The purpose of this study was to evaluate and
compare the effect of short segment pedicle screw instrumentation and
an intermediate screw (SSPI+IS) on the radiological outcome of type
A
Background context: Stable thoracolumbar spinal fracture is a common injury, yet there remains a relative lack of evidence that would allow reliable prediction of outcome. Variation in outcome in stable thoracolumbar spine fracture without neurological deficit could not be explained by the assessment made from x-rays and CT imaging alone, which measures mainly the bony injury severity. So far, no good classification system has been developed to assess the severity of soft tissue injury (disc). Objectives: To measure short-term outcome of stable
Stable
Study Design/Objectives: A pilot study to predict thoracolumbar kyphosis progression secondary to fracture in non-operatively treated patients. Summary of Background Data: Progressive saggital plane deformity can cause persistent pain after thoracolumbar vertebral fractures. Little data exists to suggest at what interval after the index injury the patient attains a low risk of developing further angular deformity in non-operatively treated patients. Methods: Supine and erect radiographs were assessed and the degree of fracture kyphosis was determined using an Oxford Cobbometer. The fracture kyphosis was recorded for each follow up appointment along with time after the fracture. A time/data analysis was performed using the Blyth-Still-Casella exact interval. Results: This study included 22 patients (13 male, 9 female) with average age 67.2 years (range, 14–87 years). The average length of follow up was 11.5 months (range, 5.3–19.9 months) and the average number of radiographs taken within this period was 4 (range, 2–6). The change in fracture kyphosis was plotted against time following fracture. Based on 15 patients with data extending to 200 days follow up, it was observed that the rate of change in fracture kyphosis between two time points of 100 and 150 days predicted the trend in kyphosis progression until the end of follow up in 14 out of the 15 patients. This observed rate of 14/15 (0.93) has a 95% confidence interval of 0.7 to 0.99 (Blyth-Still-Casella exact interval). Conclusions: The standing lateral radiograph of patients with conservatively treated
We assessed narrowing of the spinal canal in 39 burst fractures and fracture-dislocations of thoracolumbar vertebrae treated by the AO Internal Spinal Fixator, using CT preoperatively and at various stages postoperatively. Computer-aided planimetry was used to measure the narrowing, and its restoration shortly after instrumentation, or at 15 months. The mean initial reduction of canal area was to 63.7% +/- 18.8% of normal; this was restored to a mean of 95.4% +/- 21.2% of normal when measured either soon after surgery or at 15 months (p <
0.001 for both groups). There was more improvement in cases assessed later. For fractures from D12 to L3, the mean canal area was restored to 99.4% of normal; but at L4 or L5 the mean restitution was to only 60.9% (p <
0.05). We found no correlation between preoperative loss of area and amount of restoration, or severity of neurological deficit. Nor was there any correlation between the delay before surgery and the improvement achieved. The mechanism of fracture reduction appears to be a combination of distraction ligamentotaxis and forced hyperextension.
Of a total of 905 patients with fracture or fracture-dislocation of the thoracolumbar spine admitted from 1969 to 1982, a neurological deficit was present in 334 (37%). All unstable injuries were initially treated by reduction and posterior fusion. In 79 of these patients, an anterolateral decompression was undertaken later because of persistent neurological deficit and radiographic demonstration of encroachment on the spinal canal. One patient died of pulmonary embolism; 78 were reviewed after a mean period of four years. Of these 78 patients 18 made a complete neurological recovery while 53 appeared to have benefited from the procedure; 25 remained unchanged. The best results were obtained in burst
Introduction. The management of
The aim of this study was first, to determine
whether CT scans undertaken to identify serious injury to the viscera were
of use in detecting clinically unrecognised fractures of the thoracolumbar
vertebrae, and second, to identify patients at risk of ‘missed injury’. We retrospectively analysed CT scans of the chest and abdomen
performed for blunt injury to the torso in 303 patients. These proved
to be positive for thoracic and intra-abdominal injuries in only
2% and 1.3% of cases, respectively. However, 51 (16.8%) showed a
fracture of the thoracolumbar vertebrae and these constituted our subset
for study. There were eight women and 43 men with mean age of 45.2
years (15 to 94). There were 29 (57%) stable and 22 (43%) unstable
fractures. Only 17 fractures (33.3%) had been anticipated after
clinical examination. Of the 22 unstable fractures, 11 (50%) were
anticipated. Thus, within the whole group of 303 patients, an unstable spinal
injury was missed in 11 patients (3.6%); no harm resulted as they
were all protected until the spine had been cleared. A subset analysis
revealed that patients with a high Injury Severity Score, a low
Glasgow Coma Scale and haemodynamic instability were most likely
to have a significant fracture in the absence of positive clinical
findings. This is the group at greatest risk. Clinical examination alone cannot detect significant fractures
of the thoracolumbar spine. It should be combined with CT imaging
to reduce the risk of missed injury.
