Thoracolumbar Spine Fractures Research Articles

Current concepts in management for fractures of thoracolumbar spine

Thoracolumbar fractures are common in high energy trauma patients and could be divided into compression fractures, burst fractures, flexion-distraction injury, and fracture dislocations. A comprehensive evaluation of the patient is crucial including end-to-end motor and sensation examination and possible associated injuries. The current treatment methods are still controversial. The goal of treatment is to restore proper alignment and mechanical stability, to induce neurological recovery, and to achieve early mobilization and rehabilitation. The stability of the spine, the neurological status, and the integrity of the posterior ligament complex (PLC) are the keys to determine the treatment policy. The role of percutaneous posterior fixation without arthrodesis increased in recent years. But it is still controversial for the use of these treatments and there is no verified evidence for long-term results yet. The necessity of decompression and the treatment methods in regards to the degree of neurologic injury is discussed as well. Generally, early decompression within 24 hours over incomplete spinal cord injury is recommended.

Treatment of Thoracolumbar Spinal Fracture Accompanied by Diffuse Idiopathic Skeletal Hyperostosis Using Transdiscal Screws for Diffuse Idiopathic Skeletal Hyperostosis: Preliminary Results.

Study DesignThis retrospective case series enrolled 13 patients who underwent posterior fixation with both transdiscal screws for diffuse idiopathic skeletal hyperostosis (TSDs) and pedicle screws (PSs) to treat spinal injury accompanied by diffuse idiopathic skeletal hyperostosis (DISH).PurposeTo describe the usefulness, feasibility, and biomechanics of TSD.Overview of LiteratureVertebral bodies accompanied by DISH generally have lower bone mineral density than normal vertebral bodies because of the stress shielding effect. This phenomenon tends to makes screw fixation challenging. To our knowledge, solutions for this issue have not previously been reported.MethodsPatients were assessed using the data on surgical time, estimated intraoperative blood loss, mean number of stabilized intervertebral segments, number of screws used, perioperative complications, union rate, and the three-level EuroQol five-dimensional questionnaire (EQ5D-3L) score at the final follow-up. The Hounsfield unit (HU) values of the screw trajectory area, and the actual intraoperative screw insertion torque of TSDs and PSs were also analyzed and compared.ResultsThe surgical time and estimated intraoperative blood loss were 165.9±45.5 minutes and 71.0±53.4 mL, respectively. The mean number of stabilized intervertebral segments was 4.6±1.0. The number of screws used was 4.9±1.3 for TSDs and 3.0±1.4 for PSs. One death occurred after surgery. The union rate and EQ5D-3L scores were 100% and 0.608±0.128, respectively. The HU value and actual intraoperative screw insertion torque of TSDs were significantly better than those of PSs (p<0.001, p=0.033).ConclusionsWe were able to achieve stable surgical outcomes using the combination of TSDs and PSs. The HU value and actual intraoperative screw insertion torque were significantly higher for TSDs than for PSs. Based on these results, when treating thoracolumbar spinal fractures accompanied by DISH in elderly populations, the TSD could be a stronger anchor than the PS.

Minimally invasive lateral corpectomy for thoracolumbar traumatic burst fractures.

