Burst Fractures Of Thoracolumbar Spine Research Articles

The trend in Management of Stable Burst Fracture of Thoracolumbar Spine with Intact Neurology among Members of the Association of Spine Surgeons of Nepal: A Survey

Background:The management of stable burst fracture of thoracolumbar spine with intact neurology is controversial. The radiological interpretation of such fractures differs among the surgeons and hence the treatment. So, this survey aims to study discrepancies in management of such fractures among the members of the Association of Spine Surgeons of Nepal (ASSN). Methods: Two representative cases of stable burst fracture with intact neurology (Case 1 AO type A3 and Case 2 AO type A4) were chosen by the authors. Questionnaire was formulated in Google form which also contained X-rays and CT scans of the cases. Google form was circulated among the members of ASSN. The response was recorded in excel and was analyzed. Results:Out of 67 members of ASSN, 55 (82.08%) responded the survey. 35 responders (63.63%) used both AO classification and TLICS. Majority of responders responded correctly as AO Type A3 and A4 burst fractures after looking at X-rays and CT scans of Case 1 and Case 2 respectively. Regardless of TLICS of 0-3 or 4 in both the cases, majority (81.81% in Case 1 and 78.18% in Case 2) chose surgical intervention. The degree of kyphosis for 48 respondents (87.27%), the level of fracture for 45 respondents (81.81%), bone quality for 41 respondents (74.54%), the severity of canal compromise for 40 respondents (72.72%) were some important factors in treatment decisions. Conclusion:The wide interobserver variability exists among members of ASSN in the management of stable burst fractures of the thoracolumbar spine with intact neurology. KeyWords: Intact neurology, Interobserver variability, Stable burst fracture, Trend in management

Safety and Effectiveness of Expandable Intravertebral Implant Use for Thoracolumbar Burst Fractures

PurposeTo determine the safety and effectiveness of an expandable intravertebral implant (Spinejack; Stryker, Kalamazoo, Michigan) as a treatment option for patients with thoracolumbar spine burst fractures without fracture-related neurologic deficit. Materials and MethodsImaging studies before and after expandable intravertebral implantation and medical records of 33 patients, 11 (33.3%) men and 22 (66.6%) women with an overall mean age of 71.7 years ± 8.3, were reviewed for 60 thoracolumbar Magerl Type A3 injuries secondary to osteoporosis, trauma, or malignancy. The mean follow-up time was 299 days. ResultsImplantation of an expandable intravertebral device resulted in a statistically significant reduction in bone fragment retropulsion (mean ± SD, 0.64 mm ± 16.4; P < .001), reduction in the extent of canal compromise (mean, 5.5%; P < .001), increased central canal diameter (mean ± SD, 0.71 mm ± 1.3; P < .001), and restoration of vertebral body height, with a mean increase of 5.0 mm (P < .001). However, the implantation did not result in a statistically significant kyphosis reduction (mean, 1.38°; P = .10). All patients except for 1 reported improvement in pain after surgery, with a mean improvement of 1.54 on a 4-point pain scale (P < .001). No clinically significant adverse events were reported. ConclusionsThis study suggests that expandable intravertebral device implantation is a safe and effective treatment for thoracolumbar vertebral burst fractures in patients without fracture-related neurologic deficit. Although implantation did not result in a statistically significant reduction in kyphotic angle, it offered significant improvement in pain, vertebral body height, fracture fragment retropulsion, and central canal diameter compromise.

Biomechanical analysis of the effect of ‘intermediate screws’ in short segment posterior fixation of unstable burst fractures of thoracolumbar spine in calf spine model

Background: Efforts in preserving motion levels in unstable thoracolumbar burst fractures steered to short segment fixation. However, short segment spanning fixation in clinical scenario reported high failure rates. Augmentation of spanning fixation by inserting intermediate screws into the fracture level is proposed to enhance stability. An experimental comparative study was performed to assess the biomechanical role of the ‘intermediate screws.’ Methods: Five calf spine specimens were freshly prepared to record the biomechanical characteristics, range of motion (ROM), and stiffness. CT scan confirmed an unstable burst fracture in each specimen. Each specimen was instrumented with short-segment posterior fixation with an intermediate screw. The same test protocols were repeated with and without intermediate screws. Results: Intermediate screws contribute to 20.2%, 16.5%, 14.5% and 23% decrease in ROM and 15.4%, 25.6%, 48.3%, and 160.2% increase in construct stiffness. Conclusions: Intermediate screws significantly increase the construct stiffness and decrease the ROM.

Short segment versus long segment pedicle screws fixation in management of thoracolumbar burst fractures

Background: Selection of stabilization procedures for treating thoracolumbar burst fractures remains controversial. Both long-segment and short-segment pedicle screw fixation have been used widely with no consensus on the better method. Aim of study: To compare the outcome of long segment and short segment posterior fixation as amanagement of thoracolumbar burst fractures. Patients and Methods: 60 patients fulfilling the inclusion criteria who underwent posterior pedicle screw fixation for burst fracture of thoracolumbar spine in Neurosurgery Department of Al-Azhar University Hospitals and El-Ahrar General Hospital, Zagazig between August 2019 and Febrauray 2022. Patients were randomized into one of two groups. Short segment group (30 patients) was treated by short segment fixation, i.e., 1 level above and 1 level below the fractured vertebra. Long segment group (30 patients) was treated by long segment pedicle screw fixation, i.e., fixation of 2 levels above and below the fractured vertebra. Assessment of kyphosis correction by using the Cobb method and restoration of the anterior vertebral body height was performed radiologically postoperatively and at 3 and 6 months follow up. Results: Demographic data of both groups were quite comparable. thoracolumbar burst fracture

Efficacy of Short and Mono segment Spinal Fixations in Traumatic Incomplete Thoracolumbar Burst Fractures

Background: Controversies still mount over the long segment, short segment and mono segment screw fixation for traumatic thoracolumbar spine burst fractures. This article aims to provide our initial experience of the effectiveness of these management modalities with additive focus on their potential benefits upon preventing the loss of correction over time.&#x0D; Methods: We included all operated cases of thoracolumbar fractures presenting with the ASIA grade of above ‘C’ between December 2014to December 2017 in a retrospective manner in terms of operative time, estimated intra-operative blood loss, any post-operative surgical wound complications, implant cost, average time lapse for the patients to return to physiotherapy and the follow up radiological imaging at 6 months.&#x0D; Results: Long segment fixation is comparatively more time consuming with considerable blood loss and high incidence of postoperative wound complications. We observed that both short as well as mono segment crew fixations had similar incidences with regards to the common complications pertaining to the spinal implant placement procedures.&#x0D; Conclusions: Both short and mono-segment fixation procedures resulted in comparable short and long term results. Though long segment fixation is comparatively more stable, it is, however, expensive with a higher incidence of other postoperative complications.

Retrospective analysis of conservatively treated thoracolumbar burst fracture

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Thoracolumbar burst fractures accounts for 10 to 40 percent of the spinal column fractures caries a significant morbidity and mortality. &lt;span&gt;Vertebral fractures are usually followed by chronic pain, deformity, loss of height and crowding of internal organs. A combination of the above problems can adversely affect the self-esteem and ability to carry on the daily activities&lt;/span&gt;&lt;span lang="EN-IN"&gt;.&lt;/span&gt;The objective of the study was to find proportion of the conservatively treated thoracolumbar burst fracture and the factors associated with the final outcome of the treatment with the clinical, radiological evidences.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; In this study 36 patients with burst fracture of thoracolumbar spine without neurological deficit, treated conservatively from January 2015–August 2016 were included. The overall follow up period was 18 months. Various radiological parameters were taken in to consideration like Cobb angle, canal stenosis, sagittal alignment, and fragment displacement. Treatment outcome was evaluated by short form survey questionnaire (SF-36), Denis score for pain and work and the visual analogue scale (VAS).&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The overall functional outcome in this study group 30.55% returned to the previous employment. 25% back to their previous job with restrictions.27.7% unable to return to the previous job but works fulltime in a new job. 16.7% unable to return to full time work. No one is completely disabled. The Cobb angle remains same or decreased in 53% and in 47% with minimum -8 maximum 5. The severe pain score was in 5.6% of cases&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Proper selection of patients and their prior activities, social and educational background and future plans in addition to a thorough physical, neurological and spinal examination are mandatory to achieve satisfactory result&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;

CONSERVATIVE TREATMENT FOR THORACOLUMBAR SPINE BURST FRACTURES

ABSTRACT Objective: To identify the category of evidence and the strength of recommendation for the conservative treatment of thoracolumbar spine burst fractures. Method: A systematic review was conducted from April 2014 to June 2015, selecting articles according to their prospective design, related to thoracolumbar spine burst fractures and their treatment. These studies were published in the electronic bibliographic databases from January 2009 to January 2015. Results: A total of 9,504 articles were found in a free search, of which 7 met the selection criteria and were included for analysis in a study of a total of 435 patients, of whom 72 underwent surgical treatment and 363 received some type of conservative treatment, showing predominantly level of evidence "1b", with strength of recommendation type "A". Conclusions: According to the evidence obtained, the conservative treatment is a choice for patients with stable burst fracture in a single level of thoracolumbar spine and with no neurological injury.

