight pseudarthrosis in 13 cases (24%). Secondary surgical stabilisation was performed in 6 cases (11%). Isolated type III atlas fractures and type III dens fractures had very high consolidation rates of 86% and 92%, respectively. In the subgroups of patients older than 65 years or with a CCI ≥ 4, unstable pseudarthroses were found more frequently. Complications included pin infection (6%), pin dislocation (9%), and pressure ulceration from the halo vest (6%). Cardiopulmonary complications did not occur. No patient died. DISCUSSION: Good rates of bony consolidation were seen for atlas fractures type III as well as dens fractures type III, which correlate with data in the literature. Dens fractures type II (isolated and combined) and atlas fractures type III in combination with dens fractures showed a worse radiological outcome, which is also unsatisfactory compared to the literature. The rates for procedure-specific complications were relatively low. In particular, work from recent years has demonstrated very good rates for bony consolidation and low complication rates for the treatment of atlas and/or dens fractures with the halofixator, which are confirmed by our results. In contrast, however, a significantly higher cardiac/respiratory complication rate has been reported than occurred in our own patient population.

Objective Assessment of Syndesmosis Stability Using the Hook Test.

The hook test is a widely used intraoperative method for assessing syndesmosis stability. However, there are no recommendations regarding the force required to perform this test. Furthermore, the reliability of the test is unclear. Ten experienced surgeons performed hook tests on a cadaver bone model. The applied forces were recorded in a blinded manner. In addition, standardized hook tests with defined forces (50, 80, and 100 N) were performed on 10 pairs of cadaver lower legs and the syndesmosis was sequentially destabilized. Diastasis of the syndesmosis was recorded using an optical 3D camera system. A median force of 81 N (Range: 50 N-145 N) was applied. A proportion of 82% of the tests showed a force < 100 N. The data showed good intraraterreliability and poor interraterreliability. In the standardized investigation of the hook test on the cadaver bone model, both the force and the instability of the syndesmosis had a significant influence on the syndesmosis diastasis. Nevertheless, even with maximum instability of the syndesmosis, diastasis > 2 mm could only be measured in 12 of the 19 evaluable specimens. The widely used hook test shows a high variability when performed in practice. Even in a standardized manner, the hook test cannot detect a relevant syndesmosis injury.

Treatment and Outcome of Osteoporotic Thoracolumbar Vertebral Body Fractures With Deformation of Both Endplates With or Without Posterior Wall Involvement (OF 4): Short-Term Results from the Prospective EOFTT Multicenter Study.

STUDY DESIGN: Multicenter prospective cohort study. OBJECTIVE: To analyse therapeutical strategies applied to osteoporotic thoracolumbar OF 4 injuries, to assess related complications and clinical outcome. METHODS: A multicenter prospective cohort study (EOFTT) including 518 consecutive patients who were treated for an Osteoporotic vertebral compression fracture (OVCF). For the present study, only patients with OF 4 fractures were analysed. Outcome parameters were complications, Visual Analogue Scale, Oswestry Disability Questionnaire, Timed Up & Go test, EQ-5D 5L, and Barthel Index after a minimum follow-up of 6 weeks. RESULTS: A total of 152 (29%) patients presented with OF 4 fractures with a mean age of 76 years (range 41-97). The most common treatment was short-segment posterior stabilization (51%; hybrid stabilization in 36%). Mean follow up was 208 days (±131 days), mean ODI was 30 ± 21. Dorsoventral stabilized patients were younger compared to the other groups (P < .001) and had significant better TuG compared to hybrid stabilization (P = .049). The other clinical outcomes did not differ in the therapy strategies (VAS pain: P = 1.000, ODI: P > .602, Barthel: P > .252, EQ-5D 5L index value: P > .610, VAS-EQ-5D 5L: P = 1.000). The inpatient complication rate was 8% after conservative and 16% after surgical treatment. During follow-up period 14% of conservatively treated patients and 3% of surgical treated patients experienced neurological deficits. CONCLUSIONS: Conservative therapy of OF 4 injuries seems to be viable option in patients with only moderate symptoms. Hybrid stabilization was the dominant treatment strategy leading to promising clinical short-term results. Stand-alone cement augmentation seems to be a valid alternative in selected cases.

