Thoracolumbar Fracture Patients Research Articles

Percutaneous Pedicle Screw for Thoracolumbar Fractures: A Long-term Follow-up.

Objective: This is a retrospective cohort study to analyze the long-term outcomes of thoracolumbar spine fracture patients who underwent minimally invasive percutaneous fixation. Methods: The cases of 17 patients with thoracolumbar spine fractures who had percutaneous fixation between 2009 and 2011 were the subject of a retrospective analysis. Clinical and radiographic variables were collected. For the clinical evaluation the questionnaires SF-36 and Oswestry were used. Radiographic parameters were evaluated using fracture's classification based on Magerls's criteria, the fractured vertebra's wedging angle, and the affected segment's segmental Cobb angle. The measures were made at different stages: before surgery, immediately after surgery, one year later, and at a late follow-up (5 years later). Trauma associated injuries, post-surgical and implant related complications were among the additional information taken into account. Results: The SF-36 questionnaire showed averages above 63,5% in all domains in the late postoperative data (from 5 years after the surgery). Oswestry questionnaire answers showed minimal or no physical limitations in 80% of the patients with a mean score of 10,8%±10,5. The average preoperative Cobb angle value was 5,53° ± 13,80° of kyphosis, the immediate postoperative 2,18° ± 13,38° of kyphosis, one year postoperative 5,26 ± 13,95° of kyphosis, and the late follow-up 8,78° ± 15,06° of kyphosis. The mean correction was 3,35°, and mean loss of correction was 6,6°. There were no complications observed, no case of neurological deficit, infection or implant failure occurred. Conclusion: Thoracolumbar vertebrae fractures can be surgically treated with positive late clinical and radiological outcomes and low complication rates using a minimally invasive percutaneous method.

Association between paraspinal muscle fat infiltration and regional kyphosis angle in thoracolumbar fracture patients: a retrospective study

This study aims to evaluate the impact of percutaneous pedicle screw fixation (PPSF) and open pedicle screw fixation (OPSF) on the postoperative paraspinal muscle fat infiltration (FI) rate in patients with thoracolumbar fractures through magnetic resonance imaging (MRI), and explore the association between paraspinal muscle FI rate and regional kyphosis angle. We retrospectively analyzed clinical data from 35 patients who underwent either PPSF or OPSF for thoracolumbar fractures, examining data at preoperative, 1-month postoperative, and 9-months postoperative time points, which included Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and regional kyphosis angle. We obtained preoperative and 9-month postoperative paraspinal muscle FI rates using T2-weighted MRI images and ImageJ software. We analyzed the correlation of FI rates with VAS, ODI, as well as the correction loss percentage of regional kyphosis angle. The analysis revealed a positive correlation between postoperative FI rate increase and correction loss percentage of regional kyphosis angle (r = 0.696, p < 0.001). The increase in paraspinal muscle FI rate was positively correlated with 9-month postoperative ODI (r = 0.763, p < 0.001). These findings indicate that an increase in postoperative paraspinal muscle FI rate may result in more significant correction loss of regional kyphosis angle and can lead to increased functional impairment in patients.

Epidemiological study of thoracolumbar spine fracture patients reported to tertiary care center of Central India

Background: Thoracic and lumbar spine fractures account for 90% of all spine fractures recorded. In low- and middle-income countries, spinal injuries are associated with significant disability and decreased life expectancy. Non-operatively, these injuries can be managed with a thoracolumbar orthosis or hyperextension cast. The operative management with a posterior, anterior or combined approach will offer immediate mobilization and earlier rehabilitation, providing a better environment for restoration of neurological function. Aim of the study was to find out epidemiology of patients with thoracolumbar spine fracture patients. Methods: A cross sectional observational study was conducted in department of orthopaedics at tertiary care, teaching hospital among patients with traumatic thoracolumbar spine fractures. Epidemiological data variables were collected. In statistical analysis data from 60 patient reported was recorded and analysed. Results: Fall from height is the leading mechanism of injury among middle aged people (30-60years) with male predominance, accounting for 58.33 percent of all spinal cord injury cases. The majority (45%) of fractures were of the burst kind, followed by compression (28.3%), and then translation/rotation (21.6%). And the most-rare of all was the distracted type (just 5%). An only 15% of patients had had a complete spinal injury, whereas the remaining 85% had sustained incomplete/ no spinal cord injury. Conclusions: Knowledge about the burden brought on by spinal cord injury makes it clear that preventing such injuries is the backbone of care. preventive measures for high-risk individuals and early definitive response by paramedics can help reducing the load caused by these injuries.

