Surgery versus conservative management of stable thoracolumbar fracture: the PRESTO feasibility RCT (original) (raw)
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Pilot and Feasibility Studies
Background A thoracolumbar fracture is the most common fracture of the spinal column. Where the fracture is not obviously stable or unstable, the optimal management is uncertain. There are variations between surgeons, treating centres and within the evidence base as to whether surgical or non-surgical approaches should be used. In addition, the boundaries of this zone of uncertainty for stability are unclear. This study has been designed in response to an NIHR HTA commissioning brief to assess the feasibility of undertaking a large-scale trial to evaluate the effectiveness of surgical and non-surgical treatments for thoracolumbar fractures without neurological deficit. Methods Assessment of feasibility will be addressed through three elements: a randomised external feasibility study, a national survey of surgeons and a qualitative study. The external feasibility study is a pragmatic, parallel-group, randomised controlled trial comparing surgical fixation (intervention) versus non-su...
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...
Management of traumatic thoracolumbar fractures: a systematic review of the literature
European Spine Journal, 2005
The management of unstable traumatic thoracolumbar fractures without neurological deficits remains controversial. The objective of this study was to compare the effectiveness of operative and conservative treatment of unstable traumatic thoracolumbar fractures. PubMed was used to search for articles published from January 1992 to January 2003 using a variety of keywords. References were checked to identify additional studies. Inclusion criteria were: (1) traumatic lumbar, thoracic or thoracolumbar fractures, (2) unstable fractures without neurological deficits, (3) a comparison between operative and conservative treatment, (4) at least ten patients were included in the study. Seventeen studies were identified; four prospective and 13 retrospective studies. Sample sizes in 15 studies were relatively small (18-100 patients); two studies had larger sample sizes. Comparison among different studies was difficult due to insufficient description of interventions, different outcome measures, and different length of follow-up periods. The current literature does not provide a reliable answer to whether operative or conservative treatment is more effective for unstable traumatic thoracolumbar fractures. High quality randomised controlled trials are direly needed. Keywords Traumatic thoracolumbar fractures AE Management AE Operative AE Non-operative treatment
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.
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...
The Internet Journal of Spine Surgery
The treatment of traumatic thoracolumbar fractures in the adult population remains controversial. To create an insight of the treatment performed by spine surgeons in the Netherlands a questionnaire survey was developed. This survey was sent to all departments of trauma-surgery and orthopedic surgery in the Netherlands and focused on their operative-or non-operative treatment of traumatic thoracolumbar fractures in adults. A minority of 32% of the departments offered operative treatment of thoracolumbar fractures. The Magerl/AO classification is still predominantly used among Dutch spine surgeons. The most used stabilization technique is an open dorsal stabilization. A large majority of the departments performs less than 10 operative thoracolumbar spine stabilizations per year. This is the first overview of the treatment of adult patients with thoracolumbar fractures in The Netherlands.