Reliability Analyses of Radiographic Measures of Vertebral Body Height Loss in Thoracolumbar Burst Fractures

2019 ◽  
Vol 129 ◽  
pp. e191-e198
Author(s):  
Jae-Young Hong ◽  
Sung-Woo Choi ◽  
Gi Deok Kim ◽  
HyunKwon Kim ◽  
Byung-Joon Shin ◽  
...  
Keyword(s):  
Vertebral Body ◽  
Body Height ◽  
Height Loss ◽  
Vertebral Body Height ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures

scholarly journals Short term radiological outcome of inserting screw at fracture level in posterior short segment fixation in thoracolumbar burst fractures

2017 ◽  
Vol 4 (3) ◽  
pp. 71-76
Author(s):  
Rabindra Lal Pradhan ◽  
Bimal Kumar Pandey ◽  
Krishna Raj Khanal
Keyword(s):  
Vertebral Body ◽  
Body Height ◽  
Fracture Site ◽  
Implant Failure ◽  
Vertebral Body Height ◽  
Short Segment ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures ◽  
Short Segment Fixation

Background: Unstable thoracolumbar burst fractures are treated surgically by short segment fixation but may be associated with high implant failure. Supplementation of anterior column by insertion of screw at fracture site makes it more biomechanically stable.Objectives: The purpose of this prospective study was to evaluate radiological parameters in thoracolumbar fractures treated with intermediate screw fixation with a minimum follow up of two years.Methods: This prospective study was conducted from 2011 till 2012 where unstable  thoracolumbar fractures treated with short segment posterior instrumentation with screw at fracture site were evaluated. All patients (average age 34.64 were followed up for at least 24 months and were classified according to Thoracolumbar Injury Classification and Severity Score and load sharing classifi cation. Out of total 32 patients, four lost to follow up. Radiological parameters like vertebral body height and segmental kyphosis were evaluated and pain was evaluated by Visual Analogue Scale score.Results: Preoperative pain showed mean Visual Analogue Scale Score score of 8.29 that improved to 0.97 at fi nal follow up. Average preoperative loss of vertebral body height was 48.19 %, which improved to 11.4 % after surgery (p<.001). Final vertebral body collapse was 12.98 % with mean percentage loss of vertebral height at 1.57%. Average segmental kyphotic angle was 22.54 before surgery, which corrected to 5.89 immediately after surgery (p<0.001). Final segmental kyphosis was 8.46. Loss of kyphosis correction was 2.57. Two patients had implant failure, but was solidly united during implant removal in both cases.Conclusion: Excellent maintenance of reduction in thoracolumbar burst fractures with short segment fixation with intermediate screws at fracture site with limited decompression resulted in improved neurologic function and satisfactory clinical outcomes, with a low incidence of implant failure and progressive deformity.

scholarly journals The Association between Sagittal Index, Canal Compromise, Loss of Vertebral Body Height, and Severity of Spinal Cord Injury in Thoracolumbar Burst Fractures

2016 ◽  
Vol 07 (S 01) ◽  
pp. S057-S061
Author(s):  
Mehmet Onur Yüksel ◽  
Mehmet Sabri Gürbüz ◽  
Şevki Gök ◽  
Numan Karaarslan ◽  
Merih İş ◽  
...  
Keyword(s):  
Vertebral Body ◽  
Burst Fracture ◽  
Body Height ◽  
Neurological Injury ◽  
Vertebral Body Height ◽  
Predictive Values ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures ◽  
Cord Injury ◽  
Sagittal Index

