Clinical and Radiological Factors Affecting Thoracolumbar Fractures Outcome: WFNS Spine Committee Recommendations

To obtain a list of recommendations about clinical and radiological factors affecting outcome in thoraco-lumbar fractures with the aim of helping spine surgeons in daily practice. A systematic literature search in PubMed and Google Scholar database was done from 2010 to 2020 on the topic “thoracolumbar fracture AND radiology AND surgical outcomes” and “thoracolumbar fracture AND radiology AND surgical outcomes.” A total of 58 papers were analyzed and WFNS (World Federation of Neurosurgical Societies) Spine Committee organized 2 consensus meetings to formulate the specific recommendations the first in Peshawar in December 2019 and in a subsequent virtual meeting in June 2020 to reach an agreement. Both meetings utilized the Delphi method to analyze preliminary literature review statements based on the current evidence levels to generate recommendations through a comprehensive voting session. Eight statements were presented and reached the consensus about this topic. A variety of clinical factors is known to influence outcome of patients with thoracolumbar fractures. Some of these are well-known established factors such as blood pressure augmentation and patient age, while some are not well studied. Overall, the quality of evidence is low and we need more randomized controlled studies to validate our results. Similarly, radiological factors that can predict outcome are well stated and there is a high accordance worldwide. In reverse, still under debate is the application to choose which surgical treatment is advisable based on them.

Aortic Impingement in Displaced Traumatic Spine Fracture with Complete Spinal Cord Transection: A Case Report

Aortic impingement associated with traumatic thoracic spinal fractures is a rare and potentially lethal complication that creates management challenges in an already complex clinical problem. Traumatic aortic injury is one of the leading causes of death in blunt trauma. Magerl divided thoracic and lumbar fractures into 3 categories; the primary focus of this report, type C fractures, describes rotational injury and is one of the less common types, especially associated with aortic impingement as such. In this case, a young man was admitted following a near-fatal fall resulting in blunt force trauma to the midthoracic region. Emergency CT revealed a type C complete transection at the level of T11 and a grade I aortic injury. Definitive fixation of the spinal injury was delayed in favor of preventing further vascular injury by prioritizing the securing of hemodynamic stability. In traumatic thoracolumbar injuries, blunt traumatic aortic injury is often managed conservatively. However, blunt thoracic aortic injury is one of the leading causes of death from trauma, and each case requires its own case-by-case multidisciplinary management. In this occasion, management of the vascular insult was paramount to ensuring patient survival and favorable outcome.

Efficiency of a Novel Vertebral Body Augmentation System (Tektona™) in Non-osteoporotic Spinal Fractures

BackgroundThe restauration of the local kyphosis is crucial for spinal fractures outcomes. Recently, the Tektona™, (Spine Art) system, constituted by a flexible lamella for reduction has emerged as a promising solution for osteoporotic fractures. However, no study has yet focused on its results on traumatic fractures. MethodsA retrospective longitudinal study on prospectively collected data was conducted on 53 patients. The data collected were clinical, surgical and scannographic (measurement of AVH, MVH and PVH (anterior/medium/posterior vertebral height), and RTA (regional traumatic angle) in°), preoperatively, early post-operative and at follow-up. ResultsFractures were mainly located at the upper lumbar spine and were Magerl A3.1 type for 51%. The mean RTA was 12° in pre-operative, 4° in post-operative (p=2e-9), and 8° at the last follow-up (p=0,01). The mean correction of RTA for the fixation group was -10±6° versus -7±4° for the vertebroplasty alone group (p=0,006). The mean correction for fractures located at T10-T12 was -9±3°, -9±5° for L1, -8±3° for L2 and -5±3° for L3-L5 (p=0,045). ConclusionsThe Tektona® system appears to be efficient for acute thoraco-lumbar fractures, comparable to other available systems, allowing a real intracorporeal reduction work. Its relevance, especially in the long term needs further investigation. The association of a percutaneous fixation allow to obtain a better correction of the RTA but did not seem to prevent the loss of correction at follow-up.

Efficacy of Ligamentotaxis for Thoracic and Lumbar Traumatic Fractures and Factors Influence Outcome

Background Traumatic thoracic and lumbar fractures are very common specially in the thoracolumbar junction and the most common causes are road traffic accidents and falling from height. Aim of the Work to evaluate efficacy of ligamentotaxis in thoracic and lumbar compressed and burst spine fractures using intact posterior longitudinal ligament and factors affect its outcome without anterior vertebral decompression through repositioning retropulsed segments, restoring vertebral height. Patients and Methods This study was conducted on 20 patients (with Non-propability convenience sample) with traumatic thoracic and lumbar spine fractures with intact posterior longitudinal ligament in El-maadi military hospital, Ain Shams university hospital during the period of 2017-2018. Results The most common postoperative complication was infection in 5 % of patients and CSF leakage infection in 5 % of patients. Conclusion The outcome in the study were successful in 95% of patients as reduction of retropulsed part occurred by the intact posterior longitudinal ligament.

Management of fractures of thoraco lumbar spine with pedicle screw fixation

<p class="abstract"><strong>Background:</strong> Thoraco-lumbar fractures are serious injuries of concern, if left untreated may result in marked morbidity and disability to the patient. To study the efficacy of pedicular screw and rod fixation system (ZETA system) in achieving ‘stabilization’ in thoracic and lumbar fractures of the spine.</p><p class="abstract"><strong>Methods:</strong> This was a prospective comparative on-randomized study of 20 patients who underwent pedicle screws and rod fixation in Goverment District headquarters hospital Nagapattinam with a follow-up ranging from September 2018 to December 2018 duration of 4 months. Patient selection was according to the inclusion and exclusion criteria and was surgically treated with pedicle screw and rod system (ZETA).<strong></strong></p><p class="abstract"><strong>Results:</strong> In 75% of the patients, the fractures were reduced by using polyaxial implants and in 25% of the patients both monoaxial and polyaxial implants were used. The average regional angle during the pre-operative stage was 16.50±5.020 and 4.450±4.150 during the 1-year post-operative period. There was a significant difference between pre-op and post-operative regional angles.</p><p class="abstract"><strong>Conclusions:</strong> There is a very high statistical significant restoration of vertebral body height, mean regional angle, and mean anterior wedge angle with this procedure in thoracolumbar fractures. Neurological recovery was seen significantly when all cases with neurological deficits were clubbed together.</p>