Percutaneous Vertebroplasty versus Nonoperative Treatment of Osteoporotic Vertebral Fractures: A Meta-Analysis of Randomized Controlled Trials.

Osteoporotic vertebral fractures frequently result in pain and decreased quality of life (QoL). The management of these fractures remains a topic of debate. Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we analyzed randomized controlled trials comparing percutaneous vertebroplasty (PV) with non-operative treatment (non-OT). The outcomes of interest included pain, QoL, cement leakage, and new osteoporotic vertebral fractures after 1 year. Compared to non-OT regarding pain relief, PV yielded significant improvement at 1-2 weeks, 1 month, 6 months (standard mean difference [SMD] = -0.67 (6/14; 95% confidence interval [CI]: -1.29 to -0.06; I2 = 92%, random effects) and 1 year (mean difference = -1.07 (4/14; 95% CI: -1.97 to -0.18; I2 = 97%, random effects). For QoL, notable improvements were observed at 1 week (standard mean difference = -2.10 (5/14; 95% CI: -3.77 to -0.42; I2 = 98%, random effects) and 3 months (mean difference = -1.58 (4/14; 95% CI: -3.07 to -0.09; I2 = 96%, random effects), with 1 month, 6 months and 1 year being inconclusive. A cement leakage rate of 42% (10/14; 95% CI: 25% to 59%; I2 = 99%, random effects) was found. Further, PV did not significantly heighten the risk of new fractures within a year (odds ratio = 1.26 (6/14; 95% CI: 0.63 to 2.53; I2 = 74%, random effects). PV emerges as a promising intervention for specific time intervals regarding pain relief, especially in the extended-term analysis, and QoL, especially in the short-term analysis, compared to non-OT. However, clinicians must consider cement leakage risks. Heterogeneity among studies underscores careful patient selection.

Prevalence of Morphometric Vertebral Fractures After Bariatric Surgery and Its Relationship with Bone Mineral Density and Bone Markers.

BACKGROUND: Bariatric surgery (BS) can lead to bone loss and an increased fracture risk. METHODS: To determine the morphometric vertebral fracture (MVF) prevalence, and its relationship with bone mineral density (BMD), and biomarker's turnover after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), we analyzed post-surgery X-rays of the spine in 80 patients (88% female, 51% RYGB, age 41.2 [6.8] years) from 117 participants' retrospective cohort (1-2 years, >2 and <5 years, and >5 years). We still analyzed body composition and BMD by dual-energy X-ray absorptiometry and bone parameters. RESULTS: MVF prevalence was 17.5% (14/80), with no statistical difference between groups (p = 0.210). RYGB group had a higher prevalence of secondary hyperparathyroidism (SHPT) (PTH ≥ 65 pg/ml; 18.4% vs 7.8%, respectively, p = 0.04), PTH (61.3 vs 49.5 pg/ml, p = 0.001), CTX (0.766 [0.29] ng/ml vs 0.453 [0.30] ng/ml, p = 0.037), and AP (101.3 [62.4] U/L vs 123.9 [60.9] U/L, p = 0.027) than the SG group. Up to 5 years postoperatively, RYGB had a lower total (1.200 [0.087] vs 1.236 [0.100] g/cm2, p = 0.02), femoral neck (1.034 [0.110] vs 1.267 [0.105], p = 0.005), and total femur BMD (1.256 [0.155] vs 1.323 [0.167], p = 0.002) than SG group. We found no statistically significant difference between the MFV (+) and MVF (-) groups regarding age, sex, BMI, surgery time, BMD, or bone and metabolic parameters, including leptin. CONCLUSION: We found a high prevalence of MVF after BS with no differences between RYGB and SG.

Percutaneous Pedicle Screw for Thoracolumbar Fractures: A Long-term Follow-up / Parafuso pedicular percutâneo em fraturas toracolombares: Acompanhamento em longo prazo

Abstract Objective: This is a retrospective cohort study to analyze the long-term outcomes of thoracolumbar spine fracture patients who underwent minimally invasive percutaneous fixation. Methods: The cases of 17 patients with thoracolumbar spine fractures who had percutaneous fixation between 2009 and 2011 were the subject of a retrospective analysis. Clinical and radiographic variables were collected. For the clinical evaluation the questionnaires SF-36 and Oswestry were used. Radiographic parameters were evaluated using fracture's classification based on Magerls's criteria, the fractured vertebra's wedging angle, and the affected segment's segmental Cobb angle. The measures were made at different stages: before surgery, immediately after surgery, one year later, and at a late follow-up (5 years later). Trauma associated injuries, postsurgical and implant related complications were among the additional information taken into account. Results: The SF-36 questionnaire showed averages above 63,5% in all domains in the late postoperative data (from 5 years after the surgery). Oswestry questionnaire answers showed minimal or no physical limitations in 80% of the patients with a mean score of 10,8% ± 10,5. The average preoperative Cobb angle value was 5,53º ± 13,80º of kyphosis, the immediate postoperative 2,18º ± 13,38º of kyphosis, one year postoperative 5,26 ± 13,95º of kyphosis, and the late follow-up 8,78º ± 15,06º of kyphosis. The mean correction was 3,35º, and mean loss of correction was 6,6º. There were no complications observed, no case of neurological deficit, infection or implant failure occurred. Conclusion: Thoracolumbar vertebrae fractures can be surgically treated with positive late clinical and radiological outcomes and low complication rates using a minimally invasive percutaneous method.