Imaging parameters and clinical significance of posterior ligament complex injury in thoracolumbar fracture.

This study aims to investigate whether the combination of radiographs and computed tomography (CT) images can be used as an alternative means of magnetic resonance imaging examination or a preliminary screening method before examination, so as to improve the accuracy of determining the degree of posterior ligament complex injury in thoracolumbar fracture patients. From May 2011 to May 2019, the patients with thoracolumbar fracture were collected. A total of 150 patients were enrolled. The reference standard was 1.5T magnetic resonance imaging examination and lipid suppression sequence was applied. All radiographs and CT imaging results were measured in the Picture Archiving and Communication System workstation. The upper endplate angle and lower endplate angle, the percentage of vertebral height drop, the difference of inter-spinous process distance on CT images and the translation distance were statistically significant between the 2 groups (P < .05). Receiver operating characteristic curve showed that the diagnostic performance was excellent (all area under the curve > 0.7). To sum, the results showed that endplate angle + inter-spinous process distance on CT images combination had relatively high-quality diagnostic value for posterior ligamentous complex injury in thoracolumbar fracture patients.

Reliability of the thoracolumbar injury classification and severity score compared with the McAfee classification among young neurosurgeons

Objective: The reliability of the thoracolumbar injury classification and severity (TLICS) score is well established; however, its reliability among young neurosurgeons in particular has not been investigated. This study was designed to identify intra- and inter-observer differences between the TLICS system and the McAfee classification among young neurosurgeons, with the goal of facilitating communication between physicians and treatment decision-making for patients with thoracolumbar injuries.Methods: Six young neurosurgeons reviewed thoracolumbar spinal fracture patients between January 2016 and October 2020 and analyzed thoracolumbar fractures according to the 2 classification systems. The intra- and inter-observer reliability of the TLICS and the McAfee scale was assessed with the Cohen and Fleiss kappa tests.Results: The intra-observer kappa value for the TLICS exhibited excellent reliability (κ=0.85) compared to the McAfee classification (κ=0.79). The inter-observer kappa values for each category of the TLICS were 0.69 (morphology), 0.93 (neurologic status), 0.74 (posterior ligamentous complex), and 0.72 (total score). The kappa value of the McAfee classification was lower (κ=0.52).Conclusion: The TLICS system showed higher reliability than the McAfee classification. The TLICS score showed more consistent results for thoracolumbar spinal fractures and may thus serve as a guideline for young neurosurgeons in treating patients with thoracolumbar fractures.

Comparison of the Outcomes between AO Type B2 Thoracolumbar Fracture with and without Disc Injury after Posterior Surgery.

ObjectiveThe type AO B2 thoracolumbar fracture is a kind of flexion‐distraction injury and the effect of disc injury on treatment results of patients with B2 fracture remains unclear. The objective of the current study was to compare and analyze the outcomes in AO Type B2 thoracolumbar fracture patients with and without disc injuries in terms of the Cobb angle of kyphosis, the incidence of complication, and the rate of implant failure.MethodsThis is a retrospective study. Of the 486 patients with thoracolumbar fractures who underwent posterior fixation, 38 patients with AO type B2 injuries were included. All the patients were divided into two groups according to changes in the adjoining discs. Disc injury group A included 17 patients and no disc injury group included 21 patients. Clinical and radiologic parameters were evaluated before surgery, after surgery, and at follow‐up. Clinical outcomes included visual analogue scale (VAS) scores, incidence of complications, and incidence of implant failure. Radiologic assessment was accomplished with the Cobb angle (CA), local kyphosis (LK), percentage of anterior vertebral height (AVBH%), intervertebral disc height, and intervertebral disc angle. Fisher's precision probability tests were employed and chi square test were used to compare categorical variables. Paired sample t tests and independent‐sample t tests were used to compare continuous data.ResultsDisc injury mainly involved the cranial disc (15/19, 78.9%). The mean follow‐up period for the patients was 30.2 ± 20.1 months. No neurologic deterioration was reported in the patients at the last follow‐up. Radiological outcomes at the last follow‐up showed significant differences in the CA (18.59° ± 13.74° vs 8.16° ± 9.99°, P = 0.008), LK (12.74° ± 8.00° vs 6.55° ± 4.89°, P = 0.006), and %AVBH (77.16% vs 90.83%, P = 0.01) between the two groups.Implant failure occurred after posterior fixation in five patients with disc injury who did not undergo interbody fusion during the initial surgery. Additionally, in the subgroup analysis, interbody fusion in the implant failure group were significantly different than in the no implant failure group (0% vs 75%, P = 0.009).ConclusionsAO B2 fracture patients with disc injury have higher risk of complications, especially implant failure after posterior surgery. Interbody fusion should be considered in AO type B2 fracture patients with disc injury.

