An updated management algorithm for incorporating minimally invasive techniques to treat thoracolumbar trauma

2021 ◽  
pp. 1-10
Author(s):  
Jacob K. Greenberg ◽  
Stephen Shelby Burks ◽  
Christopher F. Dibble ◽  
Saad Javeed ◽  
Vivek P. Gupta ◽  
...  
Keyword(s):  
Literature Review ◽  
Minimally Invasive ◽  
Expert Opinion ◽  
Treatment Algorithm ◽  
Interrater Agreement ◽  
Neurological Deficits ◽  
Spine Trauma ◽  
Thoracolumbar Injury ◽  
Survey Results ◽  
Neurologically Intact

OBJECTIVE Minimally invasive surgery (MIS) techniques can effectively stabilize and decompress many thoracolumbar injuries with decreased morbidity and tissue destruction compared with open approaches. Nonetheless, there is limited direction regarding the breadth and limitations of MIS techniques for thoracolumbar injuries. Consequently, the objectives of this study were to 1) identify the range of current practice patterns for thoracolumbar trauma and 2) integrate expert opinion and literature review to develop an updated treatment algorithm. METHODS A survey describing 10 clinical cases with a range of thoracolumbar injuries was sent to 12 surgeons with expertise in spine trauma. The survey results were summarized using descriptive statistics, along with the Fleiss kappa statistic of interrater agreement. To develop an updated treatment algorithm, the authors used a modified Delphi technique that incorporated a literature review, the survey results, and iterative feedback from a group of 14 spine trauma experts. The final algorithm represented the consensus opinion of that expert group. RESULTS Eleven of 12 surgeons contacted completed the case survey, including 8 (73%) neurosurgeons and 3 (27%) orthopedic surgeons. For the 4 cases involving patients with neurological deficits, nearly all respondents recommended decompression and fusion, and the proportion recommending open surgery ranged from 55% to 100% by case. Recommendations for the remaining cases were heterogeneous. Among the neurologically intact patients, MIS techniques were typically recommended more often than open techniques. The overall interrater agreement in recommendations was 0.23, indicating fair agreement. Considering both literature review and expert opinion, the updated algorithm indicated that MIS techniques could be used to treat most thoracolumbar injuries. Among neurologically intact patients, percutaneous instrumentation without arthrodesis was recommended for those with AO Spine Thoracolumbar Classification System subtype A3/A4 (Thoracolumbar Injury Classification and Severity Score [TLICS] 4) injuries, but MIS posterior arthrodesis was recommended for most patients with AO Spine subtype B2/B3 (TLICS > 4) injuries. Depending on vertebral body integrity, anterolateral corpectomy or mini-open decompression could be used for patients with neurological deficits. CONCLUSIONS Spine trauma experts endorsed a range of strategies for treating thoracolumbar injuries but felt that MIS techniques were an option for most patients. The updated treatment algorithm may provide a foundation for surgeons interested in safe approaches for using MIS techniques to treat thoracolumbar trauma.

scholarly journals Using Expert Opinion to Quantify Uncertainty in and Cost of Using Nondestructive Evaluation on Bridges

2017 ◽  
Vol 2017 ◽  
pp. 1-12 ◽  
Author(s):  
Alex A. Hesse ◽  
Rebecca A. Atadero ◽  
Mehmet E. Ozbek
Keyword(s):  
Experimental Data ◽  
Literature Review ◽  
Nondestructive Evaluation ◽  
Expert Opinion ◽  
Delphi Method ◽  
Bridge Management ◽  
Inspection Planning ◽  
True Response ◽  
Starting Point ◽  
Survey Results

A previous literature review indicated that there is little published experimental data that can be used to determine quantities such as bias, accuracy, reliability, and cost of common Nondestructive Evaluation (NDE) methods as far as their use on bridges is concerned. This study attempts to quantify these parameters for common bridge NDE methods through a four-round Delphi method survey with experts in the NDE bridge field. The survey results indicate that most commonly used bridge NDE methods tend to be underbiased and relatively reliable. Furthermore, the accuracy of commonly used bridge NDE methods tends to be relatively variable with the average test measuring a true response between 80% and 85% of the time. In general, it was shown by the participant responses that the more expensive the method was, the better the bias, accuracy, and reliability the method had, and vice versa. The information presented in this paper can serve as a starting point for characterizing different NDE methods for use in bridge management and inspection planning and identifies the type of information that is still needed. As such, this research has the potential to promote further research on this subject.