Treatment and Outcome of Osteoporotic Thoracolumbar Vertebral Fractures With Anterior or Posterior Tension Band Failure (OF 5): Short-Term Results From the Prospective EOFTT Multicenter Study.

STUDY DESIGN: Subgroup analysis of a multicenter prospective cohort study. OBJECTIVE: To analyse surgical strategies applied to osteoporotic thoracolumbar osteoporotic fracture (OF) 5 injuries with anterior or posterior tension band failure and to assess related complications and clinical outcome. METHODS: A multicenter prospective cohort study (EOFTT) was conducted at 17 spine centers including 518 consecutive patients who were treated for an osteoporotic vertebral fracture (OVF). For the present study, only patients with OF 5 fractures were analysed. Outcome parameters were complications, Visual Analogue Scale (VAS), Oswestry Disability Questionnaire (ODI), Timed Up & Go test (TUG), EQ-5D 5L, and Barthel Index. RESULTS: In total, 19 patients (78 ± 7 years, 13 female) were analysed. Operative treatment consisted of long-segment posterior instrumentation in 9 cases and short-segment posterior instrumentation in 10 cases. Pedicle screws were augmented in 68 %, augmentation of the fractured vertebra was performed in 42%, and additional anterior reconstruction was done in 21 %. Two patients (11 %) received short-segment posterior instrumentation without either anterior reconstruction or cement-augmentation of the fractured vertebra. No surgical or major complications occurred, but general postoperative complications were observed in 45%. At a follow-up of mean 20 ± 10 weeks (range, 12 to 48 weeks), patients showed significant improvements in all functional outcome parameters. CONCLUSIONS: In this analysis of patients with type OF 5 fractures, surgical stabilization was the treatment of choice and lead to significant short-term improvement in terms of functional outcome and quality of life despite a high general complication rate.

Mediating Medical Comorbidities in Geriatric Patients Undergoing Surgery for OVCF: From Preoperative Screening to Risk and Outcomes Optimization.

OBJECTIVES: Osteoporotic vertebral compression fractures (OVCF) are a common increasing entity in elderly patients and represent a tremendous economic burden. Surgical treatment is related to high complication rates and little is known about patient-specific and internal risk factors associated with poor clinical results. METHODS: We carried out a comprehensive, systematic literature search according to the PRISMA checklist and algorithm. Risk factors for perioperative complications, for early inpatient readmission, for the duration of the hospital stay, the hospital mortality, the total mortality and the clinical result were analyzed. RESULTS: A total of 739 potentially usable studies were identified. After considering all inclusion and exclusion criteria, 15 studies with 15,515 patients were included. Non-adjustable risk factors were age >90 years (OR 3.27), male gender (OR 1.41), BMI less than 18.5 kg/m2 (OR 3.97), ASA score >3 (OR 2.7), activity of daily live (ADL) (OR 1.52), dependence (OR 5.68), inpatient admission status (OR 3.22), Parkinson disease (OR 3.63) and disseminated cancer (OR 2.98). Adjustable factors were insufficient kidney function (GFR <60 mL/min, and Creatinine Clearance below 60 mg/dl) (OR 4.4), nutrition status (hypalbuminemia (<3.5 g/dl)), liver function (OR 8.9) and further cardiac and pulmonary comorbidities. DISCUSSION: We identified a couple of non-adjustable risk factors, which should be considered preoperatively in terms of risk assessment. However, even more important were adjustable factors that can be influenced preoperatively. In conclusion, we recommend a perioperative interdisciplinary cooperation, especially with geriatricians, to achieve the best possible clinical results in geriatric patients undergoing surgery for OVCF.