Resumo Objetivo: Este é um estudo de coorte retrospectivo para analisar os desfechos em longo prazo de pacientes com fratura da coluna toracolombar submetidos à fixação percutânea minimamente invasiva. Métodos: Os casos de 17 pacientes com fraturas da coluna toracolombar submetidos à fixação percutânea entre 2009 e 2011 foram objeto de análise retrospectiva. Variáveis clínicas e radiográficas foram coletadas. A avaliação clínica foi baseada nos questionários SF-36 e Oswestry. Os parâmetros radiográficos foram avaliados de acordo com a classificação de fratura baseada nos critérios de Magerls, o ângulo de cunha da vértebra fraturada e o ângulo de Cobb do segmento acometido. As medidas foram feitas em diferentes momentos: antes da cirurgia, imediatamente após a cirurgia, um ano depois e no acompanhamento tardio (cinco anos depois). Lesões associadas a traumas, complicações pós-cirúrgicas e relacionadas a implantes também foram consideradas. Resultados: O questionário SF-36 apresentou médias acima de 63,5% em todos os domínios no período pós-operatório tardio (a partir de cinco anos após a cirurgia). As respostas do questionário Oswestry mostraram limitações físicas mínimas ou nulas em 80% dos pacientes, com pontuação média de 10,8% ± 10,5%. O valor médio do ângulo de Cobb foi de 5,53º± 13,80º de cifose no período pré-operatório, 2,18º ± 13,38º de cifose no pós-operatório imediato, 5,26 ±13,95º de cifose no pós-operatório de um ano e de 8,78º ± 15,06º de cifose no período pós-operatório tardio. A correção média foi de 3,35º e a perda média de correção foi de 6,6º. Não foram observadas complicações, casos de déficit neurológico, infecções ou falhas do implante. Conclusão: As fraturas das vértebras toracolombares podem ser tratadas cirurgicamente com desfechos clínicos e radiológicos tardios positivos e baixas taxas de complicações usando um método percutâneo minimamente invasivo.

[Analysis of life quality on patients with thoracolumbar fractures]. / Análisis de calidad de vida en pacientes con fracturas toracolumbares.

Background: Patients with thoracolumbar fractures with TLICS 4 classification are at the limit of surgical fixation with regards to conservative treatment; however, results in our environment are not known, which is why this study has innovative characteristics. Objective: To determine the quality of life in patients with TLICS 4 thoracolumbar fractures using traditional fixation with regards to no fixation in a third level hospital. Material and methods: A cohort prospective study was carried out in patients with TLICS 4 classification thoracolumbar fractures using traditional fixation with regards to no fixation in beneficiaries from the Mexican Institute for Social Security. The SF-12 instrument, which assessed quality of life, was administered; age, sex, days of hospitalization, time of spinal cord injury were searched in the patients' medical history. It was used descriptive and inferential statistics using Student's t or Mann-Whitney U. Results: 20 patients participated and 9 had traditional fixation (45%). All patients had type E spinal cord injuries according to the International Standards for Neurological Classification of Spinal Cord Injury. Mean age of non-fixation was 42.2 ± 12.9 and of fixation 44.9 ± 10.2; in non-fixation 6 (67%) were male. The quality of life score was 29.1 ± 0.9 in the conservative treatment and 28.7 ± 1.3 in the surgical treatment, p < 0.462. Conclusions: No differences in quality of life were observed in patients with TLICS 4 thoracolumbar fractures using traditional fixation with regards to no fixation.

Introducción: los pacientes con fracturas toracolumbares con clasificación TLICS 4 se encuentran en el límite de la fijación quirúrgica con respecto al tratamiento conservador; sin embargo, resultados en nuestro medio no son conocidos, por lo que este estudio tiene características innovadoras. Objetivo: determinar la calidad de vida en pacientes con fracturas toracolumbares clasificación TLICS 4, mediante fijación tradicional con respecto a no fijación en un hospital de tercer nivel. Material y métodos: estudio de cohorte prospectiva en pacientes con fracturas toracolumbares clasificación TLICS 4 mediante fijación tradicional con respecto a no fijación en población derechohabiente del Instituto Mexicano del Seguro Social (IMSS). Se aplicó el instrumento SF-12, que evaluó la calidad de vida; se buscó en los expedientes de los pacientes edad, sexo, días de hospitalización, tiempo de lesión medular. Se usó estadística descriptiva e inferencial mediante t de Student o U de Mann Whitney. Resultados: participaron 20 pacientes y 9 (45%) tuvieron fijación tradicional. Todos los pacientes pertenecían a la clase E según las Normas Internacionales para la Clasificación Neurológica de lesiones de la médula espinal. Edad media de no fijación con 42.2 ± 12.9 y de fijación 44.9 ± 10.2; en no fijación, 6 (67%) eran varones. La puntuación de calidad de vida fue en el tratamiento conservador con 29.1 ± 0.9 y quirúrgico 28.7 ± 1.3, p < 0.462. Conclusiones: no se observaron diferencias en la calidad de vida en pacientes con fracturas toracolumbares clasificación TLICS 4 mediante fijación tradicional y no fijación.

