Is conservative treatment really the best option for all thoracolumbar injury patients with a thoracolumbar injury classification and severity scale score<4?

2020 ◽  
Author(s):  
Yang Xu ◽  
Zhiyuan Zeng ◽  
Fubiao Ye ◽  
Feiyue Lin ◽  
Chuncai Xu ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Burst Fracture ◽  
Treatment Recommendation ◽  
Thoracolumbar Fractures ◽  
Severity Scale ◽  
Thoracolumbar Injury ◽  
Significant Difference ◽  
Injury Classification ◽  
Surgical Group

Abstract Objectives: The conservative treatment recommendation for patients with thoracolumbar burst fractures with a TLICS score<4 has always been controversial. This retrospective review was conducted to investigate the reliability and validity of thoracolumbar injury classification and severity scale(TLICS) recommendations for thoracolumbar burst fracture patients with a score<4. Methods: A retrospective analysis was conducted from Jan. 2010 through Jun. 2018 for patients with thoracolumbar fractures in a single local institute; patients with a TLICS score <4 were enrolled and grouped according to the therapeutic strategy (surgical or nonsurgical). Imaging and clinical data were collected and compared between the two groups before and after treatment. Results: In total, 119 patients were enrolled (75 in the nonsurgical group and 44 in the surgical group). There was no significant difference between the two groups with regard to both the VAS and ODI values ( p =0.91 and 0.79, respectively) at the last follow-up. Importantly, despite no improvements in the local sagittal angle (LSA, α) of the spine( p =0.09),a worsened regional sagittal angle (RSA, β) ( p =0.03)was observed in the nonsurgical group, while significant improvements in the LSA and RAS were both observed in the surgical group( p <0.01). Conclusions: There were no clinical quantifiable benefits (VAS pain and ODI scores) between nonsurgical and surgical patients with comminuted thoracolumbar fractures (TLICS score<4). However, this type of patient deserves a very careful preoperative evaluation if a nonoperative decision is made; a close follow-up is mandatory due to the high likelihood of long-term kyphotic deformities.

scholarly journals Predictors of the failure of conservative treatment in patients with a thoracolumbar burst fracture

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Ehsan Alimohammadi ◽  
Seyed Reza Bagheri ◽  
Paniz Ahadi ◽  
Sahar Cheshmehkaboodi ◽  
Homa Hadidi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Conservative Treatment ◽  
Burst Fracture ◽  
Binary Logistic Regression ◽  
Operative Management ◽  
Binary Logistic Regression Analysis ◽  
Thoracolumbar Burst Fracture ◽  
Potential Risk Factors ◽  
Non Operative Management

Abstract Background There is a controversy about the management of patients with a thoracolumbar burst fracture. Despite the success of the conservative treatment in most of the cases, some patients failed the conservative treatment. The present study aimed to evaluate risk factors for the need for surgery during the follow-up period in these patients. Methods We retrospectively evaluated 67 patients with a traumatic thoracolumbar burst fracture who managed conservatively at our center between May 2014 and May 2019. Suggested variables as potential risk factors for the failure of conservative treatment including age, gender, body mass index (BMI), smoking, diabetes, vertebral body compression rate (VBCR), percentage of anterior height compression (PAHC), Cobb angle, interpedicular distance (IPD), canal compromise, and pain intensity as visual analog scale (VAS) were compared between patients with successful conservative treatment and those with failure of non-operative management. Results There were 41 males (61.2%) and 26 females (38.8%) with the mean follow-up time of 15.52 ± 5.30 months. Overall, 51 patients (76.1%) successfully completed conservative treatment. However, 16 cases (23.9%) failed the non-operative management. According to the binary logistic regression analysis, only age (risk ratio [RR], 2.21; 95% confidence interval [95%], 1.78–2.64; P = 0.019) and IPD (RR 1.97; 95% CI 1.61–2.33; P = 0.005) were the independent risk factors for the failure of the non-operative management. Conclusions Our results showed that older patients and those with greater interpedicular distance are at a higher risk for failure of the conservative treatment. As a result, a closer follow-up should be considered for them.