The Difference of Disease Injury and Postoperative Recovery in the Occupational Characteristics of Thoracolumbar Fracture Patients: A Retrospective Study.

ObjectivesUnderstanding the occupational characteristics of patients is not only related to patients' life and health, but also conducive to improving their happiness. However, there were no studies that had been conducted on the relationship between occupation characteristic and postoperative recovery in patients with spinal fractures. The purpose of this study was to explore the relationship between the occupation characteristics of patients with thoracolumbar fracture and the characteristics of disease injury, treatment, and recovery so as to reduce the incidence and improve postoperative rehabilitation.MethodsPatients (n = 719) with thoracolumbar fractures were recruited. Patients were grouped according to the characteristic of occupations: unemployed group (n = 299), white‐collar worker group (n = 20), and blue‐collar worker group (n = 400). Data were collected, including the characteristics, injury and treatment information, and the recovery records for 1 year after operation. One‐way ANOVA analysis, χ 2 test, and binary logistic regression analysis was used to explore the relationship among these factors.ResultsMale, high‐falling injuries and single segment injury (mainly T 11, T 12 and L2) were common in patients with thoracolumbar fractures, especially in the blue‐collar worker group (70.8%, 78.3%, and 85.4%). Compared with the unemployed group, the patients in the white‐collar worker group and blue‐collar worker group had a higher proportion of young patients, a higher height and weight, a lesser rate of hypertension or diabetes. One week after injury, 73.4% of patients underwent surgery, with the blue‐collar worker group accounted for the largest proportion. One month after surgery, 77.1% of patients were able to get out of bed, with the white‐collar worker group accounted for the largest proportion. In the postoperative recovery information, patients in the blue‐collar worker group were more likely to have severe low back pain (OR = 2.023, 95% CI: 1.440‐2.284) and pain‐disturbed sleep (OR = 2.287, 95% CI: 1.585‐3.299) than those who in the unemployed group.ConclusionsBlue‐collar workers, with a high risk of thoracolumbar fracture, have a higher incidence of low back leg pain and pain‐disturbed sleep in the recovery after thoracolumbar fracture surgery, and this requires more attention.

Minimally invasive short segment pedicle screw fixation for Thoraco-Lumbar Trauma: Where we stand?

Background &amp; Overview of Literature: Use of MISS or Percutaneous pedicle screws for thoracolumbar trauma has shown superiority in terms of postoperative pain, blood loss, operating time, hospital stay and incision size as compared to open surgical method. The use of MISS in thoracolumbar trauma has been limited due to the high cost and lack of posterolateral fusion. There is conflicting evidence for and against the use of MISS in AO spine A3/A4 fractures without any neurological deficit and maybe managed conservatively as well. Purpose: To establish efficacy and safety of MISS, short segment pedicle screw fixation in patients of thoraco-lumbar fractures but without any neurological deficit. Study Design: Retrospective case reports of 2 years in which 20 patients of thoraco-lumbar trauma that underwent minimally invasive short segment spine fixation were included. Material &amp; Methods: Retrospective analysis of 20 patients of thoraco-lumbar spine fractures that were operated from 2017 to 2019 at Government Medical College &amp; Hospital, Chandigarh. Patients included were in the age group of 23-70 years, operated within one week of trauma, AO type A3 and A4, and operated using short segment fixation. Our exclusion criteria were trauma more than one week old, multiple levels of fractures and non-traumatic fractures. Clinical and radiological data were collected and tabulated. Results: Most patients (8 out of 20) had fracture of D12 vertebra. 18 out of 20 patients were involved in a road traffic accident. The mean blood loss was 25.78 mL. Cobb’s angle was used to measure focal deformity and the average gain in Cobb’s angle after surgery was 10.9°. Mean loss in correction was 2.35°. All patients were pain-free after 6 months as measured on the VAS score. The average time taken in getting back to work after surgery was 26 days. Conclusion: MISS is the ideal treatment of choice in patients of thoraco-lumbar spine trauma without any neurological deficit. MISS provides higher safety, early mobilization, less blood loss during surgery, shorter recovery time, and less post-operative pain.

