Indications for Nonsurgical Treatment of Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations (original) (raw)
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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...
Introduction to Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations
Neurospine, 2021
World Federation of Neurosurgical Societies (WFNS) Spine Committee is focused on giving a new horizon in light of research and available recent past data. With the increasing advances and day to day variations in surgical approaches, it has become extremely important to develop new guidelines and recommendations. After developing and publishing guidelines about cervical trauma, 1 spinal cord injury, 2 lumbar spinal stenosis, 3 and cervical spondylotic myelopathy, 4 the WFNS Spine Committee has developed recommendations regarding thoracolumbar (TL) spine trauma. This was achieved after a gross literature search between 2010 and 2020 and then holding a consensus meeting. It is an honour for me to be part of this work done during the chairmanship of Prof Zileli, Prof Fornari, and myself. Up-to-date information was reviewed to reach an agreement in the World Federation of Neurosurgical Societies (WFNS) Spine Committee meeting. The first meeting was conducted live in Peshawar in December 2019, and the second meeting was a virtual meeting on June 12, 2020. Both meetings aimed to analyze a preformulated questionnaire through preliminary literature review statements based on the current evidence levels to generate recommendations through a comprehensive voting session. Delphi method was utilized to administer the questionnaire to preserve a high degree of validity. 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. The 6 papers you will find in the following pages are guidelines for almost all aspects of the TL fracture. The annual incidence of TL fractures is about 30/100,000 inhabitants, including osteoporotic fractures. There is a trend towards increasing fractures in developed countries, especially due to low velocity falls in the elderly population. The mortality rate after the spinal injury decreases in developed countries due to improvements in motor vehicle safety and traffic regulations. 5 The TL spine is the most frequently injured spinal region in blunt trauma. The potential risk of concomitant injury to the spinal cord, chronic pain, and lifelong disability presents a significant burden on patients and the health service. Due to the range of injury classification systems and varied treatment efficacy, literature on the indications for nonoperative treatment of TL fractures is conflicting. The WFNS Spine Committee was able to formulate numerous key recommendations to guide clinical practice. Although compression-type fractures and stable burst fractures can
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...
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
(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.
Incidence and Epidemiology of Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations
Neurospine, 2021
This review aims to search the epidemiology and incidence rates of thoracolumbar spine fractures. A systematic review of the literature of the last 10 years gave 586 results with “incidence,” and 387 results with “epidemiology,” of which 39 papers were analyzed. The review results were discussed and voted in 2 consensus meetings of the WFNS (World Federation of Neurosurgical Societies) Spine Committee. Out of 39 studies, 15 studies have focused on thoracolumbar trauma, remaining 24 studies have looked at all spine trauma. Most were retrospective in nature; few were prospective and multicenter. Some studies have focused on specific injuries. The annual incidence of TL fractures is about 30/100,000 inhabitants including osteoporotic fractures. There is a trend to increase the fractures in elderly population especially in developed countries, while an increase of motor vehicle accidents in developing countries. The mortality rate among male elderly patients is relatively high. The inci...
Indications and principles of surgical treatment in injuries affecting the thoracolumbar spine
Orthopaedics and Trauma, 2020
Vertebral fractures are very common and primarily affect the thoracolumbar spine as the result of an isolated injury or in polytrauma patients. The majority of these fractures can be treated nonoperatively. Surgical stabilization of thoracolumbar fractures may be indicated after high-energy trauma or in the multiply injured patient. Surgery aims to provide a stable spinal column to allow early mobilization and optimize neurological outcome. This article considers the principles of clinical assessment and decision-making in the surgical management of thoracolumbar fractures. The AO spine thoracolumbar classification system can be used to guide treatment because the choice of surgical strategy depends on the biomechanics of the injury. Most injuries can be stabilized through a posterior approach but anterior column reconstruction can be performed, either as a stand-alone procedure or in order to support a posterior stabilization. The use of minimally invasive techniques is discussed. Interventional spinal technologies for osteoporotic vertebral compression fractures are also considered.
Practice Management Guidelines for the Screening of Thoracolumbar Spine Fracture
Journal of Trauma-injury Infection and Critical Care, 2007
Background: Fractures to the thoracolumbar spine (TLS) commonly occur because of major trauma mechanisms. In one series, 4.4% of all patients arriving at a Level I trauma center were diagnosed as having TLS fracture. Approximately 19% to 50% of these fractures in the TLS region will be associated with neurologic damage to the spinal cord. To date there are no randomized studies and only a few prospective studies specifically addressing the subject. The Eastern Association for the Surgery of Trauma organization Practice Management Guidelines committee set out to develop an EBM guideline for the diagnosis of TLS fractures.