scholarly journals Effect of manual reduction and indirect decompression on thoracolumbar burst fracture: a comparison study

2020 ◽  
Author(s):  
Jian Huang ◽  
Limin Zhou ◽  
Zhaodong Yan ◽  
Zongbo Zhou ◽  
Xuejian Gou
Keyword(s):  
Burst Fracture ◽  
Wedge Angle ◽  
Control Group ◽  
Thoracolumbar Burst Fracture ◽  
Manual Reduction ◽  
Significant Difference ◽  
Indirect Decompression ◽  
The Difference ◽  
Experimental Group

Abstract Study designRetrospective cohort study.ObjectiveTo evaluate the effect of manual reduction and indirect decompression on thoracolumbar burst fracture.Methods60 patients with thoracolumbar burst fracture who were hospitalized from January 2018 to October 2019 were selected and divided into experimental group (33 cases) and control group (27 cases) according to different treatment methods. The experimental group was treated with manual reduction and indirect decompression, while the control group was not treated with manual reduction. The operation time and intraoperative blood loss were recorded. VAS score was used to evaluate the improvement of pain. The anterior height of injured vertebra, wedge angle of injured vertebral body, encroachment ratio of injured vertebral canal were used to evaluate spinal canal decompression and fracture reduction. JOA score was used to evaluate the improvement of spinal function.ResultsThere was no significant difference in operation time and intraoperative blood loss between the two groups. Compared with the control group, the VAS score and the wedge angle of injured vertebral body of the experimental group on 3 days after operation and the last follow-up were significantly lower than that of the control group, and the difference was statistically significant. The ratio of anterior height of injured vertebra of the experimental group on 3 days after operation and the last follow-up were significantly higher than that of the control group, and the difference was statistically significant. The difference of the encroachment ratio of injured vertebral canal between preoperation and 3 days after operation was significantly higher than that of the control group, and the difference was statistically significant. The bladder function of JOA on 3 days after operation of the experimental group was significantly higher than that of the control group, and the difference was statistically significant. And the rest aspect of JOA on 3 days after operation and last follow-up of the experimental group were no significant difference Compared with the control group.ConclusionManipulative reduction and indirect decompression can obtain better clinical effect in the treatment of thoracolumbar burst fractures.

scholarly journals Application of Ultrasonography in Conservative Treatment of Humeral Shaft Fracture in Children

2021 ◽  
Author(s):  
Jun Li ◽  
Xin Tan ◽  
Xiang Li ◽  
Pan Gou ◽  
Xiaowei Yuan ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Nerve Injury ◽  
Shaft Fracture ◽  
Humeral Shaft Fracture ◽  
Humeral Shaft ◽  
Dash Score ◽  
X Ray ◽  
Epidemic Period ◽  
Significant Difference

Abstract Purpose: Most of humeral shaft fractures in children could be treated satisfactorily by conservative treatment. This study aimed to evaluate the application value of ultrasonography in conservative treatment of humeral shaft fracture in children.Methods: We retrospectively reviewed children admitted to our hospital, for humeral shaft fracture from January 2014 to March 2018. The patients were divided into two groups: ultrasonography group and X-ray group. All patients were instructed to re-examined at 1 week, 2 weeks, 4 weeks, 12 weeks, 24 weeks and 1 year from the injury date for follow-up, and evaluated the prognosis according to the Disabilities of Arm, Shoulder and Hand (DASH) score at 12 months.Results: A total of 37 children were divided into ultrasonography group, 32 children were divided into X-ray group. There was no significant difference in prognosis between the two groups. The mean number of radiation exposures of ultrasonography group was less and ultrasonic examination found radial nerve injury, and using ultrasound reduced the chance of direct or in direct contact with infected peoples.Conclusion: Ultrasound is a non-invasive, non-radioactive test, which could decrease risk of COVID-19 infection and detect the vascular nerve injury caused by fracture. Ultrasonography may be the examination method for follow-up conservative treatment of humeral shaft fracture in children during the epidemic period.

