scholarly journals Behavior of Injured Lamina in Lumbar Burst Fractures during Reduction Maneuvers: A Biomechanical Study

2017 ◽  
Vol 11 (4) ◽  
pp. 507-512
Author(s):  
Nihat Acar
Keyword(s):  
Lumbar Spine ◽  
Statistical Significance ◽  
Burst Fracture ◽  
Biomechanical Study ◽  
Neural Element ◽  
Burst Fractures ◽  
Fresh Frozen ◽  
Extension Gap ◽  
Spine Movement ◽  
Flexion And Extension

<sec><title>Study Design</title><p>An experimental biomechanical study.</p></sec><sec><title>Purpose</title><p>This study aims to investigate the behavior of a lamina injury in lumbar burst fractures during reduction maneuvers.</p></sec><sec><title>Overview of Literature</title><p>Lumbar burst fractures are frequently accompanied by a lamina fracture. Many researchers concluded that any reduction maneuver will close the fractured lamina edges and possibly crush the entrapped neural elements. This conclusion did not rely on solid biomechanical trials and was based primarily on clinical experience.</p></sec><sec><title>Methods</title><p>Eighteen fresh-frozen lamb spines were randomly divided into three groups. Using the preinjury and the dropped-mass technique, a burst fracture model was developed. A central laminectomy of 5 mm of the L3 lumbar spine was created to mimic a complete type of lamina fracture. To measure the movement of the fractured laminar edges, two holes were drilled on both sides of the upper and lower regions of the lamina to allow for optic marker placement. A single specific spine movement was applied to each group: traction, flexion, and extension. Gap changes were measured by camera extensometers.</p></sec><sec><title>Results</title><p>After traction, the average values of the upper and lower aspects of the lamina interval showed narrowing of 1.65±0.82 mm and 1.97±1.14 mm, respectively. No statistical significance was detected between the two aspects. The upper and lower regions of the lamina gap behaved differently during extension. At 10°, 20°, and 30°, the upper part of the lamina interval was widened by an average of 0.016±0.024, 0.29±0.32, and 1.73±1.45 mm, respectively, whereas the lower part was narrowed by an average of 0.023±0.012, 0.47±0.038, and 1.94±1.46 mm, respectively.</p></sec><sec><title>Conclusions</title><p>Neural element crushing may take place, particularly at the lower aspect of the fractured lamina gap during extension and throughout the whole lamina gap during traction. The lamina gap widens during flexion. Reduction maneuvers should be attempted after exploring the fractured lamina to prevent further neurological compromise.</p></sec>

Biomechanical evaluation of an intramedullary clavicle screw in simple oblique and butterfly wedge fractures

2021 ◽  
pp. 095441192110310
Author(s):  
Bryce F Kunkle ◽  
John D DesJardins ◽  
Joel R Campbell ◽  
Josef K Eichinger ◽  
Michael J Kissenberth ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Bending Moment ◽  
Biomechanical Properties ◽  
Fracture Pattern ◽  
Biomechanical Study ◽  
Torsional Stiffness ◽  
Oblique Fracture ◽  
Torsional Testing ◽  
Fresh Frozen ◽  
Wedge Fracture

This biomechanical study evaluates the performance of a solid titanium-alloy intra-medullary ( IM) clavicular screw in torsion and cantilever bending in cadaveric clavicle specimens with simulated simple oblique and butterfly wedge midshaft fractures. Thirty-two fresh-frozen male clavicles were sorted into six experimental groups: Torsion Control, Torsion Simple Oblique Fracture, Torsion Butterfly Wedge Fracture, Bending Control, Bending Simple Oblique Fracture, and Bending Butterfly Wedge Fracture. The experimental groups were controlled for density, length, diameter, and laterality. All other samples were osteotomy-induced and implanted with a single 90 mm × 3 mm clavicle screw. All groups were tested to physiologically relevant cutoff points in torsion or bending. There were no statistically significant differences in the performance of the oblique and butterfly wedge fracture models for any torsion or bend testing measures, including maximum torsional resistance ( p = 0.66), torsional stiffness ( p = 0.51), maximum bending moment ( p = 0.43), or bending stiffness ( p = 0.73). Torsional testing of samples in the direction of thread tightening tended to be stronger than samples tested in loosening, with all groups either approaching or achieving statistical significance. There were no significant differences between the simple oblique or the butterfly-wedge fracture groups for any of the tested parameters, suggesting that there is no difference in the gross biomechanical properties of the bone-implant construct when the IM clavicle screw is used in either a simple midshaft fracture pattern or a more complex butterfly wedge fracture pattern.

