1
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Kweh BTS, Tee JW, Dandurand C, Vaccaro AR, Lorin BM, Schnake K, Vialle E, Rajasekaran S, El-Skarkawi M, Bransford RJ, Kanna RM, Aly MM, Holas M, Canseco JA, Muijs S, Popescu EC, Camino-Willhuber G, Joaquim AF, Chhabra HS, Bigdon SF, Spiegel U, Dvorak M, Öner CF, Schroeder G. The AO Spine Thoracolumbar Injury Classification System and Treatment Algorithm in Decision Making for Thoracolumbar Burst Fractures Without Neurologic Deficit. Global Spine J 2024; 14:32S-40S. [PMID: 38324601 PMCID: PMC10867534 DOI: 10.1177/21925682231195764] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
STUDY DESIGN Prospective Observational Study. OBJECTIVE To determine the alignment of the AO Spine Thoracolumbar Injury Classification system and treatment algorithm with contemporary surgical decision making. METHODS 183 cases of thoracolumbar burst fractures were reviewed by 22 AO Spine Knowledge Forum Trauma experts. These experienced clinicians classified the fracture morphology, integrity of the posterior ligamentous complex and degree of comminution. Management recommendations were collected. RESULTS There was a statistically significant stepwise increase in rates of operative management with escalating category of injury (P < .001). An excellent correlation existed between recommended expert management and the actual treatment of each injury category: A0/A1/A2 (OR 1.09, 95% CI 0.70-1.69, P = .71), A3/4 (OR 1.62, 95% CI 0.98-2.66, P = .58) and B1/B2/C (1.00, 95% CI 0.87-1.14, P = .99). Thoracolumbar A4 fractures were more likely to be surgically stabilized than A3 fractures (68.2% vs 30.9%, P < .001). A modifier indicating indeterminate ligamentous injury increased the rate of operative management when comparing type B and C injuries to type A3/A4 injuries (OR 39.19, 95% CI 20.84-73.69, P < .01 vs OR 27.72, 95% CI 14.68-52.33, P < .01). CONCLUSIONS The AO Spine Thoracolumbar Injury Classification system introduces fracture morphology in a rational and hierarchical manner of escalating severity. Thoracolumbar A4 complete burst fractures were more likely to be operatively managed than A3 fractures. Flexion-distraction type B injuries and translational type C injuries were much more likely to have surgery recommended than type A fractures regardless of the M1 modifier. A suspected posterior ligamentous injury increased the likelihood of surgeons favoring surgical stabilization.
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Affiliation(s)
- Barry T S Kweh
- National Trauma Research Institute, Melbourne, VIC, Australia
- Department of Neurosurgery, The Alfred Hospital, Melbourne, VIC, Australia
- Department of Neurosurgery, Royal Melbourne Hospital, Parkville, VIC, Melbourne
| | - Jin Wee Tee
- National Trauma Research Institute, Melbourne, VIC, Australia
- Department of Neurosurgery, The Alfred Hospital, Melbourne, VIC, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Charlotte Dandurand
- Combined Neurosurgical and Orthopedic Spine Program, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Benneker M Lorin
- Spine Unit, Sonnenhof Spital, University of Bern, Bern, Switzerland
| | - Klaus Schnake
- Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany
- Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany
| | - Emiliano Vialle
- Cajuru Hospital, Catholic University of Paraná, Curitiba, Brazil
| | | | - Mohammad El-Skarkawi
- Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Richard J Bransford
- Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Rishi M Kanna
- Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, India
| | - Mohamed M Aly
- Department of Neurosurgery, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabi
- Department of Neurosurgery, Mansoura University, Mansoura, Egypt
