Abstract
ABSTRACT Objective: To evaluate the importance of radiography in the orthostatic position in the initial assessment of patients with thoracolumbar transition fractures and whether this image changes the surgical indication. Methods: Medical records and imaging tests of patients treated for thoracolumbar transition fractures from June 2018 to June 2019 were evaluated. Trauma patients between 18 and 60 years of age with fractures of T10 to L3 who had been indicated for conservative treatment were included. Cases of fractures considered unstable were excluded. Radiographs were taken with the patient in the supine position (supine X-ray), computed tomography (CT), and orthostatic radiography (orthostatic X-ray). Segmental kyphosis and degree of wedging were evaluated. The measurements were compared using the Wilcoxon test. The McNemar test was used to assess changes in conduct according to the criteria for surgical indication (kyphosis ≥ 25 ° and wedging ≥ 50%). Results: Fifty patients were evaluated, nine of whom (18%) were indicated for a change of conduct according to the orthostatic examinations and were submitted to surgical treatment. Vertebral kyphosis increased by 40.6% (p <0.001). The wedging increased by 25.62% (p <0.0001). Conclusion: Eighteen percent of the total number of patients who did not present instability criteria in radiographs in the supine position satisfied at least one of these criteria when the orthostatic X-ray was performed. Level of evidence 3B; Retrospective case series study.
Highlights
IntroductionRadiography is considered the initial examination for diagnosis, evaluation of severity, and therapeutic conduct
Compression-type fractures of the thoracolumbar spine correspond for the most part to injuries between T10 and L3 and there is no consensus around their management in the literature, especially when it comes to burst fractures (A3 and A4) without associated neurological deficit.[1]
We evaluated how many patients changed their conduct based on the instability criteria using the McNemar paired measures test for categorical data
Summary
Radiography is considered the initial examination for diagnosis, evaluation of severity, and therapeutic conduct. The treatment of these fractures is based on the anatomical aspects related to stability (wedging of the vertebral body and segmental kyphosis) and on the functional state of the patient (pain and neurological examination). In the absence of neurological deficit, protocols and objective radiographic measurements of the wedging of the vertebral body and kyphotic deformity are described in the literature to exclude fractures considered unstable, in which the posterior ligament complex may be injured and evolve with pain or deformity.[2]. We know that some patients experience worsening deformity and chronic pain during long-term follow-up
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