scholarly journals Multicenter retrospective evaluation of the validity of the Thoracolumbar Injury Classification and Severity Score system in children

2016 ◽  
Vol 18 (2) ◽  
pp. 164-170 ◽  
Author(s):  
Jonathan N. Sellin ◽  
William J. Steele ◽  
Lauren Simpson ◽  
Wei X. Huff ◽  
Brandon C. Lane ◽  
...  
Keyword(s):  
Decision Making ◽  
Age Group ◽  
Pediatric Age ◽  
Conservative Group ◽  
Children's Hospital ◽  
Pediatric Age Group ◽  
Thoracolumbar Injury ◽  
Children’S Hospital ◽  
Injury Classification ◽  
Surgical Group

OBJECTIVE The Thoracolumbar Injury Classification and Severity Score (TLICS) system was developed to streamline injury assessment and guide surgical decision making. To the best of the authors' knowledge, external validation in the pediatric age group has not been undertaken prior to this report. METHODS This study evaluated the use of the TLICS in a large retrospective series of children and adolescents treated at 4 pediatric medical centers (Texas Children's Hospital, Children's Healthcare of Atlanta, Riley Children's Hospital, and Doernbecher Children's Hospital). A total of 147 patients treated for traumatic thoracic or lumbar spine trauma between February 1, 2002, and September 1, 2015, were included in this study. Clinical and radiographic data were evaluated. Injuries were classified using American Spinal Injury Association (ASIA) status, Denis classification, and TLICS. RESULTS A total of 102 patients (69%) were treated conservatively, and 45 patients (31%) were treated surgically. All patients but one in the conservative group were classified as ASIA E. In this group, 86/102 patients (84%) had Denis type compression injuries. The TLICS in the conservative group ranged from 1 to 10 (mean 1.6). Overall, 93% of patients matched TLICS conservative treatment recommendations (score ≤ 3). No patients crossed over to the surgical group in delayed fashion. In the surgical group, 26/45 (58%) were ASIA E, whereas 19/45 (42%) had neurological deficits (ASIA A, B, C, or D). One of 45 (2%) patients was classified with Denis type compression injuries; 25/45 (56%) were classified with Denis type burst injuries; 14/45 (31%) were classified with Denis type seat belt injuries; and 5/45 (11%) were classified with Denis type fracture-dislocation injuries. The TLICS ranged from 2 to 10 (mean 6.4). Eighty-two percent of patients matched TLICS surgical treatment recommendations (score ≥ 5). No patients crossed over to the conservative management group. Eight patients (8/147, 5%) had a calculated TLICS of 4, which meant they were candidates for surgery or conservative therapy by TLICS criteria. Excluding these patients, the degree of agreement between TLICS and surgeon decision was deemed to be very good (κ = 0.878). CONCLUSIONS The TLICS results and recommendations matched treatment in 96% of conservative group cases. In the surgical group, TLICS recommendations matched treatment in 93% of cases. The TLICS recommendations and surgeon decision making displayed very good concordance. The TLICS appears to be effective in the classification of thoracic and lumbar spine injuries and in guiding treatment in the pediatric age group.

Volumetric Growth of Cervical Schwannoma as a Predictor of Surgical Intervention

2016 ◽  
Vol 156 (1) ◽  
pp. 152-155 ◽  
Author(s):  
A. Sean Alemi ◽  
Chase M. Heaton ◽  
William R. Ryan ◽  
Ivan El-Sayed ◽  
Steven J. Wang
Keyword(s):  
Growth Rate ◽  
Gamma Knife ◽  
Surgical Intervention ◽  
Academic Medical Center ◽  
Benign Tumors ◽  
Entire Group ◽  
Average Growth ◽  
Significant Difference ◽  
Surgical Group

