scholarly journals What is the importance of the spinal canal encroachment in the management of thoracolumbar burst fracture without neurological deficit?

2018 ◽  
Vol 21 (4) ◽  
pp. 234-238
Author(s):  
Fabrizio Borges Scardino ◽  
Alécio Cristino Evangelista Santos Barcelos ◽  
Vanessa Bizarri Da Silva ◽  
Paulo Augusto Silva Dumont ◽  
José Marcus Rotta ◽  
...  
Keyword(s):  
Neurological Deficit ◽  
Burst Fracture ◽  
Thoracolumbar Fracture ◽  
Neurological Deficits ◽  
Instability Criterion ◽  
Thoracolumbar Fractures ◽  
Neurological Damage ◽  
Surgical Indications ◽  
Burst Fractures ◽  
Canal Encroachment

Introduction: The relevant features in the treatment of thoracolumbar fractures vary in the literature. The classical surgical indications of burst fractures are loss of vertebral body height, kyphosis, neurological deficit and canal encroachment. Recent papers have attributed less importance to canal impingement as a surgical indicator in intact patients, irrespectively of the degree of encroachment. The several thoracolumbar fracture classifications have prompted efforts to guide the surgical indications. We analyzed the relevance attributed to the canal encroachment by thoracolumbar fracture classifications in the management of burst fractures without neurological deficit. Objective: To evaluate the relevance attributed by the thoracolumbar fractures classifications to the canal encroachment in the management of burst fractures without posterior ligamentous complex disruptions or neurological deficits. Methods: A literature search was performed by tracking the related articles of thoracolumbar fractures classifications from Vaccaro’s to Holdsworth’s study. We analyzed the role of canal impingement in the management of burst fractures without posterior ligament complex injury or neurological deficits in each classification. Results: Seven classifications were included. Holdsworth considered the burst fractures as stable, irrespectively of the amount of canal impingement or neurological deficit. Denis considered that the burst fracture carried a neurological instability criterion, therefore, in these cases he suggested surgical treatment because of the riskof new neurological damage. McAffee postulated that there is no reliable predictor to correlate the severity of canal encroachment with the risk of neurological damage. Ferguson and Allen discussed the possibility of anterior decompression, stabilization and anterior fusion of the spine in certain cases of burst fractures. The classifications of McCormack, Karaikovic and Gaines, Magerl and Vaccaro did not include canal encroachment in their considerations. Conclusion: The thoracolumbar fractures classifications did not directly consider the severity of canal encroachment in the treatment decision making of burst fractures without neurological damage. It is not possible to predict which patients will deteriorate if not operated. It remains unclear what is the risk of neurological deterioration in a SCE greater than 50%.

Effect of Spinal Level and Loading Conditions on the Production of Vertebral Burst Fractures in a Porcine Model

2011 ◽  
Vol 133 (9) ◽  
Author(s):  
Dominic Boisclair ◽  
Jean-Marc Mac-Thiong ◽  
Stefan Parent ◽  
Yvan Petit
Keyword(s):  
Porcine Model ◽  
Loading Rate ◽  
Burst Fracture ◽  
Flexion Angle ◽  
Spinal Level ◽  
Compressive Stiffness ◽  
Burst Fractures ◽  
Load To Failure ◽  
Canal Encroachment ◽  
Full Factorial

Vertebral burst fractures are commonly studied with experimental animal models. There is however a lack of consensus as to what parameters are important to create an unstable burst fracture with a significant canal encroachment on such model. This study aims to assess the effect of the loading rate, flexion angle, spinal level, and their interactions on the production of a vertebral thoracolumbar burst fracture on a porcine model. Sixteen functional spinal units composed of three vertebrae were harvested from mature Yucatan minipigs. Two loading rates (0.01 and 500 mm/s), two flexion angles (0° and 15°), and two spinal levels (T11-T13 and T14-L2) were studied, following a full factorial experimental plan with one repetition. Compression was applied to each functional unit to create a vertebral fracture. The load-to-failure, loss of compressive stiffness, final canal encroachment, and fracture type were used as criteria to evaluate the resulting fracture. All specimens compressed without flexion resulted in burst fractures. Half of the specimens compressed with the 15° flexion angle resulted in compression fractures. Specimens positioned without flexion lost more of their compressive stiffness and had more significant canal encroachment. Fractured units compressed with a higher loading rate resulted in a greater loss of compressive stiffness. The spinal level had no significant effect on the resulting fractures. The main parameters which affect the resulting fracture are the loading rate and the flexion angle. A higher loading rate and the absence of flexion favors the production of burst fractures with a greater canal encroachment.

