Prevention of vertebral body-splitting fractures after multilevel ProDisc-L implantation.

Autor:	Sullivan HG; Department of Neurosurgery, Gundersen Lutheran Health System, La Crosse, WI., Bertagnoli R; Department of Radiology, Gundersen Lutheran Health System, La Crosse, WI., Nigogosyan MA; Spine Center, St Elizabeth Klinikum, Straubing, Germany., Ladwig NR; Department of Medical Research, Gundersen Lutheran Medical Foundation, La Crosse, WI., Born HL; Department of Medical Research, Gundersen Lutheran Medical Foundation, La Crosse, WI., Cerniglia MM; Department of Neurosurgery, Gundersen Lutheran Health System, La Crosse, WI., Habbicht H; Department of Radiology, Gundersen Lutheran Health System, La Crosse, WI., Mathiason MA; Department of Medical Research, Gundersen Lutheran Medical Foundation, La Crosse, WI., McHugh VL; Department of Medical Research, Gundersen Lutheran Medical Foundation, La Crosse, WI.
Jazyk:	angličtina
Zdroj:	International journal of spine surgery [Int J Spine Surg] 2012 Dec 01; Vol. 6, pp. 93-102. Date of Electronic Publication: 2012 Dec 01 (Print Publication: 2012).
DOI:	10.1016/j.ijsp.2011.12.004
Abstrakt:	Background: Prior studies of multilevel ProDisc-L (PD-L) implants (Synthes Spine, Inc., West Chester, Pennsylvania) using the standard US technique have used conventional radiography postoperatively. We found vertebral body-splitting fractures (VB-SFs) in interposed vertebral bodies after 5 sequential multilevel PD-L device implantations using the standard US technique. These were identified with postoperative computed tomography (CT) but were not visible on plain radiographs. In an additional patient, we found that a stress-relieving, pilot holes-only technique did not prevent VB-SFs. The 5 patients operated on with the standard technique composed the background series against which we compared the incidence of VB-SFs in patients operated on with a modification of the standard US technique-a combination of stress-relieving pilot holes, removal of cortex in the chisel path, and a fenestrated chisel (PH/CR/FC)-intended to reduce the incidence of VB-SFs in multilevel PD-L constructs. Methods: Patients receiving multilevel PD-L implants at 2 sites-1 in the United States and the other in Germany-were operated on with the PH/CR/FC technique and their postoperative CT scans evaluated for the presence of VB-SFs. The frequency of VB-SFs in these patients was compared with that of the 5 patients from the background series who were operated on by the standard US technique. The groups' mean sex, age, body mass index, and vertebral body height, as well as average spinal T score, were also compared. Results: No fractures were found in 13 interposed vertebral bodies in 11 patients operated on with the PH/CR/FC technique, as compared with 4 VB-SFs and 1 anterior keel cut-to-anterior keel cut fracture in 5 interposed vertebral bodies in 5 patients operated on with the US technique (P ≤ .001). Although the sample sizes were small, this difference in fracture rate was not associated with sex, age, body mass index, or average spinal T score. At up to 13 months of follow-up of patients in the background series, we found that VB-SFs tend not to bridge with bone, instead forming sclerotic margins. Conclusions: The PH/CR/FC technique studied reduced the incidence of VB-SF in multilevel PD-L implants. Because previously published multilevel studies did not use postoperative CT scans and because VB-SFs are not visible on conventional radiography, the incidence of VB-SFs in multilevel PD-L applications may be higher than previously reported. Our findings may contribute to prevention of complications in total disc replacement.
Databáze:	MEDLINE
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