Many authors recommend surgery to remove retropulsed bone fragments from the canal in burst fractures to 'decompress' the spinal canal. We believe, however, that neurological damage occurs at the moment of injury when the anatomy is most distorted, and is not due to impingement in the resting positions observed afterwards. We studied 20 consecutive patients admitted to our spinal injuries unit over a two-year period with a T12 or L1 burst fracture. There was no correlation between bony or canal disruption and the degree of neurological compromise sustained but there was a significant correlation between the energy of the injury (as gauged by the Injury Severity Score) and the neurological status (p <
0.001). This suggests that neurological injury occurs at the time of trauma rather than being a result of pressure from fragments in the canal afterwards and questions the need to operate simply to remove these fragments.
In 139 patients with burst fractures of the thoracic, thoracolumbar or lumbar spine, the least sagittal diameter of the spinal canal at the level of injury was measured by computerised tomography. By multiple logistic regression we investigated the joint correlation of the level of the burst fracture and the percentage of spinal canal stenosis with the probability of an associated neurological deficit. There was a very significant correlation between neurological deficit and the percentage of spinal canal stenosis; the higher the level of injury the greater was the probability. The severity of neurological deficit could not be predicted.
Study design. Retrospective study. Objectives. To identify patient outcomes, in particular employment, >5-years following traumatic
Objectives. This presentation discusses the experience at our Centre with treating traumatic
Thoracolumbar injury classification systems are not used or researched extensively in paediatric population yet. This systematic review aims to explore the validity and reliability of the two main thoracolumbar injury classification systems in the paediatric population (age ≤ 18). It also aims to explore the transferability of adult classification systems to paediatrics. The Thoracolumbar Injury Classification System (TLICS) published in 2005 and the AO Spine published in 2013 were assessed in this paper because they both provide guidance for the assessment of the severity of an injury and recommend management strategies. A literature search was conducted on the following databases: Medline, EMBASE, Ovid during the period November 2020 to December 2020 for studies looking at the reliability and validity of the TLICS and AO Spine classification systems in paediatric population. Data on validity (to what extent TLICS/ AO Spine recommended treatment matched the actual treatment) and reliability (inter-rater and intra-rater reliability) was extracted. There is an “almost perfect validity” for TLICS. There is a “strong association” between the validity of TLICS and AO Spine. The intra-rater reliability is “moderate” for TLICS and “substantial” for AO Spine. The intra-rater reliability is “substantial” for TLICS and “almost perfect” for AO Spine. The six studies show a good overall validity and reliability for the application of TLICS and AO Spine in pediatric
Introduction:. Most of the published papers on AI based diagnosis have focused on the algorithm's diagnostic performance in a ‘binary’ setting (i.e. disease vs no disease). However, no study evaluated the actual value for the clinicians of an AI based approach in diagnostic. Detection of Traumatic
Study design: retrospective clinical study . Objective: To study radiological late results after posterior stabilization of
Background: Thoraco-lumbar fractures without a neurological deficit are usually suitable for non-operative treatment. The main area of clinical interest is the deformity at the injured levels. The deformity may be evident at the time of presentation, though could be expected to progress in time. Objective: Accurate assessment of the temporal behaviour in the geometry of the injured segments in non-operatively treated
Introduction: Spinal fractures are associated with pain, disability, neurological dysfunction and mortality. Osteoporosis and risky leisure time activities are increasing in the population. New treatment options have been introduced. However, only a few international studies have reported its descriptive epidemiology. There are no clear consensuses regarding the choice of operative interventions versus non-operative treatment in patients with
Background: There is conflicting evidence of correlation between clinical outcome and severity of thoracolumbar spine fractures in neurologically intact patients. 1. Kalyan et al2 presented the results of their prospective study of thoracolumbar spinal fractures and concluded that the clinical outcome was consistently better predicted by the severity of disc injury than that of the bony fracture. They suggested that if severe disc injury was present, treatment of the disc injury may result in a better short term clinical outcome. The aim of this study was to detail the incidence and type of disc injury in patients with thoracolumbar spinal fractures with intact neurology. Methods: Retrospective analysis of a prospectively collected spinal injury database at a regional spinal injuries unit. Only patients with a thoracolumbar spinal fracture and intact neurology were included. Retrospective analysis of magnetic resonance imaging (MRI) findings. One hundred and thirty nine neurologically intact patients (89M:50F, mean age 36 years, range 15 – 77yrs) with a thoracolumbar (T11 –L5) spinal fracture were admitted to our spinal unit over the last 11 years (1994 – 2004). Patient data was collected prospectively onto a spinal injuries database. All of these patients had an MRI scan on admission. All types of