scholarly journals TREATMENT OF UNSTABLE THORACOLUMBAR FRACTURES IN PEDIATRIC PATIENTS

2015 ◽  
Vol 14 (3) ◽  
pp. 227-229 ◽  
Author(s):  
Roberto Chapa Sosa ◽  
Edgar Rubén Urrutia Vega
Keyword(s):  
Pediatric Patients ◽  
Pediatric Population ◽  
Cross Sectional Study ◽  
Thoracolumbar Fracture ◽  
Anatomical Site ◽  
Thoracolumbar Fractures ◽  
Sectional Study ◽  
Neurological Damage ◽  
Cross Sectional ◽  
Common Cause

Objective:To analyze the characteristics of unstable thoracolumbar fractures in the pediatric population.Methods:A retrospective cross-sectional study was conducted with pediatric patients (0 to 15 years) who presented with unstable thoracolumbar fracture with or without neurological damage. Twenty-four operated patients were analyzed: 13 male and 11 female.Results:Falls from height are the most common cause, being the thoracolumbar junction the anatomical site most frequently injured.Conclusion:The thoracolumbar fractures are rare in the pediatric population, as well as post-surgical instrumentation structural deformities.

Comparison of operative and nonoperative treatment for thoracolumbar burst fractures in patients without neurological deficit: a systematic review

2006 ◽  
Vol 4 (5) ◽  
pp. 351-358 ◽  
Author(s):  
Kenneth C. Thomas ◽  
Christopher S. Bailey ◽  
Marcel F. Dvorak ◽  
Brian Kwon ◽  
Charles Fisher
Keyword(s):  
Neurological Deficit ◽  
Data Extraction ◽  
Scientific Evidence ◽  
Burst Fracture ◽  
Nonoperative Treatment ◽  
Thoracolumbar Burst Fractures ◽  
Posttraumatic Kyphosis ◽  
Burst Fractures ◽  
Related Quality ◽  
Health Related

Object Despite extensive published research on thoracolumbar burst fractures, controversy still surrounds which is the most appropriate treatment. The objective of this study was to evaluate the scientific literature on operative and nonoperative treatment of patients with thoracolumbar burst fractures and no neurological deficit. Methods In their search of the literature, the authors identified all possible relevant studies concerning thoracolumbar burst fracture without neurological deficit. Two independent observers performed study selection, methodological quality assessment, and data extraction in a blinded and objective manner for all papers identified during the search. In a synthesis of the literature, the authors obtained evidence for both operative and nonoperative treatments. Conclusions There is a lack of evidence demonstrating the superiority of one approach over the other as measured using generic and disease-specific health-related quality of life scales. There is no scientific evidence linking posttraumatic kyphosis to clinical outcomes. The authors found that there is a strong need for improved clinical research methodology to be applied to this patient population.

scholarly journals A Rare Case of Contiguous Three-level Lumbar Burst Fractures-treated with Combined Posterior Stabilization and Anterior Fusion

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Charanjit Singh Dhillon ◽  
Ahamed Shafeek Nanakkal ◽  
Nilay Prafulsinh Chhasatia ◽  
Narendra Reddy Medagam ◽  
Anandkumar Khatavi
Keyword(s):  
Lumbar Spine ◽  
English Literature ◽  
Burst Fracture ◽  
High Energy ◽  
Individual Characteristics ◽  
Neurological Deficits ◽  
Surgical Approaches ◽  
Anterior Fusion ◽  
Posterior Stabilization ◽  
Burst Fractures

Introduction: Burst fractures occur frequently in high energy trauma and are commonly associated with falls from height and road traffic accidents. While multiple burst fractures are not uncommon in thoracic spine, three or more contiguous level burst fractures are a relative rarity especially, in lumbar spine. The treatment of multilevel burst fractures must be individualized, and each fracture should be treated according to its inherent stability. To the best of our knowledge, this is the only case of such injury reported in English literature. Case Report: A 17-year-old girl who sustained contiguous three-level lumbar burst fractures with neurological compromise following alleged history of fall from height. Radiographs/computed tomography scan revealed burst fractures of L2, L3, and L4 vertebrae with retropulsion of bony fragments at all the levels. Patient underwent minimally invasive posterior stabilization and anterior Hemi-corpectomy of L2, L4, and fusion. The patient recovered completely from neurological deficits by the end of 6 months. Conclusion: Multiple contiguous burst fractures in the lumbar spine are a rare entity. To the best of our knowledge, this is the only case of such injury reported in English literature. The treatment requires a thorough assessment of the fracture pattern and often requires a combination of surgical approaches. Each fracture merits treatment based on individual characteristics of fracture patterns and the amount of canal compromise at each level. Keywords: Lumbar, burst fracture, multiple, contiguous.

