Bracing of thoracic and lumbar spine fractures (original) (raw)
Related papers
Research Square (Research Square), 2023
Background. Dislocated thoracolumbar fractures are uncommon injuries following major trauma. However, the resulting spinal cord injuries do not always correspond to the radiological characteristics of osteo-discoligamentary injuries. We report a case of thoraco-lumbar dislocated fracture of which radiological nding was in discrepancy with clinical aspect and postoperative evolution according to spinal cord injury. Case presentation. A 32-year-old congolese, female, admitted in Neurosurgery Department of the University Hospital of Kinshasa for low back pain and functional impotence of lower limbs and urinary retention following a road tra c accident three weeks prior. The physical examination was normal. We found a painful swelling at level of T12-L2 spinous processes and Wagner's grade IV gluteal pressure sores. Neurologically, the sensation was preserved on both limbs, motor strength on lower limbs was graded 3/5 globally. She had urinary retention. We made a diagnosis of an incomplete spinal cord injury (ASIA C) secondary to a thoraco-lumbar spinal trauma. CT-Scan showed a fracture of the vertebral body and pedicles of L2 with retrolisthesis of L1/L2 grade IV (Magerl B.3.3). She underwent posterior spinal decompression followed by spinal stabilisation with pedicle screws. The gluteal ulcers were debrided and sutured during the same surgery. Postoperatively, the pressure ulcers healed and the patient recovered full motor and urinary sphincter functions after several sessions of physiotherapy months. Conclusion. This case report demonstrates the possibility of discordance between radiological images of dislocated thoracolumbar fractures and spinal cord injury clinical.
Surgical Management of Lumbar Spine Fractures and Dislocations
Journal of Advanced Zoology
Background: Lumbar spine fractures and dislocations, which are part of the thoracolumbar region, are critical injuries with significant morbidity. The epidemiological shift in the median age of injury and the high prevalence of these injuries, particularly in the T10-L2 region, highlight the necessity for effective therapeutic interventions. With advancements in spine biomechanics, imaging technologies, and surgical techniques, there has been a paradigm shift from conservative to surgical management, though high-quality comparative studies remain limited. Objective: To synthesize recent data on the epidemiology, evaluation, and management of lumbar spine fractures and dislocations, and to elucidate the comparative efficacy of surgical interventions and conservative approaches in optimizing patient outcomes. Method: This paper conducts a comprehensive review of epidemiological data on thoracolumbar traumatic injuries, diagnostic techniques, and management strategies, especially focus...
Spinal Cord Series and Cases, 2020
Introduction We report two cases of fracture-dislocation of the thoracolumbar spine without neurological deficit and outline the putative mechanisms responsible for the escape of neural tissues from injurious forces and the surgical management strategies for this type of injury. We also review similar cases described in the literature. Case reports A 24-year-old female with post-traumatic fracture dislocation at the T10-T11 level without neurological deficit, along with a right femoral shaft fracture, was managed with laminectomy of T10-T11 levels with bilateral facetectomy and transpedicular screws and with an intramedullary interlocking nail for the femur fracture. Another 26-year-old female (posttraumatic fracture dislocation at the T12-L1 level treated by open reduction and pedicle screw instrumentation elsewhere) presented with implant failure and re-dislocation which was managed with laminectomy of T12-L1 levels, facetectomy and discectomy, and deformity correction, followed by 9 mm × 25 mm bullet cage insertion and fixation using transpedicular screws. Neurological function was preserved postoperatively. Both individuals returned to household activity 6 months postoperatively. Discussion Fracture-dislocations of the thoracolumbar spine without neurological deficit have been infrequently reported. The mechanism responsible for the preservation of normal neurological function; is either posterior element fractures leading to free-floating laminae or a fracture-separation of the vertebral arch, in which pedicle fractures allow the posterior elements to remain nearly aligned, with preservation of the spinal canal integrity and maintenance of normal spinal cord function. These fracture-dislocations need to be managed carefully to achieve a good outcome.
When and how to operate on thoracic and lumbar spine fractures?