ABSTRACT Aim: Our aim was to determine whether a combination of sagittal index (SI), canal compromise (CC), and loss of vertebral body height (LVBH) is associated with the severity of neurological injury in patients with thoracolumbar burst fractures. Materials and Methods: Seventy-four patients with thoracolumbar burst fracture undergoing instrumentation between 2010 and 2015 were analyzed retrospectively. The degree of neurological injury was determined using the American Spinal Injury Association (ASIA) scoring system. The association between the morphology of the fracture and the severity of neurological injury was analyzed. Results: There was a strong association between fracture morphology and the severity of neurological injury. Of the patients, 77.5% with SI ≥20°, 81.6% with CC ≥40%, and 100% with LVBH ≥50% had lesion according to ASIA. All of 7 patients with ASIA A had SI ≥20°, CC ≥40%, and LVBH ≥50%. On the other hand, 79% of the patients with ASIA E had SI <20°, 83.7% of the patients with ASIA E had CC <40%, and all of the patients with ASIA E had LVBH <50%. SI, CC, and LVBH were lower in neurologically intact patients (ASIA E), whereas they were higher in patients with neurological deficits (ASIA A, B, C, D) (P = 0.001; P < 0.01). These measurements had 100% negative predictive values and relatively high positive predictive values. Conclusion: SI, CC, and LVBH are significantly associated with the severity of neurological injury in patients with thoracolumbar burst fractures. The patients with SI >25°, the patients with CC >40%, and the patients with LVBH >50% are likely to have a more severe neurological injury.

scholarly journals Efficacy of Computed Tomography-assisted Limited Decompression in the Surgical Management of Thoracolumbar Fractures With Neurological Deficit

2021 ◽  
Author(s):  
Landa Shi ◽  
Dean Chou ◽  
Yuqiang Wang ◽  
Mirwais Alizada ◽  
Yilin Liu
Keyword(s):  
Quality Of Life ◽  
Postoperative Complications ◽  
Vertebral Body ◽  
Burst Fracture ◽  
Body Height ◽  
Height Loss ◽  
Vertebral Body Height ◽  
Single Segment ◽  
Significant Difference

Abstract Objective: to investigate the effect of CT-assisted limited decompression in the management of single segment A3 lumbar burst fracture. Method: A retrospective study of 106 cases with a single-level Magerl type A3 lumbar burst fractures treated with short-segment posterior internal fixation and limited decompression from January 2015 to June 2019 was performed. Patients were divided into two groups: CT-assisted and non-CT-assisted. Perioperative factors, clinical outcomes, postoperative complications, imaging parameters and health-related quality of life (HRQoL) were evaluated. Results: There was no significant difference between the two groups in the kyphosis, anterior vertebral body height loss, posterior vertebral body height loss, operative time, and postoperative complications. The visual analogue score (VAS) and spinal canal encroachment in the CT-assisted group were lower than those in the non-CT-assisted group (P < 0.05). The Japanese Orthopaedic Association score (JOA), the simplified HRQoL scale and American Spinal Injury Association (ASIA) Spinal Cord Injury Grade in the CT-assisted group were higher than those in the non-CT-assisted group (P < 0.05).Conclusion: CT-assisted limited decompression in the treatment of single-segment A3 lumbar burst fracture can achieve better fracture reduction and surgical results, and improve the long-term recovery of neurological function and quality of life of the patients.

scholarly journals Analysis of Related Factors on The Vertebral Height Restoration of Percutaneous Vertebral Augmentation

2019 ◽  
Vol 104 (7-8) ◽  
pp. 398-405
Author(s):  
Weixing Xie
Keyword(s):  
Vertebral Body ◽  
Compression Ratio ◽  
Univariate Analysis ◽  
Body Height ◽  
Height Loss ◽  
Loss Ratio ◽  
Vertebral Body Height ◽  
Kyphosis Angle ◽  
Local Kyphosis