scholarly journals Treatment of Osteoporotic Thoracolumbar Burst Fractures by Bilateral Pedicle Vertebroplasty Combined With Postural Reduction

2021 ◽  
Author(s):  
Haoyu Wang ◽  
Lifeng Zhang ◽  
Xiaotao Wu
Keyword(s):  
Surgical Complications ◽  
Clinical Symptoms ◽  
Burst Fracture ◽  
Wedge Angle ◽  
Neurological Deficits ◽  
Spine Injury ◽  
Thoracolumbar Fractures ◽  
Kyphosis Correction ◽  
Alternative Method ◽  
Postural Reduction

Abstract Background: Osteoporotic thoracolumbar burst fracture (OTLBF) is common in seniors. Due to the fracture of the posterior vertebra and spinal canal occupancy, the risk of cement leakage and spine injury is high in OTLBF patients, thus the application of vertebroplasty is limited in these patients. This study aims to investigate the efficacy and safety of vertebroplasty for treating OTLBF via bilateral pedicle approach combined with postural reduction. To determine whether percutaneous vertebroplasty (PVP) combined with body reduction is an alternative method for treating OTLBF that prevents major surgical complications.Methods: Thirteen patients (aged≥65years) with thoracolumbar fractures but without neurological deficits underwent vertebroplasty. In all fracture cases, the anterior and middle columns of the vertebrae were affected and the canal was mildly compressed. To assess the clinical symptoms and the effects of the procedure, patient mobility and pain were assessed prior to the procedure and at 1 day and 3 months after the procedure. Kyphosis correction, wedge angle, and height restoration were also observed and measured. Results: Improvements in pain and mobility were observed immediately after vertebroplasty in all patients. These results were observed for 6 months. Significant improvements were also noted at 1 day and 6 months after vertebroplasty. Pain was reduced by at least 4 levels after 6 months. No comorbidities were observed. Kyphosis Correction, Wedge Angle and height recovery were improved. Postoperative computed tomography revealed polymethylmethacrylate leakage through the endplate fracture site into the disc space and paravertebral spacein one patient. No intraspinal leakage was found in all patients. Conclusions: Vertebroplasty is assumed to be contraindicated in patients with osteoporotic thoracolumbar fractures with posterior body involvement. However, this procedure was successfully performed to safely treat such fractures without causing neurological deficits. PVP combined with body reduction may be an alternative method for treating OTLBF that prevents major surgical complications. Moreover, it helps patients achieve early mobilization and pain relief.

Surgical versus non-surgical treatment for thoracolumbar burst fractures without neurological deficit: A systematic review and meta-analysis v1

2021 ◽  
Author(s):  
Tzu-Yi Chou ◽  
Fon-yih Tsuang ◽  
Chung Liang Chai
Keyword(s):  
Systematic Review ◽  
Surgical Treatment ◽  
Neurological Deficit ◽  
Meta Analysis ◽  
Burst Fracture ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures ◽  
Non Surgical Treatment

The aim of this systematic review is to compare the outcomes of burst fracture between non-operative treatments and operative treatments.

scholarly journals Transdural reduction of a bone fragment protruding into the spinal canal during surgical treatment of lumbar burst fracture: A case report

2021 ◽  
Vol 12 ◽  
pp. 406
Author(s):  
Wakiko Saruta ◽  
Toshiyuki Takahashi ◽  
Toshihiro Kumabe ◽  
Manabu Minami ◽  
Ryo Kanematsu ◽  
...  
Keyword(s):  
Spinal Canal ◽  
High Speed ◽  
Burst Fracture ◽  
Cauda Equina ◽  
High Energy ◽  
Sensory Function ◽  
Neurological Deficits ◽  
Burst Fractures ◽  
Cauda Equina Compression ◽  
Bone Fragments

