Thoracolumbar Burst Fractures

2018 ◽  
pp. 123-132
Author(s):  
Omaditya Khanna ◽  
Geoffrey P. Stricsek ◽  
James S. Harrop
Keyword(s):  
Treatment Options ◽  
Thoracolumbar Spine ◽  
Axial Loading ◽  
Classification Systems ◽  
Surgical Approaches ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures ◽  
Thoracolumbar Injury ◽  
Fall From Height ◽  
Thoracolumbar Spine Fractures

Ten to twenty percent of all thoracolumbar spine fractures are burst fractures. Burst fractures are typically a result of an axial-loading mechanism, such as from jumping or a fall from height. In this chapter, the authors provide an overview of the different classification systems for thoracolumbar fractures, including the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification system and Thoracolumbar Injury Classification and Severity (TLICS) score. The various treatment options, both surgical and nonsurgical, are discussed, including criteria for when surgical intervention is warranted. The authors discuss the various surgical approaches for treatment of these fractures and their relative efficacies and outcomes. Finally, the authors review the evidence, outcomes, and potential complications of the various treatment options in order to aid the surgeon in their decision-making when these fractures are encountered in their practice.

scholarly journals Creating reproducible thoracolumbar burst fractures in human specimens: an in vitro experiment

2016 ◽  
Vol 24 (4) ◽  
pp. 580-585 ◽  
Author(s):  
Ludwig Oberkircher ◽  
Maya Schmuck ◽  
Martin Bergmann ◽  
Philipp Lechler ◽  
Steffen Ruchholtz ◽  
...  
Keyword(s):  
Treatment Options ◽  
Thoracolumbar Spine ◽  
Neurological Impairment ◽  
High Energy ◽  
Classification Systems ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures ◽  
Before And After ◽  
Fixation Techniques

OBJECT The treatment of traumatic burst fractures unaccompanied by neurological impairment remains controversial and ranges from conservative management to 360° fusion. Because of the heterogeneity of fracture types, classification systems, and treatment options, comparative biomechanical studies might help to improve our knowledge. The aim of the current study was to create a standardized fracture model to investigate burst fractures in a multisegmental setting. METHODS A total of 28 thoracolumbar fresh-frozen human cadaveric spines were used. The spines were dissected into segments (T11–L3). The T-11 and L-3 vertebral bodies were embedded in Technovit 3040 (cold-curing resin for surface testing and impressions). To simulate high energy, a metallic drop tower was designed. Stress risers were used to ensure comparable fractures. CT scans were acquired before and after fracture. All fractures were classified using the AO/OTA classification. RESULTS The preparation and embedding of the spine segments worked well. No repositioning or second embedding of the specimen, even after fracture, was required. It was possible to create single burst fractures at the L-1 level in all 28 spine segments. Among the 28 fractures there were 16 incomplete burst fractures (Type A3.1), 8 burst-split fractures (Type A3.2), and 4 complete burst fractures (Type A3.3). The differences before and after fracture for stiffness and for anterior, posterior, and central heights were all significant (p < 0.05). CONCLUSIONS The ability to create reproducible burst fractures of a single vertebral body in a thoracolumbar spine segment may serve as a basis for future biomechanical studies that will provide better understanding of mechanical properties or fixation techniques.

scholarly journals Lesión dural asociada a fracturas de charnela toracolumbar y lumbares con compromiso del muro posterior. Relación con las variables del sistema de clasificación AOSpine. [Thecal sac injury secondary to burst fractures of the thoracolumbar and lumbar spine, and its association with the AOSpine Classification System variables].

2019 ◽  
Vol 84 (3) ◽  
pp. 216-223
Author(s):  
Guillermo Alejandro Ricciardi ◽  
Ignacio Gabriel Garfinkel ◽  
Gabriel Genaro Carrioli ◽  
Daniel Oscar Ricciardi
Keyword(s):  
Vertebral Body ◽  
Neurological Deficit ◽  
Classification System ◽  
Spinal Canal ◽  
Body Wall ◽  
Thoracolumbar Spine ◽  
Cauda Equina ◽  
Acute Angle ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures

Introducción: Las lesiones del saco dural con atrapamiento de la cauda equina entre los fragmentos óseos pueden estar asociadas con fracturas toracolumbares.Objetivo: Realizar un análisis retrospectivo de las variables clínico-radiográficas y el sistema de clasificación AOSpine y la posibilidad de lesión dural asociada en una serie de fracturas toracolumbares por estallido, tratadas en nuestro Centro.Materiales y Métodos: Estudio retrospectivo, observacional de una serie de pacientes con fracturas toracolumbares con compromiso del muro posterior operados en nuestra institución, entre enero de 2012 y diciembre de 2017.Resultados: Se incluyeron 46 pacientes, 16 casos con lesión del saco dural asociada. Las variables porcentaje de ocupación del canal, distancia interpedicular, ángulo del fragmento retropulsado y déficit neurológico asociado mostraron diferencias estadísticamentesignificativas según la comparación en función de la presencia o ausencia de lesión dural (p = 0,046, p = 0,007, p = 0,046 y p = 0,004, respectivamente).Conclusiones: Según nuestros resultados, la lesión dural traumática podría ser contemplada en la planificación del tratamiento de fracturas toracolumbares ante fragmentos voluminosos del muro posterior con ángulo agudo, compromiso severo del canal raquídeo, distancia interpedicular elevada y daño neurológico asociado, tal como se propone en la bibliografía. AbstractIntroduction: Fractures of the thoracolumbar spine can trigger thecal sac injuries due to the impingement of the cauda equina between bone fragments.Objective: To carry out a retrospective analysis of clinical and radiological variables, the AOSpine Classification System and the possibility of secondary thecal sac injury in a series of thoracolumbar burst fractures treated at our center.Materials and Methods: A retrospective, observational study of a series of patients with thoracolumbar fractures with compromise of the posterior vertebral body wall, who underwent surgery at our center between January 2012 and December 2017.Results: Forty-six patients were included, 16 of which had secondary thecal sac injury. The differences in the variables—percentage of spinal canal involvement, interpedicular distance, angle of the retropulsed fragment, neurological deficit and type C fractures—were statistically significant according to the comparison made with the presence or absence of thecal sac injury (p=0.046, p=0.007, p=0.046, p=0.004, p=0,001 respectively).Conclusions: This study suggests that traumatic thecal sac injury could be suspectedwhen managing burst fractures with prominent fragments in the posterior vertebral body wall, acute angle of the retropulsed fragment, severe compression of the spinal canal, wide interpedicular distance, neurological deficit and fracture displacement (fracturetype C according to the AOSpine Classification System).

scholarly journals Efficacy of Short and Mono segment Spinal Fixations in Traumatic Incomplete Thoracolumbar Burst Fractures

2019 ◽  
Vol 15 (3) ◽  
pp. 197-201
Author(s):  
Binod Bhattarai ◽  
Sashi Shah
Keyword(s):  
Blood Loss ◽  
Thoracolumbar Spine ◽  
Time Lapse ◽  
Long Term Results ◽  
Wound Complications ◽  
Thoracolumbar Burst Fractures ◽  
Spinal Implant ◽  
Implant Placement ◽  
Burst Fractures ◽  
Potential Benefits

Background: Controversies still mount over the long segment, short segment and mono segment screw fixation for traumatic thoracolumbar spine burst fractures. This article aims to provide our initial experience of the effectiveness of these management modalities with additive focus on their potential benefits upon preventing the loss of correction over time. Methods: We included all operated cases of thoracolumbar fractures presenting with the ASIA grade of above ‘C’ between December 2014to December 2017 in a retrospective manner in terms of operative time, estimated intra-operative blood loss, any post-operative surgical wound complications, implant cost, average time lapse for the patients to return to physiotherapy and the follow up radiological imaging at 6 months. Results: Long segment fixation is comparatively more time consuming with considerable blood loss and high incidence of postoperative wound complications. We observed that both short as well as mono segment crew fixations had similar incidences with regards to the common complications pertaining to the spinal implant placement procedures. Conclusions: Both short and mono-segment fixation procedures resulted in comparable short and long term results. Though long segment fixation is comparatively more stable, it is, however, expensive with a higher incidence of other postoperative complications.

Thoracolumbar spine trauma classification: the Thoracolumbar Injury Classification and Severity Score system and case examples

2009 ◽  
Vol 10 (3) ◽  
pp. 201-206 ◽  
Author(s):  
Alpesh A. Patel ◽  
Andrew Dailey ◽  
Darrel S. Brodke ◽  
Michael Daubs ◽  
James Harrop ◽  
...  
Keyword(s):  
Severity Score ◽  
Injury Severity ◽  
Thoracolumbar Spine ◽  
Neurological Status ◽  
Classification Systems ◽  
Spine Trauma ◽  
Injury Characteristics ◽  
Severity Of Injury ◽  
Thoracolumbar Injury ◽  
Injury Classification