[Analysis of life quality on patients with thoracolumbar fractures]. / Análisis de calidad de vida en pacientes con fracturas toracolumbares.

Background: Patients with thoracolumbar fractures with TLICS 4 classification are at the limit of surgical fixation with regards to conservative treatment; however, results in our environment are not known, which is why this study has innovative characteristics. Objective: To determine the quality of life in patients with TLICS 4 thoracolumbar fractures using traditional fixation with regards to no fixation in a third level hospital. Material and methods: A cohort prospective study was carried out in patients with TLICS 4 classification thoracolumbar fractures using traditional fixation with regards to no fixation in beneficiaries from the Mexican Institute for Social Security. The SF-12 instrument, which assessed quality of life, was administered; age, sex, days of hospitalization, time of spinal cord injury were searched in the patients' medical history. It was used descriptive and inferential statistics using Student's t or Mann-Whitney U. Results: 20 patients participated and 9 had traditional fixation (45%). All patients had type E spinal cord injuries according to the International Standards for Neurological Classification of Spinal Cord Injury. Mean age of non-fixation was 42.2 ± 12.9 and of fixation 44.9 ± 10.2; in non-fixation 6 (67%) were male. The quality of life score was 29.1 ± 0.9 in the conservative treatment and 28.7 ± 1.3 in the surgical treatment, p < 0.462. Conclusions: No differences in quality of life were observed in patients with TLICS 4 thoracolumbar fractures using traditional fixation with regards to no fixation.

Introducción: los pacientes con fracturas toracolumbares con clasificación TLICS 4 se encuentran en el límite de la fijación quirúrgica con respecto al tratamiento conservador; sin embargo, resultados en nuestro medio no son conocidos, por lo que este estudio tiene características innovadoras. Objetivo: determinar la calidad de vida en pacientes con fracturas toracolumbares clasificación TLICS 4, mediante fijación tradicional con respecto a no fijación en un hospital de tercer nivel. Material y métodos: estudio de cohorte prospectiva en pacientes con fracturas toracolumbares clasificación TLICS 4 mediante fijación tradicional con respecto a no fijación en población derechohabiente del Instituto Mexicano del Seguro Social (IMSS). Se aplicó el instrumento SF-12, que evaluó la calidad de vida; se buscó en los expedientes de los pacientes edad, sexo, días de hospitalización, tiempo de lesión medular. Se usó estadística descriptiva e inferencial mediante t de Student o U de Mann Whitney. Resultados: participaron 20 pacientes y 9 (45%) tuvieron fijación tradicional. Todos los pacientes pertenecían a la clase E según las Normas Internacionales para la Clasificación Neurológica de lesiones de la médula espinal. Edad media de no fijación con 42.2 ± 12.9 y de fijación 44.9 ± 10.2; en no fijación, 6 (67%) eran varones. La puntuación de calidad de vida fue en el tratamiento conservador con 29.1 ± 0.9 y quirúrgico 28.7 ± 1.3, p < 0.462. Conclusiones: no se observaron diferencias en la calidad de vida en pacientes con fracturas toracolumbares clasificación TLICS 4 mediante fijación tradicional y no fijación.

Early Outcomes of Operative Versus Nonoperative Management of Stress-Positive Minimally Displaced Lateral Compression Type 1 Pelvic Ring Injuries.

OBJECTIVES: To compare the early outcomes of patients with stress-positive minimally displaced lateral compression type 1 (LC1b) pelvic ring injuries managed with or without operative fixation. DESIGN: Retrospective comparison study. SETTING: Level 1 trauma center. PATIENTS/PARTICIPANTS: Forty-three patients with LC1b injuries. INTERVENTION: Operative versus nonoperative. MAIN OUTCOME MEASUREMENTS: Discharge to subacute rehabilitation (SAR); 2- and 6-week pain visual analog score, opioid use, assistive device use, percentage of normal single assessment numerical evaluation, SAR status; fracture displacement; and complications. RESULTS: The operative group did not differ in age, gender, body mass index, high-energy mechanism, dynamic displacement stress radiographs, complete sacral fractures, Denis sacral fracture classification, Nakatani rami fracture classification, follow-up length, or American Society of Anesthesiologists classification. The operative group was less likely to be using an assistive device at 6 weeks [observed difference (OD) -53.9%, 95% confidence interval (CI) -74.3% to -20.6%, OD/CI 1.00, P = 0.0005], less likely to remain in an SAR at 2 weeks (OD -27.5%, CI, -50.0% to -2.7%, OD/CI 0.58, P = 0.02), and had less fracture displacement at follow-up radiographs (OD -5.0 mm, CI, -9.2 to -1.0 mm, OD/CI 0.61, P = 0.02). There were no other differences in outcomes between treatment groups. Complications occurred in 29.6% (n = 8/27) of the operative group compared with 25.0% (n = 4/16) of the nonoperative group resulting in 7 and 1 additional procedures, respectively. CONCLUSIONS: Operative treatment was associated with early benefits over nonoperative management, including shorter time using assistive devices, less SAR use, and less fracture displacement at follow-up. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Surgical timing prevails as the main factor over morphologic characteristics in the reduction by ligamentotaxis of thoracolumbar burst fractures.