Clinical Evaluation of the Osteoporotic Fracture Treatment Score (OF-Score): Results of the Evaluation of the Osteoporotic Fracture Classification, Treatment Score and Therapy Recommendations (EOFTT) Study.

STUDY DESIGN: Multicenter prospective cohort study. OBJECTIVE: The study aims to validate the recently developed OF score for treatment decisions in patients with osteoporotic vertebral compression fractures (OVCF). METHODS: This is a prospective multicenter cohort study (EOFTT) in 17 spine centers. All consecutive patients with OVCF were included. The decision for conservative or surgical therapy was made by the treating physician independent of the OF score recommendation. Final decisions were compared to the recommendations given by the OF score. Outcome parameters were complications, Visual Analogue Scale, Oswestry Disability Questionnaire, Timed Up & Go test, EQ-5D 5 L, and Barthel Index. RESULTS: In total, 518 patients (75.3% female, age 75 ± 10) years were included. 344 (66%) patients received surgical treatment. 71% of patients were treated following the score recommendations. For an OF score cut-off value of 6.5, the sensitivity and specificity to predict actual treatment were 60% and 68% (AUC .684, P < .001). During hospitalization overall 76 (14.7%) complications occurred. The mean follow-up rate and time were 92% and 5 ± 3.5 months, respectively. While all patients in the study cohort improved in clinical outcome parameters, the effect size was significantly less in the patients not treated in line with the OF score's recommendation. Eight (3%) patients needed revision surgery. CONCLUSIONS: Patients treated according to the OF score's recommendations showed favorable short-term clinical results. Noncompliance with the score resulted in more pain and impaired functional outcome and quality of life. The OF score is a reliable and save tool to aid treatment decision in OVCF.

Fibula Nail versus Locking Plate Fixation-A Biomechanical Study.

In the treatment of ankle fractures, complications such as wound healing problems following open reduction and internal fixation are a major problem. An innovative alternative to this procedure offers a more minimally invasive nail stabilization. The purpose of this biomechanical study was to clarify whether this method was biomechanically comparable to the established method. First, the stability (range of motion, diastasis) and rotational stiffness of the native upper ankle were evaluated in eight pairs of native geriatric specimens. Subsequently, an unstable ankle fracture was created and fixed with a locking plate or a nail in a pairwise manner. The ankles showed significantly less stability and rotational stiffness properties after nail and plate fixations than the corresponding native ankles (p < 0.001 for all parameters). When comparing the two methods, both showed no differences in their range of motion (p = 0.694) and diastasis (p = 0.166). The nail also presented significantly greater rotational stiffness compared to the plate (p = 0.001). However, both fixations remained behind the native stability and rotational stiffness. Due to the comparable biomechanical properties of the nail and plate fixations, an early weight-bearing following nail fixation should be assessed on a case-by-case basis considering the severity of fractures.

Georg Schmorl prize of the German spine society (DWG) 2022: current treatment for inpatients with osteoporotic thoracolumbar fractures-results of the EOFTT study.

AIM: Osteoporotic thoracolumbar fractures are of increasing importance. To identify the optimal treatment strategy this multicentre prospective cohort study was performed. PURPOSE: Patients suffering from osteoporotic thoracolumbar fractures were included. Excluded were tumour diseases, infections and limb fractures. Age, sex, trauma mechanism, OF classification, OF-score, treatment strategy, pain condition and mobilization were analysed. METHODS: A total of 518 patients' aged 75 ± 10 (41-97) years were included in 17 centre. A total of 174 patients were treated conservatively, and 344 were treated surgically, of whom 310 (90%) received minimally invasive treatment. An increase in the OF classification was associated with an increase in both the likelihood of surgery and the surgical invasiveness. RESULTS: Five (3%) complications occurred during conservative treatment, and 46 (13%) occurred in the surgically treated patients. 4 surgical site infections and 2 mechanical failures requested revision surgery. At discharge pain improved significantly from a visual analogue scale score of 7.7 (surgical) and 6.0 (conservative) to a score of 4 in both groups (p < 0.001). Over the course of treatment, mobility improved significantly (p = 0.001), with a significantly stronger (p = 0.007) improvement in the surgically treated patients. CONCLUSION: Fracture severity according to the OF classification is significantly correlated with higher surgery rates and higher invasiveness of surgery. The most commonly used surgical strategy was minimally invasive short-segmental hybrid stabilization followed by kyphoplasty/vertebroplasty. Despite the worse clinical conditions of the surgically treated patients both conservative and surgical treatment led to an improved pain situation and mobility during the inpatient stay to nearly the same level for both treatments.