| | - Martin Holas
- Klinika Úrazovej Chirurgie SZU a FNsP F.D.Roosevelta, Banská Bystrica, Slovakia
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Sander Muijs
- University Medical Centers, Utrecht, The Netherlands
| | | | - Gaston Camino-Willhuber
- Orthopaedic and Traumatology Department, Institute of Orthopedics "Carlos E. Ottolenghi" Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Andrei F Joaquim
- Neurosurgery Division, Department of Neurology, State University of Campinas, Campinas-Sao Paulo, Brazil
| | | | - Sebastian Frederick Bigdon
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital, University of Bern, Bern, Switzerland
| | - Ulrich Spiegel
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig, Leipzig, Germany
| | - Marcel Dvorak
- Combined Neurosurgical and Orthopedic Spine Program, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Cumhur F Öner
- University Medical Centers, Utrecht, The Netherlands
| | - Gregory Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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2
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Chen SW, Wu WT, Lee RP, Yu TC, Chen IH, Wang JH, Yeh KT. Correlations between Sagittal Parameters and Functional Scores in 65-Year-Old Osteoporotic Females with Vertebral Body Fracture under Low-Energy Mechanism. J Clin Med 2024; 13:774. [PMID: 38337470 PMCID: PMC10856549 DOI: 10.3390/jcm13030774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
Background: Vertebral compression fractures (VCFs) are the most common fragility fractures associated with low-energy injury mechanisms in postmenopausal women with osteoporosis. No clear consensus is currently available on the optimal timing for surgical intervention in specific cases. Methods: This study examined the correlations between sagittal parameters, functional scores, and the appropriate timing for surgical intervention during the recovery stage in patients with osteoporosis with thoracolumbar (TL) vertebral body fractures. A total of 161 women aged ≥ 65 years with osteoporosis were included in the study. Spinal sagittal parameters from standing plain films and functional outcomes as the Oswestry disability index (ODI) and the visual analogue scale (VAS) were collected. Results: We found that TL junction Cobb angle was significantly correlated with ODI > 30 (p < 0.001) and VAS > 6 (p < 0.001) and the discriminative values for predicting ODI > 30 and VAS > 6 were a TL kyphotic angle of 14.5° and 13.5°, respectively. Among women aged ≥ 65 years with osteoporosis, the back pain and functional impairment observed within 6 months following a compression fracture are associated with a greater TL kyphosis angle. Conclusions: This suggests that a more proactive approach may be necessary when addressing the conditions of these patients.
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Affiliation(s)
- Szu-Wei Chen
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan; (S.-W.C.); (W.-T.W.); (T.-C.Y.); (I.-H.C.)
| | - Wen-Tien Wu
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan; (S.-W.C.); (W.-T.W.); (T.-C.Y.); (I.-H.C.)
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien 970374, Taiwan;
| | - Ru-Ping Lee
- Institute of Medical Sciences, Tzu Chi University, Hualien 970374, Taiwan;
| | - Tzai-Chiu Yu
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan; (S.-W.C.); (W.-T.W.); (T.-C.Y.); (I.-H.C.)
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan
| | - Ing-Ho Chen
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan; (S.-W.C.); (W.-T.W.); (T.-C.Y.); (I.-H.C.)
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan;
| | - Kuang-Ting Yeh
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan; (S.-W.C.); (W.-T.W.); (T.-C.Y.); (I.-H.C.)