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.

A Prospective Study of Posterior (Transpedicular) Approach versus Anterior (Transthoracic/Thoracoabdominal) Approach for Posttraumatic Compression Fracture of Thoracolumbar Vertebra in a Tertiary Care Center: Comparison of Clinical and Radiological Outcomes

Abstract Objective The aim of this article was to analyze the clinical and radiological outcomes of transpedicular decompression (posterior approach) and anterolateral approach in patients with traumatic thoracolumbar spinal injuries. Materials and Methods It was a prospective study of patients with fractures of dorsolumbar spine from December 2011 to December 2013. A total of 60 patients with traumatic spinal injuries were admitted during the study period (December 2011–2013), of which 51 cases were finally selected and taken for operations while 3 were eventually lost in follow-up. Twenty patients were operated by anterolateral approach, titanium mesh cage, and fixation with bicortical screws. Twenty-eight patients were treated with posterior approach and transpedicular screw fixation. Clinical and radiographic evaluations were performed on all 48 patients before and after surgery. Results There were 48 patients of thoracolumbar burst fractures with 40 male and 8 female patients. Range of follow-up was from 1 month to 20 months, with a mean of 7.4. Preoperatively in anterior group, 65% of the patients were bed ridden, 20% patients were able to walk with support, and 15% of the patients were able to walk without support. In posterior group, 78.57% patients were bed ridden, 10.71% were able to walk with support, and 10.71% patients were able to walk without support. Kyphotic angle changes were seen in 16 patients out of 18 in anterior group and 20 patients in posterior group out of 25. Out of 18 patients in anterior group, 14 showed reduction in kyphotic angle of 10 to 100 (improvement), with mean improvement of 4.070. In posterior group, 7 patients showed improvement of 10 to 80 (reduction in kyphotic angle) whereas 13 patients showed deterioration of 1 to 120. The mean improvement was 2.140 in 7 patients and mean deterioration was 4.920. No statistical difference was found (p &gt; 0.05) regarding improvement in urinary incontinence during the follow-up period. Conclusion There are significant differences in anterior and posterior approaches in terms of clinical improvement. Compared with posterior approach, the anterolateral approach can reduce fusion segment and well maintain the kyphosis correction. The selection of treatment should be based on clinical and radiological findings, including neurological deficit.

Cortical Bone Trajectory Instrumentation with Vertebroplasty for Osteoporotic Thoracolumbar Compression Fracture.

Background: Osteoporotic spinal fractures commonly occur in elderly patients with low bone mineral density. In these cases, percutaneous vertebroplasty or percutaneous kyphoplasty can provide significant pain relief and improve mobility. However, studies have reported both the recurrence of vertebral compression fractures at the index level after vertebroplasty and the development of new vertebral fractures at the adjacent level that occur without any additional trauma. Pedicle screw fixation combined with percutaneous vertebroplasty has been proposed as an effective procedure for addressing osteoporotic thoracolumbar fractures. However, in osteoporotic populations, pedicle screws can loosen, pullout, or migrate. Currently, the efficacy of cortical bone trajectory screw fixation for osteoporotic fractures remains unclear. Thus, we assessed the effects of using cortical bone trajectory instrumentation with vertebroplasty on patient outcomes. Method: We retrospectively reviewed data from 12 consecutively sampled osteoporotic thoracolumbar fracture patients who underwent cortical bone trajectory instrumentation with vertebroplasty. Patients were enrolled beginning in October 2015 and were followed for >24 months. Result: The average age was 74 years, and the average dual-energy x-ray absorptiometry T-score was −3.6. The average visual analog scale pain scores improved from 8 to 2.5 after surgery. The average blood loss was 36.25 mL. All patients regained ambulation and experienced reduced pain post-surgery. No recurrent fractures or instrument failures were recorded during follow-up. Conclusions: Our findings suggest that cortical bone trajectory instrumentation combined with percutaneous vertebroplasty may be a good option for treating osteoporotic thoracolumbar fractures, as it can prevent recurrent vertebral fractures or related kyphosis in sagittal alignment.