Object The aim of this study was to review the Thoracolumbar Injury Classification and Severity Score (TLICS) and to demonstrate its application through a series of spine trauma cases. Methods The Spine Trauma Study Group collaborated to create and report the TLICS system. The TLICS system is reviewed and applied to 3 cases of thoracolumbar spine trauma. Results The TLICS system identifies 3 major injury characteristics to describe thoracolumbar spine injuries: injury morphology, posterior ligamentous complex integrity, and neurological status. In addition, minor injury characteristics such as injury level, confounding variables (such as ankylosing spondylitis), multiple injuries, and chest wall injuries are also identified. Each major characteristic is assigned a numerical score, weighted by severity of injury, which is then summated to yield the injury severity score. The TLICS system has demonstrated initial success and its use is increasing. Limitations of the TLICS system exist and, in some instances, have yet to be addressed. Despite these limitations, the severity score may provide a basis to judge spinal stability and the need for surgical intervention. Conclusions By addressing both the posterior ligamentous integrity and the patient's neurological status, the TLICS system attempts to overcome the limitations of prior thoracolumbar classification systems. The TLICS system has demonstrated both validity and reliability and has also been shown to be readily learned and incorporated into clinical practice.

PERCUTANEOUS INSTRUMENTATION WITHOUT ARTHRODESIS FOR THORACOLUMBAR BURST FRACTURES (A3/A4, B): A RETROSPECTIVE STUDY

2021 ◽  
Vol 20 (4) ◽  
pp. 295-299
Author(s):  
Pedro Henrique Cortat Proba Couri ◽  
Leandro Duil Kim ◽  
William Zarza Santos ◽  
Rodrigo Góes Medéa de Mendonça ◽  
Nelson Astur ◽  
...  
Keyword(s):  
Oswestry Disability Index ◽  
Treatment Options ◽  
Cross Sectional Study ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Thoracolumbar Burst Fractures ◽  
Percutaneous Instrumentation ◽  
Burst Fractures ◽  
Minimally Invasive Fixation ◽  
Cobb Method

ABSTRACT Objective: There is still no consensus as to the treatment options for thoracolumbar burst fractures, although these fractures are widely described in the literature. The aim of this study was to evaluate the clinical and radiological outcomes of percutaneous instrumentation without arthrodesis as a method of fixation of these lesions. Methods: This retrospective, cross-sectional study evaluated 16 patients by measuring regional kyphosis using the Cobb method and the scores for quality of life and return to work (Oswestry Disability Index, VAS, SF-36 and Denis). Results: Six months after surgical treatment, 62.5% of all patients showed minimal disability according to the Oswestry Disability Index, maintenance of regional kyphosis correction and no synthesis failure. Conclusions: The clinical and radiological outcomes of the study suggest that minimally invasive fixation is indicated for the treatment of thoracolumbar burst fractures. Level of evidence IV; Observational study: retrospective cohort.

scholarly journals COMPARATIVE ANALYSIS OF TWO CLASSIFICATION SYSTEMS OF THORACOLUMBAR SPINE FRACTURES

2018 ◽  
Vol 17 (1) ◽  
pp. 35-38
Author(s):  
ANDRÉ LUIZ PAGOTTO VIEIRA ◽  
JULIANO RODRIGUES DOS SANTOS ◽  
GUILHERME GALITO HENRIQUES
Keyword(s):  
Thoracolumbar Spine ◽  
Case Series ◽  
Analysis Data ◽  
Classification Systems ◽  
Spine Fractures ◽  
Level Of Evidence ◽  
Significance Level ◽  
Thoracolumbar Spine Fractures ◽  
Coefficient Of Concordance ◽  
Magerl Classification

ABSTRACT Objective: To evaluate the reproducibility and the interobserver coefficient of concordance between the AO/Magerl and AOSpine classifications for thoracolumbar spine fractures. Methods: Retrospective study of radiographic data analysis. Data were collected from 31 radiographic studies of patients with thoracolumbar spine fracture and distributed to a team involving spinal surgeons and residents. The fractures were classified according to the AO/Magerl and AOSpine classifications. Statistical analysis was performed using the Cohen Kappa test to assess the coefficient of concordance. Results: The Kappa value for interobserver concordance of AO/Magerl classification was κ = 0.70 and standard deviation was 0.16. For the AOSpine classification, we observed κ = 0.76, both with significance level α = 0.05 and P<0.001. Conclusions: We conclude that the interobserver concordance of the new AOSpine classification is similar to the AO/Magerl classification. This conclusion reinforces the reproducibility of the new AOSpine classification. Level of evidence: IV,Type of Study: Case series.