Current Minimally Invasive Surgical Concepts for Sacral Insufficiency Fractures. / Aktuelle minimalinvasive operative Konzepte für Insuffizienzfrakturen des Sakrums.

An increasing incidence of sacral insufficiency fractures in geriatric patients has been documented, representing a major challenge to our healthcare system. Determining the accurate diagnosis requires the use of sectional imaging, including computed tomography and magnetic resonance imaging. Initially, non-surgical treatment is indicated for the majority of patients. If non-surgical treatment fails, several minimally invasive therapeutic strategies can be used, which have shown promising results in small case series. These approaches are sacroplasty, percutaneous iliosacral screw fixation (S1 with or without S2), trans-sacral screw fixation or implantation of a trans-sacral bar, transiliac internal fixator stabilisation, and spinopelvic stabilisation. These surgical strategies and their indications are reported in detail. Generally, treatment-related decision making depends on the clinical presentation, fracture morphology, and attending surgeon's experience.

[Value of routine transpedicular biopsies in kyphoplasty and vertebroplasty for vertebral compression fractures : A survey among 250 spine surgeons]. / Stellenwert der transpedikulären Biopsie bei Kypho- und Vertebroplastien von Wirbelkörperfrakturen : Eine Umfrage unter 250 Wirbelsäulenchirurgen.

BACKGROUND: Transpedicular cement augmentation is an established therapeutic option in the treatment of pathologic compression fractures of the spine. In addition to osteoporosis, underlying metastatic diseases or, more rarely, a primary bone tumor are recurrent causes of vertebral compression fractures without adequate trauma. OBJECTIVE: To obtain a current opinion among spine surgeons in Germany, Switzerland, and Austria on the value of transpedicular biopsy during kyphoplasty and vertebroplasty of vertebral body fractures. MATERIAL AND METHODS: A web-based (UmfrageOnline®) questionnaire with 11 questions was created and sent to the email distribution lists of the German Spine Society (DWG), the Austrian Society for Spine Surgery (spine.at), and the Swiss Society for Spinal Surgery (SGS), as well as to the email distribution list of the Spine Section of the German Society for Orthopedics and Trauma Surgery (DGOU). RESULTS: Of a total of 2675 spine surgeons contacted 250 (9.3%) responded to the survey. Approximately one third (29.8%) of respondents regularly perform a transpedicular biopsy with each kyphoplasty or vertebroplasty. Reasons cited for biopsy were image morphology (79.7%) or history of suspected (66.0%) or present (71.4%) tumor disease. Reasons cited against routine biopsy were the associated costs and the limited informative value of the biopsies obtained. DISCUSSION: Nearly one third of the spine surgeons surveyed regularly perform a transpedicular biopsy with each kyphoplasty or vertebroplasty. Almost all respondents perform biopsies at least when there is an imaging morphologic suspicion of tumor disease or tumor disease is known or suspected based on risk factors. Future studies need to further clarify the cost-effectiveness of transpedicular biopsy.

Perioperative outcome of minimally invasive stabilisation of bilateral fragility fractures of the sacrum: a comparative study of bisegmental transsacral stabilisation versus spinopelvic fixation.

