Thoracolumbar Trauma Research Articles

The Utility of In-Hospital Postoperative Radiographs Following Surgical Treatment of Traumatic Thoracolumbar Injuries.

A retrospective cohort study. The objective of this study was to assess the utility of routine in-hospital postoperative radiographs for identifying hardware failure following surgical treatment of traumatic thoracolumbar (TL) injuries. Postoperative radiographs following spine surgery are considered standard of care despite a lack of evidence supporting their utility. Previous studies have concluded that postoperative radiographs following lumbar fusion for degenerative conditions have limited clinical value. A retrospective chart review was performed on patients who underwent surgical treatment of traumatic TL injuries between December 2006 and October 2015 at a level I trauma center. Before discharge, postoperative upright anteroposterior and lateral radiographs were obtained and reviewed by 1 surgeon and 1 radiologist as per protocol. Patients who subsequently underwent revision surgery during their initial hospital stay were identified. These patients were further analyzed to identify the indications for surgery and determine if the results of the radiographs obtained led to the subsequent revision surgery. A total of 463 patients were identified who underwent surgical treatment following TL trauma. The rate of revision surgery during the initial hospitalization was 1.3% (6/463). Three patients underwent revision surgery due to worsening neurological status. One patient underwent reoperation because of advance imaging obtained for abdominal trauma. Two patients underwent revision surgery due to abnormal findings on postoperative radiographs. The overall sensitivity and specificity of routine postoperative radiographs was 33.3% and 100%, respectively. In the absence of new clinical signs and symptoms, obtaining routine in-hospital postoperative radiographs following surgical treatment of TL injuries provides minimal value. Clinical assessment should help determine if additional imaging is indicated for the patient. Avoiding unnecessary inpatient tests such as routine postoperative radiograph may offer multitude of benefits including lowering patient radiation exposure, reducing health care costs and better allocation of hospital resources. Level III.

Radiographic Evaluation of Minimally Invasive Instrumentation and Fusion for Treating Unstable Spinal Column Injuries.

Study Design:Retrospective cohort.Objective:Facet fusion in minimally invasive spine surgery (MISS) may reduce morbidity and promote long-term construct stability. The study compares the maintenance of correction of thoracolumbar (TL) trauma patients who underwent MISS with facet fusion (FF) and without facet fusion (WOFF) and evaluates instrumentation loosening and failure.Methods:TL trauma patients who underwent MISS between 2006 and 2013 were identified and stratified into FF and WOFF groups. To evaluate progressive kyphosis and loss of correction, Cobb angles were measured at immediate postoperative, short-term, and long-term follow-up. Evidence of >2 mm of radiolucency on radiographs indicated screw loosening. If instrumentation was removed, postremoval kyphosis angle was obtained.Results:Of the 80 patients, 24 were in FF and 56 were in WOFF group. Between immediate postoperative and short-term follow-up, kyphosis angle changed by 4.0° (standard error [SE] 1.3°) in the FF and by 3.0° (SE 0.4°) in the WOFF group. The change between immediate postoperative and long-term follow-up kyphosis angles was 3.4° (S.E 1.1°) and 5.2° (S.E 1.6°) degrees in the FF and WOFF groups, respectively. Facet fusion had no impact on the change in kyphosis at short term (P = .49) or long term (P = .39). The screw loosening rate was 20.5% for the 80 patients with short-term follow-up and 68.8% for the 16 patients with long-term follow-up. There was no difference in screw loosening rate. Fifteen patients underwent instrumentation removal—all from the FF group.Conclusion:FF in MISS does not impact the correction achieved and maintenance of correction in patients with traumatic spine injuries.

3D Computed Tomography Mapping of Thoracolumbar Vertebrae Fractures.

