Stellenwert der Höhenrekonstruktion und der anterioren Stabilisierung bei inkompletten Berstungsfrakturen der Lendenwirbelsäule – eine biomechanische Studie
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Philipps-Universität Marburg
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Abstract
One of the most common vertebral injuries in young people is the incomplete burst
fracture in the thoracolumbar junction after high-speed trauma. The treatment of these
vertebral fractures without neurological deficits is still controversial in the literature.
Within current recommended surgical methods, a distinction is made between pure dorsal
stabilization, ventral stabilization and a combination of both. There are several open
surgical techniques, as well as minimal invasive procedures. In recent studies there was
always a relevant loss of height and insufficient ventral stabilization with pure dorsal
stabilization in the thoracolumbar junction. Also, an additional open ventral stabilization
showed an increased perioperative complication rate. Moreover, the data situation is
rather insufficient, especially in regard to larger case numbers.
The specific objective of this work was to compare different combined minimally
invasive surgical methods using the SpineJack®, to evaluate which method offers the best
outcome in vertebral elevation and additional ventral stability. In addition, a technique to
be developed that could generate standardized vertebral fractures. For this purpose, 28
human vertebral bodies Th11 to L3 were prepared and controlled fractures of the vertebral
body L1 were generated. Subsequently, the fractures were treated with four different
combined surgical procedures. The SpineJack® with and without cement, was combined
with a dorsal minimal invasive surgical procedure. The vertebral bodies were
postoperatively loaded with a hydraulic loading machine and the height loss of the
vertebral body was determined ventrally, medially and posteriorly.
In all 28 spinal columns a fracture of the LWK 1 could be achieved with a so-called
"Freefall Tower". Significant anatomical height reconstruction was demonstrated in all
groups when SpineJack® was introduced, as opposed to dorsal stabilization alone. Thus,
dorsal stabilization in combination with intravertebral reconstruction of a vertebral body
has been shown to be a successful surgical procedure, which may also be seen as an
alternative to ventral vertebral body stabilization.
However, the low number of cases, measurement inaccuracies in the CT evaluation and
the median age of the carcasses of 64.9 ± 6.5 years must be considered critically.
Moreover, the transferability of test results from biomechanical cadaver studies to in vivo
conditions is also difficult. Future experimental and clinical studies are nedded to reach a 78
Summary
conclusion on the successful surgical treatment of burst fractures in the thoracolumbar
junction.
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Dates
Created: 2021Issued: 2021-04-21Updated: 2021-04-21
Faculty
Medizin
Publisher
Philipps-Universität Marburg
Language
ger
Data types
DoctoralThesis
Keywords
inkomplette Berstungsfrakturenanteriore Höhenrekonstruktionthorakolumbaler Überganghigh-speed trauma,thoracolumbar burst fractures
DFG-subjects
LendenwirbelsäuleSpineJack
DDC-Numbers
610
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Rotsch, Maya: Stellenwert der Höhenrekonstruktion und der anterioren Stabilisierung bei inkompletten Berstungsfrakturen der Lendenwirbelsäule – eine biomechanische Studie. : Philipps-Universität Marburg 2021-04-21. DOI: https://doi.org/10.17192/z2021.0165.