The Efficacy of the Treatment of Thoracolumbar Spine Fractures with Short-segment Posterior Instrumentation and Fusion

Abstract Background Thoracolumbar spine fractures are common injuries that can result in significant disability, deformity and neurological deficit. Controversies exist regarding the appropriate radiological investigations, the indications for surgical management and the timing, approach and type of surgery. Aim of the Work to discuss: Guidelines and controversies of short versus long posterior fixation in management of thoracolumbar spine fractures. Patients and Methods 20 articles were identified through specified electronic databases. After application of the inclusion and exclusion criteria, 9 comparative studies were finally included in this systematic review. Various other approaches were used in combination with posterior pedicle screw fixation according to the underlying pathology (e.g. Discectomy, Laminectomy, Vertebroplasty, Kyphoplasty, etc.). A total of 194 patients underwent short segment pedicle screw fixation compared to 158 patients who underwent Long segment pedicle screw fixation for various indications. The majority of the included trials were small studies with between 12 and 69 participants. The patients’ characteristics were comparable within each study group. Individual patient data were available from these articles. Results A total of 194 patients underwent short segment pedicle screw fixation compared to 158 patients who underwent Long segment pedicle screw fixation for various indications. The majority of the included trials were small studies with between 12 and 69 participants. The patients’ characteristics were comparable within each study group. Individual patients data were available from these articles; longest follow up post operative record was about 71 months; 162 male and 93 female in these studies; the mean age about 38 years; the level of thoracolumbar fracture was: 60 patients at T12,104 patients at L1 and 41 patients at L2. Conclusion This review suggest work on the guidelines with evaluating of each case according to age, angels, height, weight (BMI), comorbidities, ability to anaesthesia and types of instability in the patient before as osteoporosis and kyphosis. Degree of angels of cobb and kyphotic angel which are major factors determine if posterior long or short.

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One Stage Anterior Reconstruction and Posterior Instrumentation in Surgical Management of Thoracolumbar Spine Fractures

Open Journal of Orthopedics ◽

10.4236/ojo.2015.51002 ◽

2015 ◽

Vol 05 (01) ◽

pp. 6-15

Author(s):

Khaled Omran ◽

Hesham Ali ◽

Ahmed Saleh ◽

Ahmed Omar ◽

Ibrahim Elhawery ◽

...

Keyword(s):

Surgical Management ◽

Posterior Instrumentation ◽

Thoracolumbar Spine ◽

Spine Fractures ◽

One Stage ◽

Thoracolumbar Spine Fractures ◽

Anterior Reconstruction

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Timing of surgery in thoracolumbar trauma: is early intervention safe?

Neurosurgical FOCUS ◽

10.3171/2014.5.focus1473 ◽

2014 ◽

Vol 37 (1) ◽

pp. E7 ◽

Cited By ~ 19

Author(s):

Christopher Paul O'Boynick ◽

Mark F. Kurd ◽

Bruce V. Darden ◽

Alexander R. Vaccaro ◽

Michael G. Fehlings

Keyword(s):

Spinal Cord ◽

Posterior Instrumentation ◽

Thoracolumbar Spine ◽

Spine Fractures ◽

Thoracolumbar Fractures ◽

Surgical Timing ◽

Cord Injury ◽

Thoracolumbar Spine Fractures ◽

Support Cost ◽

Early Fixation

The understanding of the optimal surgical timing for stabilization in thoracolumbar fractures is severely limited. Thoracolumbar spine fractures can be devastating injuries and are often associated with significant morbidity and mortality. The role of early surgical stabilization (within 48–72 hours of injury) as a vehicle to improve outcomes in these patients has generated significant interest. Goals of early stabilization include improved neurological recovery, faster pulmonary recovery, improved pain control, and decreased health care costs. Opponents cite the potential for increased bleeding, hypotension, and the risk of further cord injury as a few factors that weigh against early stabilization. The concept of spinal cord injury and its relationship to surgical timing remains in question. However, when neurological outcomes are eliminated from the equation, certain measures have shown positive influences from prompt surgical fixation. Early fixation of thoracolumbar spine fractures can significantly decrease the duration of hospital stay and the number of days in the intensive care unit. Additionally, prompt stabilization can reduce rates of pulmonary complications. This includes decreased rates of pneumonia and fewer days on ventilator support. Cost analysis revealed as much as $80,000 in savings per patient with early stabilization. All of these benefits come without an increase in morbidity or evidence of increased mortality. In addition, there is no evidence that early stabilization has any ill effect on the injured or uninjured spinal cord. Based on the existing data, early fixation of thoracolumbar fractures has been linked with positive outcomes without clear evidence of negative impacts on the patient's neurological status, associated morbidities, or mortality. These procedures can be viewed as “damage control” and may consist of simple posterior instrumentation or open reductions with internal fixation as indicated. Based on the current literature it is advisable to proceed with early surgical stabilization of thoracolumbar fractures in a well-resuscitated patient, unless extenuating medical conditions would prevent it.

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Treatment Options for Thoracolumbar Spine Fractures

Bosnian Journal of Basic Medical Sciences ◽

10.17305/bjbms.2005.3279 ◽

2005 ◽

Vol 5 (2) ◽

pp. 20-26 ◽

Cited By ~ 1

Author(s):

Eldin E. Karaiković ◽

Hector O. Pacheco

Keyword(s):

Nonoperative Management ◽

Treatment Options ◽

Thoracolumbar Spine ◽

Educational Background ◽

Spine Fractures ◽

Thoracolumbar Fractures ◽

Short Segment ◽

Risks And Benefits ◽

Thoracolumbar Spine Fractures ◽

Surgical Option

A decision for operative versus nonoperative management of thoracolumbar fractures should NEVER be based solely on one factor. Only after a thorough physical, neurological, and spinal examination, and an assessment of a patient’s prior activity, social and educational background and patient’s expectations, one should review the patient’s radiographs and CT scans to determine risks and benefits of operative versus nonoperative care. Both treatment options are discussed in this paper. As a surgical option our preference is short-segment instrumentation and fusion. Careful and appropriate patient selection and an excellent operative technique insure the minimum complications.

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