PURPOSE: Pelvic fragility fractures have steadily risen over the past decades. The primary treatment goal is the fastest possible mobilisation. If conservative therapy fails, surgical fixation is a promising approach. This study compares the outcome of bisegmental transsacral stabilisation (BTS) and spinopelvic fixation (SP) as minimally invasive techniques for bilateral fragility fractures of the sacrum (BFFS). METHODS: We performed a prospective, non-randomised, case-controlled study. Patients were included if they remained bedridden due to pain despite conservative treatment. Group assignment depended on sacral anatomy and fracture type. The outcome was estimated by blood loss calculation, cut-seam time, fluoroscopy time, complications, duration of stay at the intensive/intermediate care unit (ICU/IMC), and total inpatient stay. The mobility level at discharge was recorded. RESULTS: Seventy-three patients were included (SP: 49, BTS: 24). There was no difference in blood loss (BTS: 461 ± 628 mL, SP: 509 ± 354 mL). BTS showed a significantly lower cut-seam time (72 ± 23 min) than SP (94 ± 27 min). Fluoroscopy time did not differ (BTS: 111 ± 61 s vs. 103 ± 45 s). Thirteen percent of BTS and 16% of SP patients required ICU/IMC stay (BTS: 0.6 ± 1.8 days, SP: 0.5 ± 1.5 days) during inpatient stay (BTS: 9 ± 4 days, SP: 8 ± 3 days). Fourteen patients suffered from urinary tract infections (BTS: 8%; SP: 25%). In-patient mortality was low (BTS: 4.2%, SP: 4.1%). At discharge, the BTS group was almost back to the initial mobility level. In SP patients, mobility was significantly lower than before complaints (p = 0.004). CONCLUSION: Both methods allow early mobilization of BFFS patients. Blood loss can be kept low. Hence, transfusion requirement is correspondingly low. The IMC/ICU and the total inpatient stay are lower than reported in the literature. Both BTS and SP can be recommended as safe and low-complication methods for use in BFFS patients. BTS is superior to SP with respect to surgery duration and level of mobility at discharge.

Impact of Spino-Pelvic Parameters on the Prediction of Lumbar and Thoraco-Lumbar Segment Angles in the Supine Position.

Background: The correction of malposition according to vertebral fractures is difficult because the alignment at the time before the fracture is unclear. Therefore, we investigate whether the spinal alignment can be determined by the spino-pelvic parameters. Methods: Pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), adjacent endplate angles (EPA), age, sex, body weight, body size, BMI, and age were used to predict mono- and bisegmental EPA (mEPA, bEPA) in the supine position using linear regression models. This study was approved by the Ethics Committee of the Medical Association of Saxony-Anhalt Germany on 20 August 2020, under number 46/20. Results: Using data from 287 patients, the prediction showed R2 from 0.092 up to 0.972. The adjacent cranial and caudal EPA showed by far the most frequently significance in the prediction of all parameters used. Anthropometric and spino-pelvic parameters showed sparse impact, which was frequently in the lower lumbar regions. On average, a very good prediction was found. For two mEPA (L3/4 R2 = 0.914, L4/5 R2 = 0.953) and two bEPA (L3 R2 = 0.899, L4 R2 = 0.972), the R2 was >0.8. However, the predicted EPA differed for individual patients, even in these very effective prediction models­roughly around ±10° as compared to the measured EPA. Conclusions: In general, the prediction showed good to perfect results. In the supine position, the spinopelvic and anthropometric parameters show sparse impact on the prediction of mEPA or bEPA.

Risk Factors for Failure in Conservatively Treated Osteoporotic Vertebral Fractures: A Systematic Review.