Traumatic thoracolumbar spinal injury: an algorithm for minimally invasive surgical management

2014 ◽  
Vol 37 (1) ◽  
pp. E9 ◽  
Author(s):  
Sanjay S. Dhall ◽  
Rishi Wadhwa ◽  
Michael Y. Wang ◽  
Alexandra Tien-Smith ◽  
Praveen V. Mummaneni
Keyword(s):  
Minimally Invasive ◽  
Spinal Injury ◽  
Treatment Algorithm ◽  
Trauma Treatment ◽  
Posterior Decompression ◽  
The Past ◽  
Minimally Invasive Surgical ◽  
Thoracolumbar Injury ◽  
Mini Open

Object Minimally invasive spinal (MIS) surgery techniques have been used sporadically in thoracolumbar junction trauma cases in the past 5 years. A review of the literature on the treatment of thoracolumbar trauma treated with MIS surgery revealed no unifying algorithm to assist with treatment planning. Therefore, the authors formulated a treatment algorithm. Methods The authors reviewed the current literature on MIS treatment of thoracolumbar trauma. Based on the literature review, they then created an algorithm for the treatment of thoracolumbar trauma utilizing MIS techniques. This MIS trauma treatment algorithm incorporates concepts form the Thoracolumbar Injury Classification System (TLICS). Results The authors provide representative cases of patients with thoracolumbar trauma who underwent MIS surgery utilizing the MIS trauma treatment algorithm. The cases involve the use of mini-open lateral approaches and/or minimally invasive posterior decompression with or without fusion. Conclusions Cases involving thoracolumbar trauma can safely be treated with MIS surgery in select cases of burst fractures. The role of percutaneous nonfusion techniques remains very limited (primarily to treat thoracolumbar trauma in patients with a propensity for autofusion [for example, those with ankylosing spondylitis]).

scholarly journals Operative versus Non-Operative Management of Traumatic Thoracolumbar Injuries according to the AO Spine Thoracolumbar Spine Injury Classification System

2020 ◽  
Vol 39 (03) ◽  
pp. 181-188
Author(s):  
Andrei F. Joaquim
Keyword(s):  
Nonoperative Management ◽  
Treatment Options ◽  
Thoracolumbar Spine ◽  
Neurological Deficits ◽  
Spine Injury ◽  
Spine Trauma ◽  
Ligamentous Injury ◽  
Injury Type ◽  
Neurologically Intact ◽  
Injury Classification

Abstract Introduction The AOSpine Thoracolumbar Spine Injury Classification (AOSTSIC) system has been proposed to better characterize injury morphologies and improve the classification of thoracolumbar (TL) spine trauma. However, the indications for surgical treatment according to the AOSTSIC system are still debated. Additionally, the proposed Thoracolumbar AOSpine Injury Score (AOSIS) is quite complex, which may preclude its use in daily practice. The objective of this review is to discuss the AOSTSIC system and its indications for initial nonoperative versus surgical management of acute TL spine trauma. Methods We analyzed the literature for each injury type (and subtype, when pertinent) according to the AOSTSIC system as well as their potential treatment options. Results Patients with AOSTSIC subtypes A0, A1, and A2 are neurologically intact in the vast majority of the cases and initially managed nonoperatively. The treatment of A3- and A4-subtype injuries (burst fractures) in neurologically-intact patients is still debated with great controversy, with initially nonoperative management being considered an option in select patients. Surgery is recommended when there are neurological deficits or failure of nonoperative management, with the role of magnetic resonance findings in the Posterior Ligamentous Complex (PLC) evaluation still being considered controversial. Injuries classified as type B1 in neurologically-intact patients may be treated, initially, with nonoperative management, provided that there are no ligamentous injury and non-displacing fragments. Due to severe ligamentous injury, type-B and type-C injuries should be considered as unstable injuries that must be surgically treated, regardless of the neurological status of the patient. Conclusions Until further evidence, we provided an easy algorithm-based guide on the spinal trauma literature to help surgeons in the decision-making process for the treatment of TL spine injuries classified according to the new AOSTSIC system.