Objective Cervical schwannomas are benign tumors that commonly present as asymptomatic masses and are managed with observation, radiation, or surgery. To our knowledge, the rate of volumetric change seen on serial imaging is not currently used to determine surgical candidacy. We assess average growth rates and determine whether growth rate of cervical schwannoma predicts having undergone surgery. Study Design Case series with chart review. Setting Quaternary academic medical center. Subjects and Methods Patients were identified with at least 2 imaging studies and pathologic or imaging characteristics of cervical schwannoma. Volume was calculated with the formula 4/3π xyz, with x, y, and z representing the 3 orthogonal dimensions. Volume and rate of volume change were compared among observed, surgical, and gamma knife groups. Results Thirteen patients were identified and divided into subgroups: surgical (n = 5), observation (n = 6), and gamma knife (n = 2). Mean follow-up time was 21 months (range, 1-80 months) and not significantly different among subgroups. The average changes in volume were 3.61 cm3/mo (entire group), –2.75 cm3/mo (observation), 11.97 cm3/mo (surgery), and 1.78 cm3/mo (gamma knife). Average initial volume for the entire group was 124.4 cm3 (range, 5-608 cm3) and 142 cm3 (range 5-613) at follow-up. The surgical group had a statistically significant change in volume ( P = .03). A statistically significant difference in growth rate was seen between the surgical and observation groups ( P = .016) and between the surgical group and all nonsurgical patients ( P = .011). Conclusions Rate of tumor growth can be used in the evaluation of patients with cervical schwannoma, and it may predict surgical intervention.

Conservative versus surgical treatment of venous leg ulcers: 10-year follow up of a randomized, multicenter trial

2015 ◽  
Vol 30 (1_suppl) ◽  
pp. 35-41 ◽  
Author(s):  
WB van Gent ◽  
FS Catarinella ◽  
YL Lam ◽  
FHM Nieman ◽  
IM Toonder ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Compression Therapy ◽  
Multicenter Trial ◽  
Leg Ulcers ◽  
Conservative Group ◽  
Perforating Veins ◽  
Significant Difference ◽  
Disease Specific ◽  
Surgical Group

Introduction Leg ulcers have a large socio-economic impact. Treatment modalities are either conservative or surgical. Conservative treatment involves local treatment and compression therapy. Surgical treatment of venous ulcers is based on correcting venous hypertension, by treating incompetent superficial, deep, and perforating veins. A prospective randomized multicenter trial comparing surgical treatment (combined superficial and perforating vein surgery) with ambulatory compression therapy was conducted during 1998 and 2001. This paper presents the results of a 10-year follow-up period of this trial. Materials and methods All patients enrolled in the original prospective trial were approached and invited for additional examination and duplex ultrasound evaluation. Secondary, disease specific and generic quality-of-life (QoL) was assessed. Current ulcer state and recurrence during the follow-up period was assessed. Results After a mean of 97 months follow up, 80 (41%) out of 196 legs could be inspected. The incidence of “ulcer-free”, the main outcome, was significantly ( p = 0.007) higher in the surgical group (58.9%), compared to the conservative group (39.6%). Observed ulcer recurrence was 48.9% for the surgical group and 94.3% for the conservative group. The number of incompetent perforating veins appears to be a significant ( p < 0.001) risk factor for not being ulcer-free. Disease specific QoL showed no significant difference between the surgical and conservative groups. Conclusions The addition of surgical treatment in patients with venous ulceration leads to a significantly higher chance of being ulcer-free, than just ambulatory compression therapy. This effect persists after 10 years of follow up. The number of incompetent perforating veins has a significant effect on the ulcer-state and recurrence.

scholarly journals Effect of manual reduction and indirect decompression on thoracolumbar burst fracture: a comparison study

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Jian Huang ◽  
Limin Zhou ◽  
Zhaodong Yan ◽  
Zongbo Zhou ◽  
Xuejian Gou
Keyword(s):  
Burst Fracture ◽  
Wedge Angle ◽  
Control Group ◽  
Thoracolumbar Burst Fracture ◽  
Manual Reduction ◽  
Significant Difference ◽  
Indirect Decompression ◽  
The Difference ◽  
Experimental Group