STUDY DESIGN: Systematic review. OBJECTIVES: Osteoporosis is one of the most common diseases of the elderly, whereby vertebral body fractures are in many cases the first manifestation. Even today, the consequences for patients are underestimated. Therefore, early identification of therapy failures is essential. In this context, the aim of the present systematic review was to evaluate the current literature with respect to clinical and radiographic findings that might predict treatment failure. METHODS: We conducted a comprehensive, systematic review of the literature according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) checklist and algorithm. RESULTS: After the literature search, 724 potentially eligible investigations were identified. In total, 24 studies with 3044 participants and a mean follow-up of 11 months (range 6-27.5 months) were included. Patient-specific risk factors were age >73 years, bone mineral density with a t-score <-2.95, BMI >23 and a modified frailty index >2.5. The following radiological and fracture-specific risk factors could be identified: involvement of the posterior wall, initial height loss, midportion type fracture, development of an intravertebral cleft, fracture at the thoracolumbar junction, fracture involvement of both endplates, different morphological types of fractures, and specific MRI findings. Further, a correlation between sagittal spinal imbalance and treatment failure could be demonstrated. CONCLUSION: In conclusion, this systematic review identified various factors that predict treatment failure in conservatively treated osteoporotic fractures. In these cases, additional treatment options and surgical treatment strategies should be considered in addition to follow-up examinations.

Concomitant injuries in patients with thoracic vertebral body fractures-a systematic literature review.

PURPOSE: The aim of this study was to give a systematic overview over the rate and location of concomitant injuries, the probability of suffering from neurological deficits, and to give evidence of the timing of surgery in severely injured patients with unstable thoracic vertebral body fractures. METHODS: This review is based on articles retrieved by a systematic search in the PubMed and Web of Science database for publications up to November 2020 dealing with unstable fractures of the mid-thoracic spine. RESULTS: Altogether, 1109 articles were retrieved from the literature search. A total of 1095 articles were excluded. Thus, 16 remaining original articles were included in this systematic review depicting the topics timing of surgery in polytraumatized patients, outcome neurologic deficits, and impact of concomitant injuries. The overall level of evidence of the vast majority of studies is low. CONCLUSION: The evidence of the available literature is low. The cited studies reveal that thoracic spinal fractures are associated with a high number of neurological deficits and concomitant injuries, particularly of the thoracic cage and the lung. Thereby, diagnostic algorithm should include computer tomography of the whole thoracic cage if there is any clinical sign of concomitant injuries. Patients with incomplete neurologic deficits benefit from early surgery consisting of decompression and long-segmental stabilization.

[Local spinal profile following operative treatment of thoracolumbar and lumbar fractures : Impact of reduction technique and bone quality]. / Lokales Wirbelsäulenprofil nach operativer Behandlung thorakolumbaler und lumbaler Frakturen : Einfluss von Repositionstechnik und Knochenqualität.

BACKGROUND: The goal of surgery for spinal injuries is fracture reduction, fixation and stable healing in a physiological position. Several open and minimally invasive surgical techniques are available. OBJECTIVE: The extent of open reduction and the fixation potential achieved by the AOSpine (AT) and Kluger (KT) techniques were compared. The influence of fracture morphology, age, sex, and bone quality on fracture reduction and secure fixation was investigated. MATERIAL AND METHODS: In this monocentric retrospective cohort study data of patients with traumatic thoracolumbar and lumbar fractures treated by AT or KT were analyzed. The bisegmental kyphotic angle (bGDW) of each injured spinal segment was determined. Normal bGDW values were extrapolated from the literature. The change of bGDW over time was analyzed under consideration of the bone quality in Hounsfield units (HU), injury severity according to the AOSpine classification, gender and age of patients. RESULTS: A total of 151 data sets were evaluated. The AT and KT methods achieved a similar extent of reduction (AT 10 ± 6°, KT 11 ± 8°; p = 0.786). In follow-up a mean reduction loss of -5 ± 4° was seen. The technique had no influence on this (p = 0.998). The fracture morphology just managed to achieve a significant influence (p = 0.043). Low HU correlated significantly but weakly with lower extent of reduction (r = 0.241, p < 0.003) and greater reduction loss (r = 0.272, p < 0.001). In the age group 50-65 years 21% of men and 43% of women had bone quality of < 110 HU. Age and HU were significantly correlated (r = -0.701, p < 0.001). CONCLUSION: The AT and KT are equivalent in terms of reduction and secure fixation properties. The high proportion of male and female patients with HU < 110 in the age group under 65 years and the influence on reduction and secure fixation emphasize the need for preoperative bone densitometry.