scholarly journals Expectations of recovery and functional outcomes following thoracolumbar trauma: an evidence-based medicine process to determine what surgeons should be telling their patients

2015 ◽  
Vol 22 (1) ◽  
pp. 101-111 ◽  
Author(s):  
Rowan Schouten ◽  
Peter Lewkonia ◽  
Vanessa K. Noonan ◽  
Marcel F. Dvorak ◽  
Charles G. Fisher
Keyword(s):  
Literature Review ◽  
Range Of Motion ◽  
Expert Opinion ◽  
Burst Fracture ◽  
Patient Expectations ◽  
Thoracolumbar Junction ◽  
Published Data ◽  
Spine Trauma ◽  
Expected Outcomes ◽  
Consensus Expert

OBJECT The aim of this study was to define the expected functional and health-related quality of life outcomes following common thoracolumbar injuries on the basis of consensus expert opinion and the best available literature. Patient expectations are primarily determined by the information provided by health care professionals, and these expectations have been shown to influence outcome in various medical and surgical conditions. This paper presents Part 2 of a multiphase study designed to investigate the impact of patient expectations on outcomes following spinal injury. Part 1 demonstrated substantial variability in the information surgeons are communicating to patients. Defining the expected outcomes following thoracolumbar injury would allow further analysis of this relationship and enable surgeons to more accurately and consistently inform patients. METHODS Expert opinion was assembled by distributing questionnaires comprising 4 cases representative of common thoracolumbar injuries to members of the Spine Trauma Study Group (STSG). The 4 cases included a thoracolumbar junction burst fracture treated nonoperatively or with posterior transpedicular instrumentation, a low lumbar (L-4) burst fracture treated nonoperatively, and a thoracolumbar junction flexion-distraction injury managed with posterior fusion. For each case, 5 questions about expected outcomes were posed. The questions related to the proportion of patients who are pain free, the proportion who have regained full range of motion, and the patients' recreational activity restrictions and personal care and social life limitations, all at 1 year following injury, as well as the timing of return to work and length of hospital stay. Responses were analyzed and combined with the results of a systematic literature review on the same injuries to define the expected outcomes. RESULTS The literature review identified 38 appropriate studies that met the preset inclusion criteria. Published data were available for all injuries, but not all outcomes were available for each type of injury. The survey was completed by 31 (57%) of 53 surgeons representing 24 trauma centers across North America (15), Europe (5), India (1), Mexico (1), Japan (1) and Israel (1). Consensus expert opinion supplemented the available literature and was used exclusively when published data were lacking. For example, 1 year following cast or brace treatment of a thoracolumbar burst fracture, the expected outcomes include a 40% chance of being pain free, a 70% chance of regaining pre-injury range of motion, and an expected ability to participate in high-impact exercise and contact sport with no or minimal limitation. Consensus expert opinion predicts reemployment within 4–6 months. The length of inpatient stay averages 4–5 days. CONCLUSIONS This synthesis of the best available literature and consensus opinion of surgeons with extensive clinical experience in spine trauma reflects the optimal methodology for determining functional prognosis after thoracolumbar trauma. By providing consistent, accurate information surgeons will help patients develop realistic expectations and potentially optimize outcomes.

scholarly journals Evaluating Conscious Consumption: A Discussion of a Survey Development Process

2021 ◽  
Vol 13 (6) ◽  
pp. 3339
Author(s):  
Madhavi Venkatesan ◽  
Fenner Dreyfuss-Wells ◽  
Anjali Nair ◽  
Astrid Pedersen ◽  
Vishnu Prasad
Keyword(s):  
Literature Review ◽  
Development Process ◽  
Coffee Consumption ◽  
Consumer Good ◽  
Survey Instrument ◽  
Survey Development ◽  
Behavioral Bias ◽  
Survey Results ◽  
Single Use ◽  
Questions And Responses

