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Radiological Results and Clinical Patient Outcome After Implantation of a Hydraulic Expandable Vertebral Body Replacement following Traumatic Vertebral Fractures in the Thoracic and Lumbar Spine

A 3-Year Follow-Up

Kreinest, Michael MD, PhD; Schmahl, Dorothee MD∗,†; Grützner, Paul A. MD; Matschke, Stefan MD

doi: 10.1097/BRS.0000000000001862

Study Design. A prospective monocentric study.

Objective. The aim of the current study was the analysis of patient outcome and radiological results 3 years after implantation of a hydraulic expandable vertebral body replacement (VBR) system.

Summary of Background Data. Around 70% to 90% of all traumatic spinal fractures are located in the thoracic and lumbar spine. Dorso-ventral stabilization is a frequently used procedure in traumatic vertebral body fracture treatment. VBR systems can be used to bridge bony defects. In the current study, a new VBR expanded by water pressure with adjustable endplates is used.

Methods. All patients who suffered a singular traumatic fracture to a thoracic or lumbar vertebral body (Th 5-L 5) in the period from November 2009 to December 2010 and (i) underwent dorsal instrumentation and (ii) afterwards received the implantation of a hydraulic VBR were included in this study. The clinical outcome (visual analogue scale [VAS] spine score, questionnaire) and radiological findings (sagittal angle, implant subsidence, and implant position) 3 years after implantation were analyzed.

Results. The follow-up was successful for n = 47 patients (follow-up rate: 89%). Most of the patients (n = 40) were “generally/very satisfied” with their outcome. The mean rating of the VAS spine score was 65.2 ± 23.1 (range: 20.5–100.0). The analysis of the radiological data showed an average subsidence of the implants of 1.1 ± 1.2 mm (range 0.0–5.0 mm). After the initial operation, the local sagittal angle remained stable in the follow-up 3 years later both for the thoracic spine and lumbar spine. Furthermore, no change in the implant's position was observed.

Conclusion. The implantation of a hydraulically expandable VBR allows a permanent stable fixation after traumatic fractures of the thoracic and lumbar spine.

Level of Evidence: 2

Department of Trauma Surgery and Orthopedic Surgery, BG Trauma Centre Ludwigshafen, Ludwigshafen, Germany

Department of Anaesthesiology, Heidelberg University Hospital, Heidelberg, Germany.

Address correspondence and reprint requests to Dr. Michael Kreinest, MD, PhD, Klinik für Unfallchirurgie und Orthopädie, BG-Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany. E-mail:

Received 18 April, 2016

Revised 3 June, 2016

Accepted 3 August, 2016

The device (s)/drug (s) is/are FDA-approved or approved by corresponding national agency for this indication.

Aesculap AG, Tuttlingen, Germany, funds were received in support of this work.

No relevant financial activities outside the submitted work.

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved