Management Of Thoracolumbar Fractures Research Articles

The Importance of Orthostatic Radiography in the Management of Thoracolumbar Fractures: Case Report

AbstractPatients who are victims of traumatic injuries in the spine are evaluated by radiological protocols, as recommended by Advanced Trauma Life Support (ATLS), including a computed tomography (CT) scan with the patient in the decubitus position. Spine fractures considered stable with initial nonoperative management should be further evaluated with a standard simple plain radiograph in orthostasis and/or a magnetic resonance image (MRI), to exclude any associated ligament injury and avoid neurological damage caused by occult instabilities. We present an illustrative case with an injury diagnosed through orthostasis X-ray to discuss its importance in the management of thoracolumbar fractures.

Characterization of the influence of spinopelvic parameters on thoracolumbar trauma.

The current Roussouly classification identifies four groups of "normal" sagittal spine morphology, which has greatly expanded the understanding of normal heterogeneity of the spine. While there has been extensive characterization of the influence of spinopelvic parameters on outcomes after degenerative spine surgery, the influence of spinopelvic parameters on thoracolumbar trauma has yet to be described. The goal of this study was to determine if spinopelvic parameters and global spine morphology influence fracture location, fracture morphology, and rate of neurological deficit in the setting of thoracolumbar trauma. Of 2896 patients reviewed in the authors' institutional spine database between January 2014 and April 2020 with an ICD-9/10 diagnosis of thoracolumbar trauma, 514 met the inclusion criteria of acute thoracolumbar fracture on CT and visible femoral heads on sagittal CT. Pelvic incidence (PI) was calculated on sagittal CT. Demographic and clinical data including age, sex, BMI, smoking status, concomitant cervical fracture, mechanism of injury, major fracture location, neurological deficit, AO Spine thoracolumbar injury classification, and management type (operative vs nonoperative) were collected. Patients were stratified into high-PI (≥ 50°) and low-PI (< 50°) groups. Patients with high PI had a lower incidence of fractures in the lower lumbar spine (below L2) compared with patients with low PI (16% vs 8%, p < 0.01). The last lordotic vertebrae were observed between T10 and L4, and of fractures that occurred at these levels, 75% were at the last lordotic vertebrae. Fall from height was the most common cause of neurological deficit, accounting for 47%. Of the patients presenting with a fall from height, AO Spine type B distraction injuries were more common in the high-PI group (41% vs 18%, p = 0.01). Similarly, within the same subgroup, AO Spine type A compression injuries were more common in the low-PI group (73% vs 53%, p = 0.01). Spinopelvic parameters and sagittal balance influence the location and morphology of thoracolumbar fractures. Fractures of the thoracolumbar junction are strongly associated with the inflection point, which is defined by sagittal alignment. While the importance of considering sagittal balance is known for decision-making in degenerative spinal pathology, further studies are required to determine if spinopelvic parameters and sagittal balance should play a role in the decision-making for management of thoracolumbar fractures.

Unipedicular-Screw Index Vertebra Manipulation Technique for Minimally Invasive Short-Segment Thoracolumbar Fracture Fixation.

Minimally invasive spine surgery (MIS) has revolutionized fixation of thoracolumbar fractures with burst elements. Recent studies have proven that percutaneous pedicle screw instrumentation is as effective as open instrumentation but with reduced intraoperative blood loss and operative duration. Techniques such as short-segment pedicle screw fixation including the fractured vertebra have shown satisfactory radiological correction and functional outcomes, avoiding the need for extensile posterior constructs. In the present study, the authors our technique utilizing unipedicular index vertebra fixation and manipulation in MIS for thoracolumbar fractures with burst elements. To our knowledge, this technique is not well described in literature as open approaches are often adopted for the above. The authors sought to highlight the 2-year radiological and functional outcomes of 20 consecutive patients who underwent this technique. A retrospective review of prospectively collected data was conducted on 20 patients with thoracolumbar fractures with burst elements who underwent fixation using our technique. Patient data collected included demographic characteristics, mechanism of injury, associated injuries, neurological deficit at the time of admission, pre- and postoperative neurological evaluation, and length of hospital stay. Radiological investigations included plain radiographs, computed tomography of the spine with reconstruction, and magnetic resonance imaging of the spine, which provided data for radiological fracture classifications such as AO Spine and derivation of Thoracolumbar Injury Classification and Severity Score, as well as preoperative planning. Radiological investigations in the postoperative period were carried out by standing radiographs or EOS whole spine at each postoperative follow-up for up to 2 years. Radiological parameters-vertebral wedge angle, regional kyphosis angle, coronal Cobb angle, and anterior and posterior vertebral body heights-were recorded at preoperative, intraoperative, postoperative, and up to 2-year follow-up. Clinical outcome scores (visual analog score [VAS] and Oswestry Disability Index [ODI]) were also recorded at similar timepoints. Radiological outcomes reflect significant lordotic corrections of the vertebral wedge angles up to 2-year follow-up when compared with preoperative values (intraoperative: P = 0.06; postoperative: P = 0.001; 3 months: P = 0.002; 6 months: P = 0.004; 1 year: P = 0.011; 2 years: P = 0.016). Additionally, significant lordotic corrections of regional kyphosis angles (intraoperative: P = 0.00; postoperative: P = 0.00; 3 months: P = 0.031; 6 months: P = 0.039) and increases in anterior vertebral body heights (postoperative: P = 0.001; 3 months: P = 0.010; 6 months: P = 0.020) at up to 6-month follow-up were found. Preoperatively, median VAS of 85 (range 30-100) and ODI of 90 (range 40-98) were recorded. Statistically significant improvements in VAS and ODI were found across all timepoints when compared with preoperative values, with a mean VAS of 11.5 (SD 4.8) and ODI of 9.9 (SD 4.5) at 2-year follow-up. Surgical management of thoracolumbar fractures with or without neurological deficit has a role in reducing nursing requirements and postoperative morbidity in patients with polytrauma and other associated injuries. Our approach in treating thoracolumbar fractures with burst elements using MIS short-segment fixation and unipedicular screw manipulation technique shows satisfactory radiological correction and high rates of fracture union while reducing approach-related morbidity and improving functional outcomes.

Frequency of Misplacement of Percutaneously Placed Pedicle Screws in Thoracolumbar Fractures

of thoracolumbar fractures. Material and Methods: A descriptive case series was conducted at the Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore. The study comprised all individuals who had minimally invasive percutaneously implanted thoracic or lumbar pedicle screws placed. CT scans were conducted on the patient 24 hours after surgery as part of their usual post-operative care to capture axial pictures to find Pedicular cortical breaches in any direction. Results: Mean age of the patients was 32 years. 82.7% were male whereas 17.3% were females. We found that the frequency of misplacement was 10.9% in the management of thoracolumbar fractures. 110 patients received 600 pedicle screws placed percutaneously. Of these, 534 screws (89.1%) were ideally placed inside the pedicle. 7% showed minor pedicle penetration, 3.6% showed moderate pedicle penetration and only 0.3% showed severe penetration. Out of misplaced screws (10.9%), 7.3% of patients were between 15 – 40 years, and 3.6% were between 41 – 50 years. Out of misplaced screws (10.9%), 9.7% were male patients and 1.3% were female patients. For thoracic injury, 4.5% of patients suffered from misplaced screws, and for lumbar injury, 6.5% of patients were observed for misplaced screws (p-value: 0.008). Conclusion: The frequency of misplacement was 10.9% in the management of thoracolumbar fractures. The misplacement rate of the percutaneously placed screw is low. Therefore, we concluded that the percutaneously placed screw is safe to use.

438 Benefits of Short- Versus Long-segment Fixation for the Treatment of Thoracolumbar Chance Fractures: A Comparison of Perioperative and Radiological Outcomes

INTRODUCTION: Discussion continues regarding optimal surgical management of thoracolumbar fractures. Some have indicated long-segment posterior fixation (LSPF) is favorable when evaluating implant stability, kyphotic deformity, and pain. However, most studies either included multiple fracture subtypes or focused on burst fractures. Short-segment fixation (SSPF) may be similarly effective for a subset of patients while minimizing surgical time and length of stay (LOS). This study reviews inpatient and follow-up outcomes of chance fractures managed with SSPF versus LSPF. METHODS: Retrospective review of 50 consecutive patients with thoracolumbar distraction injuries (AO B1 and B2) at a single center over a five-year period. Patients underwent pedicle fixation one level (SSPF) or two to three levels (LSPF) above and below the fracture. Patient demographics, preoperative characteristics, and perioperative outcomes were compared between groups. Radiological outcomes were assessed by measuring Cobb angles immediately postoperatively and up to 12 months postoperatively. RESULTS: There was a 31% reduction in mean surgical time for SSPF patients vs LSPF (134 vs 195 minutes, independent samples t test, p = 0.037) without a significant difference in ICU LOS (4.6 vs 4.8 days, independent samples t test, p = 0.947), hospital LOS (15 vs 14 days, independent samples t test, p = 0.865) or complication rates (2 of 35 vs 2 of 15 patients, Fisher’s Exact, p = 0.574). Longitudinal assessment of kyphosis by measuring Cobb angles immediately postoperatively and 2 - 4, 6, 8 - 12, and &gt; 12 months postoperatively showed no significant differences in radiological outcomes between groups. There was a trend toward an increased likelihood of discharge to home (Likelihood ratio = 5.299, ꭓ2 test, p = 0.032) with SSPF. CONCLUSIONS: SSPF is non-inferior to LSPF for thoracolumbar chance fractures while offering reduced surgery time. Our results additionally suggest SSPF may offer increased likelihood of discharge home.

Long- versus short-segment fixation with an index vertebral screw for management of thoracolumbar fractures.

The choice of the best stabilization technique for thoracolumbar fractures remains controversial. While LSF includes too many motion segments, SSF is associated with a high rate of fixation failure and subsequent loss of kyphotic correction. Our objective is to compare the surgical, clinical, and radiological outcomes of thoracolumbar spine fixation using long-segment fixation (LSF) versus short-segment fixation (SSF) with a screw in the fractured vertebra. We retrospectively evaluated 63 patients with single- level thoracolumbar fracture types A and B treated during the period between 2010 and 2017 in our institution. Group A (30 patients) was treated by SSF with an intermediate screw in the fractured vertebra, while group B (33 patients) was treated by LSF. Both groups were compared in terms of surgical, clinical, and radiological outcomes. The mean operative blood loss was significantly lower in group A than in group B (451.3 ± 79.9 and 690 ± 92.1 ml, respectively). The mean operative time in Group A was significantly shorter than in group B (58.4 ± 14.8 and 81.5 ± 12.3 minutes, respectively). Both groups achieved a similar Visual Analogue Scale (VAS) for pain and Oswestry Disability Index (ODI) score. No significant difference was found as regards the kyphotic angle correction and the correction loss at final follow-up. In conclusion, SSF with a screw in the fractured vertebra achieved comparable functional and radiological outcomes to LSS with less blood loss and operative time.

Development and validation of a simplified thoracolumbar spine fracture classification system.

Development and validation of fracture classification system. To develop and validate a Simplified Classification System (SCS) for Thoraco-Lumbar (TL) fractures (SCS - TL fractures). Tertiary Spinal Injuries Centre, New Delhi, India METHODS: Based on the International Spinal Cord Society Spine Trauma Study Group (ISCoS STSG, n = 23) experts' clinical consensus conducted by the senior author and on his own experience, the Denis classification for TL fractures was modified to develop a SCS-TL fractures that could guide the management. After Face and Content validation, Construct validation was done in two stages. First stage analyzed if management of 30 cases of TL fractures, as suggested by the SCS - TL fractures and ISCoS STSG (n = 9) as well as other (n = 5) experts, matched. Second stage was a one year prospective study analyzing if the management suggested matched the management actually carried out by different spine surgeons (n = 10) working at a single institution. In the first stage there was 100% agreement for management (conservative or surgical) as proposed by experts and that suggested by the proposed classification for TL fractures whereas for surgical approach there was 88% agreement. In the second stage, there was 100% agreement for the management as well as surgical approach as carried out at our centre and that proposed by the SCS for TL fractures. The proposed SCS-TL fractures helps in classifying and in decision making for management of TL fractures. The next phase of validation would involve multicentric reliability studies and prospective application of the SCS- TL fractures.

Management of AO-type C thoracolumbar fractures during COVID-19 pandemic using distractor device: a novel technique

Study design Prospective cohort study. Introduction Management of the severe thoracolumbar (TL) spine fracture–dislocation injuries have been further complicated by the COVID-19 pandemic. The need to optimize resources and minimize the personnel in the operating room (OR) led us to develop a novel technique to reduce TL fracture–dislocations (AO type-C) using an orthopedic distractor device (ODD). Methods This prospective study was conducted at a tertiary care spine center with a study duration from March 2020 to May 2020 coinciding with the nationwide lockdown and travel restrictions imposed in view of the COVID-19 crisis. Only patients with AO type C fracture–dislocation managed using the ODD operated by a single surgeon were included in the study. Results Of 12 cases, the most commonly affected level was D12-L1. Nine patients were American Spinal Injury Association Impairment Scale (AIS) A at presentation, two patients were AIS B, and one AIS C. The mean operative time was 125 min and mean blood loss was 454 ml. Eight patients remained AIS A, one patient improved from AIS B to C. Two patients became independent walkers, one remained AIS B. The post-operative VAS score improved to a mean value of 2.33. The improvement in kyphosis was 26.24° immediate postoperatively and maintained at 25.9°, percentage height loss reduced to 2.75% immediate postoperatively and maintained at 3.16% at 3 months follow-up. Conclusions Management of TL fracture–dislocations in COVID times of health care resource scarcity can be challenging. Single surgeon with ODD is a useful technique for achieving good results in these injuries.

Efficacy of computed tomography-assisted limited decompression in the surgical management of thoracolumbar fractures with neurological deficit

ObjectiveTo investigate the effect of CT-assisted limited decompression in managing single segment A3 lumbar burst fracture.MethodA retrospective study (January 2015–June, 2019). One hundred six cases with single-level Magerl type A3 lumbar burst fractures treated with short-segment posterior internal fixation and limited decompression. Patients were divided into two groups: CT-assisted group and non-CT-assisted group. Perioperative factors, clinical outcomes, post-operative complications, imaging parameters, and health-related quality of life (HRQoL) were evaluated.ResultsKyphosis, loss of anterior and posterior vertebral body heights, operative time, and post-operative complications were not significantly different between the two groups. The visual analog score (VAS) and spinal canal encroachment in the CT-assisted group were lower compared with the non-CT-assisted group (p < 0.05). The Japanese Orthopaedic Association (JOA) score, the simplified HRQoL scale, and the American Spinal Injury Association (ASIA) Spinal Cord Injury Grade in the CT-assisted group were significantly higher compared with the non-CT-assisted group (p < 0.05).ConclusionCT-assisted limited decompression in the treatment of single-segment A3 lumbar burst fracture can achieve better fracture reduction and surgical results and improve the long-term recovery of the patients’ neurological function and quality of life.

Pedicle screw fixation with a novel external frame for thoracolumbar fractures: A comparative study

Summary Objective Controversy exists in treatment of thoracolumbar fractures without neurologic deficits. Percutaneous pedicle screw implantation with external frame is a less invasive procedures. This study was conducted to compared outcomes of percutaneous pedicle screws with a novel external fixation (micro-motional adjustable external fixator-MAEF) and open surgery for thoracolumbar fracture without neurologic deficits. Methods Between October 2017 to October 2018, 42 patients of thoracolumbar fractures without neurologic deficits treated at our trauma center were analyzed retrospectively. The mean age of the patients was 42 years old (range 17–65). Pedicle screw and a novel external frame or open surgery were performed by senior surgeons. Perioperative and radiographic data were collected. Results There was no significant statistically difference between MAEF and open surgery in demographics and preoperative data. There were statistically significant differences in blood loss intraoperative between the two groups (44.3 ± 15.1 vs 291.1 ± 175.9, p 0.05). There are 1 complication in MAEF while 3 in open surgery group. Conclusion The MAEF is a less invasive procedure, which provides reduced bleeding and no necessity of secondary surgery. The technique is effective in the management of thoracolumbar fractures as well as maintaining reduction. It may be a good choice for thoracolumbar fractures without neurological deficits. The translational potential of this article This study showed that the new spinal external frame was as effective as open reduction and internal fixation in the treatment of thoracolumbar fractures, but had more advantages in postoperative kyphotic deformity. We will continue to investigate its advantages in open fractures, multiple jumping spine fractures and postoperative recovery.

Indications and principles of surgical treatment in injuries affecting the thoracolumbar spine

Vertebral fractures are very common and primarily affect the thoracolumbar spine as the result of an isolated injury or in polytrauma patients. The majority of these fractures can be treated non-operatively. Surgical stabilization of thoracolumbar fractures may be indicated after high-energy trauma or in the multiply injured patient. Surgery aims to provide a stable spinal column to allow early mobilization and optimize neurological outcome. This article considers the principles of clinical assessment and decision-making in the surgical management of thoracolumbar fractures. The AO spine thoracolumbar classification system can be used to guide treatment because the choice of surgical strategy depends on the biomechanics of the injury. Most injuries can be stabilized through a posterior approach but anterior column reconstruction can be performed, either as a stand-alone procedure or in order to support a posterior stabilization. The use of minimally invasive techniques is discussed. Interventional spinal technologies for osteoporotic vertebral compression fractures are also considered.

Management of thoracolumbar fracture in France. Analysis of practices and radiologic results of a cohort of 407 thoracolumbar fractures

BackgroundThoracolumbar fractures are a public health issue due to their severity and frequency. Management varies according to demographic, clinical and radiologic features, from non-operative treatment to extensive fusion. In the two last decades, improvements and new techniques have emerged, such as kyphoplasty and percutaneous approaches. The main goal of this study was to describe the management of thoracolumbar fractures in France in 2018. HypothesisThe study hypothesis was that management of thoracolumbar fractures in France has progressed in recent decades. Material and methodsThe files of 407 adult patients operated on between January 1, 2015 and December 31, 2016 for T4-L5 thoracolumbar fracture in 6 French teaching hospitals were retrospectively reviewed, at a mean follow-up at 10.2±8.2 [1; 42] months. Demographic, surgical and postoperative radiological data were collected. p-values<0.05 on Student test were considered significant. ResultsFive hundred and thirty-one fractures were analyzed (27% of patients presented more than one fracture). Surgery consisted in internal fixation for 56% of patients, including 17% with associated kyphoplasty; 29% had fusion, and 15% stand-alone kyphoplasty. Surgery used an open posterior approach in 54% of cases, and a percutaneous approach in 46%. Initial sagittal angulation was not a significant decision criterion for screwing (p=0.8) or for a secondary anterior approach in case of fusion (p=0.6). Immediate postoperative sagittal correction was significantly better with an open than a percutaneous approach (p=0.004), but without significant difference at last follow-up (p=0.8). Correction at last follow-up was significantly better with anterior associated to posterior fusion (p=0.003). DiscussionManagement of the thoracolumbar fractures has progressed in France in recent years: 46% of surgeries used a percutaneous approach, compared to 28% in 2013; 90% used a posterior approach only, compared to 83% in 2013; rates of combined approach were unchanged, at 6%. Twenty-five percent of burst fractures were treated by fusion, possibly due to lack of preoperative MRI in 79% of cases. Level of evidenceIV, retrospective cohort study.

A novel retractor for reducing operation time and radiation exposure in percutaneous pedicle screw placement.

Design a novel hand-held retractor to reduce operation time and radiation exposure in percutaneous pedicle screw placement. 126 patients with single segment thoracolumbar vertebral fracture were surgically treated with percutaneous pedicle screws through our novel hand-held retractor technique（group A） or conventional fluoroscopic method(group B), the operation time and fluoroscopy shot times were compared, and the accuracy of screw placement were assessed. There was no serious complications occurring during our study, such as infection, blood vessel injury, spinal cord or nerve root injury. We did not find any statistically difference between the two groups in corrected rate of regional Cobb's angle or vertebral body height percentage(P 0.05), however, the mean operation time was found to be 75.9±2.37min in the novel hand-held retractor method group and 94.2±2.19min in the conventional method group. The difference was statistically significant (p﹤0.001). Fluoroscopy shot times averaged 9.01±0.41 in the novel hand-held retractor group versus 16.8±0.56 in the conventional group (P 0.001), the novel hand-held retractor group had apparent advantages over the conventional method in postoperative improvement on visual analog scale (VAS) scores and Oswestry Disability Index (ODI) at 2days, 3month after operation and last follow-up (P 0.05). There was no statistical difference between group A and B in the radiographic results and screw position violation grade. The novel hand-held method retractors have several advantages, including shorter operation time, less fluoroscopy shot times, and better postoperative improvement on visual analog scale (VAS) scores and Oswestry Disability Index (ODI). It provides a new alternative method for effective management of thoracolumbar fractures.

Thoracolumbar Fractures, Posterior versus Anterior Management: A Case Series and Literature Review

Background Data: The management of unstable traumatic thoracolumbar fractures has shifted from more conservative treatment towards more operative treatment modalities. Different surgical options have been reported in the literature. Purpose: To review two surgical techniques, anterolateral and posterior approaches, in management of thoraco-lumbar fractures and present a brief literature review. Study Design: A retrospective case series with review of literature. Patients and Methods: Thirty patients managed in the period from October 2012 to November 2016 for thoraco-lumbar burst fractures. Two patients’ groups were identified, group 1 underwent anterolateral fixation and included 15 patients whereas group 2 underwent posterior fixation and included 15 patients. Follow up was done at 3 months, 6 months and one year postoperative using VAS for pain assessment and ASIA scale for neurological status evaluation. Radiological outcome involved the vertebral height restoration, spinal canal compromise and kyphus deformity correction. Operative time, operative blood loss and perioperative complications were all reported for both groups. Results: The most common spinal level affected in our study was L1 vertebra in 10 cases. Operative time and blood loss were found to be significantly less in the posterior approach. A significant improvement of VAS has been reported in both study groups with more improvement in the posterior group compared to the anterolateral one. 93.3% of anterior group patients within the showed either improved or fixed neurological status according to ASIA scale where in posterior group all patients showed either improved or fixed neurological status. The mean canal compromise percentage decreased in group 1 from 69.3% preoperatively to 15.62% postoperative whereas in group 2 it decreased from 66.2% preoperative to 18.8%. Kyphotic angle has been corrected in posterior group from 13.42° preoperative to 11° at 6 months and 12.5° at one year, where in anterolateral group has been corrected from 19.42° to 17.57° and 20.9° respectively with a statistically significant difference between both groups (P<0.01). Conclusion: Our data suggest that both anterior and posterior approach showed no difference in neurological outcome in patients with thoraco-lumbar fractures. However anterior approach was superior to the posterior one in spinal canal compromise clearance and kyphotic angle correction.

Management of Thoracolumbar Fracture with Posterior Decompression with Fusion and Fixation by Pedicle Screw and Rod—Our Experience

Management of Thoracolumbar Fracture with Posterior Decompression with Fusion and Fixation by Pedicle Screw and Rod—Our Experience

The Top 50 Most-Cited Articles on Thoracolumbar Fractures

To identify the top 50 most-cited articles in the literature focusing on thoracolumbar spine fractures. Using the ISI Web of Science version 5.11 database and the search phrase "thoracolumbar fracture," we queried for the 50 most-cited articles on thoracolumbar fractures. The study was performed in September 2017. We searched for articles published between 1900 and 2017. Articles were sorted and ranked based on the total number of citations. We evaluated the following information pertaining to each article: first author, year of publication, journal, and title. A total of 2718 studies matched our search criteria, of which the top 50 most-cited ranged between 267 and 81 citations. Twelve articles were cited more than 200 times. The article by McLain etal. was the most-cited article, with 267 citations, followed by Vaccaro etal. with 237 and Mumford etal. with 236. The majority of the studies originated from the United States (n= 26) and were published in the 1990s. Spine was the most frequent destination journal (n=26), followed by the Journal of Bone and Joint Surgery (n= 7). Most of the articles focused on the clinical management of thoracolumbar fracture (82%). Vaccaro and McAfee were the most cited first authors, with 3 articles each. Thoracolumbar fractures are the most common injuries of the spine, and the incidence is increasing globally. To understand current treatment guidelines and how treatment of these fractures has evolved, it is important to know the most-cited articles pertaining to these fractures.

In-hospital medical complications after non-operative and operative treatment of thoracolumbar fractures in patients over 75 years of age

Management of spine fractures among the elderly is complicated by preexisting comorbidities and increased risk of osseous nonunion. Whether operative treatment is superior for the management of thoracolumbar fractures in the aged is unknown. The purpose of this study was to investigate the rates of in-hospital medical complications after non-operative and operative treatment of thoracolumbar fractures in elderly patients. The Nationwide Inpatient Sample database from 2002 to 2011 was used to identify patients over 75 years of age with a principal discharge diagnosis of thoracolumbar fracture without spinal cord injury. Three treatment groups were compared: non-operative treatment, operative treatment, and minimally-invasive vertebroplasty/kyphoplasty (VP/KP). A total of 59,565 patients were identified; 46,962 treated non-operatively, 1,487 treated operatively, and 11,116 treated with VP/KP. Operative patients had the longest length of hospital stay (P < 0.001) and the highest injury severity scores (P < 0.001). The percentage of patients who developed at least one complication was highest in the operative group (16.3%), versus 8.7% in the non-operative and 8.1% in the VP/KP group (P < 0.001). Even after controlling for potential confounders such as injury severity score, surgical patients had significantly higher odds of complication occurrence (P < 0.001). Adjusted charges were highest for operative patients ($123,777 ± 135,997 vs. $27,116 ± 32,694 [non-operative] and $42,326 ± 31,984 [VP/KP]). Operative treatment for elderly patients has higher complication rates that need to be considered during preoperative patient counseling. Future research is necessary to elucidate the comparative rates of long-term complications and functional status outcomes for thoracolumbar fracture treatment among elderly patients.

A Comparison of Three Different Methods of Fixation in the Management of Thoracolumbar Fractures.

Management of thoracolumbar fractures remains controversial in the literature. The primary aims of this study were to assess different levels of fixation with respect to radiological outcomes in terms of fracture reduction and future loss of correction. This is a single center, retrospective study. Fifty-five patients presenting with thoracolumbar fractures between January 2012 and December 2015 were analyzed in the study. The levels of fixation were divided in 3 groups: 1 vertebra above and 1 below the fracture (1/1), 2 above and 2 below (2/2), and 2 above and 1 below (2/1). The most common mechanism was high fall injury, and the most common vertebra L1. Burst fractures were the ones with the highest incidence. The 2/2 fixation achieved the best reduction of the fracture, but with no statistical significance. The correction is maintained better by the 2/2 fixation, but there is no statistical difference compared to the other fixations. Insertion of screws at the fracture level did not improve outcomes. The data of this study identified a trend toward better radiological outcomes for fracture reduction and maintenance of the correction in the 2/2 fixations. However, these results are not statistically significant. Future multicenter prospective clinical trials are needed in order to agree on the ideal management and method of fixation for thoracolumbar fractures.

Sohag experience in treatment of Dorsolumbar fractures according to Thoracolumbar injury classification and severity score(TLICS)

Background:.The Thoracolumbar Injury Classification and Severity Score (TLICS) was developed to improve injury classification and guide surgical decision making, yet validation remains necessary. This study evaluates the functional ,clinical and radiological outcome of patients with thoracolumbar spine trauma (TLST) treated according to the TLICS. Aim of the work:To validate the efficacy of Thoracolumbar injury classification and severity score (TLICS) in orthopaedic emergency department at sohag university hospitals. Patients and methods:The TLICS was prospectively applied to a consecutive series of patients (30 cases) treated for TLST between October 2016 and October 2017. Patients with a TLICS score more than 4 points were surgically treated, whereas patients with a TLICS score of less than 4 points were conservatively managed.Those with a score of equal 4 ,group were managed conservatively and the other were operated.The primary outcome was the American Spinal Injury Association Impairment Scale (AIS)(1). Results:The decision taken according to TLICS either conservative if the final score 4. Conservative treatment in the form of rest and dorsolumbosacral brace .Operative in form of posterior fixation with or without decompression .Transpedicular fixation and decompression was needed in 10 cases (33.33%) because they were suffering from neurological insult.The mean age was 34years.There were a marked improvement in angle of kyphosis , vertebral height loss and Oswestry disability index .No patient had neurological worsening during the follow-up. Conclusion:.Thoracolumnar injury and severity score is valid and safe for management of thoracolumbar fractures and has good reliability.

Assessment of variability in Turkish spine surgeons' trauma practices

ObjectivesThe aim of this study was to analyse the variability among Turkish spinal surgeons in the management of thoracolumbar fractures by carrying out a web survey. MethodsAn invitation text and web-link of the survey were sent to the members of the Turkish Spine Society mail group. A fictitious spine trauma vignette, a 23 year-old male with a L1 burst fracture, was presented and 25 questions were asked to participants. Variability of answers in a given question was assessed with the Index of Qualitative Variation (IQV). Questions with high IQV values (>%80) were selected to evaluate the relation between participant factors (speciality, age, degree and experience level of the surgeon, type of the work centre and volume of the trauma patients). ResultsSixty-four (88%) among the 73 participating surgeons completed the survey. 45 (70%) of them were orthopaedic surgeons and 19 (30%) were neurosurgeons. 11 questions had very high variability (IQV ≥ 0.80), 5 had high variability (0.58–0.75) and 2 had low variability (IQV≤0.20). The question with the highest variability was related to the use of brace after surgery (IQV = 0.93). Following one was about the selection of fixation levels (IQV = 0.91). Neurosurgeons were more likely to use brace postoperatively and professors were less likely to perform decompression. ConclusionThis survey shows that thoracolumbar spine trauma practice significantly varies among Turkish spine surgeons. Surgeons' characteristics affected some specific answers. Lack of enough knowledge about spine trauma care, fracture classifications and surgical techniques and/or ethical factors may be other reasons for this variability.