The need for anterior column reconstruction after thoracolumbar burst fractures remains controversial. Here, the authors present their experience with minimally invasive lateral thoracolumbar corpectomies for traumatic fractures. Between 2012 and 2019, 59 patients with 65 thoracolumbar fractures underwent 65 minimally invasive lateral corpectomies (MIS group). This group was compared to 16 patients with single-level thoracolumbar fractures who had undergone open lateral corpectomies with the assistance of general surgery between 2007 and 2011 (open control group). Comparisons of the two groups were made with regard to operative time, estimated blood loss, time to ambulation, and fusion rates at 1 year postoperatively. The authors further analyzed the MIS group with regard to injury mechanism, fracture characteristics, neurological outcome, and complications. Patients in the MIS group had a significantly shorter mean operative time (228.3 ± 27.9 vs 255.6 ± 34.1 minutes, p = 0.001) and significantly shorter mean time to ambulation after surgery (1.8 ± 1.1 vs 5.0 ± 0.8 days, p < 0.001) than the open corpectomy group. Mean estimated blood loss did not differ significantly between the two groups, though the MIS group did trend toward a lower mean blood loss. There was no significant difference in fusion status at 1 year between the MIS and open groups; however, this comparison was limited by poor follow-up, with only 32 of 59 patients (54.2%) in the MIS group and 8 of 16 (50%) in the open group having available imaging at 1 year. Complications in the MIS group included 1 screw misplacement requiring revision, 2 postoperative femoral neuropathies (one of which improved), 1 return to surgery for inadequate posterior decompression, 4 pneumothoraces requiring chest tube placement, and 1 posterior wound infection. The rate of revision surgery for the failure of fusion in the MIS group was 1.7% (1 of 59 patients). The minimally invasive lateral thoracolumbar corpectomy approach for traumatic fractures appears to be relatively safe and may result in shorter operative times and quicker mobilization as compared to those with open techniques. This should be considered as a treatment option for thoracolumbar spine fractures.

Man with trauma following motorcycle crash.

A 56-year-old male presented to the emergency department (ED) following a frontal impact motorcycle accident. The patient was pale with persistent hypotension, tachypnea, and tachycardia along with bilateral lower limbs paralysis and a complete loss of sphincter functions. Patient was intubated, and transesophageal echocardiography performed by attending emergency physician at ED critical care bayshowed the transverse and longitudinal view of the descending aorta with hypoechoic, well-defined, crescent-shaped thickening of anterior aortic wall suggestive of intramural hematoma (Figures 1, 2; Supporting Information Videos S1 and S2). Computed tomography (CT) showed fracture T11 vertebra, intramural hematoma, and peri-aortic hematoma along the arch of the aorta extending down to upper abdominal aorta at the level of T12 (Figure 3). Traumatic thoracolumbar spine fracture with a concomitant blunt aortic injury is uncommon (1.4%) but potentially fatal.1 Most fractures associated with blunt traumatic aortic injury occurred at the level of T11–L2 vertebra (62%).1 ED transesophageal echocardiography is a potential new imaging adjunct in resuscitation.2-4 Even though the surface ultrasound has become an important bedside imaging tool in initial management of trauma patients in ED, its limitations include poor evaluation of vascular pathologies (ie, BTAI).5 The role of ED transesophageal echocardiography for the early detection of BTAI in hemodynamically unstable trauma patient was reported by Osman et al.6 The patient was managed conservatively and was discharged from spinal intensive care unit after day 10. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Radiological diagnostics of lumbar spine fractures

The lumbar spine forms the lowermost part of the mobile spinal column. Due to anatomical properties, the lumbar spine is highly flexible in the sagittal directions, thus, rendering it susceptible to both flexion and extension forces with the thoracolumbar junction being the most vulnerable part of it. To date, the modern thoracolumbar spine fracture classification is given by the AOSpine classification system based on the well-known Magerl classification of vertebral fracture morphology but now includes both neurological criteria and clinical modifiers, such as ankylosing spondylitis. Whereas plain radiography remains amainstay in the diagnostic evaluation of low-energy trauma patients, computed tomography (CT) exhibits its unsurpassed power in polytrauma and plays adecisive role in all equivocal cases where the osseous situation is unclear. However, magnetic resonance imaging (MRI) is increasingly gaining importance for assessing both discoligamentous integrity and intraspinal condition. Both CT and MRI have direct input in classifying fractures according to the AOSpine classification. Regarding fracture morphology, three main types(A-C) based on the stability are distinguished. C‑type spinal injuries are all considered unstable, irrespective of type and severity of vertebral malalignment. Injuries to the anterior and posterior ligamentous complex are also considered to interfere with stability (B-type injuries). Special fracture patterns of the injured ankylosed and osteoporotic spine as well as of the pediatric lumbar spine are discussed. Asurvey is also given about several differential diagnoses (malignant fractures, anomalies, normal variants).

