Pragmatic randomised evaluation of stable thoracolumbar fracture treatment outcomes (PRESTO): study protocol for a randomised controlled feasibility trial combined with a qualitative study and survey (original) (raw)
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Surgery versus conservative management of stable thoracolumbar fracture: the PRESTO feasibility RCT
Health Technology Assessment, 2021
Background There is informal consensus that simple compression fractures of the body of the thoracolumbar vertebrae between the 10th thoracic vertebra and the second lumbar vertebra without neurological complications can be managed conservatively and that obvious unstable fractures require surgical fixation. However, there is a zone of uncertainty about whether surgical or conservative management is best for stable fractures. Objectives To assess the feasibility of a definitive randomised controlled trial comparing surgical fixation with initial conservative management of stable thoracolumbar fractures without spinal cord injury. Design External randomised feasibility study, qualitative study and national survey. Setting Three NHS hospitals. Methods A feasibility randomised controlled trial using block randomisation, stratified by centre and type of injury (high- or low-energy trauma) to allocate participants 1 : 1 to surgery or conservative treatment; a costing analysis; a national...
Spine, 2015
Web-based-multicenter study OBJECTIVE.: To assess and compare the management strategy for traumatic thoracolumbar fractures between German and Dutch spine surgeons. To date, there is no evidence-based treatment algorithm for thoracolumbar spine fractures. Thereby an international controversy concerning optimal treatment exists. In this web-based-multicenter study (www.spine.hostei.com) CT-scans of traumatic thoracolumbar fractures (T12-L2) were evaluated by German and Dutch spine surgeons. Supplementary case-specific information as age, gender, height, weight, neurological status, and injury mechanism were provided.By use of a questionnaire, fractures were classified according to the AO-Magerl Classification, followed by six questions concerning the treatment algorithm. Data were analyzed using SPSS (Version 21, 76 Chicago IL, USA). The interobserver agreement was determined by Cohens-Kappa. Statistical significance was defined as p < 0.05. Twelve surgeons (six/country) evaluated...
Neurospine
To obtain a list of recommendations about clinical and radiological factors affecting outcome in thoraco-lumbar fractures with the aim of helping spine surgeons in daily practice. A systematic literature search in PubMed and Google Scholar database was done from 2010 to 2020 on the topic “thoracolumbar fracture AND radiology AND surgical outcomes” and “thoracolumbar fracture AND radiology AND surgical outcomes.” A total of 58 papers were analyzed and WFNS (World Federation of Neurosurgical Societies) Spine Committee organized 2 consensus meetings to formulate the specific recommendations the first in Peshawar in December 2019 and in a subsequent virtual meeting in June 2020 to reach an agreement. Both meetings utilized the Delphi method to analyze preliminary literature review statements based on the current evidence levels to generate recommendations through a comprehensive voting session. Eight statements were presented and reached the consensus about this topic. A variety of clin...
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...
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
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...
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2018
To determine the health-related quality of life (QOL), safety and radiologic parameters after thoracoscopic treatment of traumatic thoracolumbar fractures using a distractible cage in patients without spinal cord injury (SCI). Retrospective cohort study of patients treated between 2004 and 2012 in a university level-one trauma center. Patient and treatment characteristics were collected from the hospital information system. All available radiographic material was assessed for fracture characteristics and Cobb angle at consecutive times. Patients completed the SF-36 and EQ-5D QOL questionnaires at follow-up. 105 patients were treated with a distractible cage, which was performed thoracoscopically in 86 cases, including 16 patients with SCI. Of 70 eligible patients, 46 were available for follow-up and completed the questionnaires at median 49 months after surgery. QOL was lower on most domains compared to the general population. Compared to patients who underwent solely posterior fixa...
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.