Background: There have been many reports on the clinical, radiographic, and surgical management of thoracolumbar burst fractures attributed to high-energy trauma. Interestingly, few reports have described how to extract bone fragments associated with these injuries protruding into the spinal canal contributing to significant neurological deficits. Methods: An 18-year-old male presented with a severe L3-level paraparesis (i.e., loss of motor/sensory function below L3 lower extremity hyporeflexia, and sphincter dysfunction: American Spinal Injury Association [ASIA] Impairment Scale B) following a high-speed crash. The computed tomography and magnetic resonance studies revealed a L3 burst fracture with bone fragments protruding into the spinal canal causing marked cauda equina compression. Following a L3-L4 laminectomy, and opening of the dorsal dura, the bone fragments were ventrally impacted into the fractured L3 vertebral body a pedicle/screw L1-L5 fusion was then completed. Results: One month later, the patient recovered to an ASIA Scale of C, (i.e., residual proximal 3/5 and distal 2/5 motor deficits, with partial sensory sparing). Conclusion: Transdural ventral impaction of protruded bone fragments attributed to high speed lumbar burst fractures contributing to significant cauda equina compression can be safely/effectively accomplished.

Nonoperative Treatment

2007 ◽  
Vol 6 (1) ◽  
pp. 97 ◽  
Author(s):  
Stephen E. Natelson
Keyword(s):  
Neurological Deficit ◽  
Data Extraction ◽  
Scientific Evidence ◽  
Burst Fracture ◽  
Nonoperative Treatment ◽  
Thoracolumbar Burst Fractures ◽  
Posttraumatic Kyphosis ◽  
Burst Fractures ◽  
Related Quality ◽  
Health Related

Object Despite extensive published research on thoracolumbar burst fractures, controversy still surrounds which is the most appropriate treatment. The objective of this study was to evaluate the scientific literature on operative and nonoperative treatment of patients with thoracolumbar burst fractures and no neurological deficit. Methods In their search of the literature, the authors identified all possible relevant studies concerning thoracolumbar burst fracture without neurological deficit. Two independent observers performed study selection, methodological quality assessment, and data extraction in a blinded and objective manner for all papers identified during the search. In a synthesis of the literature, the authors obtained evidence for both operative and nonoperative treatments. Conclusions There is a lack of evidence demonstrating the superiority of one approach over the other as measured using generic and disease-specific health-related quality of life scales. There is no scientific evidence linking posttraumatic kyphosis to clinical outcomes. The authors found that there is a strong need for improved clinical research methodology to be applied to this patient population.

scholarly journals Classification of Radiological Changes in Burst Fractures

2018 ◽  
Vol 6 (2) ◽  
pp. 359-363
Author(s):  
Salim Şentürk ◽  
Ahmet Öğrenci ◽  
Ahmet Gürhan Gürçay ◽  
Ahmet Atilla Abdioğlu ◽  
Onur Yaman ◽  
...  
Keyword(s):  
Neurological Deficit ◽  
Clinical Status ◽  
Burst Fracture ◽  
High Energy ◽  
Organ Injury ◽  
Burst Fractures ◽  
Radiological Staging ◽  
Radiological Images ◽  
Radiological Changes

AIM: Burst fractures can occur with different radiological images after high energy. We aimed to simplify radiological staging of burst fractures.METHODS: Eighty patients whom exposed spinal trauma and had burst fracture were evaluated concerning age, sex, fracture segment, neurological deficit, secondary organ injury and radiological changes that occurred.RESULTS: We performed a new classification in burst fractures at radiological images.CONCLUSIONS: According to this classification system, secondary organ injury and neurological deficit can be an indicator of energy exposure. If energy is high, the clinical status will be worse. Thus, we can get an idea about the likelihood of neurological deficit and secondary organ injuries. This classification has simplified the radiological staging of burst fractures and is a classification that gives a very accurate idea about the neurological condition.

Controversies in Managing of Thoracic-Lumbar Upper Burst Fractures

2018 ◽  
Vol 1 (2) ◽  
Author(s):  
Sahat Edison Sitorus
Keyword(s):  
Decision Making ◽  
Spinal Cord ◽  
Posterior Instrumentation ◽  
Burst Fracture ◽  
Surgical Decompression ◽  
Neurologic Deficit ◽  
Retroperitoneal Approach ◽  
Burst Fractures ◽  
Lateral Fixation

Upper burst fracture of Th12-L1 has unique anatomy because it contains lower spinal cord, medullary cone, and diaphragm which separates between the thoracic and lumbar spine.The presence or absence of neurologic deficit is the single most important factor in the decision making. The presence of profound but incomplete neural deficit in association with canal compromise represents an urgent indication of surgical decompression. Antero-lateral direct decompression with trans-thoracic trans-pleural–retroperitoneal approach given the proximity the cord and conus is the most effective method, with inter-vertebral instrumentation with or without lateral fixation or posterior instrumentation.

Sign in / Sign up

Export Citation Format

Share Document