Anterior stabilization of spine column in the staged surgical treatment of patients with fractures of thoracic and lumbar vertebrae with low bone mineral density

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Abstract


Aim. To determine the clinical effectiveness of anterior stabilization in the surgical treatment of patients with traumatic injuries of the thoracic and lumbar spine with reduced bone mineral density.

Materials and methods. The study included 238 patients with thoracic and lumbar vertebral fractures with reduced bone mineral density (BMD). The age of patients is from 48 to 85 years. There are following types of fractures according to F. Magerl (1992): A1.2, A1.3, B1.2, B2.3. BMD of the vertebrae was decreased (T-score from –1.5 to –3.5).

Results. All patients underwent short segment transpedicular fixation (TPF) with four-screw systems. In group 1 were included 68 patients who underwent TPF without cemented augmentation of screws. Group 2 included 170 patients who underwent TPF reinforced with a cement. Both groups were divided into 2 subgroups. Subgroup 1.1 included patients, which were operated on in two stages. The first stage is TPF. The second stage is the anterior stabilization. Subgroup 1.2 included patients who underwent only TPF. Patients in group 2 were divided into two subgroups in a similar way. The results and complications according to clinical and spondylometric criteria were studied. Correlation analysis was performed between surgical technique, surgical tactics and the treatment results in the four selected subgroups. The observation period is at least 2 years.

Conclusion. 1. When using TPF with cement augmentation for the treatment of patients with fractures of the thoracic and lumbar spine with reduced BMD, the anterior stabilization of injured spinal motion segment as a second stage of surgical treatment does not provide clinical advantages compared to the use of only TPF with cement augmentation. 2. In case of cementless TPF in patients with reduced BMD, anterior stabilization of the injured spinal motion segment is necessary. Only when anterior stabilization is performed, the stability of fixation is ensured. It is sufficient to preserve the anatomical relationships restored during the operation and functional adaptation of patients in the long-term period after surgery.


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About the authors

Asker A. Afaunov

Federal State Budgetary Institution of Higher Education “Kuban State Medical University” of the Ministry of Health of the Russian Federation

Author for correspondence.
Email: afaunovkr@mail.ru
ORCID iD: 0000-0001-7976-860X

Russian Federation, Krasnodar

professor, MD, PhD

Igor V. Basankin

State Budgetary Healthcare Institution “Research Institute — Regional Clinical Hospital No. 1 named after Professor S.V. Ochapovsky”

Email: basankin@rambler.ru
ORCID iD: 0000-0003-3549-0794

Russian Federation, Krasnodar

MD, PhD

Karapet K. Takhmazyan

State Budgetary Healthcare Institution “Research Institute — Regional Clinical Hospital No. 1 named after Professor S.V. Ochapovsky”

Email: dr.karpo@gmail.com
ORCID iD: 0000-0002-4496-2709

Russian Federation, Krasnodar

Traumatologist-orthopedist, neurosurgeon. Physician of Neurosurgery department No. 3

Abram A. Giulzatyan

State Budgetary Healthcare Institution “Research Institute — Regional Clinical Hospital No. 1 named after Professor S.V. Ochapovsky”

Email: abramgulz@gmail.com
ORCID iD: 0000-0003-1260-4007

Russian Federation, Krasnodar

MD

Mikhail L. Mukhanov

Federal State Budgetary Institution of Higher Education “Kuban State Medical University” of the Ministry of Health of the Russian Federation

Email: pputinn@yandex.ru
ORCID iD: 0000-0002-9061-6014

Russian Federation, Krasnodar

MD

Nikita S. Chaikin

State Budgetary Healthcare Institution “Stavropol Regional Clinical Hospital”

Email: ch.nik92@yandex.ru
ORCID iD: 0000-0003-4297-6653

Russian Federation, Stavropol

Neurosurgeon

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Supplementary files

Supplementary Files Action
1.
Fig. 1. Distribution of patients by localization of spinal injury

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2.
Fig. 2. Scheme of distribution of patients into groups and subgroups

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3.
Fig. 3. Average values of local kyphosis in subgroups of patients

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4.
Fig. 4. Average values of the wedge index in subgroups 1.2 and 2.2 before surgery

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5.
Fig. 5. Distribution of patients by the Charlson comorbidity index

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6.
Fig. 6. Dynamics of VAS indicators in patients in subgroups 1.1, 1.2 and 2.1, 2.2

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7.
Fig. 7. Dynamics of ODI indicators in patients in subgroups 1.1, 1.2 and 2.1, 2.2

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Copyright (c) 2020 Afaunov A.A., Basankin I.V., Takhmazyan K.K., Giulzatyan A.A., Mukhanov M.L., Chaikin N.S.

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