Traumatic Fractures of the Thoracic Spine

2020 ◽  
Author(s):  
Ulrich J. A. Spiegl ◽  
Klaus John Schnake ◽  
Frank Hartmann ◽  
Sebastian Katscher ◽  
Marion Riehle ◽  
...  
Keyword(s):  
Thoracic Spine ◽  
Vertebral Fractures ◽  
High Energy ◽  
Thoracolumbar Junction ◽  
Thoracic Injuries ◽  
Vertebral Body Fractures ◽  
Thoracic Spine Fractures ◽  
Fracture Instability ◽  
Upper Thoracic ◽  
Sternal Fractures

AbstractThe majority of traumatic vertebral fractures occur at the thoracolumbar junction and the lumbar spine and less commonly at the mid-thoracic and upper thoracic spine. In accordance, a high number of articles are dealing with thoracolumbar fractures focusing on the thoracolumbar junction. Nonetheless, the biomechanics of the thoracic spine differ from the thoracolumbar junction and the lumbar vertebral spine. The aim of this review is to screen the literature dealing with acute traumatic thoracic vertebral fractures in patients with normal bone quality. Thereby, the diagnostic of thoracic vertebral body fractures should include a CT examination. Ideally, the CT should include the whole thoracic cage particularly in patients suffering high energy accidents or in those with clinical suspicion of concomitant thoracic injuries. Generally, concomitant thoracic injuries are frequently seen in patients with thoracic spine fractures. Particularly sternal fractures cause an increase in fracture instability. In case of doubt, long segment stabilization is recommended in patients with unstable mid- und upper thoracic fractures, particularly in those patients with a high grade of instability.

Upper Thoracic Spine Fractures Outcomes and Complications in King Abdul-Aziz Medical City, Riyadh

2021 ◽  
pp. 16
Author(s):  
Faisal Konbaz
Keyword(s):  
Thoracic Spine ◽  
Sagittal Alignment ◽  
High Energy ◽  
Spine Fractures ◽  
Associated Injuries ◽  
Upper Thoracic Spine ◽  
Thoracic Spine Fractures ◽  
The Mean ◽  
Upper Thoracic ◽  
The Impact

Introduction: Upper thoracic spine fractures (T1-T6) are not uncommon. They are often high-energy injuries complicated by multiple life-threatening comorbidities. There is a controversial discussion in the literature regarding the treatment choices. Thoracic pedicle screw fixation has replaced all other fixation techniques for its success rate and safety. Despite the number of studies discussing upper thoracic spine fractures, data on literature reporting postoperative complications are deficient. The aim of the study was to assess, in a series of patients, the impact of traumatic upper thoracic fractures on sagittal alignment, the incidence of possible complications, and the effect of associated injuries. Methodology: This retrospective chart review study included all adult cases diagnosed as traumatic upper thoracic spine fractures in KAMC in Riyadh. Data were obtained from the computerized database. The information reviewed included fracture characteristics, associated injuries, pre- and postoperative neurological status and sagittal alignment, follow-up duration, and the presence of complications. Result: A total of 19 patients were included in the study. Of them, 17 (89.5%) were injured secondary to a motor vehicle accident. There were three patients with a fixation level crossing the CT junction, more blood loss and procedure time was noticed with these cases. There was a notable improvement in upper thoracic kyphosis by 9º when measuring pre- and postop fracture Cobb's angle. The mean preop angle was 28.98 and the mean postop was 20.76. Of all the 19 cases involved in the study, 3 patients had developed surgical site infection as a complication. No other complication was reviewed. Conclusion: It is well-known in the literature that the correction of kyphosis and the absence of residual deformity postoperatively are indicators of the success and safety of the procedure used. Our findings correspond to the literature discussion that the current practice in managing traumatic upper thoracic spine fracture in KAMC in Riyadh is relatively safe and effective. Yet, further studies are needed to elaborate more on the relationship between the presence of other injuries and patients’ factors and postoperative outcomes.

scholarly journals Burst fracture Th 9-10 treat with Transthoracal Corpectomy and stabilization: A Cases Report

2019 ◽  
Vol 1 (2) ◽  
Author(s):  
Halim Rahman Manurung ◽  
Sabri Ibrahim ◽  
Ridha Dharmajaya
Keyword(s):  
Cervical Spine ◽  
Thoracic Spine ◽  
Burst Fracture ◽  
Thoracolumbar Spine ◽  
Spinal Fractures ◽  
High Energy ◽  
Spinal Fracture ◽  
Thoracolumbar Junction ◽  
Unstable Fracture ◽  
Burst Fractures