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 Biomechanical study of a semi-rigid stabilization system combined with transpedicular intracorporeal bone grafting for thoracolumbar burst fractures

2020 ◽  
Author(s):  
xiaoyong zheng ◽  
qingwen yu ◽  
zhi zhang
Keyword(s):  
Bone Grafting ◽  
Burst Fracture ◽  
Axial Rotation ◽  
Biomechanical Study ◽  
Stabilization System ◽  
Thoracolumbar Burst Fracture ◽  
Lateral Bending ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures ◽  
Flexion Extension

Abstract Background: For fresh thoracolumbar burst fracture, a new method which can not only promote the fracture healing, but also retain the movement segment, and restore the spinal movement function to the maximum extent is needed. The purpose of this study is to determine the performance of stabilization of a semi-rigid stabilization system combined with transpedicular intracorporeal bone grafting for thoracolumbar burst fractures.Methods Six thoracolumbar cadaver spines were used for testing. A controlled L2 burst fracture was created. The L1-3 motions were determined.Results In extension, flexion and lateral bending, the semi-rigid fixator stabilized the segment to a range of motion(ROM) and neutral zone(NZ) below the magnitude of the intact spine, but showed increased ROM and NZ of axial rotation (P < 0.05) compared with the intact spine.Conclusions Restoration of stability with the semi-rigid dynamic system combined with transpedicular intracorporeal bone grafting is possible in flexion, extension, right and left lateral bending for thoracolumbar burst fracture but for axial rotation.

scholarly journals Low Lumbar Fractures: Unique Biomechanics and Treatment Options

2020 ◽  
Vol 6 (1) ◽  
pp. 3-12
Author(s):  
Kaveh Haddadi ◽  
◽  
Saeed Ehteshami ◽  
Keyword(s):  
Lumbar Spine ◽  
Treatment Options ◽  
Burst Fracture ◽  
Body Height ◽  
Mechanical Instability ◽  
Severe Injuries ◽  
Burst Fractures ◽  
Lower Lumbar Spine ◽  
Lower Lumbar ◽  
Lumbar Fractures

Background and Aim: Acute lower lumbar spinal fractures (L4 and L5) can cause major neurologic damage and mechanical instability. The ultimate surgical method for the management of unstable lower lumbar spine fractures Methods and Materials/Patients: Online search databases including Google scholar databases, PubMed and Ovid was performed using the keywords: Low lumbar, fractures, spine trauma, biomechanics, classification, anatomy, spinopelvic alignment, non-operative and surgical treatment options. Finally, about 47 related studies were identified and reviewed. Results: The L4 and L5 vertebra and related discs contribute to 50% of the lordosis in the lumbar area. Fracture of the trapezoidal body of the fifth vertebra can considerably decrease this and change the L4-L5 and L5-S1 biomechanics. The lower lumbar spine, in contrast to the thoracolumbar junction, is secure by the pelvis and the robust musculature. There is great controversy about the treatment of lumbar burst fractures without neurologic deficit. The surgical indication and optimal procedure may be influenced by numerous aspects such as the severity of signs and symptoms, the amount of loss of vertebral body height and the involvement of the spinal canal, and finally, the stability of the posterior spinal components. Conclusion: There is no consensus on what establishes the paramount treatment for low lumbar burst fractures. Conservative care has been related to acceptable outcomes for patients with a burst fracture which are neurologically intact. In more severe injuries, spinal decompression and stabilization via a posterior or anterior approach are based on the surgeon’s preference. For lower lumbar burst fractures or fracture-dislocations of the lumbosacral junction with neurologic injury, posterior decompression and stabilization, and a period of rest and bracing for the preservation of lumbar lordosis are appropriate.