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien 970374, Taiwan;
- Department of Medical Education, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan
- Graduate Institute of Clinical Pharmacy, Tzu Chi University, Hualien 970374, Taiwan
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3
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Chevalerias M, Coiffier G, Darrieutort-Laffite C, Godot S, Ottaviani S, Henry J, Brochard J, Cormier G, Couderc M, Hoppe E, Mulleman D, Khatchatourian L, Le Thuaut A, Bart G, Le Goff B. Association between radiographic and functional outcome in vertebral osteomyelitis SPONDIMMO, a 6-month prospective multicenter cohort. Joint Bone Spine 2023; 90:105600. [PMID: 37330001 DOI: 10.1016/j.jbspin.2023.105600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/22/2023] [Accepted: 05/31/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES This study aimed to describe radiographic and functional evolution over 6 months in a large cohort of VO patients. METHODS We prospectively recruited patients with VO from 2016 to 2019 in 11 French centers. X-rays were performed at baseline, 3 months, and 6 months to assess progression using structural and static criteria. Functional impairment was evaluated using the Oswestry Disability Index (ODI) at 3 months and 6 months. RESULTS Two hundred and twenty-two patients were included. Mean age was 67.8±14 years, mostly men (67.6%). After 3 months, there was a significant increase in vertebral fusion (16.4% vs 52.7%), destruction of vertebral bodies (10.1% vs 22.8%), and of all the static features (frontal angulation (15.2% vs 24.4%), segmental (34.6% vs 56%) and regional (24.5% vs 41%) kyphosis). From 3 to 6 months, among the different X-ray abnormalities, only the complete fusion progressed significantly (16.6% vs 27.2%). Median ODI showed significant improvement from 3 to 6 months (24, IQR [11.5-38] vs 16, IQR [6-34]). At 6 months, 14.1% of the patients had a severe disability, 2% a major disability. The persistence of vertebral destruction at 6 months was associated with a higher ODI (16, IQR [7.5-30.5] vs 27, IQR [11.5-44.5]). No differences in radiological progression were observed with immobilization using a rigid brace. CONCLUSION Our study demonstrates structural and static radiographic progression after 3 months. Only the complete fusion progressed over the long-term. Functional impairment was associated with persistence of vertebral destruction.
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Affiliation(s)
| | | | | | - Sophie Godot
- Department of Rheumatology, AP-HP DCSS, Paris, France
| | | | - Julien Henry
- Department of Rheumatology, AP-HP Bicêtre, Paris, France
| | - Julia Brochard
- Department of Infectious Diseases, CH de Saint-Nazaire, Saint-Nazaire, France
| | - Grégoire Cormier
- Department of Rheumatology, CHD de Vendée, La Roche-sur-Yon, France
| | - Marion Couderc
- Department of Rheumatology, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Emmanuel Hoppe
- Department of Rheumatology, CHU d'Angers, Angers, France
| | | | - Lydie Khatchatourian
- Department of Internal Medicine and Infectious Disease, CH de Cornouaille, Quimper, France
| | - Aurélie Le Thuaut
- Direction of Research, Methodology and Biostatistics Platform, CHU de Nantes, Nantes, France
| | - Géraldine Bart
- Department of Rheumatology and Internal Medicine, Percy Military Training Hospital, Paris, France
| | - Benoit Le Goff
- Department of Rheumatology, CHU de Nantes, Nantes, France
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4
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Vialle EN, Falavigna A, Arruda ADO, Guasque JBCR, Pinto BMDO, Finger G, Sfreddo E, Cecchini AMDL. Comparison Between Surgical and Conservative Treatment for AOSpine Type A3 and A4 Thoracolumbar Fractures without Neurological Deficit: Prospective Observational Cohort Study. Rev Bras Ortop 2023; 58:42-47. [PMID: 36969773 PMCID: PMC10038708 DOI: 10.1055/s-0042-1749622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 04/28/2022] [Indexed: 03/26/2023] Open
Abstract
Objective
To compare the clinical results between conservative (CS) and surgical treatment (CXS) of A3 and A4 fractures without neurological deficit.
Methods
Prospective observational study of patients with thoracolumbar fractures type A3 and A4. These patients were separated between the surgical and conservative groups, and evaluated sequentially through the numeric rating scale (NRS), Roland-Morris disability questionnaire (RMDQ), EuroQol-5D (EQ-5D) quality of life questionnaire, and Denis work scale (DWS) up to 2.5 years of follow-up.
Results
Both groups showed significant improvement, with no statistical difference in pain questionnaires (NRS: CXS 2.4 ± 2.6; CS 3.5 ± 2.6;
p
> 0.05), functionality (RMDQ: CS 7 ± 6.4; CXS 5.5 ± 5.2;
p
> 0.05), quality of life (EQ-5D), and return to work (DWS).