Early Spinal Injury Stabilization in Multiple-Injured Patients: Do All Patients Benefit?

Background: Thoracolumbar spine fractures in multiple-injured patients are a common injury pattern. The appropriate timing for the surgical stabilization of vertebral fractures is still controversial. The purpose of this study was to analyse the impact of the timing of spinal surgery in multiple-injured patients both in general and in respect to spinal injury severity. Methods: A retrospective analysis of multiple-injured patients with an associated spinal trauma within the thoracic or lumbar spine (injury severity score (ISS) >16, age >16 years) was performed from January 2012 to December 2016 in two Level I trauma centres. Demographic data, circumstances of the accident, and ISS, as well as time to spinal surgery were documented. The evaluated outcome parameters were length of stay in the intensive care unit (ICU) (iLOS) and length of stay (LOS) in the hospital, duration of mechanical ventilation, onset of sepsis, and multiple organ dysfunction syndrome (MODS), as well as mortality. Statistical analysis was performed using SPSS. Results: A total of 113 multiple-injured patients with spinal stabilization and a complete dataset were included in the study. Of these, 71 multiple-injured patients (63%) presented with an AOSpine A-type spinal injury, whereas 42 (37%) had an AOSpine B-/C-type spinal injury. Forty-nine multiple-injured patients (43.4%) were surgically treated for their spinal injury within 24 h after trauma, and showed a significantly reduced length of stay in the ICU (7.31 vs. 14.56 days; p < 0.001) and hospital stay (23.85 vs. 33.95 days; p = 0.048), as well as a significantly reduced prevalence of sepsis compared to those surgically treated later than 24 h (3 vs. 7; p = 0.023). These adverse effects were even more pronounced in the case where cutoffs were increased to either 72 h or 96 h. Independent risk factors for a delay in spinal surgery were a higher ISS (p = 0.036), a thoracic spine injury (p = 0.001), an AOSpine A-type spinal injury (p = 0.048), and an intact neurological status (p < 0.001). In multiple-injured patients with AOSpine A-type spinal injuries, an increased time to spinal surgery was only an independent risk factor for an increased LOS; however, in multiple-injured patients with B-/C-type spinal injuries, an increased time to spinal surgery was an independent risk factor for increased iLOS, LOS, and the development of sepsis. Conclusion: Our data support the concept of early spinal stabilization in multiple-injured patients with AOSpine B-/C-type injuries, especially of the thoracic spine. However, in multiple-injured patients with AOSpine A-type injuries, the beneficial impact of early spinal stabilization has been overemphasized in former studies, and the benefit should be weighed out against the risk of patients’ deterioration during early spinal stabilization.

Possible advantages of early stabilization of spinal fractures in multiply injured patients with leading thoracic trauma\xa0- analysis based on the TraumaRegister DGU\xae

BackgroundMajor trauma often comprises fractures of the thoracolumbar spine and these are often accompanied by relevant thoracic trauma. Major complications can be ascribed to substantial simultaneous trauma to the chest and concomitant immobilization due to spinal instability, pain or neurological dysfunction, impairing the respiratory system individually and together. Thus, we proposed that an early stabilization of thoracolumbar spine fractures will result in significant benefits regarding respiratory organ function, multiple organ failure and length of ICU / hospital stay.MethodsPatients documented in the TraumaRegister DGU®, aged ≥16 years, ISS ≥ 16, AISThorax ≥ 3 with a concomitant thoracic and / or lumbar spine injury severity (AISSpine) ≥ 3 were analyzed. Penetrating injuries and severe injuries to head, abdomen or extremities (AIS ≥ 3) led to patient exclusion. Groups with fractures of the lumbar (LS) or thoracic spine (TS) were formed according to the severity of spinal trauma (AISspine): AISLS = 3, AISLS = 4–5, AISTS = 3 and AISTS = 4–5, respectively.Results1740 patients remained for analysis, with 1338 (76.9%) undergoing spinal surgery within their hospital stay. 976 (72.9%) had spine surgery within the first 72 h, 362 (27.1%) later on. Patients with injuries to the thoracic spine (AISTS = 3) or lumbar spine (AISLS = 3) significantly benefit from early surgical intervention concerning ventilation time (AISLS = 3 only), ARDS, multiple organ failure, sepsis rate (AISTS = 3 only), length of stay in the intensive care unit and length of hospital stay. In multiple injured patients with at least severe thoracic spine trauma (AISTS ≥ 4) early surgery showed a significantly shorter ventilation time, decreased sepsis rate as well as shorter time spend in the ICU and in hospital.ConclusionsMultiply injured patients with at least serious thoracic trauma (AISThorax ≥ 3) and accompanying spine trauma can significantly benefit from early spine stabilization within the first 72 h after hospital admission. Based on the presented data, primary spine surgery within 72 h for fracture stabilization in multiply injured patients with leading thoracic trauma, especially in patients suffering from fractures of the thoracic spine, seems to be beneficial.