Traumatic spondylolisthesis of the axis: a biomechanical comparison of clinically relevant anterior and posterior fusion techniques

2009 ◽  
Vol 11 (4) ◽  
pp. 379-387 ◽  
Author(s):  
Prashant Chittiboina ◽  
Esther Wylen ◽  
Alan Ogden ◽  
Debi P. Mukherjee ◽  
Prasad Vannemreddy ◽  
...  
Keyword(s):  
Pedicle Screws ◽  
Biomechanical Study ◽  
Posterior Fixation ◽  
Anterior Fusion ◽  
Type Ii ◽  
Hangman’S Fracture ◽  
Fresh Frozen ◽  
Hangman's Fracture ◽  
Flexion And Extension ◽  
Traumatic Spondylolisthesis

Object Surgical management of unstable traumatic spondylolisthesis of the axis includes both posterior and anterior fusion methods. The authors performed a biomechanical study to evaluate the relative stability of anterior fixation at C2–3 and posterior fixation of C-1 through C-3 in hangman's fractures. Methods Fresh-frozen cadaveric spine specimens (occipital level to T-2) were subjected to stepwise destabilization of the C1–2 complex, replicating a Type II hangman's fracture. Intact specimens, fractured specimens, and fractured specimens with either anterior screw and plate or posterior screw and rod fixation were each tested for stability. Each spine was subjected to separate right and left rotation, bending, flexion, and extension testing. Results Anterior fixation restored stiffness in flexion and extension movements to values greater than those for intact specimens. For other movement parameters, the values approximated those for intact specimens. Posterior fixation increased the stiffness to above those values seen for anterior fixation specimens. Conclusions In cadaveric spine specimens subjected to a Type II hangman's fracture, both anterior fixation at C2–3 and posterior fixation with C-1 lateral mass screws and C-2 and C-3 pedicle screws resulted in a consistent increase in stiffness, and hence in stability, over intact specimens.

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.

Functional Outcomes of Nerve Root Sparing Posterior Corpectomy in Lumbar Vertebral Burst Fractures

2021 ◽  
pp. 219256822098412
Author(s):  
Abhinandan Reddy Mallepally ◽  
Nandan Marathe ◽  
Abhinav Kumar Shrivastava ◽  
Vikas Tandon ◽  
Harvinder Singh Chhabra
Keyword(s):  
Blood Loss ◽  
Burst Fracture ◽  
Operating Time ◽  
Deformity Correction ◽  
Neurological Status ◽  
Height Loss ◽  
Vas Score ◽  
Post Surgery ◽  
Burst Fractures ◽  
The Difference

Study Design: Retrospective observational. Objectives: This study aimed to document the safety and efficacy of lumbar corpectomy with reconstruction of anterior column through posterior-only approach in complete burst fractures. Methods: In this retrospective study, we analyzed complete lumbar burst fractures treated with corpectomy through posterior only approach between 2014 and 2018. Clinical and intraoperative data including pre and post-operative neurology as per the ISNCSCI grade, VAS score, operative time, blood loss and radiological parameters, including pre and post-surgery kyphosis, height loss and canal compromise was assessed. Results: A total of 45 patients, with a mean age of 38.89 and a TLICS score 5 or more were analyzed. Preoperative VAS was 7-10. Mean operating time was 219.56 ± 30.15 minutes. Mean blood loss was 1280 ± 224.21 ml. 23 patients underwent short segment fixation and 22 underwent long segment fixation. There was no deterioration in post-operative neurological status in any patient. At follow-up, the VAS score was in the range of 1-3. The difference in preoperative kyphosis and immediate post-operative deformity correction, preoperative loss of height in vertebra and immediate post-operative correction in height were significant (p < 0.05). Conclusion: The posterior-only approach is safe, efficient, and provides rigid posterior stabilization, 360° neural decompression, and anterior reconstruction without the need for the anterior approach and its possible approach-related morbidity. We achieved good results with an all posterior approach in 45 patients of lumbar burst fracture (LBF) which is the largest series of this nature.