BACKGROUND: thoracolumbar burst fractures are associated with spinal canal occupation. The indirect decompression of the spinal canal and reduction of the fragment can be achieved with the distraction of the middle column and ligamentotaxis. Nevertheless, the factors that influence the effectiveness of this procedure and its temporality are controversial. METHODS: The aim of this observational, cross-sectional study was to evaluate the effectiveness of indirect reduction by ligamentotaxis in thoracolumbar burst fractures according to the fracture's radiologic characteristics and the procedure's temporality. Patients diagnosed with a thoracolumbar burst fracture between 2010 and 2021 were submitted to indirect reduction by distraction and ligamentotaxis. A retrospective analysis of radiologic characteristics and temporality of the procedure was performed with an independent sample t-test or Pearson's correlation coefficient, as required. RESULTS: A total of 58 patients were included in the analysis. Postoperatively, ligamentotaxis significantly improved all radiologic parameters (canal occupation, endplates distance, and vertebra height). Still, none of the radiological characteristics of the fracture (width, height, position, sagittal angle) were associated with the postoperative change in canal occupation. The endplates distance and the temporality of ligamentotaxis significantly predicted the reduction of the fracture. CONCLUSION: Fragment reduction effectiveness is more significant when performed as early as possible and adequate distraction is achieved using the internal fixator system. The radiologic characteristics of the fractured fragment do not determine its reduction capacity.

Comparison Between Surgical and Conservative Treatment for AOSpine Type A3 and A4 Thoracolumbar Fractures without Neurological Deficit: Prospective Observational Cohort Study / Comparação entre tratamento cirúrgico e conservador para fraturas toracolombares AOSpine tipo A3 e A4 sem déficit neurológico: Estudo de coorte prospectivo observacional

Abstract Objective To compare the clinical results between conservative (CS) and surgical treatment (CXS) of A3 and A4 fractures without neurological deficit. Methods Prospective observational study of patients with thoracolumbar fractures type A3 and A4. These patients were separated between the surgical and conservative groups, and evaluated sequentially through the numeric rating scale (NRS), Roland-Morris disability questionnaire (RMDQ), EuroQol-5D (EQ-5D) quality of life questionnaire, and Denis work scale (DWS) up to 2.5 years of follow-up. Results Both groups showed significant improvement, with no statistical difference in pain questionnaires (NRS: CXS 2.4 ± 2.6; CS 3.5 ± 2.6; p> 0.05), functionality (RMDQ: CS 7 ± 6.4; CXS 5.5 ± 5.2; p> 0.05), quality of life (EQ-5D), and return to work (DWS). Conclusion Both treatments are viable options with equivalent clinical results. There is a tendency toward better results in the surgical treatment of A4 fractures.

Resumo Objetivo Comparar os resultados clínicos entre os tratamentos conservador (CS) e cirúrgico (CXS) das fraturas A3 e A4 sem déficit neurológico. Métodos Estudo prospectivo observacional de paciente com fraturas toracolombares tipo A3 e A4. Esses pacientes foram separados entre os grupos cirúrgico e conservador e avaliados sequencialmente através da escala numérica de dor (NRS), do questionário de incapacidade de Roland-Morris (RMDQ), do EuroQol-5D (EQ-5D) e da escala de trabalho de Denis (DWS) até 2,5 anos de acompanhamento. Resultados Ambos os grupos apresentaram melhora significante, sem diferença estatística nos questionários de dor (NRS: CXS 2,4 ± 2,6; CS 3,5 ± 2,6; p> 0,05), funcionalidade (RMDQ: CS 7 ± 6,4; CXS 5,5 ± 5,2; p> 0,05), qualidade de vida (EQ-5D) e retorno ao trabalho (DWS). Conclusão Ambos os tratamentos são opções viáveis e com resultados clínicos equivalentes. Há uma tendência a melhores resultados no tratamento cirúrgico das fraturas A4.

A practical access for fluoroscopically-guided percutaneous sacroplasty: Case report.

BACKGROUND: Sacral metastases represent the lowest percentage of invasion to the spine, however, as chemotherapy treatments progress, the cancer survival rate has become higher, and the percentage of sacral metastases has increased. Treatment options for sacrum metastases are surgery, radiotherapy, and minimally invasive techniques such as sacroplasty and radiofrequency ablation. Knowing the repercussions that advancing the needle anteriorly (viscera) or medially (sacral roots) can have during the sacroplasty we are describing a technique to perform c-arm sacroplasty in coaxial vision, to identify the anterior sacral cortical bone that is in the limits of the pelvic viscera as well as the sacral foraminal line. CASE PRESENTATION: In the current report, we present a 75-year-old male patient with prostate cancer metastatic to S1, S2, S3 and iliac, with severe lumbar axial pain VAS 8/10. With a caudal tilt between 35-45 degrees until aligning the sacrum in a coaxial view, a 11-gauge Jamshidi needle is advanced from s3 to s1. The trajectory of the needle during the procedure is corroborated in AP and lateral, S1 is cemented, and the needle is withdrawn to cement S2 and S3. After the sacroplasty with the coaxial access, the patient reported VAS 1-2/10. CONCLUSIONS: It is important to offer an adequate quality of life to patients with sacral fractures, whether associated with cancer or sacral insufficiency fractures (SIF). Sacroplasty, being a recently described technique, can be a very viable option for these patients, that's why it is important to have safe and reliable techniques to complement the approach of this minimally invasive technique.The coaxial access may be a safe and practical way to perform sacroplasty in these patients.

