Biomechanics and clinical outcome after posterior stabilization of mid-thoracic vertebral body fractures: a systematic l
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REVIEW ARTICLE
Biomechanics and clinical outcome after posterior stabilization of mid‑thoracic vertebral body fractures: a systematic literature review Ulrich J. Spiegl1 · Georg Osterhoff1 · Philipp Bula2 · Frank Hartmann3 · Max J. Scheyerer4 · Klaus J. Schnake5 · Bernhard W. Ullrich6 Received: 18 September 2020 / Accepted: 16 November 2020 © The Author(s) 2020
Abstract Purpose The aim of this review is to systematically screen the literature for clinical and biomechanical studies dealing with posterior stabilization of acute traumatic mid-thoracic vertebral fractures in patients with normal bone quality. Methods This review is based on articles retrieved by a systematic search in the PubMed and Web of Science database for publications up to December 2018 dealing with the posterior stabilization of fractures of the mid-thoracic spine. Results Altogether, 1012 articles were retrieved from the literature search. A total of 960 articles were excluded. A total of 16 articles were dealing with the timing of surgery in polytraumatized patients, patients suffering of neurologic deficits after midthoracic fractures, and the impact of concomitant thoracic injuries and were excluded. Thus, 36 remaining original articles were included in this systematic review depicting the topics biomechanics, screw insertion, and outcome after posterior stabilization. The overall level of evidence of the vast majority of studies is low. Conclusion High quality studies are lacking. Long-segmental stabilization is indicated in unstable midthoracic fractures with concomitant sternal fractures. Generally, long-segmental constructs seem to be the safer treatment strategy considering the relative high penetration rate of pedicle screws in this region. Thereby, navigated insertion techniques and intraoperative 3D-imaging help to improve pedicle screw placement accuracy. Keywords Thoracic spine fractures · Posterior stabilization · Clinical outcome · Pedicle screw placement · Additional thoracic injuries
Introduction
* Ulrich J. Spiegl [email protected] 1
Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
2
Department of Orthopaedics and Trauma Surgery, Klinikum Gütersloh, Gütersloh, Germany
3
Center for Trauma and Orthopedic Surgery, Gemeinschaftsklinikum Mittelrhein, Ev. Stift, Koblenz, Germany
4
Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
5
Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany
6
Department of Trauma Surgery and Reconstructive Surgery, BG Klinikum Bergmannstrost, Halle, Germany
The majority of traumatic vertebral fractures occur at the thoracolumbar junction and less commonly at the midthoracic or mid-lumbar spine [32]. In accordance, a high number of articles are dealing with thoracolumbar fractures focusing on the thoracolumbar junction. Nonetheless, the anatomy and biomechanics of the mid-thoracic spine differ from the thoracolu
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