scholarly journals Functional outcome of traumatic paraplegia and paraparesis patients treated with pedicle screw stabilization with decompression

2021 ◽  
Vol 7 (2) ◽  
pp. 369
Author(s):  
Arif P. K. ◽  
Tigy Thomas Jacob
Keyword(s):  
Pedicle Screw ◽  
Neurological Deficit ◽  
Thoracolumbar Spine ◽  
Neurological Status ◽  
Neurological Improvement ◽  
Complete Paralysis ◽  
Fracture Dislocations ◽  
Fall From Height ◽  
Thoracolumbar Spine Fractures ◽  
Operative Recovery

<p class="abstract"><strong>Background:</strong> In this study, unstable thoracolumbar spine fractures with neurological deficit fixed with Moss Miami pedicle screw and decompression were followed up for neurological improvement (sensory and motor functions). Patients were admitted in the department of Orthopaedics, Government medical college, Kottayam from November 2016 to October 2017.</p><p class="abstract"><strong>Methods:</strong> In this observational study, 96 patients (aged 17 to 60 years) are followed up. The preoperative neurological status and post-operative recovery are follow-up at 1, 3 and 6 months and graded by Frankel’s grading. Change from Frankel’s grade A OR B to Frankel grade C, D OR E was said to be improved neurologically.<strong></strong></p><p class="abstract"><strong>Results:</strong> 87.3% males and 12.7% females with 58.3% patients having fall from height sustained wedge compression fractures (49.1%), burst fractures (46.8%) and fracture dislocations (4.1%). vertebra fractured were L1-31.4%, T12-22.9% and L2-19.7%. Complete paralysis was 44.8% and 55.2% incomplete. At 6 months 75% patients showed improvement and 25% patients showed nil. 95.5% patients (18-30 years) showed improvement and only 50% (51-60 years). Incomplete neurological deficit showed significant improvement (100%) compared to patients with complete paralysis (44.2%). Preoperative Frankel score has significant relationship with final neurological (44% of patients with Frankel A and 100% with Frankel D.</p><p class="abstract"><strong>Conclusions:</strong> Moss Miami pedicle screw stabilization with decompression is an effective surgical technique in maintaining stability of spine in traumatic paraplegia and paraparesis patients and there is significant improvement in neurological status.</p>

Predictors of Recovery After Conservative Treatment of AO-Type A Thoracolumbar Spine Fractures Without Neurological Deficit

Spine ◽  
2018 ◽  
Vol 43 (2) ◽  
pp. 141-147 ◽  
Author(s):  
Peter Vorlat ◽  
Geert Leirs ◽  
Farhad Tajdar ◽  
Heinz Hulsmans ◽  
Hugo De Boeck ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Neurological Deficit ◽  
Thoracolumbar Spine ◽  
Type A ◽  
Spine Fractures ◽  
Thoracolumbar Spine Fractures

scholarly journals THORACOLUMBAR SPINAL ARTHRODESIS - EPIDEMIOLOGY AND COSTS

2017 ◽  
Vol 16 (1) ◽  
pp. 52-55
Author(s):  
TOBIAS LUDWIG DO NASCIMENTO ◽  
LUIZ PEDRO WILLIMANN ROGÉRIO ◽  
MARCELO MARTINS DOS REIS ◽  
LEANDRO PELEGRINI DE ALMEIDA ◽  
GUILHERME FINGER ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Neurological Deficit ◽  
Traffic Accidents ◽  
Thoracolumbar Spine ◽  
Hospital Costs ◽  
Spine Fracture ◽  
Female Ratio ◽  
Cord Injury ◽  
Fall From Height

ABSTRACT Objective: To describe the epidemiology of patients with thoracolumbar spine fracture submitted to surgery at Hospital Cristo Redentor and the related costs. Methods: Prospective epidemiological study between July 2014 and August 2015 of patients with thoracolumbar spine fracture with indication of surgery. The variables analyzed were sex, age, cost of hospitalization, fractured levels, levels of arthrodesis, surgical site infection, UTI or BCP, spinal cord injury, etiology, length of stay, procedure time, and visual analog scale (VAS) . Results: Thirty-two patients were evaluated in the study period, with a mean age of 38.68 years. Male-female ratio was 4:1 and the most frequent causes were fall from height (46.87%) and traffic accidents (46.87%). The thoracolumbar transition was the most affected (40.62%), with L1 vertebra involved in 23.8% of the time. Neurological deficit was present in 40.62% of patients. Hospital stay had a median of 14 days and patients with neurological deficit were hospitalized for a longer period (p<0.001), with an increase in hospital costs (p= 0.015). The average cost of hospitalization was U$2,874.80. The presence of BCP increased the cost of hospitalization, and patients with spinal cord injury had more BCP (p= 0.014) . Conclusion: Public policies with an emphasis on reducing traffic accidents and falls can help reduce the incidence of these injuries and studies focusing on hospital costs and rehabilitation need to be conducted in Brazil to determinate the burden of spinal trauma and spinal cord injury.

scholarly journals Does Tranexamic Acid Reduce Perioperative Bleeding in Short Segment Pedicle Screw Fixation in Thoracolumbar Spine Fractures?

