Additional internal fixation improves fusion rate of anterior spondylodesis in thoracic and lumbar spine fractures - a CT-based analysis

TL;DR

Adding internal fixation improves fusion success in spine fracture surgery, according to a CT-based study of 83 patients.

Contribution

Demonstrates that additional anterior plating increases fusion rates in anterior spondylodesis for spine trauma.

Findings

Fusion rate was 10% with additional anterior plate vs. 48% with bone graft alone.

Patient factors like BMI, age, and ISS had no effect on fusion outcomes.

Improved stability from plating likely reduces motion and pseudarthrosis.

Abstract

Lack of fusion remains a challenge in posterior-anterior spine surgery in general and after trauma. Additional anterior stabilizing procedures bear a risk of complications. There are still few studies available on the role of different surgical strategies to investigate fusion. This study was designed to enhance the role of additional stabilizing locking plates in cases of anterior bone graft-fusion procedures in spine trauma patients.

83 patients with posterior-anterior stabilization after spine trauma using a tricortical bone graft harvested from the iliac crest were examined retrospectively concerning fusion, surgical strategy (with / without additional anterior stabilizing plate) and patient derived factors (BMI, smoking habits, neurologic symptoms, ISS). Bony fusion was determined by CT scan.

Patients with additional anterior plate showed a significantly higher fusion rate. Lack of fusion was detected in 10% of patients treated with additional plate anteriorly compared to 48% of patients with anterior bone graft alone (p = 0.035). Patient derived factors had no influence on fusion. BMI was comparable in both groups (23.5 in additional plate group, 25.1 in bone graft only-group), as was ISS (9 vs. 8.5), age (40.1ys vs. 41.7ys) and gender (male: female 1.3:1).

Additional anterior plating devices lead to an improved fusion rate. Enhanced stability of the anterior construct inserted bone graft may be the reason due to higher stiffness and less motion of the segment. As in other fields of trauma surgery, lack of stability may be responsible for pseudarthrosis in spine surgery as well.

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