BackgroundFractures of the thoracolumbar (TL) spine represent 90% of all spinal fractures, followed by cervical and lumbar spine fractures. This study aimed to create fracture maps of the traumatic thoracolumbar (TL) fracture vertebral body (T12-L2) through the use of CT mapping as a big data visualization method to reveal recurrent patterns and characteristics of traumatic TL fractures.Material/MethodsA consecutive series of 174 fractured vertebrae (T12–L2) was used to create three-dimensional (3D) reconstruction images, which were superimposed and oriented to fit a model vertebral template by aligning specific bio-landmarks and reducing reconstructed fracture fragments. Fracture lines were found and traced to create a fracture map of the vertebral body.ResultsOur study consisted of 165 patients with an average age of 47 years. A total of 174 fractured vertebrae were collected, consisting of 59 T12 vertebral fractures, 60 L1 vertebral fractures, and 55 L2 vertebral fractures. Two-dimensional (2D) maps, 3D maps, and heat maps showed that the fracture lines tended to be concentrated in the upper third and anterior third of the vertebral body, as well as being distributed in annular wedges along the anterior and lateral sides of the vertebral body. When compared with T12, the distribution of fracture lines in L1 and especially in L2 was more scattered and disorganized.ConclusionsFracture maps revealed recurrent patterns and characteristics of the traumatic TL fracture vertebral body, which improves understanding of TL fractures, as well as helping to increase opportunities for follow-up research and aid clinical decision-making.

Earlier Decompression (< 8 Hours) Results in Better Neurological and Functional Outcome after Traumatic Thoracolumbar Spinal Cord Injury.

The optimal timing of surgical intervention following spinal cord injury (SCI) remains under debate. Recent studies indicate a potential neurological and functional benefit of early surgery (< 8 h) after cervical SCI. For thoracolumbar SCI syndromes, fewer studies exist. Bladder and bowel dysfunction are highly relevant for these patients and impair their quality of life. Hence, we performed a retrospective study on patients with thoracolumbar SCI who were operated on at our institution and who met inclusion as well as exclusion criteria (n = 58 patients). Follow-up data were collected prospectively within a fixed time schedule over 1 year according to the European Multicenter Study about Spinal Cord Injury protocol. Early decompression was defined as within the first 8 h after injury and was performed in 35 patients. After the follow-up period, the early decompression group showed improved American Spinal Injury Association Impairment Scale (AIS) grades (p < 0.040) and a higher AIS conversion (p < 0.021). Further, these patients demonstrated a higher total Spinal Cord Independence Measure (SCIM) difference (p < 0.005). Special emphasis was placed on the functional bladder and bowel outcome. Here, we observed improved bladder outcome (i.e., SCIM-6 sub-item; p < 0.021) and a trend towards better functional bowel management (i.e., SCIM-7; p < 0.090). Linear regression models showed that early surgery was an independent predictor for higher AIS shifts and improved total SCIM difference. Our data suggests that prompt surgical management after thoracolumbar SCI might have a positive impact on the functional and neurological outcome.

An Unusual Cause of Buttock Pain after Posterior Thoracolumbar Fixation: Rod Migration into the Pelvis.

Introduction:Posterior surgical stabilization is commonly indicated for unstable thoracolumbar fractures. Short segment stabilization has the advantage of preserving mobile segments and reducing excessive loads on the adjacent discs but is not without complications. Rod migration is an extremely rare complication after thoracolumbar fracture fixation and can lead to catastrophic visceral and vascular injuries. To the best of our knowledge, this is the first case report of a surgically managed distant rod migration into the posterior sacrum and pelvis after a posterior thoracolumbar trauma fixation.Case Report:A 25-year-old male patient presented to our center with complaints of the right buttock and groin pain for 8weeks. He had a history of an unstable thoracolumbar fracture treated by a short segment posterior stabilization 5years back. On examination and investigations, we found that the right-sided rod migrated into the posterior sacrum and partly into the pelvis. The fracture had united well in kyphosis. Anticipating complications, the rod was removed through an incision over buttock. The other implants were also removed. The patient was asymptomatic at 2-year follow-up.Conclusion:One should keep in mind the rare possibility of rod migration during follow-up of thoracolumbar trauma fixation. A proper history and clinical examination may guide the surgeon into such a rare possibility. Radiological investigations should be performed if there is suspicion and surgery may be advised when complications are anticipated depending on the location of the rod.

Primary Imaging Test for Suspected Traumatic Thoracolumbar Spine Injury: 2017 Guidelines by the Korean Society of Radiology and National Evidence-Based Healthcare Collaborating Agency.