Conclusion
Both treatments are viable options with equivalent clinical results. There is a tendency toward better results in the surgical treatment of A4 fractures.
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Affiliation(s)
- Emiliano Neves Vialle
- Grupo de Cirurgia da Coluna, Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, PR, Brasil
- Endereço para correspondência Emiliano Neves Vialle, MD, MSc Alameda Princesa Izabel, 605, Mercês, Curitiba, PR, 80430-210Brazil
| | - Asdrubal Falavigna
- Serviço de Ortopedia e Traumatologia, Universidade de Caxias do Sul (UCS), Caxias do Sul, RS, Brasil
| | - André de Oliveira Arruda
- Grupo de Cirurgia da Coluna, Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, PR, Brasil
| | | | - Bárbara Miroski de Oliveira Pinto
- Grupo de Cirurgia da Coluna, Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, PR, Brasil
| | - Guilherme Finger
- Departamento de Neurocirurgia, Hospital Cristo Redentor, Porto Alegre, Brasil
| | - Ericson Sfreddo
- Departamento de Neurocirurgia, Hospital Cristo Redentor, Porto Alegre, Brasil
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5
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Peckett KH, Ponzano M, Steinke A, Giangregorio LM. Bracing and taping interventions for individuals with vertebral fragility fractures: a systematic review of randomized controlled trials with GRADE assessment. Arch Osteoporos 2023; 18:36. [PMID: 36840787 DOI: 10.1007/s11657-023-01224-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 02/10/2023] [Indexed: 02/26/2023]
Abstract
This systematic review analyzes the effects of bracing and taping after osteoporotic vertebral fractures. Spinal orthose may have positive effects on pain, but the evidence is of very low certainty. Clinical judgment is recommended when prescribing spinal orthoses. PURPOSE To examine the effects of bracing and taping interventions on pain, physical functioning, health-related quality of life, back extensor strength, kyphosis curvature, and adverse events in individuals with vertebral fragility fractures. METHODS Four databases were searched from inception up to January 2022. We included randomized controlled trials testing the effect of bracing or taping interventions compared with a non-intervention control in adults ≥ 45 years with vertebral fragility fractures. Narrative syntheses were presented for all the outcomes. We assessed the risk of bias using the Cochrane Risk of Bias Assessment Tool and the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation. RESULTS Three studies were included. Soft bracing interventions exhibited inconsistent effects on pain. One study showed no difference between groups, and another study should a decrease in pain in the soft bracing group compared to the control group. Rigid bracing interventions did not have a significant change in pain between the control and intervention groups. One study demonstrated a decrease in pain at rest (VAS: - 10.8 ± 19.3) and during movement (VAS: - 20.9 ± 29.8) after a taping intervention. The other outcomes were not consistent across studies. CONCLUSIONS Spinal orthoses may improve pain in people with vertebral fractures; however, we cannot draw definitive conclusions on the efficacy or harms of bracing or taping due to the very low certainty evidence and the small number of studies. Effects on other outcomes are uncertain.
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Affiliation(s)
- Kimberly H Peckett
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Matteo Ponzano
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
| | - Alex Steinke
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Lora M Giangregorio
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada.
- Schlegel-UW Research Institute for Aging, Waterloo, Canada.