Thoracolumbar spinal fractures associated with ground level falls in the elderly: An analysis of 254,486 emergency department visits

Study designretrospective. ObjectivesTo investigate the epidemiology of elderly (age ≥65 years) patients who presented to the emergency department (ED) in the United States with thoracolumbar (TL) fractures after ground level falls. MethodsUsing the National Emergency Department Sample database, we queried all ED visits in the United States from 2009 through 2012 of elderly patients who presented after ground level falls. We identified patients who sustained TL fractures with and without neurological injury. Resulting data was used to analyze the fracture prevalence, ED and patient characteristics, associated injuries, treatment patterns, inpatient mortality, and hospital charges. ResultsOf the 6,654,526 ED visits in the elderly for ground level falls, 254,486 (3.8%) were associated with a diagnosis of TL fracture. 39% patients had multiple injuries, and upper extremity fractures were the most common associated injuries. Overall, 55.6% were admitted to the hospital. Of those, 77.7% were treated non-operatively, 20.4% were treated with cement augmentation alone, 1.5% were treated with spinal fusion surgery, and 0.4% were treated with spinal decompression alone. The overall rate of inpatient mortality was 2.14%. ConclusionsThis investigation evaluated the epidemiology of elderly patients who presented to the ED in the United States with TL fractures after ground level falls. The study demonstrated a rather high incidence of TL fractures in this patient cohort. As a result, it is important for ED physicians and orthopaedic surgeons to be highly suspicious of TL fractures in elderly patients who sustain low energy trauma. With the continued aging of the population and rising health care costs, future effort ought to focus on fall prevention and increased surveillance for TL injuries in the elderly.

Exploration and Discussion on the Clinical Therapeutic Effects of the Application of Cross-Injury Vertebral Fixation and Via-Injury Vertebrae Fixation in the Treatment of Bone Tumor with Thoracolumbar Spine Fracture

Objective: To explore and discuss the clinical therapeutic effects of the application of cross-injury vertebral fixation and via-injury vertebrae fixation in the treatment of bone tumor with thoracolumbar spine fracture. Methods: A total of 58 patients with bone tumors and thoracolumbar spine fractures admitted to our hospital from February to February 2019 were selected as the study subjects. They were randomly divided into control group and observation group, with 29 cases in each group. The patients in the control group received cross-injury vertebral fixation treatment, while the patients in the observation group were treated with via-injury vertebral fixation. The therapeutic effects of the two groups were compared. Results: The operation time and hospitalization time of the observation group were significantly shorter than those of the control group (P&lt;0.05), and the postoperative drainage volume of the intraoperative blood loss was significantly less than that of the control group (P&lt;0.05). There was no significant difference in postoperative pain and spinal JOA scores between the two groups (P&gt;0.05); there was no significant difference in the compression ratio of the injured vertebrae and the kyphosis Cobb angle between the two groups (P&gt;0.05), after the operation, the two groups of patients were significantly reduced, and the compression ratio of the injured vertebrae and kyphosis Cobb angle of the observation group were more obvious (P&lt;0.05); the vertebral height loss and Cobb angle loss in the observation group were significantly lower than those in the control group (P&lt;0.05). Conclusion: In the treatment of bone tumor with thoracolumbar spine fracture, compared with cross-injury vertebral fixation, via-injury vertebral fixation has a more significant clinical effect and is more suitable for clinical application and promotion.