This paper is the outcome of a course project for Economics of Sustainability (Northeastern University, Boston, Massachusetts). Facilitated and under the direction of the instructor, course participants designed a survey instrument where questions and responses were developed to be indicators of behavioral bias related to the environment. The consumer good targeted in the survey was convenience-based coffee consumption, and convenience was defined by the use of single-use disposable coffee cups. The discussion highlights the survey development process including literature review-based expectations specific to each question. The paper concludes with next steps, which involve the administration of the instrument and evaluation of the survey results.

scholarly journals Choosing Wisely: The Canadian Rheumatology Association’s List of 5 Items Physicians and Patients Should Question

2015 ◽  
Vol 42 (4) ◽  
pp. 682-689 ◽  
Author(s):  
Shirley L. Chow ◽  
J. Carter Thorne ◽  
Mary J. Bell ◽  
Robert Ferrari ◽  
Zarnaz Bagheri ◽  
...  
Keyword(s):  
Literature Review ◽  
Delphi Method ◽  
Antinuclear Antibodies ◽  
Quality Care ◽  
Healthcare Providers ◽  
Potential Effect ◽  
Survey Results ◽  
Bone Scans ◽  
Bone Density Testing ◽  
Perceived Relevance

Objective.To develop a list of 5 tests or treatments used in rheumatology that have evidence indicating that they may be unnecessary and thus should be reevaluated by rheumatology healthcare providers and patients.Methods.Using the Delphi method, a committee of 16 rheumatologists from across Canada and an allied health professional generated a list of tests, procedures, or treatments in rheumatology that may be unnecessary, nonspecific, or insensitive. Items with high content agreement and perceived relevance advanced to a survey of Canadian Rheumatology Association (CRA) members. CRA members ranked these top items based on content agreement, effect, and item ranking. A methodology subcommittee discussed the items in light of their relevance to rheumatology, potential effect on patients, and the member survey results. Five candidate items selected were then subjected to a literature review. A group of patient collaborators with rheumatic diseases also reviewed these items.Results.Sixty-four unique items were proposed and after 3 Delphi rounds, this list was narrowed down to 13 items. In the member-wide survey, 172 rheumatologists responded (36% of those contacted). The respondent characteristics were similar to the membership at large in terms of sex and geographical distribution. Five topics (antinuclear antibodies testing, HLA-B27 testing, bone density testing, bone scans, and bisphosphonate use) with high ratings on agreement and effect were chosen for literature review.Conclusion.The list of 5 items has identified starting points to promote discussion about practices that should be questioned to assist rheumatology healthcare providers in delivering high-quality care.

scholarly journals Current status of minimally invasive surgery for gastric cancer: A literature review to highlight studies limits

2015 ◽  
Vol 17 ◽  
pp. 34-40 ◽  
Author(s):  
Amilcare Parisi ◽  
Ninh T. Nguyen ◽  
Daniel Reim ◽  
Shu Zhang ◽  
Zhi-Wei Jiang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Minimally Invasive Surgery ◽  
Literature Review ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Current Status

scholarly journals EVALUATION OF CRITICAL SUCCESS FACTORS FOR CONSTRUCTION PROJECTS – AN EMPIRICAL STUDY IN LITHUANIA

2013 ◽  
Vol 17 (1) ◽  
pp. 21-31 ◽  
Author(s):  
Neringa Gudienė ◽  
Audrius Banaitis ◽  
Nerija Banaitienė
Keyword(s):  
Project Management ◽  
Literature Review ◽  
Construction Projects ◽  
Critical Success Factors ◽  
Success Factors ◽  
Project Manager ◽  
Management Team ◽  
Team Members ◽  
Critical Success ◽  
Survey Results

This paper aims to identify a comprehensive list of critical success factors for construction projects in Lithuania. Based on the available literature review, this paper identified 71 success factors under 7 broad groups. Based on the survey results, ten factors including project manager competence, project management team members' competence, project manager coordinating skills, client clear and precise goals/objectives, project value, project management team members' relevant past experience, project manager organising skills, project manager effective and timely conflict resolution, client ability to make timely decision, and project manager experience were determined as the most important success factors for construction projects. These critical success factors are of great significance both to researchers and industry practitioners.

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