Purpose: The aim of this study was to assess safety and efficacy of vertebral body stenting (VBS) by analyzing (1) radiographic outcome, (2) clinical outcome, and (3) perioperative complications in patients with vertebral compression fractures treated with VBS at minimum 6-month follow-up. Methods: In this retrospective cohort study, 78 patients (61 ± 14 [21–90] years; 67% female) who have received a vertebral body stent due to a traumatic, osteoporotic or metastatic thoracolumbar compression fracture at our hospital between 2012 and 2020 were included. Median follow-up was 0.9 years with a minimum follow-up of 6 months. Radiographic and clinical outcome was analyzed directly, 6 weeks, 12 weeks, 6 months postoperatively, and at last follow-up. Results: Anterior vertebral body height of all patients improved significantly by mean 6.2 ± 4.8 mm directly postoperatively (p < 0.0001) and remained at 4.3 ± 5.1 mm at last follow-up compared to preoperatively (p < 0.0001). The fracture kyphosis angle of all patients improved significantly by mean 5.8 ± 6.9 degrees directly postoperatively (p < 0.0001) and remained at mean 4.9 ± 6.9 degrees at last follow-up compared to preoperatively (p < 0.0001). The segmental kyphosis angle of all patients improved significantly by mean 7.1 ± 7.6 degrees directly postoperatively (p < 0.0001) and remained at mean 2.8 ± 7.8 degrees at last follow-up compared to preoperatively (p = 0.03). Back pain was ameliorated from a preoperative median Numeric Rating Scale value of 6.5 to 3.0 directly postoperatively and further bettered to 1.0 six months postoperatively (p = 0.0001). Revision surgery was required in one patient after 0.4 years. Conclusion: Vertebral body stenting is a safe and effective treatment option for osteoporotic, traumatic and metastatic compression fractures.

In outcome research, incomplete follow-up is a major, yet potentially correctable source of bias. Cross-sectional surveys may theoretically increase completeness of follow-up, but low response rates are reported typically. We investigated whether a pre-notification letter improved patient availability for follow-up phone interviews and thereby improved cross-sectional survey yield. A consecutive series of vascular patients was randomly divided into a trial and a validation population. The trial population was then randomized 1:1 to one of two cross-sectional contact strategies: Strategy 1 consisted of direct contact attempts by up to 12 systematically timed phone calls, whereas Strategy 2 used a personalized pre-notification letter to arrange for scheduled phone call interviews. Response rates, average time and efforts needed per patient and overall survey duration were compared. Subsequently, trial findings were externally validated in the validation population. Of 728 consecutive patients, 370 were allocated to the trial population. Trial patients contacted by strategy 1 (n = 183) had a similar profile when compared to trial patients contacted by strategy 2 (n = 187). Follow-up periods following surgery (54.3 versus 53.6 months) and all-cause mortality rates (21.3% versus 18.7%) were comparable between the trial groups. Cross-sectional information on survival outcomes was almost complete after both contact strategies (99.5% versus 98.9%, P = 1.0). In 144/187 strategy 2 patients (77%) interviews were scheduled successfully necessitating significantly less contact attempts (median of 1.3 versus 2.3 per patient, P<0.0001). However, invested time per patient was similar between the groups (median of 10.1 versus 9.6 minutes), and survey strategy 1 completed earlier (median time to contact 4 versus 11 days, P<0.0001). Therefore, strategy 1 was validated in the validation population (n = 358): a low lost to follow-up rate below 1% (P = 1.0) was reconfirmed necessitating an average of 2.3 contact attempts per patient. Both contact strategies were equally successful in contacting almost all patients cross-sectionally. If systematically timed, direct phone calls were less complicated to organize and faster completed. Given the low time and effort per patient, outcome studies should invest in systematic follow-up surveys to minimize attrition bias.

Traumatic thoracolumbar burst fractures are the most common spinal injuries and the proper treatment is controversial. In central Europe in particular, these fractures are often treated with minimally invasive anterior-posterior reduction and fusion, whereas a conservative approach is preferred in the USA. Independent of the treatment strategy, no data exists regarding the outcome related to return to activity level/sport. The aim of this study was to evaluate the return to sports and activity levels after 360° fusion in patients with thoracolumbar burst fractures without neurological deficits. Between January 2013 and December 2022, 46 patients aged 18 to 40 years underwent partial or complete vertebral body replacement in the thoracolumbar region due to traumatic burst fractures without neurologic deficit as an isolated injury. Patients were contacted retrospectively by phone calls to assess their activities using a modified version of the Tegner activity scale at different time points: Before trauma, 3, 6, and 12 months post-surgery. After applying exclusion criteria, data collection was complete for 28 patients. The median modified Tegner activity scale was 5.4 before sustaining the fracture, declined to 2.9 at three months post-trauma, improved to 4.2 at six months, and reached 5.0 at 12 months. The majority (83%) of patients achieved their pre-accident activity level within 12 months. No significant differences were observed between patients with partial or complete corpectomy. This is the first study assessing return to sports/physical activity based on the modified Tegner scale in young patients undergoing 360° fusion for spinal burst fractures. The majority of patients (83%) return to the pre-injury activity level within 12 months after surgery.