Percutaneous Pedicle Fixation of Dorsolumbar Fractures without Neurological Deficits

Burst fractures are relatively common injuries in the thoracolumbar spine. However, treatment of AO type (A3) unstable thoracolumbar fractures is still controversial, especially for patients with no neurological deficits. to evaluate the efficacy and safety of percutaneous pedicle fixation using a minimally invasive technique for AO type (A.3) thoracolumbar fractures. This study was done on ten patients complaining of thoracolumbar spine fractures grade A3 at ages ranged from twenty to sixtyfive years old. Those patients were treated bypercutaneuos fixationThose effects of the surgical methodology were gathered instantly after surgery, et cetera during, Also after those catch up time. Every last one of effects might have been statistically investigated with get sure information Furthermore relationship the middle of them, difficulties might have been talked about if then afterward surgery alternately during the catch up period. The percutaneous pedicle obsession system displays radiological, clinical, Furthermore utilitarian comes about that need aid altogether superior to the distributed outcomes with preservationist medication. This intervention, helped Eventually Tom's perusing fluoroscopy, demonstrated should make An technobabble for An helter skelter correctness and reliability, with effects comparable on the individuals news person On investigations for the established transpedicular obsession in regards to the disfigurement correction, Yet predominant for respect to blood loss, postoperative rehabilitation, What's more return of the exercises for Every day living. The outcomes of this investigation demonstrate that this may be An valid, safe, Furthermore compelling medicine for (A3) thoracolumbar blast fractures without neurological deficits.

Characterization of all-terrain vehicle-related thoracolumbar spine injury patterns in children using the AOSpine classification system.

To evaluate thoracolumbar spine injury patterns, demographics, and clinical characteristics in pediatric patients following all-terrain vehicle-related trauma. A retrospective review of patients 0-17years old admitted to a level I trauma center following an ATV-related incident from 2004 to 2013 was performed. Thoracolumbar spine injury patterns, accident mechanism, driver/passenger status, and demographic and clinical data were compared between patients with and without a spine injury. Of 456 pediatric patients involved in ATV-related trauma, 36 sustained one or more thoracolumbar spine injuries (7.9%). These patients tended to be older, taller, heavier, and had a higher BMI. ATV rollover was the major statistically significant mechanism of injury to cause spine fractures (61%). Patients with spine injuries had twice the hospital length of stay compared with those without (4days vs. 2days, P = 0.003). Nonstructural spine injuries (A0) were the most common type of injury (49.1%), followed by wedge-compression fractures (A1) (41.1%). In patients with a thoracolumbar spine injury, there was a mean of 3.11 spine injuries per child. Four (10%) patients with thoracolumbar spine fractures also sustained a cervical spine fracture. Once a thoracolumbar spine injury has been detected in a patient, the entire spinal column should be scrutinized because there is a high likelihood for additional injuries throughout the spine. Younger pediatric patients (≤ 8years old) exhibit a spine fracture pattern distinct from that of older children who have a mature osseous-ligamentous complex.

Assessment of the Accuracy of the AO Spine-TL Classification for Thoracolumbar Spine Fractures Using the AO Surgery Reference Mobile App.