Abstract. Spinal fracture and dislocation are among the most feared injuries by patients and physicians alike, as the consequences can be devastating, ranging from mild pain and discomfort to severe paralysis and even death. Spinal trauma is commonly found in patients admitted to level-one trauma centers after serious accidents like traffic, falling, and sports accidents.Injuries of the cervical spine account for one third of spinal fractures and half to two thirds of all spinal cord injuries.In the thoracolumbar spine, the most common unstable fracture is the burst fracture. Altogether, burst fractures have been reported to account for about 15% of spinal injuries.Incidence of burst fractures peaked at the thoracolumbar junction and between levels T5 and T8. In 10% of cases,more than one burst fracture was seen, thereof 53% on noncontiguous levels. Main accident mechanisms were falls, traffic, and sports. Neurological deficit was highest in patients with burst fractures of the cervical spine, independent of accident mechanism, and lowest in thoracolumbar junction fractures. Burst fractures occur frequently in high energy traumas and are most commonly associated with falling and traffic accidents.Multiple burst fractures occur in 10% of cases, half thereof on noncontiguous levels.Access to the anterior thoracic spine via the transthoracic approach (via thoracotomy) can be used for decompression and fusion. To perform adequate decompression and stabilization of the thoracic spine, obtaining good exposure is a must. Preservation and protection of the vascular structures in the thoracic cavity is the key to such an exposure. Preoperative workup should include imaging modalities (plain rontgens, MRI/CT scan) to specifically define the area of decompression. If a tumor is being evaluated, CT angiography and embolization are helpful in preoperative planning. Assistance by a thoracic surgeon for exposure is highly recommended.

scholarly journals UPPER THORACIC SPINE FRACTURE ASSOCIATED WITH FRACTURE OF THE STERNUM

2017 ◽  
Vol 16 (1) ◽  
pp. 60-63
Author(s):  
JOAQUÍN VALERO ◽  
NICOLÁS MAXIMILIANO CICCIOLI ◽  
PEDRO LUIS BAZÁN ◽  
ALVARO ENRIQUE BORRI
Keyword(s):  
Thoracic Spine ◽  
Spinal Injury ◽  
High Energy ◽  
High Energy Trauma ◽  
Upper Thoracic Spine ◽  
Direct Trauma ◽  
Thoracic Spine Fracture ◽  
Upper Thoracic ◽  
Car Accident ◽  
The Impact

ABSTRACT Objectives: The objectives of this presentation are to analyze the kinematics that causes this association, describe the impact of the injury, and evaluate the treatment performed Methods: Three cases are analyzed by quantifying the displacement and angulation of the sternum, the characteristics of the spinal injury and deformity, treatment, and complications Results: The mechanism that causes the injury is flexion-distraction, the component of the vertebral body presented is type A, and the most affected region was T5. Two patients had neurological picture E. Sternum injury was caused by direct trauma Conclusion: The association of these was observed in patients who have suffered from high-energy trauma in a car accident. There was no relationship between the angulation of the sternum and its displacement to the degree of kyphosis and displacement of the thoracic spine. It is important to carry out good radiographic studies that include the sternum when there is suspicion of this relationship.

scholarly journals Sternal and vertebral fractures, a well-known association, usually overlooked: review of six clinical cases

2010 ◽  
Vol 9 (3) ◽  
pp. 334-337 ◽  
Author(s):  
Alvaro Silva G. ◽  
Paulina de la Fuente D ◽  
Andrés Schmidt-Hebbel N ◽  
Manuel Valencia C. ◽  
José Antonio Riera M ◽  
...  
Keyword(s):  
Vertebral Fractures ◽  
Early Recognition ◽  
Initial Evaluation ◽  
Diagnostic Methods ◽  
X Rays ◽  
Thoracic Region ◽  
Imaging Studies ◽  
Magnetic Resonance Imaging Mri ◽  
Upper Thoracic ◽  
Sternal Fractures

OBJECTIVE: the association of sternal and vertebral fractures has previously been described in the literature. These lesions are frequently overlooked at the initial evaluation. The purpose of this study was to review and discuss the diagnostic methods used to diagnose these lesions and to highlight the importance of early recognition of these fractures. METHODS: we performed a retrospective analysis of six patients who suffered sternal and concomitant vertebral fractures. Clinical charts and imaging studies were reviewed. RESULTS: all patients were diagnosed with sternal fractures at the initial evaluation, but only two were diagnosed with vertebral fractures. CONCLUSION: failure to recognize these fractures at initial evaluation may be associated with the fact that the upper thoracic region is difficult to explore. In the presence of sternal fractures, a vertebral fracture must be ruled out even though major injuries are not present. A computer tomography (CT) scan and magnetic resonance imaging (MRI) should be obtained despite negative X-rays if clinical suspicion is present.

