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.

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 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.

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

Balloon kyphoplasty in the treatment of metastatic tumors of the upper thoracic spine

2011 ◽  
Vol 14 (3) ◽  
pp. 372-376 ◽  
Author(s):  
Mohammed Eleraky ◽  
Ioannis Papanastassiou ◽  
Matthias Setzer ◽  
Ali A. Baaj ◽  
Nam D. Tran ◽  
...  
Keyword(s):  
Pain Relief ◽  
Thoracic Spine ◽  
Balloon Kyphoplasty ◽  
Metastatic Tumors ◽  
Kyphotic Angle ◽  
Upper Thoracic Spine ◽  
Vertebral Bodies ◽  
The Mean ◽  
Upper Thoracic

Object Balloon kyphoplasty has recently been shown to be effective in providing rapid pain relief and enhancing health-related quality of life in patients with metastatic spinal tumors. When performed to treat lesions of the upper thoracic spine, kyphoplasty poses certain technical challenges because of the smaller size of the pedicle and vertebral bodies. Fluoroscopic visualization is also difficult due to interference of the shoulder. The authors' objective in the present study was to evaluate their approach and the results of balloon kyphoplasty in the upper thoracic spine in patients with metastatic spinal disease. Methods Fourteen patients underwent kyphoplasty via an extrapedicular approach to treat metastatic tumors in the upper (T1–5) thoracic spine. Electrodiagnostic monitoring (somatosensory and motor evoked potentials) was used in 5 cases. Three levels were treated in 7 cases, 2 levels in 2 cases, and 1 level in 5 cases. In 3 cases access was bilateral, whereas in 11 cases access was unilateral. The procedure took an average of 25 minutes per treated level, and the mean amount of cement applied was 3 ml per level. Four patients were discharged from the hospital on the day of the procedure, and 10 patients went home after 24 hours. Results All patients exhibited marked improvement in mean visual analog scale scores (preoperative score 79 vs postoperative score 30, respectively) and Oswestry Disability Index scores (83 vs 33, respectively). The mean kyphotic angle was 25.03° preoperatively, whereas the mean postoperative angle was 22.65° (p > 0.3). At latest follow-up, the mean kyphotic angle did not differ significantly from the postoperative kyphotic angle (26.3°, p > 0.1). No neurological deficits or lung-related complications (pneumothorax or hemothorax) were encountered in any of the patients. Polymethylmethacrylate cement extravasations were observed in 3 (10%) of 30 treated vertebral bodies without any sequelae. By a mean follow-up of 16 months, no patients had experienced an adjacent-level fracture. Conclusions Balloon kyphoplasty of the upper thoracic spine via an extrapedicular approach is an efficient and safe minimally invasive procedure that may provide immediate and long-term pain relief and improvement in functional ability. It is technically challenging and has the potential for serious complications. With a fundamental knowledge of anatomy, as well as an ability to interpret fluoroscopy images, one can feasibly and safely perform balloon kyphoplasty in the upper thoracic spine.

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.

Computed tomography morphometric analysis for translaminar screw fixation in the upper thoracic spine of the pediatric population

2011 ◽  
Vol 7 (4) ◽  
pp. 383-388 ◽  
Author(s):  
Akash J. Patel ◽  
Jacob Cherian ◽  
Daniel H. Fulkerson ◽  
Benjamin D. Fox ◽  
Joshua J. Chern ◽  
...  
Keyword(s):  
Thoracic Spine ◽  
Pediatric Population ◽  
Linear Regression Analysis ◽  
Population Based ◽  
Upper Thoracic Spine ◽  
Screw Length ◽  
Translaminar Screw ◽  
The Mean ◽  
The Right ◽  
Upper Thoracic

