gms | German Medical Science

Objectives: Pain, disability and progressive kyphosis is a common problem after traumatic injury of the thoracolumbar (TL-) junction. There is no data about the application of short-segment posterior fusion with anterior column support using lateral lumbar or thoracic interbody (LLIF) cages in this setting.

Methods: We reviewed consecutive patients treated for traumatic injury of the TL-junction (Th10/11-L2/3) by posteriornstrumentation/fusion and LLIF. We analyzed segmental kyphosis, complications, and outcomes an average of 3 years follow-up. We perform comparative analyses regarding different surgical strategies, e.g., monosegmental vs. temporary bisegmental instrumentation.

Results and conclusion: We identified 61 patients (mean age 39.0 years (SD 13.3); 23 females (37.7%)) with mostly A3 (n=48; 78.7%) or A4 fractures (n=11; 18.0%); additional posterior tension band injury was present in n=26 (42.6%). The mostly affected levels of injury were Th12/L1 in n=25 (41.0%) and Th11/12 in n=22 (36.1%). The segmental kyphotic angle was 14.6° (6.7°) preoperative and remained significantly reduced at all times of follow-up at discharge (5.4°±5.5°; p<0.001), at 90 days (7.2°±5.5°; p<0.001), after partial hardware removal (7.2°±6.0°; p<0.001) and at last follow-up (8.1°±6.3°; p<0.001). The six patients receiving primary monosegmental fusion experienced good correction of kyphosis at discharge (mean difference (MD) 5.8°, p=0.018), but progressive kyphosis during follow-up (MD preoperative to last follow-up 1.5°, p=0.472). In n=55 patients receiving temporary bisegmental instrumentation/fusion kyphosis correction was 9.5° before discharge (p<0.001) and persisted until last follow-up (MD 7.2°, p<0.001). During a mean follow-up of, n=11 experienced complications (18%), n=58 (95.1%) had an excellent or good outcome and solid fusion was noticed in n=60 (98.4%).

Trauma LLIF should be considered as possibility for short-segment anterior-posterior fusion for injuries of the TL- junction. We observed most reproducible and long-lasting kyphosis reduction with a temporary bisegmental, two-staged procedure resulting in monosegmental fusion (posterior instrumentation/fusion with delayed LLIF and partial hardware removal to release the non-injured caudal motion segment).