Combined Anterior-Posterior versus Posterior-Only Fixation of Stress-Positive Minimally Displaced Lateral Compression Type 1 (LC1) Pelvic Ring Injuries.

OBJECTIVES: To compare hospital outcomes and late displacement between stress-positive minimally displaced lateral compression type 1 (LC1) pelvic ring injuries treated with combined anterior-posterior versus posterior-only fixation. DESIGN: Retrospective comparative cohort. SETTING: Urban level-one trauma center. PATIENTS/PARTICIPANTS: LC1 injuries managed operatively. INTERVENTION: Anterior-posterior versus posterior-only fixation. MAIN OUTCOME MEASUREMENTS: Physical therapy (PT) clearance, discharge location, hospital length of stay (LOS), inpatient morphine equivalent doses (MED), and fracture displacement at follow-up. RESULTS: Groups were similar in demographic and injury characteristics (age, high energy mechanism, ASA score, stress displacement, and rami/sacral fracture classifications). Anterior-posterior fixation resulted in longer operative times (median difference (MD): 27.0 minutes, 95% confidence interval (CI): 17.0 to 40.0, P < 0.0001) and had a trend of increased estimated blood loss (MD: 10 mL, CI: 0 to 30, P = 0.07). Patients with anterior-posterior fixation required less inpatient MEDs (MD: -180.0, CI: -341.2 to -15.0, P = 0.02), were more likely to clear PT by discharge (100% vs. 70%, proportional difference (PD): 30%, CI: 2.0%-57.2%, P = 0.02), were less likely to discharge to rehabilitation facilities (0% vs. 30%, PD: 30%, CI: 2.0%-57.2%, P = 0.02), and had a trend of less days to clear PT after surgery (MD: -1, CI: -2 to 0, P = 0.09) and decreased LOS (MD: -1, CI: -4 to 1, P = 0.17). Late fracture displacement did not differ between groups. CONCLUSION: Anterior-posterior fixation of LC1 injuries was associated with an improved early hospital course-specifically, reduced inpatient opioid use and an increased number of patients who could clear PT and discharge home. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Management of C0 Sacral Fractures Based on the AO Spine Sacral Injury Classification: A Narrative Review.

The Arbeitsgemeinschaft fur Osteosynthese fragen Spine Sacral Injury Classification hierarchically separates fractures based on their injury severity with A-type fractures representing less severe injuries and C-type fractures representing the most severe fracture types. C0 fractures represent moderately severe injuries and have historically been referred to as nondisplaced "U-type" fractures. Injury management of these fractures can be controversial. Therefore, the purpose of this narrative review is to first discuss the Arbeitsgemeinschaft fur Osteosynthese fragen Spine Sacral Injury Classification System and describe the different fracture types and classification modifiers, with particular emphasis on C0 fracture types. The narrative review will then focus on the epidemiology and etiology of C0 fractures with subsequent discussion focused on the clinical presentation for patients with these injuries. Next, we will describe the imaging findings associated with these injuries and discuss the injury management of these injuries with particular emphasis on operative management. Finally, we will outline the outcomes and complications that can be expected during the treatment of these injuries.

Predictors of hospital readmission within 30 days after surgery for thoracolumbar fractures: A mixed approach.

BACKGROUND: Readmission followed by surgery to treat spinal fractures has a substantial impact on patient care costs and reflects a hospital's quality standards. This article analyzes the factors associated with hospital readmission followed by surgery to treat spinal fractures. METHODS: This was a cross-sectional study with time-series analysis. For prediction analysis, we used Cox proportional hazards and machine-learning models, using data from the Healthcare Cost and Utilization Project, Inpatient Database from Florida (USA). RESULTS: The sample comprised 215,999 patients, 8.8% of whom were readmitted within 30 days. The factors associated with a risk of readmission were male sex (1.1 [95% confidence interval 1.06-1.13]) and >60 years of age (1.74 [95% CI: 1.69-1.8]). Surgeons with a higher annual patient volume presented a lower risk of readmission (0.61 [95% CI: 0.59-0.63]) and hospitals with an annual volume >393 presented a lower risk (0.92 [95% CI: 0.89-0.95]). CONCLUSION: Surgical procedures and other selected predictors and machine-learning models can be used to reduce 30-day readmissions after spinal surgery. Identification of patients at higher risk for readmission and complications is the first step to reducing unplanned readmissions.

Hyperextension-distraction fractures in ankylosing and spondylotic spines: injury profile and treatment results.