The Diagnosis of Type I Osteogenesis Imperfecta in A Patient with Acute Spinal Burst Fracture after Low-Energy Trauma and Its Operative Treatment: A Case Report

Objective: To report a unique case of operatively and nonoperatively treated burst fractures of thoracolumbar spine in a single patient with type I osteogenesis imperfecta (OI), who previously had not been diagnosed as OI. Summary of background data: OI is a genetic disorder that causes bone fragility. Although spinal fractures may commonly occur in these subgroup of patients, there have been only a few case report of thoracolumbar burst fractures. And to our knowledge, there has not been reported case of operative treatment for acute burst fracture of thoracolumbar spine in a patient with OI, especially in type I. Methods: We report a case of 25-year-old woman who suffered unstable burst fracture of L1 after minor fall from a chair. The patient was treated operatively (anterior corpectomy, instrumentation and interbody fusion). She suffered stable burst fracture on T11 after a slip down in 10 months after the surgery, and was treated nonoperatively. Results: The patient was diagnosed as type I OI, based on the relatively minor nature of the trauma and blue sclerae and histories of multiple fractures of her and her father. Successful bony union and good spinal alignment were achieved. Conclusion: Anterior corpectomy, instrumentation and interbody fusion may be a feasible option for treatment of unstable burst fractures, even though the patients have any pathologic cause on their fractures. And any patient manifesting severe injuries that are caused by relatively minor trauma may have an underlying pathologic cause, including OI. They should be evaluated thoroughly to determine other cause and to be treated appropriately.

Results of Staged 360-Degree Spinal Fusion for Unstable Thoracolumbar Burst Fracture

Objective: The purpose of this study was to evaluate the results obtained in patients who underwent staged 360-degree fusion with posterior fusion following anterolateral fusion for unstable thoracolumbar burst fractures. Methods: The authors performed 360-degree fusion for thoracolumbar burst fractures in 21 patients between 2006 and 2010. We reviewed the medical records and follow-up data including preand postoperative neurological status, spinal canal compromise, segmental kyphotic angulations, complications, visual analogue scale (VAS) pain scores, and revision surgery rates. Results: The mean computed tomography-measured preoperative spinal canal compromise was 55.9±20.7%. The segmental kyphotic deformity measured 20.2±4.4° preoperatively and had been corrected to 4.5±2.8° postoperatively. The mean vertebral body height loss of 57.4±6.9% improved significantly to 1.2±0.7% at the final follow-up examination. The mean preoperative VAS pain score of 8.2±0.8 improved to 1.5±0.6 at discharge. There were no cases of vascular complication, neurological deterioration, or revision surgery. Conclusion: Unstable burst fracture of thoracolumbar spine managed by staged posterior fusion and anterolateral interbody fusionis effective for kyphosis correction, significant canal decompression, pain reduction, maintaining stabilization and neurological improvement.

Clinical modification of the anterolateral approach for burst fractures of thoracolumbar spine

Objective To discuss the modified anterolateral approach for the treatment of burst fractures of the thoracolumbar spine. Methods From April 2003 to September 2006, we treated 27 patients with burst fractures of the thoracolumbar spine. Sixteen of them were operated on through the L anterolateral approach modified out of the conventional thoraco-extraperitoneal approach using the space be-tween the erector spine muscles and quadratus lumborum muscles according to the anatomic relation of the thoracolumbar spine. The other 11 cases were treated through the conventional approach. The average blood loss for vertebral exposure, operation time and the total operation blood loss, as well as intraoperative and postoperative complications were compared between the 2 approaches. Results All the 27 cases had successful surgery. There were significant differences between the 2 approaches (P 0.05) in Cobb angle, height ratio of anterior borders of injured and normal vertebrae and neurological recovery. No serious complications were found in operation. After an average follow-up of 13 months, none of the patients had neurological deterioration, the spine recovered normal curvature and no implant failure happened. Conclusion The modified antero-lateral approach for the treatment of thoracolumbar spine burst fractures have the advantages of less invasion,less blood loss, effective decompression and maintenance of the spinal stability, and fewer complications. Key words: Thoracic vertebrae; Lumbar vertebrae; Burst fracture; Operative approach

P129. Significance of the Reverse and Pseudo-reverse Cortical Signs in Thoracolumbar Spine Burst Fractures: Outcomes and Prognostic Factors