The Korean Society of Radiology and the National Evidence-based Healthcare Collaborating Agency developed a primary imaging test for suspected traumatic thoracolumbar spine injury. This guideline was developed using an adaptation process involving collaboration between the development committee and the working group. The development committee, consisting of research methodology experts, established the overall plan and provided support on research methodology. The working group, composed of radiologists with expertise in musculoskeletal imaging, wrote the recommendation. The guidelines recommend that thoracolumbar spine computed tomography without intravenous contrast enhancement be the first-line imaging modality for diagnosing traumatic thoracolumbar spine injury in adults.

Usefulness of antero-posterior radiograph and variability of management in non-major thoracolumbar injuries: a single centre pilot study and review of literature

BackgroundMost adult trauma protocols suggest that where there has been a dangerous mechanism of injury or the patient exhibits abnormal physiology, CT scan is the primary radiological investigation. Other patients who may have suffered thoraco-lumbar (T-L) trauma initially have antero-posterior (AP) and lateral plain X-rays performed. Our clinical experience suggests AP views are not particularly useful in the management of these relatively low-velocity injuries. This is the first study intended to determine the contribution made by AP X-rays in these cases.MethodsAdults with a history of T-L trauma referred to our tertiary spinal service over 20 weeks were reviewed. Those with a CT scan performed prior to X-rays were excluded. Four spine surgeons and four neuroradiologists were independently shown lateral X-rays along with the clinical details and asked to provide a management plan. Then they were shown the AP X-rays and asked if they would like to change their advice.ResultsFifty-two patients were identified. Thirty-four sets of supine and 40 sets of erect X-rays were included (four people only had lateral X-rays performed), yielding 1152 film views. Average patient age was 58.3 years with 30 (58%) males. Forty-five (87%) were AO type A (compression-type) fractures. Seven (13%) had been erroneously referred with a diagnosis of acute fracture, which on review was not considered to be the case. Fifty-four percent of fractures were between T11 and L2. Forty-six percent appeared osteoporotic.In no instance did evaluation of the AP X-ray change the management plan which had been suggested following the evaluation of the lateral X-ray alone. However, there was significant variation in advice on further management between consultants.ConclusionsOur results suggest AP X-rays do not contribute to the management of low-velocity thoraco-lumbar traumas. Larger studies are required to support these findings, but there appears to be a potential to reduce both cost and radiation exposure. More importantly, it demonstrates there is large variability in the management of such patients due to the lack of evidence-based protocols.

Abstract For Thoracolumbar Trauma

In both adult and pediatric populations, thoracolumbar trauma accounts for a large portion of traumatic injuries. There is a wide spectrum of injury types, including compression fractures, burst fractures, fracture-dislocations, and more. The traditional treatment for many of these has been instrumented stabilization by an “open” approach. However, as minimally invasive techniques have been developed for degenerative disorders, there has been considerable interest in bringing the same benefits of decreased blood loss, improved wound exposure, and potentially decreased operative time to the trauma population. Further, “minimally invasive” is a broad category, encompassing percutaneous pedicle screw fixation, endoscopic/thoracoscopic approaches, and anterior column reconstruction. A few authors have put forward some algorithms of selecting appropriate patients for MIS techniques. However, the majority of published data has been limited to small case series with very heterogeneous pathologies. Further studies are needed to assess minimally invasive surgery for thoracolumbar spine trauma, with respect to short- and long-term clinical outcome, fusion rates/radiographic outcome, and cost-effectiveness.

Thoracoscopically Assisted Vertebral Reconstruction Simultaneously with Percutaneous Pedicle Screws Fixation for Management of Thoracic and Thoracolumbar Spinal Fractures.