Study Design:Cohort study.Objectives:This study aimed to evaluate the accuracy of the AO Surgery Reference mobile app in the diagnosis of thoracolumbar fractures of the spine according to the AO TL classification, and to discuss the usefulness of this app in the teaching and training of the resident physicians in orthopedics and traumatology area.Methods:The 24 residents of Orthopedic and Traumatology program assessed 20 cases of thoracolumbar fractures selected from the hospital database on 2 different occasions, with a 30-day interval, and they classified these cases with and without using the AO Surgery Reference app. A group of spine experts previously established the gold standard and the answers were statistically compared, with the inter- and intraobserver reliability evaluated by the kappa index.Results:The use of the AO Surgery Reference app increased the classification success rate of the fracture morphology (from 53.4% to 72.5%), of the comorbidity modifier (from 61.4% to 77.9%) and of the neurological status modifier (from 55.1% to 72.9%). In addition, the mobile app raised the classification agreement and accuracy. The kappa index increased from 0.30 to 0.53 regarding the morphological classification of fractures.Conclusions:The residents improved their ability to recognize and classify thoracolumbar spine fractures, which reinforces the importance of this tool in medical education and clinical practice.

History, development and use of classification of thoracolumbar spine fractures.

The main goal of this comprehensive paper is to clarify the way of thoracolumbar spine The main goal of this summary paper is to describe the way of thoracolumbar spine injury classification development and to provide adetailed description of two of the most commonly used classifications - the Thoracolumbar Injury Classification and Severity Scale (TLICS) and the AOSpine Classification for Traumatic Fracture of the Thoracolumbar Spine, including their comparison and clarification of the merits introduced by the second one. The paper also formulates arecommendation of asimple algorithm enabling even less experienced clinicians to distinguish between an injury indicated for conservative treatment and one that requires surgery.

NUSS Procedure in a Patient who had Traumatic Thoracic Aortic Dissection and Thoracolumbar Spine Fracture: A Simple Modification

Nuss procedure, also known as minimally invasive repair of pectus excavatum (MIRPE), is a standard practice in modern surgery. Although initially, this procedure was recommended for the younger age group but nowadays, surgeons also practice in the older age group. Due to little modifications of the original Nuss procedure, the complications rate had markedly reduced. We report a case of 21 years male with pectus excavatum who had traumatic thoracic aortic dissection and fracture of the thoracic spine three years before presentation. He came to our hospital to correct pectus excavatum deformity. At the same time, he was refused by other hospitals due to previous aortic dissection treated with endovascular stent and thoracolumbar spines spine fixed with metallic bars. With a simple modification, MIRPE was performed safely, and the patient was discharged for follow up in outpatient with an excellent outcome.

Lubricin expression in the lumbar endplate and its association with Modic changes

ObjectiveTo explore the expression of lubricin in the lumbar endplate and its association with Modic changes (MCs). MethodsHuman endplate specimens harvested from patients undergoing surgery for thoracolumbar spine fractures ​or lumbar interbody fusion were divided into two groups: MCs group and normal group. Lubricin expression was examined by immunohistochemistry, and differences between the groups were analysed using quantitative polymerase chain reaction (qPCR). Lubricin expression and differences between endplates with MCs and normal endplates were confirmed using a rabbit model. In a final experiment, rabbit endplate chondrocytes were cocultured with Propionibacteria acnes (P. acnes) supernatant, and the expression of lubricin and endplate degeneration related genes were evaluated. In addition, the expression of matrix metalloproteinase 1(MMP-1), A disintegrin-like and metalloproteinase with thrombospondin type 5 motif (ADAMTS5) and inflammatory factors (Interleukin- 1β (IL-1β) and Interleukin-6 (IL-6)) were evaluated after lubricin overexpression. ResultsLubricin was found in human lumbar endplates and its expression was lower in the MCs group compared to the normal group. In the rabbit model, lubricin was also found in the endplate. In rabbits injected with P. acnes (the MCs group), lubricin expression of endplate decreased compared to the normal group. In the culture of rabbit endplate chondrocytes with P. acnes supernatant, the expression of lubricin, aggrecan, sox9 and collagen type-II decreased significantly, while that of MMP-1 and ADAMTS5 increased significantly. Moreover, lubricin overexpression could downregulate the expression of MMP-1, ADAMTS5 and inflammatory factors (IL-1β and IL-6) compared to negative control. ConclusionLubricin is present in the lumbar endplate where it may have an anti-inflammatory role. P. acnes infection inhibits lubricin expression by cartilage endplate cells and this may facilitate the progression of MCs and endplate degeneration. The translational potential of this articleLubricin may have an anti-inflammatory role. P. acnes infection inhibits lubricin expression by cartilage endplate cells and this may facilitate the progression of MCs and endplate degeneration.

