Spondylodeseraten nach Wirbelfrakturen unter Verwendung autologer Beckenkammspäne

by Theresa Brix
Doctoral thesis
Date of Examination:2024-05-29
Date of issue:2024-05-29
Advisor:PD Dr. Lukas Weiser
Referee:PD Dr. Lukas Weiser
Referee:PD Dr. Abboud Tammam
Persistent Address: http://dx.doi.org/10.53846/goediss-10489

 

 

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Abstract

English

Spinal injuries are becoming increasingly important. Autologous iliac crest chips are often used for ventral stabilisation, but are controversial with regard to the resulting morbidity. The aim of this study was to evaluate the influence of the chip/vertebral body ratio in the cervical, thoracic and lumbar spine on the fusion rates. Retrospectively, 95 patients (49 patients with cervical vertebral fractures, 46 patients with thoracic and lumbar vertebral fractures) who were surgically treated for vertebral fractures in the Department of Trauma Surgery at the University Hospital Göttingen between 2008 and 2013 were analysed. After the descriptive data analysis, the normal distribution was evaluated using the Shapiro-Wilk test. Depending on the metric or ordinal scaled data, either the ANOVA test (homogeneity was analysed as a prerequisite using the Levene test) or the Mann-White U test was used. The effect sizes were calculated as Eta squared or Cohen's d. The chi-square test was used to evaluate the difference in fusion probability between the cervical or thoracic and lumbar spine.With a generally good fusion rate in the cervical spine, no statistically significant correlation can be shown between the graft-vertebral body ratio and the fusion rate with a strongly varying ratio of the iliac crest graft to the vertebral body surface. Using the chi-square test, however, a statistically significant difference in the number of non-fused patients with respect to the expected can be shown. In contrast, in thoracolumbar fusions there is a clear statistical correlation between the chip-vertebral body ratio and the fusion rate (p = 0.01) with a large effect size (Etaquadrat 0.26). The vertebral fractures are more frequent in vulnerable zones, i.e. the transitions from the cervical to the thoracic spine and from the thoracic to the lumbar spine. An exact correlation between the fusion rate and the mobility of the vertebral body segments could not be shown. Limitations with regard to the significance of our study include the small patient population, the semi-qualitative analysis of the ingrowth behaviour and the partial lack of control images and documentation in the patient files. Follow-up studies should therefore consider a larger patient population, strive for complete documentation and standardise the timing of follow-up and diagnostics for better statistical evaluation.
Keywords: spine injury
 
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