Background Data: Thoracic and thoracolumbar fractures are commonly provoked by axial compression which disrupts the anterior column. In this setting, posterior stabilization using pedicle screws alone may lead to delayed kyphosis and hardware failure due to inadequate anterior column support. Application of thoracoscopic anterior column reconstruction while patient in prone position for posterior percutaneous instrumentation is a minimally invasive combined technique.Purpose: To evaluate the outcome of percutaneous pedicle screw instrumentation in combination with thoracoscopically assisted vertebral reconstruction using expandable titanium cage.Study Design: Prospective clinical case study.Patients and Methods: Eighteen patients with acute thoracolumbar fractures with different preoperative neurological status were recruited for this study. Patients were treated using a short segment percutaneous screw fixation construct combined with thoracoscopic corpectomy and insertion of expandable cage. Patients were followed for at least 6 months. Visual analogue scale (VAS), Oswestry disability index (ODI) and local kyphotic angle were recorded prospectively and compared to preoperative parameters. Intraoperative data including operative time, blood loss and perioperative complication was documented.Results: Patients were operated within 7 days after trauma using combined anterior and posterior stabilization technique. Mean operative time was 213±42 min (Range, 170-300). The mean blood loss was 225±79 ml (Range, 100-350). The mean VAS score improved significantly after surgery. The mean of ODI preoperatively was 74±6.9 preoperatively and improved after 6 months to become 17.5±14.6. The mean regional kyphotic angle was 22.6±6.82ᴼ preoperatively, improved to 6.9±4.1ᴼ postoperatively and at final follow-up it became 8.67±4.8ᴼ. No patient had neurological deterioration or hardware failure during ≥6 months of follow up.Conclusion: our data suggest that thoracoscopic anterior reconstruction and decompression augmented with posterior percutaneous in prone position yield good clinical and radiological results with minimal complications in thoracolumbar trauma. (2018ESJ158)

A Novel Knotless Barbed Suture Technique for Traumatic Thoracolumbar Fracture in Posterior Surgery.

Surgical wound closure directly influences spinal surgical efficiency and several postoperative complications. The traditional suture technique is time-consuming and associated with greater rates of complications. Bidirectional absorbable barbed sutures seem to compensate for some of the limitations of traditional suture; however, they rarely are reported in spinal surgery. We designed a novel suture technique for use in thoracolumbar spinal surgery. The data of 189 patients with traumatic thoracolumbar fractures were analyzed between bidirectional barbed suture closure and traditional interrupted suture closure. Data of operative time, wound closure time, length of incision, intraoperative blood loss, complications of wound dehiscence and postoperative hematoma, cost, and neurologic status were collected. No significant differences were observed in the baseline demographics of included patients. Compared with the traditional suturing group, the barbed sutures decreased the mean operative time (P= 0.037), suture time (P < 0.01), and mean suturing time (P < 0.01) significantly, although no statistically significant differences were found in blood loss (P= 0.724) and neurologic functional scores (preoperative: P= 0.901; 3 months after surgery: P= 0.208; final follow-up assessments: P= 0.163), and no statistically significant differences were found in rates of postoperative infection, hematoma, and wound dehiscence. Our findings suggest that the novel knotless barbed suture has comparable strength to traditional sutures, with the advantage of less suturing time. It is an efficient, safe technique, and alternative choice for patients with thoracolumbar fracture after posterior surgery.

Posterior-only Stabilization for Traumatic Thoracolumbar Burst Fractures.

BackgroundNo consensus exists for the management of unstable thoracolumbar (TL) burst fractures. Surgical options include anterior, lateral, or posterior stabilization (or a combination), depending on the fracture. The potential benefits of anterior reconstruction come with increased operative time and associated morbidity. A posterior-only approach can offer stable correction without increased operative risks but may result in loss of kyphotic correction over time.PurposeTo determine whether posterior-only stabilization is a viable treatment option for patients with traumatic TL fractures as opposed to anterior and combined approaches.MethodsWe performed a retrospective analysis of adult patients with TL burst fractures who underwent posterior­-only surgical intervention from 2005 to 2015. Operations were performed at two levels above and below the fractured segment using pedicle screw-rod fixation constructs with autograft and allograft. All patients received TL bracing for at least three months. Patients lost to follow­up were excluded.ResultsSixty-four consecutive patients with posterior­-only stabilization were identified, with 18 lost to follow­up. Of the remaining 46 patients, 93% (n=43) were male and 7% (n=3) were female, with a mean age of 36.8 years. All patients were followed for 12 months. The mean time until the removal of the brace was 3.54 months. No patients required additional surgical intervention for spinal stabilization. Three patients experienced postoperative complications, all of which were related to infection.ConclusionsOur data indicate that posterior­-only stabilization for traumatic TL burst fractures is a durable and effective option in select patients. The approach offers surgical intervention with a decreased perioperative risk as well as reduced morbidity and mortality, with a minimal increase in the risk of kyphotic deformity. Further prospective studies are necessary to validate these findings clinically.