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6
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Mehta S, Yusuf BS, Chiew D, Rathore S, Reddy NR, Nair D, Mahajan U, Madhusudhan TR, Vedamurthy A. Thoracolumbar Sacral Orthosis for Spinal Fractures: What’s the Evidence and Do Patients Use Them? Cureus 2022; 14:e31117. [DOI: 10.7759/cureus.31117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2022] [Indexed: 11/08/2022] Open
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7
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Schnadthorst PG, Lankes C, Schulze C. [Treatment of trauma-related vertebral body fractures of the thoracic and lumbar spine with orthotic devices : A review]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2022:10.1007/s00113-022-01195-8. [PMID: 35849146 DOI: 10.1007/s00113-022-01195-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Trauma-related fractures of the thoracic and lumbar spine occur after exposure to high kinetic energy. To assign patients to the correct kind of treatment the AO spine classification is used. OBJECTIVE The aim was to describe the role of orthotic devices in the treatment of thoracic and lumbar fractures in the nondegenerative spine. MATERIAL AND METHODS A review of the literature was carried out according to the PRISMA protocol (Preferred Reporting Items for Systematic reviews and Meta-Analyses) in PubMed, ScienceDirect, Cochrane and Google.Scholar. A total of 118 potentially important publications were found and 16 studies with a prospective study design could be included in this analysis. RoB 2 (Cochrane Risk of Bias tool in the second Version) in the case of randomized studies and the ROBINS‑I (Risk Of Bias In Nonrandomised Studies of Interventions) for nonrandomized studies were used to assess publication quality. The level of evidence was determined according to AHCPR (Agency for Health Care Policy and Research). RESULTS In the case of fractures (AO types A0-A3) without degenerative changes in the bone structure of the thoracic and lumbar spine without indications for operative procedure, conservative treatment with analgesia, physiotherapy and early mobilization is recommended and orthotic treatment is not superior. Surgical treatment, even in cases where conservative treatment was possible, led to improved functionality and pain sensation faster but there were no differences in the long-term results. Assessing the neurological functional deficit, the functional success of the treatment and the kyphosis angle were measured in different ways, reducing the extent of comparability. Although mainly a level of evidence Ib-IIa could be assigned, nearly all included studies had a high risk of bias. CONCLUSION In individual cases treatment with an orthotic device could be a helpful add-on in conservative treatment of fractures in the thoracic and lumbar spine. A treatment with orthotic devices alone cannot be recommended in these cases.
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Affiliation(s)
| | - Celine Lankes
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Doberaner Str. 142, 18057, Rostock, Deutschland
| | - Christoph Schulze
- Zentrum für Sportmedizin der Bundeswehr, Dr.-Rau-Allee 32, 48231, Warendorf, Deutschland
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Doberaner Str. 142, 18057, Rostock, Deutschland
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8
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Tan T, Huang MS, Rutges J, Marion TE, Fitzgerald M, Hunn MK, Tee J. Rate and Predictors of Failure in the Conservative Management of Stable Thoracolumbar Burst Fractures: A Systematic Review and Meta-Analysis. Global Spine J 2022; 12:1254-1266. [PMID: 34275348 PMCID: PMC9210245 DOI: 10.1177/21925682211031207] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES Management of stable traumatic thoracolumbar burst fractures in neurologically-intact patients remains controversial. Conservative management fails in a subset of patients who require subsequent surgical fixation. The aim of this review is to (1) determine the rate of conservative management failure, and (2) analyze predictive factors at admission influencing conservative management failure. METHODS A systematic review adhering to PRISMA guidelines was performed. Studies with data pertaining to traumatic thoracolumbar burst fractures without posterior osteoligamentous injury (e.g. AO Type A3/A4) and/or the rate and predictive factors of conservative management failure were included. Risk of bias appraisal was performed. Pooled analysis of rates of failure was performed with qualitative analysis of predictors of conservative management failure. RESULTS 16 articles were included in this review (11 pertaining to rate of conservative management failure, 5 pertaining to predictive risk factors). Rate of failure of conservative management from a pooled analysis of 601 patients is 9.2% (95% CI: 4.5%-13.9%). Admission factors predictive of conservative management failure include age, greater initial kyphotic angle, greater initial interpedicular distance, smaller initial residual canal size, greater Load Sharing Classification (LSC) score and greater admission Visual Analog Scale (VAS) pain scores. CONCLUSION A proportion (9.2%) of conservatively managed, neurologically-intact thoracolumbar burst fractures fail conservative management. Among other factors, age, kyphotic angle, residual canal area and interpedicular distance should be investigated in prospective studies to identify the subset of patients prone to failure of conservative management. Surgical management should be carefully considered in patients with the above risk factors.