P129. Significance of the Reverse and Pseudo-reverse Cortical Signs in Thoracolumbar Spine Burst Fractures: Outcomes and Prognostic Factors

EFFICACY OF HARTSHILL FIXATION WITH SUBLAMINAR WIRING IN MAINTAINING ANATOMICAL CORRECTION AND NEUROLOGICAL RECOVERY IN BURST FRACTURES OF THORACOLUMBAR SPINE

Hartshill fixation of thoracolumbar burst fractures is justified on grounds of providing early stabilization and correction of deformity. It is important to answer the question of whether it is able to sustain correction so that the costs and risks of surgery of this disabling problem can be justified. Reliable answers are also needed in view of the costs and risks of surgery prognostication.This before-after study is on 49/61 consecutive cases of burst fractures of thoracolumbar spine, admitted during October 1998 to November 2000. Patients were treated with Hartshill segmental spinal fixation two segments above and below the fracture and bone grafting, and followed-up for a mean of 28 months (18–43 months) to determine the fate of radiological parameters indicating correction of kyphosis and clinical indicators predicting neurological recovery.The mean pre-operative kyphosis angle of 19.59° (17.93–21.24) initially improved by 9.73° (8.07–11.39), p &lt; 0.05 but reverted to 19.71° (17.73–21.69) during follow-up. Vertebral height measurements indicated similar findings. Mild pain persisted in 48/49 patients while 1/49 needed analgesics. Improvement of neural function was seen in 37/44 patients having a pre-operative deficit. 6/16 variables had a significant univariate relation with neurological recovery at p &lt; 0.3 levels; namely initial Frankel's grade 1.85 (0.81–4.22), p = 0.14; fracture level 3.83 (0.58–25.10), p = 0.16; initial kyphosis 1.11 (0.93–1.32), p = 0.24; age 1.03 (0.96–1.11), p = 0.28; sex 0.39 (0.06–2.23), p = 0.29 and post-operative kyphosis 1.07 (0.93–1.22), p = 0.30. When combined, these variables were able to correctly classify recovery in 77.78% of cases at the probability cut-off of 0.75, sensitivity of 0.77 and specificity of 0.75, while the pre-test probability of recovery of 0.84 improved to 0.93 post-test, Negative Predictive Value (NPV) was 0.42., +Likelihood Ratio (LR) was 3.11 and -LR was 0.29. 77% of the area was under the Receiver Operator Characteristic (ROC) Curve.Although Hartshill fixation with segmental sub-laminar wiring failed to maintain kyphosis correction in thoracolumbar burst fractures, it resulted in reducing the recumbence and hospital stay, and facilitating early rehabilitation. However, the costs and the risks of such procedures have to be carefully weighed before they are recommended for wider use. We also have a rule for predicting neurological recovery in such patients.

Sagittal contour restoration and canal clearance in burst fractures of the thoracolumbar junction (T12-L1): the efficacy of timing of the surgery.

The efficacy of timing of surgery (short segment fixation using transpedicular screws), in burst fractures of thoracolumbar spine was evaluated between May 1993 and October 1994. The patients were divided into two groups according to time elapsed between injury and operation. Cases operated on within the first 24 h were taken as the early surgery group (n = 10) and cases operated on later than 24 h after the injury were considered as the late surgery group (n = 8). The efficacy of treatment was assessed by evaluation of the sagittal index (SI) restoration and reduction of canal compromise. The pre- and postoperative values for SI and canal narrowing (CN) for both groups are as follows: Early preoperative SI-23.40 degrees, late preoperative SI-24.50 degrees, p = 0.53; early preoperative CN-0.47, late preoperative CN 0.52, p = 0.33; early postoperative SI-4.20 degrees, late postoperative SI-13.50 degrees, p = 0.0001; early postoperative CN-0.10, late postoperative CN-0.39, p = 0.0000. There is still controversy concerning the relationship between canal narrowing and neurologic deficit, and the effect, if any, of decompression on neural recovery. Nevertheless, if the main aim of the surgical procedure is to restore the SI and decompress the neural canal, then other alternatives of decompression and realignment should be preferred to indirect reduction using short segment transpedicular fixation in cases to be operated on later than 24 h after injury.

胸腰つい，腰つい部における陳旧性粉砕骨折に対する手術的治療

Diagnosis and operative treatment for nine old burst fractures of thoracolumbar spine are reported. Weakness of the injured vertebral body resulted in kyphotic deformity, and caused lumbago and neurological deficits. We aimed at decompression of the spinal canal, correction of kyphotic deformity and fixed fusion. So We operated on these cases by means of anterior interbody fusion and posterior spinal fusion using Harrington instrumentation.