Thoracolumbar trauma with delayed presentation

Thoracolumbar injuries presenting in a delayed manner are uncommon, and their etiologies are varied ranging from missed injuries, wrong initial management, and delayed presentation for treatment. While improvements in healthcare awareness and delivery systems worldwide have improved the acute management of spinal injuries, the diagnosis and management of delayed spinal injuries remains a challenge to the treating physician regarding intraoperative difficulties, perioperative complications, and subsequent rehabilitation. Sequel of delayed presentation such as neurological deficit, spinal deformity, capsular contractures, muscle wasting, pulmonary and urinary tract infections and pressure sores have a significant bearing on the outcomes of management of delayed spinal trauma. Indications for surgical management include axial pain, neurological deficit, and kyphotic deformity. Management options include anterior corpectomy and fusion, combined anterior posterior surgery, and an all-posterior spinal decompression and deformity correction.

The change of volume of the lumbar vertebrae along with aging in asymptomatic population: a preliminary analysis.

Previous studies have demonstrated that the length of the lumbar spine is decreasing with age. Despite considerable research based on sagittal measurements, little is known about the changes in the volume of vertebrae. The objective of this study was to evaluate the changes in the volume of either column of the spine with age. Computed tomography scans of 62 asymptomatic subjects, performed for thoracolumbar trauma evaluation were used to create virtual 3D models. At least 10 patients were assigned to every decade of life from third to eight. We used a novel technique to measure the volume of anterior column (AC) and posterior column (PC) per each segment (a total of 310 segments). Midline sagittal images were used to measure disc height (DH) and vertebral body height (VH). With age, both DH increases, whereas the VH decreases. The overall length of lumbar segment of the spine decreases with age. The volumetric measurements performed on same subjects showed that volume of both AC and PC does not change with age in females. In males, there is a weak but statistically significant correlation between AC volume and age and no change in the volume of PC. The ratio of PC:AC volume does not change with age in women, although it decreases slightly but significantly (in favor of AC) with age in males. The overall length of lumbar spine decreases with age. This process is not a result of mere changes in the volume of either AC or PC.

The effects of steroids in traumatic thoracolumbar junction patients on neurological outcome.

In this study, we aim to evaluate the potential effects of methylprednisolone on the neurological outcome of spinal cord injury (SCI) patients with thoracolumbar junction (T10-L1) spine fractures. The data from 182 SCI patients who sustained a thoracolumbar junction spine fracture were operated by us between September 2008 to January 2015 were analysed retrospectively. The patients were divided into two groups: Group 1 underwent methylprednisolone treatment in conjunction with early surgical intervention, while group 2 underwent only early surgical intervention without methylprednisolone treatment. American Spinal Injury Association (ASIA) motor index scores of the patients were evaluated and compared with statistical methods at admission and at the first-year follow-up. The main follow-up period was 14.4±1.4 months in group 1 and 13.6±1.7 months in group 2. Initial and last follow-up ASIA scores of the patients were similar between groups (p>0.05), but the complication rate was significantly high in group 1 (p<0.05). The findings showed that steroids have no significant beneficial effects on the neurological outcome but have significant side effects and leads to increased complication rate in SCI patients.

Instability in Thoracolumbar Trauma: Is a New Definition Warranted?

Review of the articles. The objective of this study was to review all articles related to spinal instability to determine a consensus statement for a contemporary, practical definition applicable to thoracolumbar injuries. Traumatic fractures of the thoracolumbar spine are common. These injuries can result in neurological deficits, disability, deformity, pain, and represent a great economic burden to society. The determination of spinal instability is an important task for spine surgeons, as treatment strategies rely heavily on this assessment. However, a clinically applicable definition of spinal stability remains elusive. A review of the Medline database between 1930 and 2014 was performed limited to papers in English. Spinal instability, thoracolumbar, and spinal stability were used as search terms. Case reports were excluded. We reviewed listed references from pertinent search results and located relevant manuscripts from these lists as well. The search produced a total of 694 published articles. Twenty-five articles were eligible after abstract screening and underwent full review. A definition for spinal instability was described in only 4 of them. Definitions were primarily based on biomechanical and classification studies. No definitive parameters were outlined to define stability. Thirty-six years after White and Panjabi's original definition of instability, and many classification schemes later, there remains no practical and meaningful definition for spinal instability in thoracolumbar trauma. Surgeon expertise and experience remains an important factor in stability determination. We propose that, at an initial assessment, a distinction should be made between immediate and delayed instability. This designation should better guide surgeons in decision making and patient counseling.