STUDY DESIGN: Case series study. PURPOSE: To describe demographic metrics, and clinical and radiographical outcomes of surgical treatment in patients with ankylosed spine (ASP) such as diffuse idiopathic skeletal hyperostosis (DISH) or ankylosing spondylitis (AS) and non-ankylosed spines (NAS) suffering from hyperextension-distraction spine fractures. METHODS: Patients diagnosed with hyperextension-distraction fractures between 2012 and 2020 were identified. A retrospective analysis of clinical and surgical data was performed. Similarities between patients with ASP and NAS were evaluated by Fisher's exact test. RESULTS: Of the 22 patients, 13 had ASP (10 patients with DISH, 3 AS) and nine NAS. Most of these injuries involved the thoracolumbar spine (45.4%). All patients with NAS presented some sign of spondylosis: facet joint degeneration, intervertebral osteochondrosis, and anterolateral osteophytes. None of the patients with NAS and 30.7% with ASP suffered low-energy mechanisms (p = .11). All the patients with NAS and 61% of the patients with ASP had associated injuries (p = .04). On average, the instrumented levels were four (range, 2-6), achieving a fusion rate of 94.7% in all groups. Most of the ASP and NAS presented post-operative complications respectively (p = .65). CONCLUSION: Hyperextension-distraction spine fractures are not unique in ASP. In patients with spondylosis and high-energy accidents, we should suspect those fractures and rule out associated injuries, fractures in other vertebral segments, and acute spinal cord injury. The four-level instrumentation achieved an effective fusion rate in all patients.

[Surgical treatment of acetabular fractures. Long term outcomes]. / Fracturas de acetábulo tratadas mediante osteosíntesis. Resultados a largo plazo.

INTRODUCTION: acetabular fractures constitute between 0.3 and 0.6% of all observed fractures, being these injuries relatively infrequent. OBJECTIVE: to evaluate clinical and radiological outcomes of surgical treatment of patients with acetabular fracture treated in our hospital with a minimal follow-up of 11.5 years. The secondary objective is to determine the rate of failure in the hip joint of these patients and establish risk factors that are involved. MATERIAL AND METHODS: 23 patients with acetabular fractures that were treated by open reduction and internal fixation (ORIF) were retrospectively analysed. They were follow-up during an average of 14 years (range 11.5-17.5). Fractures were classified by Judet y Letournel as simple or complex. Clinical and radiological outcomes were analysed by Harris scale. RESULTS: We obtained an average of 81.90/100 on the Harris scale, aiming at better outcomes on simple fractures compare to those that were complex (p = 0.027). Higher scores were also achieved on those patients with an anatomical reduction (p = 0.033). Three patients required revision and placement of a total arthoplasty (13%). However, patients with body mass index (BMI) > 30 tend to achieve poor clinical results (p = 0.151). CONCLUSIONS: ORIF may be suggested for acetabular fractures since good clinical and radiological outcomes were recorded on a long-term follow-up. Complex fractures, non-anatomical reduction and BMI > 30 were identified as risk factors to coxarthrosis progression.

INTRODUCCIÓN: las fracturas de acetábulo constituyen entre el 0.3 y 0.6% total de fracturas observadas, siendo estás lesiones relativamente infrecuentes. OBJETIVO: evaluar los resultados clínico-radiológicos del tratamiento quirúrgico mediante osteosíntesis de fracturas acetabulares con un seguimiento mínimo de 11.5 años. El objetivo secundario fue determinar la tasa de fracaso de la cadera de estos pacientes e identificar los factores de riesgo implicados. MATERIA Y MÉTODOS: analizamos retrospectivamente una muestra de 23 pacientes intervenidos de fractura acetabular mediante reducción abierta y fijación interna, con un seguimiento medio de 14 años (11.5-17.5). Clasificamos las fracturas según Judet y Letournel en simples y complejas. Analizamos la evolución clínica y radiológica de estos pacientes mediante la escala de Harris. RESULTADOS: obtuvimos una puntuación media de 81.90/100, objetivamos mejores resultados en fracturas de trazo simple respecto a fracturas complejas (p = 0.027). Evidenciamos mejores resultados clínicos en los pacientes con una reducción anatómica de la fractura (86.9/100), respecto a los que no fue posible (74.38/100) (p = 0.033). Fue necesaria la reintervención con artroplastía por mala evolución clínica en tres pacientes (13%). Como predictores de mal pronóstico para el desarrollo de coxartrosis identificamos las fracturas complejas y la reducción no anatómica de la fractura (p < 0.05). Encontramos relación entre índice de masa corporal (IMC) > 30 con peores resultados funcionales (p = 0.151). CONCLUSIONES: el tratamiento quirúrgico de pacientes tratados con fracturas acetabulares presenta buenos resultados clínicos y radiológicos a largo plazo. Como factores de riesgo para la progresión de coxartrosis con suficiente impronta clínica como para ser necesaria una artroplastía identificamos, las fracturas complejas, la reducción no anatómica y un IMC > 30.

Morphometric vertebral fracture risk in women with postsurgical hypoparathyroidism.

