Indications and principles of surgical treatment in injuries affecting the thoracolumbar spine (original) (raw)
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(ii) Thoracolumbar spinal fractures: review of anatomy, biomechanics, classification and treatment
Orthopaedics and Trauma, 2014
The management of thoracolumbar spine fractures remains a controversial issue. There is disagreement both as to how to describe these injuries and how to manage them. No ideal classification system, accepted by the world of spinal surgery, exists and such systems are under on-going development. While the majority of these injuries can be managed conservatively, new surgical techniques have been developed alongside the evolution of diagnostic tools classification systems.
Spinal injuries affecting the thoracic and thoracolumbar spine
Orthopaedics and Trauma, 2016
Thoracic and thoracolumbar fractures range from low impact osteoporotic compression injuries to high-energy fracture/dislocations with spinal cord injury. Assessment can be broadly divided into two sections. Primary assessment should follow the principles of Advanced Trauma Life Support. The secondary assessment should relate to the spinal fracture itself. In determining the optimal treatment, the stability of the injury must be assessed by following a complete clinical and radiographic evaluation. The thoracolumbar junction (T10eL2) is a transitional region between the rigid thoracic spine and the more flexible lumbar spine and hence is susceptible to injury. The thoracic spine (T1eT9) is relatively protected area, due to the rib cage; when injuries do occur they commonly involve visceral and spinal cord injury. Many classifications exist, however the AO and Thoracolumbar Injury Classification and Severity (TLICS) systems are the most clinically useful. Although they are based on thoracolumbar injuries they are commonly extended to thoracic fractures. The majority of fractures can be managed non-operatively with early mobilization and bracing. Surgical stabilization is indicated in unstable fractures. Posterior stabilization with pedicle screws is the most widely used technique; simultaneous decompression can also be achieved with this approach. Anterior surgery has biomechanical advantages and has been shown to be equally effective.
Surgical Techniques for Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations
Neurospine
To formulate the specific guidelines for the recommendation of thoracolumbar fracture regarding surgical techniques and nonfusion surgery. WFNS (World Federation of Neurosurgical Societies) Spine Committee organized 2 consensus meeting. For nonfusion surgery and thoracolumbar fracture, a systematic literature search in PubMed and Google Scholar database was done from 2010 to 2020. The search was further refined by excluding the articles which were duplicate, not in English or were based on animal or cadaveric subjects. After thorough shortlisting, only 50 articles were selected for full review in this consensus meeting. To generate a consensus, the levels of agreement or disagreement on each item were voted independently in a blind fashion through a Likert-type scale from 1 to 5. The consensus was achieved when the sum for disagreement or agreement was ≥ 66%. Each consensus point was clearly defined with evidence strength, recommendation grade, and consensus level provided. A magnit...
Indian Journal of Neurotrauma, 2020
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. 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...
Neurospine, 2021
Thoracolumbar spine is the most injured spinal region in blunt trauma. Literature on the indications for nonoperative treatment of thoracolumbar fractures is conflicting. The purpose of this systematic review is to clarify the indications for nonsurgical treatment of thoracolumbar fractures. We conducted a systematic literature search between 2010 to 2020 on PubMed/MEDLINE, and Cochrane Central. Up-to-date literature on the indications for nonoperative treatment of thoracolumbar fractures was reviewed to reach an agreement in a consensus meeting of WFNS (World Federation of Neurosurgical Societies) Spine Committee. The statements were voted and reached a positive or negative consensus using the Delphi method. For all of the questions discussed, the literature search yielded 1,264 studies, from which 54 articles were selected for full-text review. Nine studies (4 trials, and 5 retrospective) evaluating 759 participants with thoracolumbar fractures who underwent nonoperative/surgery w...
Evaluation of Functional and Radiographic Outcomes of Thoracolumbar Fractures
Shafa Orthopedic Journal, 2015
Background: Thoracolumbar fractures are the most common fractures of the spinal column. There is no consensus about treatment method of choice among authors. Objectives: The purpose of this study was to compare radiographic and functional outcomes of conservative management with that of surgical treatment in thoracolumbar spine fractures. Patients and Methods: Forty-nine patients with single level acute thoracolumbar fractures and normal neurological examination were evaluated, of those 21 patients underwent surgery and 28 treated with orthosis. Radiographic outcomes were evaluated by measuring sagittal kyphotic angle, anterior vertebral body collapse and functional outcomes were assessed using SF36 health survey questionnaire and the Denis work and pain scales. Results: Among the surgically treated patients, sagittal kyphotic angle was significantly corrected immediately after operation and in the last follow-up compared to preoperative measurements (P < 0.001), functional results of SF36 score and pain scale were satisfactory. Among those received conservative management, sagittal kyphotic angle and anterior vertebral collapse were not significantly different before and after bracing (P = 0.4 and P = 0.8, respectively); functional outcome of SF36 scores were satisfactory and functional and radiographic results had no correlation. Conclusions: Functional outcome in both groups with surgical and non-surgical treatment was satisfactory. Radiographic indices were improved with surgical treatment and no correlation was found between functional and radiographic outcome.
European Journal of Orthopaedic Surgery and Traumatology, 2006
This year’s ARGOS International Symposium, held in Paris, January 26–27, focused on thoracolumbar fractures and their assessment.Indeed this topic is of high interest for spine surgeons around the world as the treatment of thoracolumbar is still a matter of debate. As in every year, over 250 attendees gathered at the Salons d’Iéna eager to exchange their ideas and different points of view in the well-established friendly and collegial atmosphere of ARGOS meetings. Together with the faculty members, who covered most of the issues related to this particularly hot topic, they tried to better understand thoracolumbar fractures mechanisms and define therapeutic patterns.Thursday January 26Session 1Starting the first session on Thursday afternoon, Professor Jean-Paul Steib, MD, Strasbourg, France, and Doctor Mark Weidenbaum, MD, New York, USA, discussed the “Choice of approach—Posterior, anterior, double approach—decision criteria”.The indications for surgery when dealing with thoracolumbar
Thoracolumbar Fractures: A Review of Classifications and Surgical Methods
Journal of Spine, 2015
Thoracolumbar fractures are an important topic in spinal surgery. In this article, the instability of the thoracolumbar fracture classifications and surgical treatments are discussed, with a particular focus on treatment concepts that are based on the modern classification systems.
Anterior stabilization of three-column thoracolumbar spinal trauma
2006
Object. The purpose of this study was to evaluate the results obtained in patients who underwent anterior stabilization for three-column thoracolumbar fractures. Methods. The authors retrospectively reviewed available clinical and radiographic data (1997-2006) to classify three-column thoracolumbar fractures according to the Association for the Study of Internal Fixation (AO) system, neurological status, spinal canal compromise, pre-and postoperative segmental angulation, and arthrodesis rate. The mean computed tomography-measured preoperative spinal canal compromise was 48.3% (range 8-92%), and the mean vertebral body height loss was 39.4%. The mean preoperative kyphotic deformity of 14.9˚ improved to 4.6å t the final follow-up examination. Although this angulation had increased a mean of 1.8˚ during the follow-up period, the extent of correction was still significant compared with the preoperative angulation (p Ͻ 0.01). There were no cases of vascular complication or neurological deterioration. Conclusions. Contemporary anterior spinal reconstruction techniques can allow certain types of unstable threecolumn thoracolumbar fractures to be treated via an anterior approach alone. Compared with traditional posterior approaches, the anterior route spares lumbar motion segments and obviates the need for harvesting of the iliac crest.