Pedicle Disc Wedge Osteotomy for the Correction of Late Post-traumatic Thoracolumbar kyphosis

Background Data: Late Post-traumatic thoracolumbar kyphosis can occur in a proportion of thoracolumbar fractures after inappropriate treatment. There are several surgical options to correct late post-traumatic thoracolumbar kyphosis, including anterior, posterior, and combined approaches, which are associated with varying degrees of clinical and radiological outcome success.Purpose: The aim of this study was to assess the use of a pedicle disc wedge osteotomy for the treatment of late post-traumatic thoracolumbar kyphosis and to evaluate the radiographic findings and clinical outcomes of patients treated by this technique.Study Design: A descriptive retrospective clinical case study.Patients and Methods: Ten consecutive patients with symptomatic post-traumatic thoracolumbar kyphosis were treated using a pedicle disc wedge osteotomy. The mean patient age was 37.5 years. The initial trauma in all patients was Type A3, A4 according to AOSPINE thoracolumbar trauma classification. The kyphosis apex ranged from T-12 to L-2. The sagittal alignment, kyphotic angle, neurological function, Visual Analog Scale for back pain, and Oswestry Disability Index were evaluated before surgery and at follow-up.Results: The mean preoperative regional angle was 35.5°, and the mean correction angle was 28.5°. Sagittal alignment improved with a mean correction rate of 47%. The mean surgical time was 227 minutes, and the mean intraoperative blood loss was 1380 ml. The mean Visual Analog Score for back pain improved from 8.2 to 2.0, and the Oswestry Disability Index score decreased from 56.4 to 24.4 at the last follow-up. All patients achieved bony fusion based on the presence of trabecular bone bridging at the osteotomy site.Conclusion: The pedicle disc wedge osteotomy technique achieves satisfactory kyphosis correction with direct visualization of the circumferentially decompressed spinal cord, as well as good fusion. (2017ESJ139)

199 Impact of Frailty on Complications in Patients with Thoracic and Thoracolumbar Spinal Trauma

Abstract INTRODUCTION It is well-documented that geriatric patients are at risk for serious injuries after trauma due to pre-existing medical conditions, physical changes of aging, and medication effects. Frailty has been demonstrated to be a predictor of morbidity and mortality in inpatient head and neck surgery, and for surgical intervention for adult spinal deformity and degenerative spine disease. However, the impact of frailty on complications following traumatic thoracolumbar/thoracic fracture is unknown and has not been previously assessed in the literature, particularly in a nationwide setting. METHODS This was a retrospective study of the prospectively-collected American College of Surgeons National Surgical Quality Improvement database for the years 2007 through 2012. Patients who underwent spinal decompression (+/− fusion) or an alternative intervention, defined as vertebroplasty or kyphoplasty (VP/KP) for thoracic or thoracolumbar fracture were identified. Frailty status was determined using a modified frailty index from the Canadian Study of Health and Aging Frailty Index, with frailty defined as a score = 0.27. 30-day morbidity and mortality were compared between frail and non-frail patients in each treatment group. RESULTS &gt;A total of 303 patients were included in this study. Of these, 38% of patients had VP/KP and 62% underwent surgery. Within the VP/KP cohort, 26% were frail. The proportion of these patients who developed at least one complication was 3.3% versus 3.6% for non-frail patients (P = 1.0). The 30-day mortality for frail versus not frail patients in this cohort was 0% versus 2.4% (P = 1.0) Among the surgical group, 13% were frail. In contrast, the likelihood of complications was 33.3% among frail patients and 4.2% for non-frail patients (P = &lt;0.001). Frail patients also had a 16.7% 30-day mortality rate as compared to 0.6% in the non-frail group (P = 0.001). CONCLUSION Frailty and traditional surgical intervention are correlated with a higher 30-day complication and mortality rate in patients with traumatic thoracic and thoracolumbar fracture.

Emergency and Trauma Imaging of the Thoracolumbar Spine.