Atlas ring fractures, which account for 1.3% of all spinal fractures, are predominantly managed conservatively. However, in certain cases, surgical treatment may be necessary depending on the type of fracture, degree of comminution, fracture location, and associated ligamentous injuries. Surgical stabilization frequently results in a posterior C1-2 or C0-2 fusion, which restricts movement, particularly craniocervical rotation. Coronal split fractures of the lateral mass need to be reduced and fixed due to dislocation, instability and secondary osteoarthritis. The preferred treatment approach involves internal fixation of the reduced fracture fragments, while avoiding restriction of the upper cervical spine's range of motion (ROM). Is unilateral anterior transoral lag screw for treatment of unstable coronal split fracture of lateral mass of the atlas feasible and a safe treatment option? We report on a 55-year-old female suffering from polytrauma with multiple spinal and extremity injuries. A coronal split fracture of the lateral mass of the atlas was treated minimally invasive with a transoral lag screw technique to reduce and fix the fracture that has a tendency for fracture gap widening. Stable fixation and fracture union and thus restoration of function was achieved. Transoral lag screw osteosynthesis for coronal split fracture of the lateral mass of the atlas is a potential treatment option in selected cases to preserve mobility in the upper cervical spine after spinal trauma.

Purpose: This retrospective cohort study investigated whether back protectors reduce the incidence and severity of spinal injuries in alpine winter sports, hypothesizing they may affect the type, location, and severity rather than fully prevent them. Methods: We retrospectively identified patients with alpine winter sports-related injuries admitted to our Level-1 trauma center (2017–2023). Patient and accident data were gathered via phone survey and chart review. Injuries were classified using the AO Spine system, and the impact of back protectors was analyzed using univariate and multivariate analysis in R. Results: Out of 1160 identified patients, 232 (81 spinal injuries, 151 non-spinal injuries) completed telephone follow-up (mean 52 months post-injury, SD 19.8). The presence of a spinal injury was not significantly associated with back protector use, but spinal injuries in protector users were more frequently treated conservatively, while non-users required operative treatment slightly more frequently ( p = 0.13) and presented with neurological deficits ( p = 0.008). After adjusting for confounders, there was no significant reduction in ISS scores. Moreover, wearing a back protector did not significantly impact the overall occurrence of polytrauma. Conclusion: Back protectors neither prevented spinal injuries nor provided beneficial protection in polytrauma cases among patients presenting to our level I trauma center.

Study Design: Retrospective quasi-experimental study conducted at two Level I trauma centers over a 6-year-period. Objectives: Unstable thoracolumbar burst fractures are frequently treated by circumferential (360°) stabilization. Due to ongoing debate, this study aimed to compare whether single- or two-stage 360° stabilization leads to a shorter hospital length of stay in those patients. Methods: Non-polytraumatized adults (ISS ≤15) with unstable thoracolumbar fractures who underwent 360° stabilization were included. Total hospital length of stay was defined as primary outcome. Secondary outcomes were operative time, intraoperative blood loss and in-hospital mortality. Mann-Whitney U and chi-square tests were applied to compare continuous and categorical variables, respectively, with P < 0.05 as the threshold for significance. Results: A total of 184 patients was eligible (single-stage, n = 104; two-stage, n = 80). Age, sex distribution, and ASA scores did not differ between both groups. Hospital length of stay was significantly shorter in the single-stage group (9+/−4 days) compared to the two-stage group (11+/−5 days; P < 0.001). Operative time was significantly shorter in the single-stage group (194+/−75 min) compared to the two-stage group (230+/−91 min; P = 0.003). Blood loss was significantly less in the single-stage group (500+/−400 mL) compared to the two-stage group (750+/−635 mL; P = 0.033). There was no in-hospital mortality in both groups. Conclusions: Single-stage 360° stabilization for unstable thoracolumbar fractures in non-polytraumatized patients is superior to the two-stage approach regarding length of hospital stay, operative time, and intraoperative blood loss. Consequently, a single-stage procedure should be preferred whenever feasible.