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Can implant removal restore mobility after fracture of the thoracolumbar segment? : A radiostereometric study

Axelsson, Paul LU and Strömqvist, Björn LU (2016) In Acta Orthopaedica 87(5). p.511-515
Abstract

Background and purpose — Randomized trials have found that treating spinal burst fractures with reduction and posterior fixation is adequate without the use of bone grafting for definitive fusion. Restitution of intervertebral mobility of such an unfused segment after fracture healing may unload the adjacent parts of the spine and reduce the risk of degeneration of these segments. We used radiostereometry (RSA) to study whether late implant removal would restore the intervertebral mobility of a thoracolumbar segment treated with posterior instrumentation but no bone grafting for unstable spinal fracture. Patients and methods — We identified 7 patients with implant-related back pain at least 1.5 years after a thoracolumbar fracture (Th12... (More)

Background and purpose — Randomized trials have found that treating spinal burst fractures with reduction and posterior fixation is adequate without the use of bone grafting for definitive fusion. Restitution of intervertebral mobility of such an unfused segment after fracture healing may unload the adjacent parts of the spine and reduce the risk of degeneration of these segments. We used radiostereometry (RSA) to study whether late implant removal would restore the intervertebral mobility of a thoracolumbar segment treated with posterior instrumentation but no bone grafting for unstable spinal fracture. Patients and methods — We identified 7 patients with implant-related back pain at least 1.5 years after a thoracolumbar fracture (Th12 or L1) treated with reduction and posterior instrumentation. The implants were removed and tantalum indicators for RSA were inserted. 3 months later, each patient was examined with RSA. The intervertebral translations and rotations of the thoracolumbar segment, induced by change in position from flexion to extension, were measured. Progressive deformity was registered by conventional radiography and the overall clinical outcome was assessed by the patients. Results — According to RSA, all 7 patients regained some mobility of the fractured thoracolumbar segment. In 1 patient who was primarily treated for a flexion-distraction type of injury, conventional radiography revealed a progressive kyphotic deformity 3 months after implant removal and the clinical outcome was poor. According to the patients, 1 had a fair clinical outcome and 5 had good outcome. Interpretation — Late implant removal may restore segmental mobility after posterior fracture fixation of the thoracolumbar segment if bone grafting has not been used. The clinical consequences, positive or negative, of the residual mobility demonstrated in our small number of patients should be evaluated in studies based on extended patient series and with different fracture types.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Acta Orthopaedica
volume
87
issue
5
pages
5 pages
publisher
Taylor & Francis
external identifiers
  • scopus:84976299682
  • wos:000387526300013
ISSN
1745-3674
DOI
10.1080/17453674.2016.1197531
language
English
LU publication?
yes
id
df6b251b-66de-4bff-a037-d56e2b03215e
date added to LUP
2016-07-18 09:24:28
date last changed
2017-01-01 08:30:35
@article{df6b251b-66de-4bff-a037-d56e2b03215e,
  abstract     = {<p>Background and purpose — Randomized trials have found that treating spinal burst fractures with reduction and posterior fixation is adequate without the use of bone grafting for definitive fusion. Restitution of intervertebral mobility of such an unfused segment after fracture healing may unload the adjacent parts of the spine and reduce the risk of degeneration of these segments. We used radiostereometry (RSA) to study whether late implant removal would restore the intervertebral mobility of a thoracolumbar segment treated with posterior instrumentation but no bone grafting for unstable spinal fracture. Patients and methods — We identified 7 patients with implant-related back pain at least 1.5 years after a thoracolumbar fracture (Th12 or L1) treated with reduction and posterior instrumentation. The implants were removed and tantalum indicators for RSA were inserted. 3 months later, each patient was examined with RSA. The intervertebral translations and rotations of the thoracolumbar segment, induced by change in position from flexion to extension, were measured. Progressive deformity was registered by conventional radiography and the overall clinical outcome was assessed by the patients. Results — According to RSA, all 7 patients regained some mobility of the fractured thoracolumbar segment. In 1 patient who was primarily treated for a flexion-distraction type of injury, conventional radiography revealed a progressive kyphotic deformity 3 months after implant removal and the clinical outcome was poor. According to the patients, 1 had a fair clinical outcome and 5 had good outcome. Interpretation — Late implant removal may restore segmental mobility after posterior fracture fixation of the thoracolumbar segment if bone grafting has not been used. The clinical consequences, positive or negative, of the residual mobility demonstrated in our small number of patients should be evaluated in studies based on extended patient series and with different fracture types.</p>},
  author       = {Axelsson, Paul and Strömqvist, Björn},
  issn         = {1745-3674},
  language     = {eng},
  month        = {06},
  number       = {5},
  pages        = {511--515},
  publisher    = {Taylor & Francis},
  series       = {Acta Orthopaedica},
  title        = {Can implant removal restore mobility after fracture of the thoracolumbar segment? : A radiostereometric study},
  url          = {http://dx.doi.org/10.1080/17453674.2016.1197531},
  volume       = {87},
  year         = {2016},
}