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Affiliation(s)
- Terence Tan
- Department of Neurosurgery, The Alfred Hospital, Melbourne, Australia,National Trauma Research Institute Melbourne, Victoria, Australia,Terence Tan, Department of Neurosurgery, Level 1, Old Baker Building, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia.
| | - Milly S. Huang
- Department of Neurosurgery, The Alfred Hospital, Melbourne, Australia,National Trauma Research Institute Melbourne, Victoria, Australia
| | - Joost Rutges
- Department of Orthopaedics, Erasmus MC, Rotterdam Area, The Netherlands
| | - Travis E. Marion
- Department of Orthopaedic Surgery, Northern Ontario School of Medicine, Ontario, Canada
| | - Mark Fitzgerald
- National Trauma Research Institute Melbourne, Victoria, Australia
| | - Martin K. Hunn
- Department of Neurosurgery, The Alfred Hospital, Melbourne, Australia
| | - Jin Tee
- Department of Neurosurgery, The Alfred Hospital, Melbourne, Australia,National Trauma Research Institute Melbourne, Victoria, Australia
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9
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Classifications and level of evidence trends from the most influential literature on thoracolumbar burst fractures: A bibliometric analysis. NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2022; 10:100125. [PMID: 35634130 PMCID: PMC9130577 DOI: 10.1016/j.xnsj.2022.100125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 11/25/2022]
Abstract
Background There are known classifications that describe thoracolumbar (TL) burst type injury but it is unclear which have the most influence on management. Our objective is to investigate the association of classification publications with the quantity and type of the most influential articles on TL burst fractures. Methods Web of Science was searched, and exclusion and inclusion criteria were used to extract the top 100 cited articles on TL burst fractures. The effects on type, number, and other variables were separated into four eras as defined by four major classification publications. Results 30 out of the top 100 articles represent level 1 or 2 evidence. The most influential journal was Spine, accounting for 35 articles and 4,537 citations. The highest number of articles (53) was published between the years 1995-2005, culminating with the Thoracolumbar Injury Severity Classification Score (TLICS) paper. After 2005, there was an increase in average citations per year. Following 2013, the number of highly influential articles decreased, and systematic reviews (SRs) became a larger proportion of the literature. There was a statistically significant increase in the level of 1 and 2 evidence articles with time until the publication of TLICS. The predictive value of time for higher levels of evidence was only seen in the pre-2005 years (AUC: 0.717, 95% CI 0.579-0.855, p = 0.002). Conclusions In 1994, two articles marked the beginning of an era of highly influential TL burst fracture literature. The 2005 TLICS score was associated with a preceding increase in LOE and productivity. Following 2005, the literature saw a decrease in productivity and an increase in systematic review/meta-analysis (SR-MAs). These trends represent an increase in scholarly discussion that led to a systematic synthesis of the existing literature after publication of the 2005 TLICS article.
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10
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Utility of upright radiographs in traumatic thoracolumbar fracture management. BMC Musculoskelet Disord 2022; 23:296. [PMID: 35351077 PMCID: PMC8962529 DOI: 10.1186/s12891-022-05243-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/18/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
It is common practice to use a combination approach of computed tomography (CT) scan followed by upright radiographs when assessing traumatic thoracolumbar (TL) vertebral fractures. The purpose of this study was to determine the clinical utility of upright spine radiographs in the setting of traumatic TL fracture management. Our null hypothesis is that upright TL radiographs rarely change management of acute vertebral fractures.
