Jinhui Shi

The influence of correction loss in thoracolumbar fractures treated by posterior instrumentation: a minimum 7-year follow-up.

We retrospectively studied patients who underwent posterior pedicle screw instrumentation for thoracolumbar fractures to explore the relationship between correction loss after the operation and clinical outcome. The study included 52 patients, with a minimum postoperative follow-up of 7 years (mean of 9.8 years). From the analysis of radiological and clinical outcomes, we found that the relevant factors related to functional outcome were: (i) preoperative anterior vertebral height (AVH; regression coefficient [B]=-0.075, p=0.045); and (ii) the latest follow-up AVH (B=-0.100, p=0.043). This indicates that function is likely to be worse if the anterior vertebral column is compressed more severely at the time of injury, and that function will also be worse if the AVH is decreased at the latest follow-up. However, loss of AVH was not correlated with functional outcome. Therefore, we recommend that the AVH should be restored as much as possible by posterior instrumentation during the treatment of thoracolumbar fractures. Reducing the loss of correction to maintain the postoperative AVH is also critical to maintain the AVH at latest follow-up.

Long-Term Clinical Outcomes in Patients Undergoing Lumbar Discectomy by Fenestration

Objective: To investigate the long-term outcome of discectomy and relevant factors associated with clinical outcome. Methods: Patients who underwent lumbar discectomy by fenestration were evaluated retrospectively, using the Oswestry disability index (ODI; 0 - 20 minimal, 21 - 40 moderate, > 41 severe disability) and the Stauffer-Coventry criteria (‘excellent’, ‘good’, ‘fair’, ‘poor’) to measure clinical and radiographic outcomes. Results: Sixty patients (mean follow-up, 214 months) were included in the analysis. At final follow-up, patients were rated as ‘excellent’ (n = 31), ‘good’ (n = 13), ‘fair’ (n = 5) and ‘poor’ (n = 11) using the Stauffer-Coventry criteria; the latter group included six patients who underwent reoperations. The mean ODI score was 11.2. The height of the operative intervertebral space was significantly inversely correlated with the follow-up ODI value. Heavy manual work, smoking and a long duration of aggressive preoperative symptoms were significantly associated with unsatisfactory outcomes. Conclusions: The long-term outcome of lumbar discectomy by fenestration was satisfactory in the majority of patients. Heavy manual work, smoking and the duration of aggressive preoperative symptoms were negative predictors of a good clinical outcome.

Authors reply to the comments by Moon et al. on the article by Yang H-L et al.: Fluoroscopically-guided indirect posterior reduction and fixation of thoracolumbar burst fractures without fusion.

Question 1 response Even if the AF is injured and/or the disc enters the vertebral body, as long as the PLL is intact, the burst fracture can still be reduced from the tension of the PLL. Question 2 response This point is very important, however, it is not a focus of our article. Information may be found in the references. Question 3 response This point is very important, however, it is outside of the scope of our article. Information may be found in the references. Question 4 response This point is very important, however, it is not a focus of our article. Information may be found in the references. Question 5 response The details of this method may be found in subsequent reports. Please see the following references. Question 6 response The C-arm machine’s appropriate position is very important. One must make sure the view is truly lateral and the X-ray beam is perpendicular and directly focussed on the posterior edge of the burst fracture vertebra. Question 7 response This point is outside the scope of our articles focus. Information may be found in the references. Question 8 response This point is outside the scope of our article’s focus. Information may be found in the references. Question 9 response This point is outside the scope of our article’s focus. Information may be found in the references. This is a reply to the Letter to the Editor entitled “Comments on Yang H-L et al.: Fluoroscopically-guided indirect posterior reduction and fixation of thoracolumbar burst fractures without fusion” (http://dx. doi.org/10.1007/s00264-009-0945-4). H.-l. Yang : J.-h. Shi : T. Tang The First Hospital Affiliated to Suzhou University, Suzhou, Jiangsu 215006, China