Spine trauma is a devastating event with high morbidity and mortality and many additional medical, psychological, social, and financial consequences for patients, their families, and society. The thoracolumbar spine represents the most common area fractured in the spine. Morphology, extent, and the location of fracture lines are important determinants of stability, which is the core issue in the assessment of vertebral injuries, dictating conservative or surgical treatment. After hospital admission and clinical stabilization, patients with potential spine trauma are screened radiologically. Imaging analysis is based on radiographs, computed tomography, and magnetic resonance imaging. Understanding these three tools is essential to get a clear picture of the extent of any vertebral fracture. A multidisciplinary team should provide assessment, treatment, and education to patients with a spinal injury to achieve a treatment tailored for each patient. Thoracolumbar trauma focusing on spinal biomechanics, stability, imaging modalities, morphology patterns, classifications, and treatment are discussed and reviewed.

Temporary Percutaneous Instrumentation and Selective Anterior Fusion for Thoracolumbar Fractures

Prospective clinical trial in thoracolumbar trauma with 5-year follow-up. To analyze clinical and radiographic outcomes of minimal invasive surgery, and the rational of circumferential fracture treatment with regard to age, degenerative changes, bone mineral density, and global sagittal balance. Non-neurologic fractures with anterior column defect can be treated by posterior percutaneous instrumentation and selective anterior fusion. After consolidation, instrumentation can be removed at 1 year to provide mobility in non-fused segments. Fifty-one patients, 47 (18-75) years, were operated for A2, A3, or B-type fractures. Visual analog scale (VAS) for back pain and Oswestry Disability Index (ODI) were assessed. Radiographic measurements were: sagittal index, regional kyphosis, T4-T12 kyphosis, L1-S1 lordosis, pelvic incidence, pelvic tilt, sacral slope, and T9 tilt. Anterior fusion and facet joints were analyzed on computed tomography (CT) at 1 year. The ODI was 8.8 before accident, 35.4 at 3 months, 17.8 at 2 years, 14.4 at 5 years. The VAS was 2.0 at 3 months and 1.0 at 5 years. The sagittal index was 18.0° preoperatively and 1.0° at 3 months (P < 0.0001). A loss of reduction of 1.1° occurred after implant removal (P = 0.009). Global sagittal balance remained unchanged. Ten patients with osteopenia or osteoporosis had a worse ODI: 24.7 versus 11.9 (P = 0.016), and a greater loss of correction: 4.9° versus 1.3° (P = 0.007). Cages filled with cancellous bone from the fractured vertebra fused regularly. Spontaneous facet joint fusions were observed in two patients at the fracture level in B-type injuries. Percutaneous instrumentation and selective anterior fusion using autologous bone and mesh cages lead to high fusion rates, which provided good long-term clinical results in younger patients with thoracolumbar fractures. Sagittal alignment was maintained after instrumentation removal without damaging paravertebral muscles. Outcomes were worse in elderly patients presenting osteopenia or osteoporosis. 3.

OPEN SURGICAL VS. MINIMALLY INVASIVE TREATMENT OF THORACOLUMBAR AO FRACTURES TYPE A AND B1 IN A REFERENCE HOSPITAL

ABSTRACT Objective: The thoracolumbar spine trauma represents 30% of spinal diseases. To compare the minimally invasive technique with the open technique in lumbar fractures. Method: A prospective, cross-sectional, comparative observational study, which evaluated the following variables: surgery time, length of hospital stay, transoperative bleeding, postoperative pain, analyzed by SPSS software using Student's t test with statistical significance of p ≥ 0.05, with 24 patients with single-level thoracolumbar fractures, randomly treated with percutaneous pedicle screws and by open technique with a transpedicular system. Results: The surgery time was 90 minutes for the minimally invasive technique and 60 minutes for the open technique, the bleeding was on average 50 cm3 vs. 400 cm3. The mean visual analogue scale for pain at 24 hours of surgery was 5 for the minimally invasive group vs. 8 for the open group. The number of fluoroscopic projections of pedicle screws was 220 in the minimally invasive technique vs. 100 in the traditional technique. Quantified bleeding was minimal for percutaneous access vs. 340 cm3 for the traditional system. The hospital discharge for the minimally invasive group was at 24 hours and at 72 hours for those treated with open surgery. Conclusions: It is a technique that requires longer surgical time, with reports of less bleeding, less postoperative pain and less time for hospital discharge, reasons why it is supposed to be a procedure that requires a learning curve, statistical significance with respect to bleeding, visual analogue scale for pain and showed no significant difference in the variables of surgical time.