2014
Purpose To discuss when and how to operate on thoracic and lumbar spine fractures. Patients and methods We retrospectively studied 77 consecutive patients with thoracic and lumbar spine fractures treated from 2000 to 2011; 28 patients experienced high-energy spinal trauma and 49 low-energy spinal trauma. Mean follow-up was 5 years (1-11 years). Surgical treatment was done in 15 patients with neurological deficits, and in 16 neurologically intact patients with fractures-dislocations, burst fractures and fractures with marked deformity. Non-surgical treatment was done in 46 neurologically intact patients with simple fracture configurations. Clinical and imaging examination and the Oswestry Disability Index (O.D.I.) questionnaire were obtained. Results All patients treated surgically maintained spinal alignment; patients with long fusion maintained the best alignment; however, they experienced back stiffness and moderate low back pain. Patients with combined posterior fusion and kyphoplasty experienced earlier recovery and improved sagittal correction. Mean O.D.I. was 22.4 and 14.2 % at 3 and 12 months postoperatively. Thirty six (78 %) patients treated non-surgically were asymptomatic, 22 (48 %) experienced mild residual kyphosis, 10 (22 %) developed marked deformity during their follow-up and were finally operated; mean O.D.I. was 28.6 and 12.1 % at 3 and 12 months. No difference in O.D.I. was observed between patients who had surgical and non-surgical treatment.
THE PROFESSIONAL MEDICAL JOURNAL, 2017
In this study we analyze and study the effectiveness of pedicle screw and rod fixation for the management of unstable fractures of the thoracolumbar spine. The type of study is a Study Design: Case series. Period: 1.5 year duration from April 2014 to September 2015. Setting: Tertiary Care Centre in Karachi, Pakistan. Materials and methods: N= 35 patients were operated at our institute and included in the study. The inclusion criteria was all those patients who presented to us with unstable fractures of the thoracolumbar spine via the accident and emergency department of the hospital, and were operated upon and gave full informed consent to partake in the research were included in this study. All the patients were operated under general anesthesia. The short segment fixation with pedicle screw rod fixation using the posterior approach was the technique utilized for treatment. Rehabilitation was started immediately after the surgical procedure. Data was analyzed using SPSS version 23. Results: The study population consisted of n= 35 patients of which n= 25 (71.42%) were males and n= 10 (28.57%) were females, the mean age of the study population was 33.5 years. A history of fall from height was the most common cause of injury in n= 26 (74.28%) of the patients, next was automobile accidents in n= 9 patients (25.71%). Burst fracture was the most common type of injury. The sagittal angle was 23.5 O pre operatively and 10.75 O post operatively, and at follow up the loss of angle was found to be 4.80 respectively. The sagittal index values were as follows, pre-operative 0.53, post-operative 0.75 and 0.72 at follow up (final follow up). N= 30 (85.71%) patients showed improvement in their ASIA status, n= 19 (54.28%) showed single grade improvement, n= 10 (28.57%) showed double grade improvement, n= 1 (2.85%) showed triple grade improvement, while n= 5 (14.28%) cases did not show any improvement. The mean duration between injury and surgical intervention was 5.5 days with a range of 1 to 23 days, the major cause of this delay was delay in reaching the hospital. The most common complication observed was pressure sores in n= 4 (11.42%) and urinary tract infections (UTI) seen in n= 5 (14.28%) of patients, followed by implant failure in n=3 (8.57%) patients. Conclusion: According to the results of our study unstable burst fractures was the most prevalent type of fracture observed, there was a marked improvement in the radiological parameters post operatively, while the neurological improvement was decent. The technique of pedicle screw rod and fixation using the posterior approach provides good surgical outcome and better stabilization, with a fair amount of neurological improvement for these patients.
Evaluation of Thoraco Lumbar Fractures of Spine Managed With Pedicle Screw Fixation Authors
Background: The thoracolumbar junction is the most common area of injury to the spine. The forces through kyphotic stiff spine (thoracic) spine switch abruptly into the mobile lordotic lumbar spine at the thoracolumbar junction. Goals of treatment are to maintain the stability & balance of spine without pain along with good neurological function and maximum mobility of spine. This study evaluates the effectiveness of pedicle screw instrumentation in various fractures around the TL spine to overcome the complications encountered in the conservative line of management of these fractures. Materials & Methodology: 20 cases of fractures around the TL spine were operated with posterior pedicle screw fixation one or two level above and below the fracture from November 2012 to March 2014. The cases were followed up for a mean of 7.5 months with radiological and neurological evaluation. Results: The average age groups of the patients studied were 19 to 50 years majority were males, fall from...