Background Percutaneous vertebral augmentation (PVA) is widely applied for the treatment of osteoporotic vertebral fractures. The degree of vertebral body height restoration and deformity correction after the procedure is not consistent. Methods We retrospectively reviewed 97 patients who underwent PVA, because of osteoporotic vertebral compression fractures. The following data about the patients were recorded: age, sex, bone density, number of treated vertebrae, severity of fracture of the treated vertebrae, operative approach (PVP or PKP), volume of injected bone cement, preoperative vertebral compression ratio, preoperative local kyphosis angle, cement leakage, postoperative vertebral body height restoration ratio, follow-up period, and latest follow-up height loss ratio. Bivariate regression analysis and t-test were applied for univariate analysis, while multivariate linear regression analysis was applied for multivariate analysis. Results The postoperative vertebral body height restoration ratio was (14.7% ± 15.2%), and the last follow-up height loss ratio was (13.5% ± 11.5%). The multivariate analysis showed that the number of treated vertebrae, preoperative vertebral compression ratio, and preoperative local kyphosis angle are the main factors influencing the postoperative vertebral body height restoration. The univariate analysis also showed that only the postoperative vertebral body height restoration ratio is related to the last follow-up height loss ratio. Conclusions The number of treated vertebrae, preoperative vertebral compression ratio, and preoperative local kyphosis angle are the main influencing factors of patients' vertebral body height restoration after PVA, and the postoperative vertebral body height restoration ratio is the main factor influencing the last follow-up height loss ratio.

scholarly journals Treatment of Thoracolumbar Type A3 Fractures Using a Percutaneous Intravertebral Expandable Titanium Implant: Long-term Follow-up Results of a Pilot Single Center Study

2021 ◽  
pp. E631-E638
Keyword(s):  
Vertebral Body ◽  
Body Height ◽  
Titanium Implant ◽  
Cement Leakage ◽  
Thoracolumbar Fractures ◽  
Single Center ◽  
Vertebral Body Height ◽  
Burst Fractures

BACKGROUND: There are controversies about the optimal management of AO subtype A3 burst fractures. The most common surgical treatment consists of posterior fixation with pedicle screw and rod augmentation. Nevertheless, a loss of correction in height restoration and kyphotic reduction has been observed. OBJECTIVES: The aim of this study was to assess long-term outcomes of a minimally invasive technique using a percutaneous intravertebral expandable titanium implant (PIETI). STUDY DESIGN: This prospective, single center, pilot study was carried out on a consecutive case series of 44 patients with acute (< 2 weeks) traumatic thoracolumbar fractures AO type A3. The average follow-up was 5.6 years. SETTING: A single center in Castilla y Leon, Spain METHODS: Clinical outcomes (pain intensity on visual analog scale [VAS], Oswestry Disability Index [ODI], analgesic consumption) and radiographic outcomes (anterior/mid/posterior vertebral body height, vertebral area, local kyphosis angle, traumatic regional angulation) were analyzed before surgery, at one month after surgery, and at the end of the follow-up period. RESULTS: At one-month postsurgery, significant improvements in VAS score and ODI score were observed. PIETI achieved significant vertebral body height restoration with median height increases of 2.9 mm/4.3 mm/2.3 mm for anterior/middle/posterior parts, respectively. Significant correction of the local kyphotic angle and improvement of the traumatic regional angulation were accomplished. All these improvements were maintained throughout the follow-up period. The only complication reported was a case of cement leakage. LIMITATIONS: In our opinion, the main limitation of the study is the small number of patients. However, the sample is superior to that shown in other papers. CONCLUSIONS: This study showed that using a PIETI in the treatment of fractures type A3 is a safe and effective method that allows marked clinical improvement, as well as anatomical vertebral body restoration. Unlike with other treatments, results were maintained over time, allowing a better long-term clinical and functional improvement. The rate of cement leakage was lower than other reports. KEY WORDS: Traumatic thoracolumbar fractures, burst fractures, AO type A3 fractures, kyphoplasty, percutaneous intravertebral expandable titanium implant

scholarly journals Importance of load sharing column and canal violation in the management of thoracolumbar burst fractures.