Introduction: Hypoparathyroidism (HP) is a rare endocrine disease and there are little data available on the risk of fragility fractures in these patients. PTH deficiency results in a positive bone balance with higher bone mass in all skeletal sites. However, whether these structural and dynamic skeletal changes have a negative impact on the fracture risk, it is not known. Methods: Aiming to investigate the risk of insufficiency vertebral fractures in HP, defined using morphometric criteria, a consecutive sampling of 44 women with chronic postsurgical HP was compared to a control group of 44 adult healthy women, matched by age with patients. Vertebral fractures were analyzed by the semiquantitative Genant's method followed by quantitative vertebral morphometry. Results: Morphometric vertebral fractures were identified in 5/44 (11.4%) patients and in 3/44 (6.8%) controls (p=0.731). Most fractures were classified as Genant II and III grades in HP patients, whereas most were Genant I in controls. A logistic regression multivariate analysis was conducted in which age, BMI and parathyroid status were the independent variables, and morphometric vertebral fracture was the dependent variable, but none of these factors was a significant predictor of fracture in this population (OR 1.01, 95% CI 0.96-1.07, p=0.634 for age; OR 2.24, 95%CI 0.47-10.50, p=0.306 for the presence/absence of HP and OR 0.92, 95% CI 0.76-1.10, p=0.369 for BMI). Conclusion: The results of this study cannot ensure a higher risk of fragility vertebral fractures in postsurgical HP patients. Instead, we only observed higher Genant grade classification of the deformed vertebrae in our sample.

Vertebral augmentation plus short-segment fixation versus vertebral augmentation alone in Kümmell's disease: a systematic review and meta-analysis.

Osteoporotic vertebral compression fractures of the thoracolumbar spine can progress to Kümmell's disease, an avascular vertebral osteonecrosis. Vertebral augmentation (VA)-vertebroplasty and/or kyphoplasty-is the main treatment modality, but additional short-segment fixation (SSF) has been recommended concomitant to VA. The aim is to compare clinical and radiological outcomes of VA + SSF versus VA alone. Systematic review, including comparative articles in Kümmell's disease, was performed. This study assessed the following outcome measurements: visual analog scale (VAS), Oswestry Disability Index (ODI), anterior vertebral height (AVH), local kyphotic angle (LKA), operative time, blood loss, length of stay, and cement leakage. Six retrospective studies were included, with 126 patients in the VA + SSF group and 152 in VA alone. Pooled analysis showed the following: VAS, non-significant difference favoring VA + SSF: MD -0.61, 95% CI (-1.44, 0.23), I2 91%, p = 0.15; ODI, non-significant difference favoring VA + SSF: MD -9.85, 95% CI (-19.63, -0.07), I2 96%, p = 0.05; AVH, VA + SSF had a non-significant difference over VA alone: MD -3.21 mm, 95% CI (-7.55, 1.14), I2 92%, p = 0.15; LKA, non-significant difference favoring VA + SSF: MD -0.85°, 95% CI (-5.10, 3.40), I2 95%, p = 0.70. There were higher operative time, blood loss, and hospital length of stay for VA + SSF (p < 0.05), but with lower cement leakage (p < 0.05). VA + SFF and VA alone are effective treatment modalities in Kümmell's disease. VA + SSF may provide superior long-term results in clinical and radiological outcomes but required a longer length of stay.

Minding the Gap in Vertebroplasty: Vertebral Body Fracture Clefts and Cement Nonunion.

BACKGROUND: Vertebroplasty and kyphoplasty are leading treatments for patients with vertebral body compression fractures. Although cement augmentation has been shown to help relieve pain and instability from fractures containing a cleft, there is some controversy in the literature regarding the procedure's efficacy in these cases. Additionally, some of the literature blurs the distinction between clefts and cement patterns (including cement nonunion and cement fill pattern). Both clefts and cement patterns have been mentioned in the literature as risks for poorer outcomes following cement augmentation, which can result in complications such as cement migration. OBJECTIVES: This study aims to identify the prevalence of fracture clefts and cement nonunion, the relationship between them as well as to cement fill pattern, and their association with demographics and other variables related to technique and outcomes. STUDY DESIGN: Retrospective cohort study. SETTING: Interventional radiology department at a single site university hospital. METHODS: This retrospective cohort study assessed 295 vertebroplasties/kyphoplasties performed at the University of Colorado Hospital from 2008 to 2018. Vertebral fracture cleft and cement nonunion were the main variables of interest. Presence and characterization of a fracture cleft was determined on pre-procedural imaging, defined as an air or fluid filled cavity within the fractured vertebral body on magnetic resonance or computed tomography. Cement nonunion was evaluated on post-procedural imaging, defined as air or fluid surrounding the cement bolus on magnetic resonance or computed tomography or imaging evidence of cement migration. Cement fill pattern was assessed on procedural and/or post-procedural imaging. Pain improvement scores were based on a visual analog score immediately prior to the procedure and during clinical visits in the short-term follow-up period. Additional patient demographics, medical history, and procedure details were obtained from electronic medical chart review. RESULTS: Pre-procedural vertebral fracture clefts were demonstrated in 29.8% of our cases. Increasing age, secondary osteoporosis, and thoracolumbar junction location were associated with increased odds of clefts. There was no significant difference in pain improvement outcomes in patients following cement augmentation between clefted and non-clefted compression fractures. Clefts, especially large clefts, and cleft-only fill pattern were associated with increased odds of cement nonunion. Procedure techniques (vertebroplasty, curette, and balloon kyphoplasty) demonstrated similar proportion of cement nonunion and distribution of cement fill pattern. LIMITATIONS: Cement nonunion was observed in only 6.8% of cases. Due to this low proportion, statistical inference tends to have low power. Multiple levels were treated in nearly half of the study's patients undergoing a single vertebroplasty/kyphoplasty session; in these cases, each level was treated as independent rather than spatially correlated within the same study patient. CONCLUSIONS: Vertebral body fracture clefts are not uncommon and are related to (but distinct from) cement nonunion and cement fill patterns. Our study shows that, although patients with clefts will benefit from cement augmentation just as much as patients without a cleft, the performing provider should take note of cement fill and take extra steps to ensure optimal cement fill. These providers should also identify cement nonunion and associated complications (such as cement migration) on follow-up imaging.