Diagnostic Imaging Pitfalls of Upper Thoracic Spine Fractures

Pain Medicine ◽  
2020 ◽  
Vol 21 (5) ◽  
pp. 1079-1081
Author(s):  
Aaron Conger ◽  
Christina Case ◽  
Zachary McCormick ◽  
Richard Kendall
Keyword(s):  
Diagnostic Imaging ◽  
Thoracic Spine ◽  
Spine Fractures ◽  
Upper Thoracic Spine ◽  
Thoracic Spine Fractures ◽  
Upper Thoracic ◽  
Imaging Pitfalls

Clinical and radiographic outcomes of pedicle screw fixation for upper thoracic spine (T1–5) fractures: a retrospective cohort study of 27 cases

2009 ◽  
Vol 10 (3) ◽  
pp. 207-213 ◽  
Author(s):  
Charles Fisher ◽  
Sandeep Singh ◽  
Michael Boyd ◽  
Stephen Kingwell ◽  
Brian Kwon ◽  
...  
Keyword(s):  
Thoracic Spine ◽  
Summary Score ◽  
Spine Fractures ◽  
Upper Thoracic Spine ◽  
Sf 36 ◽  
Health Related ◽  
Thoracic Spine Fractures ◽  
The Mean ◽  
Upper Thoracic

Object The use of pedicle screws (PSs) for stabilization of unstable thoracolumbar fractures has become the standard of care, but PS efficacy has not been reported in the upper thoracic spine. The primary outcome of this study was to determine the efficacy of PS fixation to achieve and maintain reduction of unstable upper thoracic spine fractures (T1–5). Secondary outcomes included scores on a 1-year postoperative generic health-related quality of life (QOL) questionnaire and postoperative complications. Methods This study was a retrospective analysis and cross-sectional outcome assessment of cases prospectively entered into a spine database from 1997 to 2004. All patients with a traumatic, unstable upper thoracic spine (T1–5) fracture who underwent PS fixation were included. Preoperative CT scans with sagittal plane reformatted images were used to determine kyphotic deformity and compared with immediate postoperative and latest follow-up radiographs or CT scans. Patient charts, operative notes, and the results of postoperative follow-up examinations were reviewed. Patients were mailed the Short Form-36v2 (SF-36 version 2) by an independent study coordinator. Results Cases involving 27 patients (23 male, 4 female) were evaluated. The patients' mean age was 39.9 years (range 16–73 years). In all, 251 PSs were passed between T-1 and T-8. The mean true kyphotic deformity was 18.2° preoperatively, 8.7° (p < 0.0005) initially postoperatively, and 10.1° at final follow-up (mean 2.3 years postoperatively). The mean SF-36 physical component summary score was 35.89 while the mental component summary score was 56.43 at a minimum of 1-year postoperatively (mean 3.2 years). There were no intraoperative vascular or neural complications. Conclusions In the hands of fellowship-trained spinal surgeons, PS fixation for reduction and stabilization of upper thoracic spine fractures is a safe and efficacious technique. Health-related QOL outcome data are deficient for spine trauma patients and should be an essential component of quantifying treatment outcomes.

scholarly journals Novel free-hand T1 pedicle screw method: Review of 44 consecutive cases

2014 ◽  
Vol 05 (04) ◽  
pp. 349-354 ◽  
Author(s):  
Mark A. Rivkin ◽  
Jessica F. Okun ◽  
Steven S. Yocom
Keyword(s):  
Pedicle Screw ◽  
Thoracic Spine ◽  
Pedicle Screws ◽  
High Rate ◽  
Imaging Modalities ◽  
Neurological Deficits ◽  
Upper Thoracic Spine ◽  
Starting Point ◽  
Grade 3 ◽  
Upper Thoracic

ABSTRACT Summary of Background Data: Multilevel posterior cervical instrumented fusions are becoming more prevalent in current practice. Biomechanical characteristics of the cervicothoracic junction may necessitate extending the construct to upper thoracic segments. However, fixation in upper thoracic spine can be technically demanding owing to transitional anatomy while suboptimal placement facilitates vascular and neurologic complications. Thoracic instrumentation methods include free-hand, fluoroscopic guidance, and CT-based image guidance. However, fluoroscopy of upper thoracic spine is challenging secondary to vertebral geometry and patient positioning, while image-guided systems present substantial financial commitment and are not readily available at most centers. Additionally, imaging modalities increase radiation exposure to the patient and surgeon while potentially lengthening surgical time. Materials and Methods: Retrospective review of 44 consecutive patients undergoing a cervicothoracic fusion by a single surgeon using the novel free-hand T1 pedicle screw technique between June 2009 and November 2012. A starting point medial and cephalad to classic entry as well as new trajectory were utilized. No imaging modalities were employed during screw insertion. Postoperative CT scans were obtained on day 1. Screw accuracy was independently evaluated according to the Heary classification. Results: In total, 87 pedicle screws placed were at T1. Grade 1 placement occurred in 72 (82.8%) screws, Grade 2 in 4 (4.6%) screws and Grade 3 in 9 (10.3%) screws. All Grade 2 and 3 breaches were <2 mm except one Grade 3 screw breaching 2-4 mm laterally. Only two screws (2.3%) were noted to be Grade 4, both breaching medially by less than 2 mm. No new neurological deficits or returns to operating room took place postoperatively. Conclusions: This modification of the traditional starting point and trajectory at T1 is safe and effective. It attenuates additional bone removal or imaging modalities while maintaining a high rate of successful screw placement compared to historical controls.

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