2018 ◽  
Vol 20 (1) ◽  
pp. 73-79
Author(s):  
Fabrizio Borges Scardino ◽  
José Marcus Rotta ◽  
Ricardo Vieira Botelho
Keyword(s):  
Vertebral Body ◽  
Body Height ◽  
Spinal Fractures ◽  
Load Sharing ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures ◽  
Treatment Objective ◽  
Posterior Ligament ◽  
Canal Encroachment ◽  
Treatment Rules

Introduction: The ideal classification of spinal fractures should include every kind of fracture and suggest patterns of treatments. Vaccaro et al. proposed a classification and treatment rules according to a comprehensive severity score. In this one, fractures with exclusive lesion of the vertebral body, burst fractures, without either damage of the posterior ligament band or neurological deficit, are considered for conservative treatment. Objective: To demonstrate that some fractures, with an exclusive lesion of the load sharing column, the vertebral body, without any posterior ligament destruction, may be unable to share physiological loads and if associated with great compression of spinal canal, carries so much risk of neural damage that it should be submitted to surgery. Methods: This review is based on the discussion of the literature and is illustrated by a case description. Results: We demonstrate the importance of inclusion of the concepts, load sharing column and intensity of canal encroachment in therapeutic decision regarding thoracolumbar fractures. Conclusions: Patients with canal compression ≥ 50% should be considered for surgery. Patients with lesser degrees of canal encroach may be submitted to erect radiography and operated if there is an additional loss of vertebral body height or neurological symptoms.

scholarly journals Measurement of kyphosis and vertebral body height loss in traumatic spine fractures: an international study

2016 ◽  
Vol 26 (5) ◽  
pp. 1483-1491 ◽  
Author(s):  
Said Sadiqi ◽  
Jorrit-Jan Verlaan ◽  
A. Mechteld Lehr ◽  
Jens R. Chapman ◽  
Marcel F. Dvorak ◽  
...  
Keyword(s):  
Vertebral Body ◽  
Body Height ◽  
International Study ◽  
Height Loss ◽  
Spine Fractures ◽  
Vertebral Body Height

scholarly journals Outcomes with fracture-level transpedicular screws used for thoracolumbar junction fractures

2020 ◽  
Vol 26 (4) ◽  
pp. 548-554
Author(s):  
S.V. Likhachev ◽  
◽  
V.V. Zaretskov ◽  
V.B. Arsenievich ◽  
V.V. Ostrovskij ◽  
...  
Keyword(s):  
Blood Loss ◽  
Vertebral Body ◽  
Demographic Data ◽  
Operating Time ◽  
Body Height ◽  
Thoracolumbar Junction ◽  
Kyphotic Angle ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures ◽  
Fracture Level

Background Short-segment transpedicular screw fixation (SSTSF) is the preferred treatment option for thoracolumbar burst fractures. Adding screws in the fractured body may be helpful in achieving and maintaining fracture reduction. However, the operative approach is disputed. Objective To compare clinical outcomes of transpedicular fixation with and without screws in the fractured vertebral body after isolated uncomplicated fractures at the thoracolumbar junction. Material and methods A retrospective cohort study enrolled 62 patients with Th11–L2 thoracolumbar burst fractures (AOSpine A3, A4) who underwent SSTSF with (n = 32) and without (n = 30) pedicle screws at the fracture level. Demographic data of the patients, operating time and blood loss were registered. Clinical evaluation using Visual analogue scale (VAS ) for pain, Oswestry Disability Index (ODI) to quantify disability and imaging parameters of segmental kyphosis, loss of correction, anterior vertebral body height (AVBH) at the fracture level, spinal canal stenosis (SCS) were measured preoperatively, at one week, 1 month, 6 and 12 months postoperatively. Results The patients of the two groups showed no statistically significant differences in the demographic data, VAS and ODI scores, measurements of kyphotic angle, AVBH, SCS preoperatively (p > 0.05). Screws at the fracture level did not affect the operating time and intraoperative blood loss relative to conventional no-screw group. Benefits with fracture screws were evident at 7 days (p < 0.01) measuring SCS, at 6 months (p < 0.01) and 12 (p < 0.01) months measuring kyphotic angle. There was better kyphosis correction (p < 0.01) and AVBH (p = 0.034) seen at 12 months after surgery. Conclusion Reinforcement of a broken vertebra with fracture-level screws has been shown to provide better stability of clinical and radiographic results as compared to those with conventional SSTSF.

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