Percutaneous fixation assisted by O-arm-based navigation for thoracolumbar fractures without neurologic deficits

Objective To investigate the clinical efficacy of percutaneous fixation assisted by O-arm-based navigation for thoracolumbar fractures without neurologic deficits. Methods A retrospective case control study was conducted to analyze the clinical data of 35 thoracolumbar fracture patients without neurologic deficits admitted to Henan Provincial People's Hospital from January 2018 to December 2018. There were 26 males and 9 females, aged 17-51 years, with an average age of 30.4 years. The injured segments were distributed at T11 in 10 patients, T12 in 15, L1 in 11, and L2 in 4 patients. A total of 19 patients (22 vertebrae, 98 pedicle screws) were treated with O-arm guided navigation assisted percutaneous internal fixation (Group A), and 16 patients (18 vertebrae, 82 pedicle screws) were treated with C-arm guided percutaneous internal fixation (Group B). The operation time, accuracy rate of nail placement, complications, Cobb angle of fracture vertebral body, visual analogue score (VAS) and Japanese Orthopaedic Association (JOA) score were recorded and compared before operation, 7 days after operation and at the last follow-up. Results The patients were followed up for 2-12 months [(7.2±2.9)months] in Group A and 3-13 months [(7.1±3.3)months] in Group B. The operation time was (70.5±11.2)minutes in Group A and (81.3±10.9)minutes in Group B (P 0.05). The VAS at day 7 after operation was (2.3±1.1)points and (2.8±1.0)points in Group A and Group B, respectively, while the VAS at the final follow-up was (0.7±0.7)points and (0.8±0.7)points in Group A and Group B respectively. The postoperative VAS was significantly decreased compared with the preoperative VAS (P 0.05). The JOA at day 7 after operation was (21.1±2.2)points and (21.8±2.5)points in Group A and Group B respectively, while the JOA at the final follow-up was (24.9±2.2)points and (23.8±1.9)points in Group A and Group B respectively. The postoperative JOA was significantly increased compared with the preoperative JOA (P 0.05). Conclusion For thoracolumbar fractures without neurologic deficits, percutaneous fixation assisted by O-arm-based navigation can shorten the operation time and deliver a higher accuracy rate in the placement of pedicle screws, in addition to the similar effects with percutaneous fixation assisted by C-arm in pain relief, function improvement and correction of fracture vertebral kyphosis. Key words: Spinal fractures; Fracture fixation, internal; Navigation