2015 ◽  
Vol 53 (199) ◽  
pp. 169-173 ◽  
Author(s):  
Rabindra Lal Pradhan ◽  
Bimal Kumar Pandey
Keyword(s):  
Tranexamic Acid ◽  
Pedicle Screw ◽  
Screw Fixation ◽  
Thoracolumbar Spine ◽  
Pedicle Screw Fixation ◽  
Control Group ◽  
Thoracolumbar Fractures ◽  
Short Segment ◽  
Perioperative Bleeding ◽  
Thoracolumbar Spine Fractures

Introduction: Blood loss with spinal surgery is common potential cause of morbidity and often requires blood transfusion. Tranexamic acid (TXA), is effective in reducing bleeding in patients undergoing knee arthroplasty. TXA used in spine surgery studies have included different cases leading to inconsistence of surgical procedures. Purpose of this prospective observational study was to examine effect of TXA decreasing bleeding in short segment pedicle screw fixation for thoracolumbar fractures. Methods: 38 patients' undergoing short segment pedicle screw for thoracolumbar fractures were enrolled in study from July to August 2013. There were 28 male and 10 female patients, with an average age of 36.5 years. Patients received 10 mg/kg of TXA or a control 30 minutes intravenously before skin incision and 3 hours post-operative and oral medication for three days. Intraoperative bleeding was estimated by weighing surgical sponges, blood collected by suction container and by subtracting all irrigation fluid. Postoperative bleeding was measured from volume in vacuum drainage bag. Results: Twenty (20) patients were in control group and eighteen(18) to TXA group. There were no statistical differences between groups in terms of age, gender, co-morbidities, and operating time, preoperative Hemoglobin, PT and INR. Intra-operative bleeding in TXA group was significant than in control group. Post-operative drainage and Hemoglobin in first 48 h was reduced compared with placebo in TXA group. Need for post-operative transfusion was nil in TXA group. Conclusions: Administration of TXA before surgery significantly reduces perioperative bleeding in patients undergoing short segment pedicle screw fixation for thoracolumbar spine fractures.  Keywords: bleeding; spinal surgery; tranexamic acid.

scholarly journals Analysis of the results of surgical management of traumatic paraplegia

2016 ◽  
Vol 3 (1) ◽  
pp. 35
Author(s):  
Kumar Nitesh ◽  
Ajay Kumar Mahto
Keyword(s):  
Surgical Management ◽  
Tertiary Care ◽  
Thoracolumbar Spine ◽  
Neurological Status ◽  
Bladder Function ◽  
Outcome Analysis ◽  
Mri Findings ◽  
Thoracolumbar Spine Fractures ◽  
Grade 3

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Thoracolumbar spine fractures are common injuries that can result in significant disability, deformity and neurological deficit. Aim of this study was to evaluate the results of surgical management of traumatic paraplegia, complete or incomplete as classified by Frankel scoring.</span></p><p class="abstract"><strong>Methods:</strong> A prospective study was conducted in patients attending outdoor and emergency department of orthopaedics of a tertiary care teaching institute in Katihar Medical College, Katihar (Bihar) with traumatic paraplegia involving the dorsolumbar spine. The duration of the study was July 2014 to July 2016. The important objectives are the time for recovery of various functions like sensory, motor and bowel and bladder function, comparison between early and late decompression, results of posterolateral fusion and time taken for solid bony fusion after operation. Cases selected for these studies were those treated surgically between July 2014 to July 2016. Total 46 cases were selected within a minimum of 6 month post-operative follow up of which 4 cases lost in follow up. Data collected from patients records including age, sex, time from injury to hospitalization, initial neurological status as per Frankel score, MRI findings, surgery performed, postoperative course and neurological status at the time of discharge and latest follow up. Patients lost to follow up were not studied for outcome analysis.<strong></strong></p><p class="abstract"><strong>Results:</strong> When decompression done within 1<sup>st</sup> week in incomplete paraplegia 80% of the patients showed return of grade 3 power. In complete paraplegia cases, 11% of the patients had return to power upto grade 3 when decompression done within 1 week where no cases return of grade 3 power when decompression done after2nd and 3<sup>rd</sup> week<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> After recovery from spinal shock, the earlier the surgical decompression done, the better the neurological and bowel/bladder function recovery both in complete and incomplete paraplegic cases. Reduction is better and easy and less time consuming in early decompression than in late. Motor recovery can continue for over 6 month after decompression<span lang="EN-IN">.</span></p><p> </p>

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.