[Thoracolumbar trauma: in situ fixation vs decompression and fixation in neurologically involved burst fractures]. / Traumatismo toracolumbar: fijación in situ vs descompresión y fijación en fracturas por estallido con compromiso neurológico.

Thoracolumbar burst fractures are a great challenge for spine surgeons and that is why the aim of this study was to perform a systematic review analyzing the current literature regarding the different factors to take into account in their management. Material and methods: Systematic search in PubMed, Cochrane, MedlinePlus sites. "Thoracolumbar Burst Fractures" were the keywords. Titles, abstracts and full text were analyzed from two independent observers. Results: Six studies were included, five (83.33%) were prospective cohort studies and only one (16.67%) was retrospective. There were a total of 289 patients among all samples. The mean age was 38.48 years and the sex ratio was male to female of 1.7:1. Conclusion: Thoracolumbar burst fractures remain controversial in their treatment with published literature of low level of evidence and without establishing a consensus at the time of decision making with different options depending on the surgeon's experience and preference. However, most of them are inclined towards treatment with short segment posterior fixation but without long-term follow-up. Regarding neurological deficit, surgical decompression achieved consensus among all surgeons.

Las fracturas por estallido toracolumbar son un gran desafío para los cirujanos de columna, es por ello que el objetivo de este estudio fue realizar una revisión sistemática analizando la literatura actual respecto a los diferentes factores a tener en cuenta en el manejo de las mismas. Material y métodos: Búsqueda sistemática en los sitios PubMed, Cochrane, MedlinePlus. "Thoracolumbar Burst Fractures" fueron las palabras claves. Se analizaron los títulos, resúmenes y texto completo a partir de dos observadores independientes. Resultados: Seis estudios han sido incluidos, cinco (83.33%) fueron de cohorte prospectivos y sólo uno (16.67%) retrospectivo. Hubo un total de 289 pacientes entre todas las muestras. La media de edad fue 38.48 años y la relación respecto al sexo fue masculino-femenino de 1.7:1. Conclusión: Las fracturas por estallido toracolumbar siguen siendo controversiales en su tratamiento con bibliografía publicada de bajo nivel de evidencia y sin establecer un consenso en el momento de la toma de decisiones con diferentes opciones según la experiencia y preferencia del cirujano. Sin embargo, la mayoría de los mismos se inclinan hacia el tratamiento con fijación posterior de segmento corto pero sin seguimiento a largo plazo. Respecto al déficit neurológico, la descompresión quirúrgica logró consenso entre todos los cirujanos.

Thoracolumbar Burst Fracture: McCormack Load-sharing Classification: Systematic Review and Single-arm Meta-analysis.

STUDY DESIGN: A systematic review and single-arm meta-analysis of randomized clinical trials. OBJECTIVE: The aim of this study was to evaluate whether the load-sharing classification (LSC) is reliable to predict the best surgical approach for thoracolumbar burst fracture (TBF). SUMMARY OF BACKGROUND DATA: There is no previous review evaluating the efficacy of the use of LSC as a guide in the surgical treatment of burst fractures. METHODS: On April 19th, 2019, a broad search was performed in the following databases: EMBASE, PubMed, Cochrane, SCOPUS, Web of Science, LILACS, and gray literature. This study was registered on the International Prospective Register of Systematic Reviews. We included clinical trials involving patients with TBF undergoing posterior surgical treatment, classified by load-sharing score, and that enabled the analysis of the outcomes loss of segmental kyphosis and implant failure (IF). We performed random- or fixed-effects models meta-analyses depending on the data homogeneity. Heterogeneity between studies was estimated by I2 and τ2 statistics. RESULTS: The search identified 189 references, out of which nine studies were eligible for this review. All articles presenting LSC up to 6 proved to be reliable in indicating that only posterior instrumentation is necessary, without screw failures or loss of kyphosis correction. For cases where the LSC was >6, only 2.5% of the individuals presented IF upon posterior approach alone. For loss of kyphosis correction, only 5% of patients had this outcome where LSC >6. For both outcomes together, we had 6% of postoperative problems (I2 = 77%, τ2 < 0.0015, P < 0.01). CONCLUSION: Load-sharing scores up to 6 are 100% reliable, only requiring posterior instrumentation for stabilization. For scores >6, the risk of implant breakage and loss of kyphosis correction in posterior fixation alone is low. Thus, other factors should be considered to define the best surgical approach to be adopted.Level of Evidence: 1.