scholarly journals Burst fracture of the thoracolumbar spine: correlation between kyphosis and clinical result of the treatment

2015 ◽  
Vol 14 (2) ◽  
pp. 129-133 ◽  
Author(s):  
Rodrigo Arnold Tisot ◽  
Juliano da Silveira Vieira ◽  
Renato Tadeu dos Santos ◽  
Augusto Alves Badotti ◽  
Diego da Silva Collares ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Burst Fracture ◽  
Thoracolumbar Spine ◽  
Cross Sectional Study ◽  
Statistical Correlation ◽  
Lumbosacral Spine ◽  
Cross Sectional ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures ◽  
Sf 36

<sec><title>OBJECTIVE:</title><p> To evaluate the correlation between kyphosis due to burst fractures of thoracic and lumbar spine and clinical outcome in patients undergoing conservative or surgical treatment.</p></sec><sec><title>METHODS:</title><p> A retrospective, cross-sectional study was conducted with 29 patients with thoracolumbar burst fractures treated by the Spine Group in a trauma reference hospital between the years 2002 and 2011. Patients were followed-up as outpatients for a minimum of 24 months. All cases were clinically evaluated by Oswestry and SF-36 quality of life questionnaires and the visual analogue scale (VAS) of pain. They were also evaluated by X-ray examinations and CT scans of the lumbosacral spine at the time of hospitalization and subsequently as outpatients by Cobb method for measuring the degree of kyphosis.</p></sec><sec><title>RESULTS:</title><p> There was no statistically significant correlation between the degree of initial kyphosis and clinical outcome measured by VAS and by most of the SF-36 domains in both patients treated conservatively and the surgically treated. The Oswestry questionnaire showed benefits for patients who received conservative treatment (p=0.047) compared to those surgically treated (p=0.335). The analysis of difference between initial and final kyphosis and final kyphosis alone in relation to clinical outcome showed no statistical correlation in any of the scores used.</p></sec><sec><title>CONCLUSION:</title><p> The clinical outcome of treatment of the thoracic and lumbar burst fractures was not influenced by a greater or lesser degree of initial or residual kyphosis, regardless of the type of treatment.</p></sec>

scholarly journals The Predictive Value of the Load Sharing Classification Concerning Sagittal Collapse and Posterior Instrumentation Failure: A Systematic Literature Review

2019 ◽  
Vol 10 (4) ◽  
pp. 486-492
Author(s):  
Wessel T. Stam ◽  
Jaap Deunk ◽  
Matthijs J. Elzinga ◽  
Frank W. Bloemers ◽  
Georgios F. Giannakopoulos
Keyword(s):  
Predictive Value ◽  
Posterior Instrumentation ◽  
Thoracolumbar Spine ◽  
Load Sharing ◽  
Cochrane Library ◽  
Inclusion Criteria ◽  
Thoracolumbar Burst Fractures ◽  
Thoracolumbar Spine Fractures ◽  
Instrumentation Failure ◽  
The Cochrane Library

Study design: Systematic review. Objective: In 1994, the Load Sharing Classification (LSC) was introduced to aid the choice of surgical treatment of thoracolumbar spine fractures. Since that time this classification system has been commonly used in the field of spine surgery. However, current literature varies regarding its use and predictive value in relation to implant failure and sagittal collapse. The objective of this study is to assess the predictive value of the LSC concerning the need for anterior stabilization to prevent sagittal collapse and posterior instrumentation failure. Methods: An electronic search of PubMed, Medline, Embase, and the Cochrane Library was performed. Inclusion criteria were (1) cohort or clinical trial (2) including patients with thoracolumbar burst fractures (3) whose severity of the fractured vertebrae was assessed by the LSC. Results: Five thousand eighty-two articles have been identified, of which 21 articles were included for this review. Twelve studies reported no correlation between the LSC and sagittal collapse or instrumentation failure in patients treated with short-segment posterior instrumentation (SSPI). Seven articles found no significant relation; 5 articles found no instrumentation failure at all. The remaining 9 articles experienced failure in patients with a high LSC or recommended a different surgical technique. Conclusions: Although the LSC was originally developed to predict the need for anterior stabilization in addition to SSPI, many studies show that SSPI only can be sufficient in treating thoracolumbar fractures regardless of the LSC. The LSC might have lost its value in predicting sagittal collapse and posterior instrumentation failure.

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