Radiological and Long-Term Patient-Reported Outcome after Stabilization of Traumatic Thoraco-Lumbar Spinal Fractures using an Expandable Vertebral Body Replacement Implant.

Background: A combined posterior and anterior stabilization was found to offer a better restoration of the sagittal profile of thoracolumbar fractures in comparison to posterior-only stabilization. Data on restoring the bisegmental kyphotic endplate angle (BKA) and on patient-reported outcome measures (PROM) is sparse.Patients and Methods136 patients with traumatic thoraco-lumbar spinal fractures were treated with an expandable VBR implant (Obelisc™, Ulrich Medical, Germany). in our trauma department between 2001 and 2015. Radiological data acquisition was completed pre- and postoperatively, after at least six months and approximately two years after surgery. The BKA was measured at each follow-up. The patient related outcome was evaluated prospectively.Results117 (31 female, 86 males; age: 52.7 ± 16.5 years) patients were included in the study. 64 patients (54.7% of included patients; age: 53.2 ± 14.8 years) completed the PROM questionnaires and therefore were assigned to the study group. An A4 fracture was seen in 99 cases (84.6%) and 85 (72.6%) fractures were located at the lumbar spine. Intraoperative reduction of the BKA in 117 patients was 6.6 ± 8.2° (p < 0.01). A significant loss of reduction of 2.6 ± 4.2° at the first follow-up (t1) and of 4.4 ± 6.6° at the second follow-up (t2) was measured (each p < 0.05). The consolidation rate was 95.7%. The total revision rate was 5.1%. 64 patients (54.7% of included patients; age: 53.2 ± 14.8 years) completed the PROM questionnaires and therefore were assigned to the study group. Mean time between index surgery and completion of the PROM questionnaire was 109.4 ± 44.6 months. Mean ODI of was 28.4 ± 17.6, the mean EQ-5D VAS reached 57.9 ± 2.5 points. The cohort showed significantly lower SF-36 values compared to a healthy reference population (each p < 0.05).ConclusionTreatment of traumatic thoraco-lumbar spinal fractures using an expandable VBR implant is an effective and safe procedure. A significant operative correction of the BKA could be achieved. Although the initial reconstruction of the BKA did not consist over time in the study group, satisfactory PROMs were found.