Clinical Features and Treatment Outcomes of Acute Multiple Thoracic and Lumbar Spinal Fractures : A Comparison of Continuous and Noncontinuous Fractures.

ObjectiveThe treatment of multiple thoracolumbar spine fractures according to fracture continuity has rarely been reported. Herein we evaluate the clinical features and outcomes of multiple thoracolumbar fractures depending on continuous or noncontinuous status. MethodsFrom January 2010 to January 2016, 48 patients with acute thoracic and lumbar multiple fractures who underwent posterior fusion surgery were evaluated. Patients were divided into two groups (group A : continuous; group B : noncontinuous). We investigated the causes of the injuries, the locations of the injuries, the range of fusion levels, and the functional outcomes based on the patients’ general characteristics. ResultsA total of 48 patients were enrolled (group A : 25 patients; group B : 23 patients). Both groups had similar pre-surgical clinical and radiologic features. The fusion level included three segments (group A : 4; group B : 5) or four segments (group A : 19; group B : 5). Group B required more instrumented segments than did group A. Group A scored 23.5 and group B scored 33.4 on the Korean Oswestry Disability Index (KODI) at the time of last follow-up. In both groups, longer fusion was associated with worse KODI score. ConclusionIn this study, due to the assumption of similar initial clinical and radiologic features in both group, the mechanism of multiple fractures is presumed to be the same between continuous and noncontinuous fractures. The noncontinuous fracture group had worse KODI scores in long-term follow-up, thought to be due to long fusion level. Therefore, we recommend minimizing the number of segments that are fused in multiple thoracolumbar and lumbar fractures when decompression is not necessary.

Management of thoracolumbar fractures: A prospective study

Thoracolumbar fractures are breakages in the vertebrae of the spinal column in the thoracic and lumbar regions. They may be associated with disruption of the ligamentous complexes, and can result in instability or compression of neural structures. Thoracolumbar fractures are the usual outcome of thoracolumbar trauma. In the present study, Thoracolumbar spine fractures are more common in 31-40 years of life with male predominance due to outdoor activities, the commonest mode of injury was road traffic accident, In the present study, Type A fracture is more common at the level of L1. In this series 12 patients polyaxial pedicle screws were used and in 4 patients monoaxial with polyaxial pedicle screws were used. Fracture-dislocations of the thoracic and lumbar spine are caused by very high-energy trauma. They can be extremely unstable injuries that often result in serious spinal cord or nerve damage.

Severity and neurosurgical management of patients with traumatic spinal fractures in Saudi Arabia: a cross sectional study.

IntroductionRoad traffic accidents (RTAs) are the most frequent cause of traumatic spinal injuries (TSIs), which account for up to 33.6% of all spinal fractures. The Kingdom of Saudi Arabia (KSA) is one of the countries which has high rates of SCIs and bears the economic burden of that situation.Methods120 patients were included in this study, using a stringent set of inclusion and exclusion criteria. The patients were followed-up from the point of triage to admission and discharge. We analysed the clinical notes of the patients to determine the severity of their traumatic spinal injuries, the neurosurgical management carried out, and other prognosticating factors such as blood transfusion and the Glasgow Coma Scale (GCS). The data collected was analysed anonymously, and the confidentiality of all participants was respected.ResultsMost of the patients were young adults and adolescents under the age of 40 (n = 96). There was a male preponderance of 84.1%. With respect to spinal injury stratification, 55 patients had cervical spine fractures, 10 patients had cervical lacerations, 85 patients had thoracolumbar spinal fractures, and 10 patients had thoracolumbar spinal lacerations. 35 patients had other fractures documented. All 120 patients were followed up to assess the management of their traumatic spinal injuries. 66.6% (n= 80) of all patients were managed conservatively, whereas the remaining 33.3% (n=40) were managed surgically.ConclusionTrauma is an important cause of spinal injuries (TSIs), and untreated TSIs may lead to poor clinical outcome, especially if the cervical region is involved.