scholarly journals The lumbar spine has an intrinsic shape specific to each individual that remains a characteristic throughout flexion and extension

2014 ◽  
Vol 23 (S1) ◽  
pp. 26-32 ◽  
Author(s):  
Anastasia V. Pavlova ◽  
Judith R. Meakin ◽  
Kay Cooper ◽  
Rebecca J. Barr ◽  
Richard M. Aspden
Keyword(s):  
Lumbar Spine ◽  
Intrinsic Shape ◽  
Flexion And Extension

A Digitizing Technique for the Study of Movement of Intradiscal Dye in Response to Flexion and Extension of the Lumbar Spine

Spine ◽  
1988 ◽  
Vol 13 (3) ◽  
pp. 309-312 ◽  
Author(s):  
BROCK E. SCHNEBEL ◽  
JAMES W. SIMMONS ◽  
JON CHOWNING ◽  
RON DAVIDSON
Keyword(s):  
Lumbar Spine ◽  
Flexion And Extension

scholarly journals Lumbar Intervertebral Motion in Healthy Male Participants: Protocol for a Motion Analysis During Flexion and Extension Cinematographic Recordings

10.2196/14741 ◽  
2020 ◽  
Vol 9 (3) ◽  
pp. e14741
Author(s):  
Inge J M H Caelers ◽  
Toon F M Boselie ◽  
Kim Rijkers ◽  
Wouter L W Van Hemert ◽  
Rob A De Bie ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Health Care Professionals ◽  
Healthy Male ◽  
Motion Patterns ◽  
Maximum Flexion ◽  
Adequate Definition ◽  
Physiological Motion ◽  
Definition Of ◽  
Medical Research Ethics ◽  
Flexion And Extension

Background Physiological motion of the lumbar spine is a subject of interest for musculoskeletal health care professionals, as abnormal motion is believed to be related to lumbar conditions and complaints. Many researchers have described ranges of motion for the lumbar spine, but only a few have mentioned specific motion patterns of each individual segment during flexion and extension. These motion patterns mostly comprise the sequence of segmental initiation in sagittal rotation. However, an adequate definition of physiological motion of the lumbar spine is still lacking. The reason for this is the reporting of different ranges of motion and sequences of segmental initiation in previous studies. Furthermore, due to insufficient fields of view, none of these papers have reported on maximum flexion and extension motion patterns of L1 to S1. In the lower cervical spine, a consistent pattern of segmental contributions was recently described. In order to understand physiological motion of the lumbar spine, it is necessary to systematically study motion patterns, including the sequence of segmental contribution, of vertebrae L1 to S1 in healthy individuals during maximum flexion and extension. Objective This study aims to define the lumbar spines’ physiological motion pattern of vertebrae L1, L2, L3, L4, L5, and S1 by determining the sequence of segmental contribution and the sequence of segmental initiation of motion in sagittal rotation of each vertebra during maximum flexion and extension. The secondary endpoint will be exploring the possibility of analyzing the intervertebral horizontal and vertical translation of each vertebra during maximum flexion and extension. Methods Cinematographic recordings will be performed on 11 healthy male participants, aged 18-25 years, without a history of spine problems. Cinematographic flexion and extension recordings will be made at two time points with a minimum 2-week interval in between. Results The study has been approved by the local institutional medical ethical committee (Medical Research Ethics Committee of Zuyderland and Zuyd University of Applied Sciences) on September 24, 2018. Inclusion of participants will be completed in 2020. Conclusions If successful, these physiological motion patterns can be compared with motion patterns of patients with lumbar conditions before or after surgery. Ultimately, researchers may be able to determine differences in biomechanics that can potentially be linked to physical complaints like low back pain. Trial Registration ClinicalTrials.gov NCT03737227; https://clinicaltrials.gov/ct2/show/NCT03737227 International Registered Report Identifier (IRRID) DERR1-10.2196/14741

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