Abstract Objective To evaluate the effect of manual reduction and indirect decompression on thoracolumbar burst fracture. Methods Sixty patients with thoracolumbar burst fracture who were hospitalized from January 2018 to October 2019 were selected and divided into an experimental group (33 cases) and control group (27 cases) according to different treatment methods. The experimental group was treated with manual reduction and indirect decompression, while the control group was not treated with manual reduction. The operation time and intraoperative blood loss were recorded. VAS score was used to evaluate the improvement of pain. The anterior height of the injured vertebra, wedge angle of the injured vertebral body, and encroachment ratio of the injured vertebral canal were used to evaluate the spinal canal decompression and fracture reduction. JOA score was used to evaluate the improvement of spinal function. Results There was no significant difference in operation time and intraoperative blood loss between the two groups. Compared with the control group, the VAS score and the wedge angle of the injured vertebral body of the experimental group 3 days after the operation and the last follow-up were significantly lower than that of the control group, and the difference was statistically significant. The ratio of the anterior height of the injured vertebra of the experimental group 3 days after the operation and the last follow-up was significantly higher than that of the control group, and the difference was statistically significant. The difference of the encroachment ratio of the injured vertebral canal between preoperation and 3 days after operation was significantly higher than that of the control group, and the difference was statistically significant. The bladder function of JOA 3 days after the operation of the experimental group was significantly higher than that of the control group, and the difference was statistically significant. And the rest aspect of JOA on 3 days after the operation and last follow-up of the experimental group has no significant difference compared with the control group. Conclusion Manipulative reduction and indirect decompression can obtain a better clinical effect in the treatment of thoracolumbar burst fractures.

scholarly journals Improved Monosegment Pedicle Instrumentation for Treatment of Thoracolumbar Incomplete Burst Fractures

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Liehua Liu ◽  
Yibo Gan ◽  
Qiang Zhou ◽  
Haoming Wang ◽  
Fei Dai ◽  
...  
Keyword(s):  
Blood Loss ◽  
Burst Fracture ◽  
Body Height ◽  
Clinical Results ◽  
Minor Trauma ◽  
Significant Difference ◽  
Postoperative Drainage ◽  
Anterior Body ◽  
Sagittal Index

Aim. Comparing the clinical results of improved monosegment pedicle instrumentation (iMSPI) and short-segment pedicle instrumentation (SSPI) retrospectively.Method. 63 patients with thoracolumbar incomplete burst fracture were managed with iMSPI or SSPI. 30 patients were managed with iMSPI and fusion. 33 patients were managed with SSPI and fusion. Operative time, blood loss, postoperative drainage, and complications were recorded. Percentage of anterior body height compression (ABHC%) and sagittal index (SI) were obtained preoperatively, one week postoperatively, and at the last followup.Results. The blood loss and postoperative drainage were significantly less in the iMSPI group than in SSPI group(P<0.05). The follow-up duration of the two groups was not significantly different(P>0.05). At 12 months postoperatively posterolateral fusion was obtained satisfactorily. Neither preoperative ABHC% and SI nor postoperative SI were significantly different(P>0.05), but there was a significant difference in postoperative ABHC%(P=0.000). The ABHC% and SI were not significantly different between the two groups at the last followup(P>0.05). There were no fixation failures or other complications.Summary. IMSPI yielded satisfactory results similar to those of SSPI in patients with type A3.1/3.2 thoracolumbar fractures. IMSPI is recommended for minor trauma, reducing one-segment fusion, and maximization of the remaining motor function.

scholarly journals Kyphoplasty for Elderly Patients With Vertebral Compression Fractures—Do We Save Lives? Mortality Rates Analysis Comparison in a Long-Term Follow-Up Cohort