Thoracolumbar spine fractures, short versus long posterior fixation: Guidelines and controversies. A Systematic Review

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ali K Ali ◽  
Ahmed M Hamad ◽  
Ahmed R Farghaly ◽  
Mohamed S Ghaly
Keyword(s):  
Systematic Review ◽  
Pedicle Screw ◽  
Screw Fixation ◽  
Thoracolumbar Spine ◽  
Pedicle Screw Fixation ◽  
Posterior Fixation ◽  
Study Group ◽  
Spine Fractures ◽  
Short Segment ◽  
Thoracolumbar Spine Fractures

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.

scholarly journals Surgical outcome of posterior decompression, posterolateral fusion and stabilization by pedicle screw and rod in thoracolumbar tuberculosis

2017 ◽  
Vol 10 (2) ◽  
pp. 89
Author(s):  
Md. Anowarul Islam ◽  
Md. Naimur Rahman ◽  
Md. Fahad Goni
Keyword(s):  
Pedicle Screw ◽  
Neurological Deficit ◽  
Spinal Tuberculosis ◽  
Spinal Column ◽  
Early Mobilization ◽  
Neurological Improvement ◽  
Neural Damage ◽  
Thoracolumbar Region ◽  
Normal Spine ◽  
Consequent Reduction

<p>Spinal tuberculosis causes severe complications like neurological and spinal deformity which may lead to respiratory distress, costo-pelvic impingement, paraplegia and consequent reduction in the quality and longevity of life. The aim of the present treatment is to avoid the consequence of neural complications and gain near-normal spine. Mechanical factor causes pathological fracture or dislocation of an affected vertebral body. Surgical decompression ensues further instability. Reconstruction of spinal column by pedicle screw and rod provide stability and prevents secondary neural damage and deformity thereby helps in early mobilization. Prospective study was done to evaluate the results in 20 cases of spinal tuberculosis in thoracolumbar region associated with neurological deficit. We operated our cases (12 males and 8 females) by posterolateral decompression, fusion and stabilization by pedicle screw and rod along with antitubercular drug treatment. All patients were with neurological deficit, single level involvement and 10 to 30 degree of mild kyphosis. After surgery, kyphosis improved from 20.7 ± 5.5 degrees to 12.5 ± 3.9 degree. Bony fusion was in 65.0% cases. Neurological improvement and pain subsided in all the patients.</p>

How safe is minimally invasive pedicle screw placement for treatment of thoracolumbar spine fractures?

2016 ◽  
Vol 26 (5) ◽  
pp. 1515-1524 ◽  
Author(s):  
Timo Michael Heintel ◽  
Stefan Dannigkeit ◽  
Annabel Fenwick ◽  
Martin Cornelius Jordan ◽  
Hendrik Jansen ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Pedicle Screw ◽  
Thoracolumbar Spine ◽  
Screw Placement ◽  
Spine Fractures ◽  
Pedicle Screw Placement ◽  
Thoracolumbar Spine Fractures

scholarly journals Assessment of the Accuracy of the AO Spine-TL Classification for Thoracolumbar Spine Fractures Using the AO Surgery Reference Mobile App

2020 ◽  
pp. 219256822090169
Author(s):  
Allan Hiroshi de Araujo Ono ◽  
Verônica Yulin Prieto Chang ◽  
Erico Myung Rodenbeck ◽  
Alex Oliveira de Araujo ◽  
Rafael Garcia de Oliveira ◽  
...  
Keyword(s):  
Thoracolumbar Spine ◽  
Fracture Morphology ◽  
Neurological Status ◽  
Mobile App ◽  
Spine Fractures ◽  
Thoracolumbar Fractures ◽  
Kappa Index ◽  
Thoracolumbar Spine Fractures ◽  
Fractures Of The Spine ◽  
Classification Agreement

Study Design: Cohort study. Objectives: This study aimed to evaluate the accuracy of the AO Surgery Reference mobile app in the diagnosis of thoracolumbar fractures of the spine according to the AO TL classification, and to discuss the usefulness of this app in the teaching and training of the resident physicians in orthopedics and traumatology area. Methods: The 24 residents of Orthopedic and Traumatology program assessed 20 cases of thoracolumbar fractures selected from the hospital database on 2 different occasions, with a 30-day interval, and they classified these cases with and without using the AO Surgery Reference app. A group of spine experts previously established the gold standard and the answers were statistically compared, with the inter- and intraobserver reliability evaluated by the kappa index. Results: The use of the AO Surgery Reference app increased the classification success rate of the fracture morphology (from 53.4% to 72.5%), of the comorbidity modifier (from 61.4% to 77.9%) and of the neurological status modifier (from 55.1% to 72.9%). In addition, the mobile app raised the classification agreement and accuracy. The kappa index increased from 0.30 to 0.53 regarding the morphological classification of fractures. Conclusions: The residents improved their ability to recognize and classify thoracolumbar spine fractures, which reinforces the importance of this tool in medical education and clinical practice.

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