Open versus minimally invasive percutaneous surgery for surgical treatment of thoracolumbar spine fractures- a multicenter randomized controlled trial: study protocol

BackgroundThoracolumbar fractures are most frequent along the spine, and surgical treatment is indicated for unstable fractures. Percutaneous minimally invasive surgery was introduced to reduce the pain associated with the open posterior approach and reduce the morbidity of the procedure by avoiding damage and dissection of the paravertebral muscles. The goal of this study is to compare the surgical treatment of fractures of the thoracolumbar spine treated by the conventional open approach and the percutaneous minimally invasive approach using similar types of pedicle spine fixation systems.Methods/designsThis study is designed as a multi-center, randomized controlled trial of patients aged 18–65 years who are scheduled to undergo surgical posterior fixation. Treatment by the conventional open approach or percutaneous minimally invasive approach will be randomly assigned. The primary outcome measure is postoperative pain, which will be measured using the visual analogue scale (VAS). The secondary outcome parameters are intraoperative bleeding, postoperative drainage, surgery time, length of hospital stay, SF-36, EQ-5D-5 l, HADS, pain medication, deambulation after surgery, intraoperative fluoroscopy time, vertebral segment kyphosis, fracture vertebral body height, compression of the vertebral canal, accuracy of the pedicle screws, and breakage or release of the implants. Patient will be followed up for 1, 2, 3, 6, 12 and 24 months postoperatively and evaluated according to the outcomes using clinical and radiological examinations, plain radiographs and computed tomografy (CT).DiscussionSurgical treatment of thoracolumbar fractures by the open or percutaneous minimally invasive approach will be compared in a multicenter randomized study using similar types of fixation systems, and the results will be evaluated according to clinical and radiological parameters at 1, 2, 3, 6, 12 and 24 months of follow-up.Trial registrationClinicalTrial.gov approval number: 1.933.631, code: NCT03316703 in may 2017.

The surgical treatment strategies for thoracolumbar spine fractures with ankylosing spondylitis: a case report

BackgroundAnkylosing spondylitis (AS) is a chronic inflammatory disease that primarily affects spine and paraspinal soft tissue. Ankylosing spondylitis is one of the causes of osteoporosis and patients with ankylosing spondylitis tend to have spinal fractures due to limited mobility and osteoporosis. In recent years, due to the increase in the number of patients with AS, patients with AS and thoracolumbar spine fractures have gradually increased. In the past 1 year, we have treated 3 cases of AS with thoracolumbar spine fractures via simple posterior internal fixation and this paper aims to report its clinic effect.Case presentationAll the three patients selected had a history of ankylosing spondylitis for nearly 30 years, and one of them developed a thoracolumbar spine fracture after falling when he walked, and the other two developed a thoracolumbar spine fracture without any reason. They were hospitalized for “low back pain” and were diagnosed as fractures after careful physical examination and imaging examinations such as X-ray, CT, and MRI. After the preoperative preparation was completed, all the three patients underwent surgery with simple posterior internal fixation-reduction of the fracture and pedicle screw fixation via posterior approach. All the implants-pedicle screws and connecting rods-are made of titanium alloy. For postoperative management, we asked all the patients to stay in bed for 3 weeks after the operation, and then slowly move down with the help of crutches. Fracture healing and neurological function recovery were observed postoperatively. All the three patients recovered satisfactorily after surgery, and the follow-up confirmed that the fracture healed successfully after 3 months.ConclusionsThe 3 patients included 2 men and 1 women. All the 3 patients recovered well after surgery, and the follow-up confirmed that the fracture healed successfully after 3 months. One man developed urination dysfunction after operation and recovered to normal 3 months after rehabilitation exercise.