2021 ◽  
pp. 219256822098228
Author(s):  
Raphael Lotan ◽  
Yossi Smorgick ◽  
Yoram Anekstein ◽  
Oren Rudik ◽  
Ilia Prosso ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Retrospective Cohort ◽  
Mortality Rates ◽  
Vertebral Compression Fractures ◽  
Compression Fractures ◽  
Medical Centers ◽  
Significant Difference ◽  
Long Term Follow Up

Study Design: Retrospective cohort. Objectives: We aimed to compare a large cohort of patients with vertebral compression fractures (VCF) treated in 2 centers using different protocols (conservative vs BKP) and compare mortality rates on a long-term follow-up. Methods: Retrospective cohort held in 2 medical centers (W and AH). All patients admitted with VCF from November 2008 to January 2015 were enrolled in the study. Exclusion criteria were patients admitted with non-osteoporotic pathological fractures (such as metastatic or MM). Results: Our study included 208 patients treated for VCF, 127 were treated with BKP (88 females, 69.3%) and 81 were treated conservatively (59 females, 72.8%). Patients from Centre W were older and frailer compared to the patients from AH center (Average age 75.12 ± 11.16 vs 69.13 ± 9.61 years and Frailty score of 0.16 ± 0.1 vs 0.12 ± 0.1 respectively, T-test, p < 0.01 for both). Hazard ratios (HR) for age, female gender and frailty were significant for increased mortality, frailty had the highest HR of 182.42 (CI 29.05-1145.33, p < 0.01). Multivariate Cox model was fitted and after accounting for Gender, Age and Frailty, no significant difference was found between the 2 medical centers mortality rates (p = 0.59), thus no difference in mortality rates between BKP and conservative treatment in our study. Conclusion: long-term follow-up following BKP treatment for VCF did not show a reduced mortality rate compared to conservative treatment after accounting for frailty, age and gender. Frailty was the most important factor in predicting mortality. Further RCTs are needed to compare the quality of life differences between the 2 treatment strategies.

scholarly journals Results of using Thoracolumbar Injury Classification and Severity Score (TLICS) in Treatment of Thoracolumbar Fractures

2021 ◽  
Author(s):  
Serdar Kabataş ◽  
Erdinç Civelek ◽  
Erek Öztürk ◽  
Eyüp Can Savrunlu ◽  
Murat Kahraman ◽  
...  
Keyword(s):  
Cobb Angle ◽  
Case Reports ◽  
Burst Fracture ◽  
Loss Of Correction ◽  
Thoracolumbar Injury ◽  
Intensity Changes ◽  
Vas Scores ◽  
The Mean

Aim: To compare short and long term pain intensity changes and long term loss of correction rates in patients who were treated either by kyphoplasty or posterior segmentation due to their TLICS and LSC scores, therefore evaluate the specificity of these classifications. Material and Methods: Medical records of 106 patients operated due to thoracolumbar compression or burst fracture in our clinics between years 2012 to 2015 have been evaluated retrospectively. The patients were evaluated with postoperative radiography (loss of reduction) and visual analogue scale (VAS) in their follow-ups. Results: The average stay on hospital was 6.53 ± 4.51 days in kyphoplasty group. The mean preoperative cobb angle was 10.76±11.67 degrees, which improved to 10.19±10.66 degrees at postoperative 1th month. Beside this, the mean preoperative VAS score was 7.93±0.68 then improved to 4.25±0.77 and 2.75 ± 1.43 at postoperative 6th, 12th month follow-ups respectively. There were 42 patients in instrumentation group. The mean hospitalization was 13.47±10.43 days. The mean preoperative cobb angle was 15.84±10.52 and it improved to 11.86±8.15 degrees at the postoperative 1th-month follow-up. The preoperative VAS scores of the patients improved from 7.71±0.71 to 4.09±0.79 and 4.26±1.23 at 6th and 12th month follow-ups. Conclusion: In long term follow up the kyphoplasty group showed more loss of correction however lesser VAS scores comparing to the instrumentation group. Although evaluating TLICS scores to kyphoplasty patients is still based on case reports in our series it was performed to 64 patients.

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