34. Timing of surgery for thoracolumbar spine trauma: patients without neurological injury

BACKGROUND CONTEXT Over 100,000 thoracolumbar fractures occur annually in North America, with presence of concurrent neurological injury associated with greater long-term morbidity and unemployment. Previous investigations document heterogeneity in timing-outcome studies for thoracolumbar fracture, with most studies failing to differentiate patients with neurological injury from those without. PURPOSE This study analyzes the effect of time from hospital admission to spinal fusion on mortality, in-hospital complications, length of stay (LOS), and hospital charges in a large population of thoracolumbar fracture patients with neurological injury. STUDY DESIGN/SETTING Retrospective cohort study of de-identified National Inpatient Sample data from 2004-2014. PATIENT SAMPLE Nonelective cases containing ICD-9-CM diagnosis codes for closed thoracic/lumbar spinal fracture with concurrent neurological injury (806.20-806.29, 806.4) and procedure codes for primary thoracolumbar/lumbosacral fusion (81.04-81.08). Patients with diagnosis codes for any open, cervical, or sacral spinal fractures or any neurological injury of a non-thoracolumbar region were excluded. OUTCOME MEASURES In-hospital mortality and complications were primary measures. Inpatient surgical complication subtypes included all complications, cardiac complications, intraoperative hemorrhage or hematoma formation, respiratory complications, and postoperative infections. In 19,136 patients analyzed, patients undergoing surgery within 72 hours (n=12,845) had the lowest odds of in-hospital complications (OR=0.834; 95% CI, 0.697-0.999), cardiac complications (OR=0.573; 95% CI, 0.350-0.937), respiratory complications (OR=0.442; 95% CI, 0.282-0.691), and postoperative infection (OR=0.573; 95% CI, 0.366-0.899). No significant differences in outcomes were observed between same-day surgery (n=4,724) and 1-2-day delay (n=8,121). A ≥7-day delay in thoracolumbar fusion (n=2,002) was associated with the greatest odds of intraoperative hemorrhage or hematoma formation (OR=2.471; 95% CI, 1.351-4.517), respiratory complications (OR=1.909; 95% CI, 1.125-3.241), and postoperative infection (OR=3.559; 95% CI, 2.162-5.859). Greater than 7-day delay to fusion was also associated with the highest total and postoperative LOS and total charges (all p METHODS Classification of time from hospital admission to fusion: Same-day, 1-2-day delay, 3-6-day delay, and ≥7-day delay. To reduce data confounding by patient health and stability status, validated injury severity scoring algorithm from the International Classification of Diseases Program for Injury Categorization was used. Survey-design-weighted logistic regressions were performed to assess the effect of surgical timing on the primary inpatient outcomes, controlling for age, sex, fusion approach, and multi-organ-system injury severity score. Using the same controls, survey-design-weighted linear regressions were performed to assess the effect of surgical timing on secondary inpatient outcomes. RESULTS In 19,136 patients analyzed, patients undergoing surgery within 72 hours (n=12,845) had the lowest odds of in-hospital complications (OR=0.834; 95% CI, 0.697-0.999), cardiac complications (OR=0.573; 95% CI, 0.350-0.937), respiratory complications (OR=0.442; 95% CI, 0.282-0.691), and postoperative infection (OR=0.573; 95% CI, 0.366-0.899). No significant differences in outcomes were observed between same-day surgery and 1-2-day delay. A ≥7-day delay in thoracolumbar fusion was associated with the greatest odds of intraoperative hemorrhage/hematoma (OR=2.471; 95% CI, 1.351-4.517), respiratory complications (OR=1.909; 95% CI, 1.125-3.241), and postoperative infection (OR=3.559; 95% CI, 2.162-5.859). Greater than 7-day delay to fusion was also associated with the highest total and postoperative LOS and total charges (all p CONCLUSIONS While timing of spinal fusion following thoracolumbar fracture with neurological injury was not associated with mortality, patients who underwent surgery in ≤3 days after admission experienced fewer in-hospital complications, including hemorrhage, hematoma, respiratory complications, and postoperative infection. These benefits may be due to secondary injury mechanism avoidance and earlier mobilization. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

흉추 및 요추 압박골절 환자의 통증 감소에 대한 한의학적 치료 효과 : 후향적 관찰연구

The aim of the study was to investigate the effect of Korean medicine treatments on pain reduction of thoracolumbar compression fracture patients. We analysed 48 patients who have been diagnosed as thoracolumbar compression fracture on Computed Tomography(CT) or Magnetic Resonance Imaging(MRI) scan and had admitted to Dunsan Korean Medical hospital from January 1,2014 to April 4, 2017. The analysis was conducted as retrospective study which analyzes patient

Wiltse Approach versus Conventional Open Approach in Neurologically Intact Patients with Thoracolumbar Fractures: Clinical and Radiological Outcome Study

Background Data: Percutaneous screws fixation became popular as it depends on minimal muscle destruction and no para-spinal muscle stripping. However, there is a lot of disadvantages of percutaneous fixation technique including the high radiation exposure. Complications reported in conventional midline approach including muscle stripping from lamina and spinous processes and long-term postoperative pain and muscle weakness led the spine surgeon to rediscover minimally invasive technique to manage spinal fractures through posterior approach. One of these techniques is Wiltse technique which access the pedicle through blunt dissection between the longissimus muscle and multifidus muscle.Purpose: This study aims to compare pedicle screw fixation via Wiltse approach, and the traditional posterior midline approach outcome.Study Design: Prospective comparative study.Patients and Methods: A total of 36 patients of single-level thoracolumbar fractures without neurologic injury underwent pedicle screw fixation using two different approaches. Twenty patients were treated using conventional technique (Group 1 ), and 16 patients were operated using Wiltse technique (Group 2 ). Screw placement accuracy rate, operative time, blood loss, postoperative hospitalization time, radiation exposure time, postoperative improvement of Cobb angle for regional kyphosis, functional disability index using Oswestry Disability Index, and Visual Analogue Scale (VAS) of the two groups were compared.Results: There were no significant differences in the accuracy rate of pedicle screw placement, radiation exposure and Cobb angle improvement between the two groups. However, the Wiltse technique had obvious advantages over the conventional technique in operative time, blood loss, hospitalization time, ODI improvement and postoperative short-term improvement in VAS.Conclusion: Our data suggest that pedicle screw insertion using Wiltse technique for treatment of thoracolumbar fracture has the advantages of less tissue trauma, short operative and rehabilitative time on the premise of guaranteed accuracy rate and no significant increased radiation exposure. (2018ESJ160)

Magnetic resonance imaging evaluation of intervertebral disc injuries can predict kyphotic deformity after posterior fixation of unstable thoracolumbar spine injuries.