Purpose: The purpose of this study was to analyse the results and morbidity of video-assisted minimally invasive thoracoctomy for anterior arthrodesis of
Introduction: Treatment of
Purpose of study: There is a controversy in the surgical treatment of unstable
Introduction and Objective. Up to 30% of
Introduction. In all traumatic injury there is a clear relationship between the structural tissue damage and resultant disability after recovery. There are no publications that compare significant thoracolumbar osseous injury to non specific soft tissue injury. Aim. To compare spinal outcome measures between patients with self reported back pain in the workplace perceived as injury to those having sustained structural injury in the form of an unstable
Introduction: Introduction of the minimal invasive surgery as a new concept in spinal surgery necessitated the need for implants that can be applied through minimal invasive approaches. One of the great challenges was the development of anterior minimal invasive vertebral replacement implants that are mechanically fit and easily applicable. Many studies were concerned with the early results of such implants but not yet the long-term or late ones. Methods: Between January 2003 and December 2003 we have operated 23 patients (13 males and 10 females) with traumatic thoracic or
Purpose of the study: The treatment of
The June 2023 Spine Roundup360 looks at: Characteristics and comparative study of thoracolumbar spine injury and dislocation fracture due to tertiary trauma; Sublingual sufentanil for postoperative pain management after lumbar spinal fusion surgery; Minimally invasive bipolar technique for adult neuromuscular scoliosis; Predictive factors for degenerative lumbar spinal stenosis; Lumbosacral transitional vertebrae and lumbar fusion surgery at level L4/5; Does recall of preoperative scores contaminate trial outcomes? A randomized controlled trial; Vancomycin in fibrin glue for prevention of SSI; Perioperative nutritional supplementation decreases wound healing complications following elective lumbar spine surgery: a randomized controlled trial.
Decision-making regarding operative versus non-operative treatment of patients with
The progressive kyphosis and pain in patients with acute
Background: It has been reported that there is poor correlation between neurological injury and degree of bony retropulsion in
Introduction: The management of patients with
Exact knowledge of the site of the lesion, and a better understanding of the traumatic mechanisms have led to a major improvement in the surgical approach used for the treatment of
To analyse the pain distribution in the acute and chronic phase following
Background.
The evaluation of early results of combined percutaneous pedicle screw fixation and kyphoplasty for the management of thoraco-lumbar burst fractures. Between October 2008 and April 2009, 9 patients with
This study was designed to assess the inter-observer reliability and intra-observer reproducibility of standard radiographic evaluation of 150
Guidelines for cervical trauma x-rays highlight the necessity for visualization of the C7-T1 junction. However, despite 15% of
We hypothesised whether MIS techniques confer any benefit when treating
We have studied the intervertebral discs adjacent to fractured vertebral bodies using MRI in 63 patients at a minimum of 18 months after injury. There were 75
Aim: To compare the radiological and functional outcomes of compression type thoracolumbar vertebral fractures treated with cloth-type thoracolumbar orthosis fitted with steel plates and bed rest. Methods: This prospective comparative study was done between July 2004 and January 2007. Twenty three patients (17 male, 6 female) with compression type (Magerl A1) thoracolumbar vertebral fractures were included. No patient had associated neurogical findings or additional injury. Eleven patients were treated with cloth-type thoracolumbar orthosis and 12 patients with only bed rest. Bed rest group cases were instructed to stand up and walk around as possible as they tolerated after pain relief just only in the house under the supervision of it’s relates. All cases were evaluated at last follow-up with SF-36 questionaire, clinical and radiological examination. Results: There was no significant difference between two groups with regard to demographic data. Radiological parameters including anterior compression angle, local kyphosis angle, sagittal index and anterior vertebral height were measured and compared on initial admittion, on the third month and at the last visit showing no significant difference (p>
0.05). Clinical evaluation was performed via work and pain criteria described by Denis. We found no significant difference between both groups for functional criteria (p>
0.05). Mental and physical points of SF-36 questionaire were recorded and compared dispaying no difference (pmental=0.15, pphysical=0.44). Conclusion: Magerl type A1