Object Translaminar screw (TLS) fixation can be used safely and efficaciously for upper cervical fusion in children. No published studies have evaluated this technique in the thoracic spine of the pediatric population, and thus the authors undertook such an analysis. Methods The upper thoracic spines (T1–4) of 130 patients, consisting of 70 boys and 60 girls, were studied using CT scans. Laminar height and thickness, screw length, and screw angle were measured. Exclusion criteria included the following: patients older than 18 years of age, trauma or congenital abnormalities of the thoracic spine, or absent demographic information or imaging studies through T-4. Statistical analysis was performed using paired or unpaired Student t-tests (p < 0.05) and linear regression analysis. Results The mean laminar heights for T-1, T-2, T-3, and T-4 were as follows: 12.3 ± 3.4, 13.0 ± 3.5, 13.4 ± 3.8, and 14.7 ± 4.1 mm, respectively. The mean laminar widths were 6.5 ± 1.3, 6.6 ± 1.3, 6.6 ± 1.3, and 6.6 ± 1.4 mm, respectively. The mean screw lengths were 29.9 ± 4.1, 25.2 ± 3.5, 22.7 ± 3.2, and 21.6 ± 3.1 mm, respectively. The mean screw angles were 47° ± 4°, 48° ± 4°, 51° ± 4°, and 53° ± 5°, respectively. There were no significant differences between the right and left sides. However, significant differences were found when comparing patients younger than 8 years with those who were 8 years or older, and when comparing boys and girls. Conclusions Careful preoperative thin-cut CT with sagittal reconstruction is mandatory to determine if the placement of TLSs is feasible in the pediatric population. Based on CT analysis, the insertion of TLSs in the pediatric thoracic spine is possible in all patients older than 8 years and in many patients younger than 8 years. Boys could accept longer screws in the upper thoracic spine compared with girls.

A computed tomography–based feasibility study of translaminar screw fixation in the upper thoracic spine

2010 ◽  
Vol 12 (3) ◽  
pp. 286-292 ◽  
Author(s):  
Ryan M. Kretzer ◽  
Christopher Chaput ◽  
Daniel M. Sciubba ◽  
Ira M. Garonzik ◽  
George I. Jallo ◽  
...  
Keyword(s):  
Thoracic Spine ◽  
Ct Imaging ◽  
Upper Thoracic Spine ◽  
Screw Length ◽  
Translaminar Screw ◽  
Ct Evaluation ◽  
The Mean ◽  
Upper Thoracic ◽  
Translaminar Screws ◽  
Pedicle Width

Object Translaminar screws (TLSs) offer an alternative to pedicle screw (PS) fixation in the upper thoracic spine. Although cadaveric studies have described the anatomy of the laminae and pedicles at T1–2, CT imaging is the modality of choice for presurgical planning. In this study, the goal was to determine the diameter, maximal screw length, and optimal screw trajectory for TLS placement at T1–2, and to compare this information to PS placement in the upper thoracic spine as determined by CT evaluation. Methods One hundred patients (50 men and 50 women), whose average age was 41.7 ± 19.6 years, were selected by retrospective review of a trauma registry database over a 6-month period. Patients were included in the study if they were over the age of 18, had standardized axial bone-window CT imaging at T1–2, and had no evidence of spinal trauma. For each lamina and pedicle, width (outer cortical and cancellous), maximal screw length, and optimal screw trajectory were measured using eFilm Lite software. Statistical analysis was performed using the Student t-test. Results The T-1 lamina was estimated to accommodate, on average, a 5.8-mm longer screw than the T-2 lamina (p < 0.001). At T-1, the maximal TLS length was similar to PS length (TLS: 33.4 ± 3.6 mm, PS: 33.9 ± 3.3 mm [p = 0.148]), whereas at T-2, the maximal PS length was significantly greater than the TLS length (TLS: 27.6 ± 3.1 mm, PS: 35.3 ± 3.5 mm [p < 0.001]). When the lamina outer cortical and cancellous width was compared between T-1 and T-2, the lamina at T-2 was, on average, 0.3 mm wider than at T-1 (p = 0.007 and p = 0.003, respectively). In comparison with the corresponding pedicle, the mean outer cortical pedicle width at T-1 was wider than the lamina by an average of 1.0 mm (lamina: 6.6 ± 1.1 mm, pedicle: 7.6 ± 1.3 mm [p < 0.001]). At T-2, however, outer cortical lamina width was wider than the corresponding pedicle by an average of 0.6 mm (lamina: 6.9 ± 1.1 mm, pedicle: 6.3 ± 1.2 mm [p < 0.001]). At T-1, 97.5% of laminae measured could accept a 4.0-mm screw with 1.0 mm of clearance, compared with 99.5% of T-1 pedicles; whereas at T-2, 99% of laminae met this requirement, compared with 94.5% of pedicles. The ideal screw trajectory was also measured (T-1: 49.2 ± 3.7° for TLS and 32.8 ± 3.8° for PS; T-2: 51.1 ± 3.5° for TLS and 20.5 ± 4.4° for PS). Conclusions Based on CT evaluation, there are no anatomical limitations to the placement of TLSs compared with PSs at T1–2. Differences were noted, however, in lamina length and width between T-1 and T-2 that must be considered when placing TLS at these levels.

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