The aim of the present study is to identify factors correlated with kyphotic deformity after thoracolumbar spine injuries. We performed a retrospective case–control study with data from thoracolumbar spine fracture patients who were treated with posterior spinal fixation. Patients with a follow-up period shorter than 6 months and who experienced low-energy trauma were excluded. Intervertebral disc injuries (IDIs) were graded from 0 to 3 upon admission in accordance with Sander's classification of traumatic intervertebral disc lesions. Vertebral wedge angles (VWAs) and local kyphosis angles (LKAs) were also measured. Patients were allocated to kyphosis and control groups if they had LKA correction losses of ≥10° and <10°, respectively. Forty-eight patients followed over a median period of 25 months were included. The median correction loss at the site of the injured vertebral body was 2.0°. The median LKA correction loss was 9.0°. Twenty-three and 25 patients were allocated to the kyphosis and control groups, respectively. Univariate analysis revealed that the median age was significantly lower in the kyphosis (35 years) than control group (56 years). The level of injury and IDI severity also significantly differed between groups, with a significantly greater proportion of more severe IDI cases in the kyphosis than control group. Finally, significantly more patients in kyphosis group underwent fusion (kyphosis, 19 vs control, 13) and implant removals (kyphosis, 19 vs control, 10). Multiple regression analysis revealed that IDI severity according to Sander's classification (P = .005; odds ratio, 5.263; 95% confidence interval [CI], 1.637–16.927) and implant removal (P = .011; odds ratio, 7.980; 95% CI, 1.603–39.728) were significantly associated with kyphotic deformity. IDI severity at initial magnetic resonance imaging (MRI) evaluation and implant removal are associated with kyphotic deformity after posterior fixation of thoracolumbar spine injuries. Thus, initial MRI evaluation of IDIs could be used to predict of recurrent kyphosis.

Clinical Effects of Posterior Limited Long-Segment Pedicle Instrumentation for the Treatment of Thoracolumbar Fractures

ABSTRACTObjective: The purpose of this study was to assess the clinical effects of treating thoracolumbar fractures with posterior limited long-segment pedicle instrumentation (LLSPI). Methods: A total of 58 thoracolumbar fracture patients were retrospectively analyzed, including 31 cases that were fixed by skipping the fractured vertebra with 6 screws using LLSPI and 27 cases that were fixed by skipping the fractured vertebra with 4 screws using short-segment pedicle instrumentation (SSPI). Surgery time, blood loss, hospital stay, Oswestry disability index (ODI), neurological function, sagittal kyphotic Cobb angle (SKA), percentage of anterior vertebral height (PAVH), instrumentation failure, and the loss of SKA and PAVH were recorded before and after surgery. Results: No significant differences were observed in either the surgery time or hospital stay (P < 0.05), while there were significant differences in blood loss between the two groups. At the final follow-up, both the ODI and the neurological status were notably improved compared to those at the preoperative state (P < 0.05), but the difference between the two groups was relatively small. Furthermore, the SKA and PAVH were notably improved at the final follow-up compared to postoperative values (P < 0.05), but no significant difference was observed between the two groups. During long-term follow-up, the loss of SKA and PAVH in the LLSPI group was significantly less than that in the SSPI group (P < 0.05). Conclusion: Based on strict criteria for data collection and analysis, the clinical effects of LLSPI for the treatment of thoracolumbar fractures were satisfactory, especially for maintaining the height of the fractured vertebra and reducing the loss of SKA and instrumentation failure rates.