Purpose of the study: Kyphoplasty was introduced to reinforce the anterior column in osteoporotic vertebral fractures. It can be used for non-osteoporotic fractures. The purpose of this work was to report the clinical and radiographic results of kyphoplasty for non-ostoporotic vertebral fractures. Material and methods: From December 2005 to August 2008, we followed prospectively 21 patients (12 M, 9 F) mean age 45 years (16–58) treated for
Introduction: The use of an ejection seat to escape from a stricken aircraft is associated with the exposure of significant forces. These vertical accelerative forces on the body are in the order of 15–25G with rates of onset of up to 250G per second. Therefore, it is common to see vertical compression fractures, mainly in the thoracolumbar region. Although most vertebral fractures are evident on plain radiographs, subtle spinal injuries elsewhere may not be immediately apparent. Aim: A prospective study to evaluate for the presence of occult spinal injuries using MRI following aircraft ejection. Methods: Between 1996 and 2003, 22 ejectees from 18 aircrafts, mean age 32 years (range 24 to 48), were admitted to a regional spinal unit for comprehensive evaluation of their injuries that included whole spine radiographs and Magnetic Resonance Imaging (T1, T2 weighted and STIR sagittal sequences). All ejections occurred within the ejection envelope and were flying below 2000 ft (mean 460 feet) and below 500 knots airspeed (mean 275 knots). Results: All 5 ejectees (23%) with vertebral compression fractures, one at T6 and 4 in thoracolumbar region, had pain and tenderness in the appropriate area of the spine that was evidently detected on plain radiographs. 3 of these patients with a
Purpose: Minimally invasive video-assisted thoracotomy can be proposed for potentially unstable fractures of the thoracolumbar junction with rupture of the anterior column after satisfactory posterior reduction and osteo-synthesis. Long-term results are improved in terms of graft quality and stability of the postoperative angular gain. Material and methods: Ninety-one patients, mean age 36 years, with spinal fractures involving T12 to L2 underwent video-assisted mini-thoracotomy for arthrodesis as a complementary procedure after posterior reduction and osteosynthesis without bone graft. The left approach was preferred over the right due to the lower risk of bleeding. A massive tricortical anterolateral iliac graft was inserted in the intersomatic space. Perfect stability was achieved with the MIASPAS system which provides an exact measure of the intersomatic space and the bone graft. Results: Follow-up was five years for the first patients and ten months for those operated on after January 2003. At last follow-up, functional outcome (Stauffer-Coventry score) was excellent or good in 52% and 41% of the patients respectively. Outcome was poor in 7%. Postoperative radiograms demonstrated 100% graft fusion which was confirmed by tomography. There was no loss of angular gain. Discussion: This novel approach provides a means of preserving the posterior instrumentation and achieving anterior fusion in the zone of maximal stress. Because of the relative facility of the technique together with the operative time and the relatively low risk of postoperative complications, surgical indications for complementary intersomatic arthrodesis can be revisited. Anterior fusion is, in our opinion, the only sure means of maintaining long-term correction. The ability to access the disc, generally without metameric hemostasis, eliminates the risk of vascular cord lesions. Conclusion: This thoracoscopic technique for anterior fusion after a short posterior osteosyntheis without graft will greatly modify indications for complementary anterior fusion for the treatment of unstable
The Mater Hospital is Ireland’s primary referral centre for spinal injuries receiving 80–90% of all spinal cases annually. In today’s society the number of people competing at more competitive and professional levels is also increasing. Over the years, a lot of work has gone into safety precautions in sport. However despite those improvements our impression was that the incidence of both minor and serious sporting injuries is increasing. The purpose of this study was to determine the incidence, pattern and mechanism of sports-related spinal injuries in Ireland over the last decade. Data was collected by performing an audit of the National Spinal Injuries Database from 1994–2001. This database is a prospective computerized database. Data entered relates to the initial presentation, mechanism, level of injury and their acute in-hospital management. On average 200–220 patients are admitted annually to the National Injuries Spinal Unit. 173 of these were related to sport, which represented 13% of total spinal injuries. 80% are male under 40 years. 29% sustained neurological deficit. The sports responsible for most spinal injuries in Ireland were equestrian (43.8%), followed by rugby (16.4%), diving (15%), GAA (13.6%) and skiing (3%). Rugby injuries were most likely to cause neurological damage. Equestrian accidents commonly caused
The October 2012 Spine Roundup. 360. looks at: a Japanese questionnaire at work in Iran; curve progression in degenerative lumbar scoliosis; the cause of foot drop; the issue of avoiding the spinal cord at scoliosis surgery; ballistic injuries to the cervical spine; minimally invasive oblique lumbar interbody fusion; readmission rates after spinal surgery; clinical complications and the severely injured cervical spine; and stabilising the