Epidemiological profile of thoracolumbar fracture (TLF) over a period of 10 years in Tianjin, China

Context/Objective: The objective of the research was to illustrate the epidemiology profile of thoracolumbar fracture (TLF) in Tianjin Medical University General Hospital, China, from 2006–2015.Design: Hospital-based retrospective study.Setting: Tianjin Medical University General Hospital.Methods: Medical records of inpatient patients with TLF from 1 January 2006 to December 2015 were collected. Detailed information on epidemiological characters were analyzed based on the medical records suffering from TLF from T11-L2 level, including incidence, age and sex, marital, occupation, etiology and fracture type, types of injuries.Results: Totally 132 cases were identified. The incidence rate was 2.4 patient per million population at 2015. Male-to-female ratio was 1.4:1, with a mean age of 49.1 ± 17.7 years. The cases number in 46–60 group, totally 35 and accounting for 26.5%, was the largest. There is a significant differences of cases number between 2011–2015 group and 2006–2010 group. Retiree, taken up 48.5%, was the largest group among TLF patients. The most common injury level was T12 (34) accounting for 25.7%. Falls (57, 43.2%) (low falls and high falls) were the leading causes, followed by motor vehicle collisions (MVCs) (23, 17.4%).Compression is the only type of osteoporosis and took up 55.3%.Conclusions: The incidence ratio is increased annually in TMUGH. Male was more vulnerable than female based on different social character. The average age was older in 2011–2015, retiree accounted for the main proportion and compression took up the largest percentage, the mean age increased and osteoporosis takes more in recent years.

Clinical study of abdominal acupoint massage combined with sticking therapy in the treatment of constipation after thoracolumbar fracture

Objective To investigate the clinical effect of massage combined with abdominal acupoint sticking therapy in the treatment of constipation after thoracolumbar fractures. Methods 50 thoracolumbar fracture patients with constipation were selected as the research subjects.According to the computer random grouping, all patients were divided into two groups, 25 cases in each group.The control group received phenolphthalein tablets.The observation group underwent abdominal acupoint massage and sticking therapy treatment.The two groups were treated for a course of 7 days.The clinical curative effect, defecation feeling, stool, defecation frequency and number of vector gas were compared between the two groups. Results After treatment, the proportions of defecation and carefree, laborious and soft, dry in the observation group were 76.00%, 24.00%, 88.00%, 12.00%, respectively, compared with the control group, there were statistically significant differences (χ2=6.65, 6.35, all P<0.01). The total improvement rate after treatment in the observation group was 96.00%, which was significantly higher than 72.00% in the control group(χ2=5.36, P=0.02). After treatment for 48 hours and 72 hours, the frequency of defecation and the number of vector gas times in the observation group were higher than the control group(t=6.22, 22.37, 10.29, 8.97, all P<0.05). Conclusion Abdominal acupoint massage combined with sticking therapy in the treatment of constipation after thoracolumbar fractures has significant clinical effect. Key words: Constipation; Phenolphthalein tablets; Acupoint sticking therapy; Massage; Lumbar vertebrae

Percutaneous kyphoplasty for the treatment of distal lumbosacral pain caused by osteoporotic thoracolumbar vertebral fracture.

Background Kyphoplasty has been demonstrated to be minimally invasive and effective in treating osteoporotic vertebral fracture patients with back pain over the level of the fractured vertebrae. Rare studies have reported on thoracolumbar vertebral fracture patients presenting with distal lumbosacral pain (DLP). Whether kyphoplasty had a favorable therapeutic benefit for these patients remains unclear. Purpose To evaluate the therapeutic efficacy of kyphoplasty in treating osteoporotic thoracolumbar vertebral fracture (OTVF) patients with DLP and assess the clinical significance of focal tenderness to palpation in these patients. Material and Methods Thirty-two OTVF patients who only complained of DLP were treated by kyphoplasty. The vertebral heights, local kyphotic angle, Visual Analogue Scale (VAS), and Oswestry Disability Index (ODI) scores were assessed preoperatively, one day after surgery, and at last follow-up. All patients were evaluated regarding their degree of satisfaction with kyphoplasty. In addition, we compared the therapeutic efficacy of kyphoplasty in patients with and without focal tenderness to palpation. Results All patients successfully underwent kyphoplasty without complications. The vertebral heights, local kyphotic angles, VAS, and ODI scores were all significantly improved after kyphoplasty and maintained at last follow-up in our patients ( P < 0.001). At last follow-up, all patients expressed satisfaction with kyphoplasty. No significant differences in these parameters were detected between patients with and without focal tenderness. Conclusion The possibility of thoracolumbar vertebral fractures in elderly patients complaining of DLP should not be neglected. Kyphoplasty presents a superior benefit in treating OTVF patients with DLP. The absence of focal tenderness does not influence the clinical efficacy in these patients.