Methods
A retrospective study was performed on patients with an initial plan of non-operative management for a TL fracture between January 2014 and June 2020 at a single Level 1 trauma center. Patients were followed from time of initial consult to either conversion to surgery (operative) or last available outpatient follow up imaging (non-operative). Lateral kyphotic angle of the fractured vertebra and anterior vertebral body height% loss on initial CT, first upright radiograph, and endpoint upright radiograph imaging were measured. Measurements were compared between and within operative and non-operative groups using t-tests and Mann-Whitney U tests when appropriate. P-values ≤ 0.05 were considered statistically significant.
Results
The study included 70 patients with an average age of 54 years and 37 (52.9%) were women. Six (8.6%) of 70 patients had a change from non-operative to operative management based on upright radiographs. The mean (standard deviation) change in degrees of kyphosis from CT scan to first X-ray was 4.6 (7.0) in the non-operative group and 11.5 (8.1) in the operative group (P = 0.03). Delta degrees of kyphosis from CT scan to endpoint X-ray was 6.4 (9.0) and 16.2 (6.2) in the non-operative and operative groups, respectively (P = 0.01). In the operative group, mean degrees of kyphosis increased from 1.6 (7.6) in initial CT to 13.1 (8.9) in first X-ray (P = 0.02). First X-ray mean anterior body height% loss was 37.5 (17.6) and 53.2 (16.1) in the non-operative and operative groups, respectively (P = 0.04).
Conclusions
Upright radiographs are useful in guiding traumatic vertebral fracture management decisions. Larger studies are needed to determine the degree of change in kyphosis between CT and first standing radiograph that is suggestive of operative management.
Trial registration number and date of registration
Not applicable.
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11
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Page PS, Parmar VK, Bond E, Josiah DT. Radiographic Outcomes of Thoracolumbar AOSpine A3 and A4 Fractures Treated With External Bracing. Cureus 2022; 14:e22490. [PMID: 35371752 PMCID: PMC8944398 DOI: 10.7759/cureus.22490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2022] [Indexed: 11/05/2022] Open
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12
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Sharif S, Zileli M. Introduction to Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations. Neurospine 2022; 18:651-653. [PMID: 35000317 PMCID: PMC8752691 DOI: 10.14245/ns.2143240.620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Salman Sharif
- Department of Neurosurgery, Liaquat National Hospital & Medical College, Karachi, Pakistan
| | - Mehmet Zileli
- Department of Neurosurgery, Ege University Faculty of Medicine, Izmir, Turkey
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13
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Peev N, Zileli M, Sharif S, Arif S, Brady Z. Indications for Nonsurgical Treatment of Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations. Neurospine 2022; 18:713-724. [PMID: 35000324 PMCID: PMC8752701 DOI: 10.14245/ns.2142390.195] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/23/2021] [Indexed: 11/19/2022] Open
Abstract
Thoracolumbar spine is the most injured spinal region in blunt trauma. Literature on the indications for nonoperative treatment of thoracolumbar fractures is conflicting. The purpose of this systematic review is to clarify the indications for nonsurgical treatment of thoracolumbar fractures. We conducted a systematic literature search between 2010 to 2020 on PubMed/MEDLINE, and Cochrane Central. Up-to-date literature on the indications for nonoperative treatment of thoracolumbar fractures was reviewed to reach an agreement in a consensus meeting of WFNS (World Federation of Neurosurgical Societies) Spine Committee. The statements were voted and reached a positive or negative consensus using the Delphi method. For all of the questions discussed, the literature search yielded 1,264 studies, from which 54 articles were selected for full-text review. Nine studies (4 trials, and 5 retrospective) evaluating 759 participants with thoracolumbar fractures who underwent nonoperative/surgery were included. Although, compression type and stable burst fractures can be managed conservatively, if there is major vertebral body damage, kyphotic angulation, neurological deficit, spinal canal compromise, surgery may be indicated. AO type B, C fractures are preferably treated surgically. Future research is necessary to tackle the relative paucity of evidence pertaining to patients with thoracolumbar fractures.
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Affiliation(s)
- Nikolay Peev
- Department of Neurosurgery, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
| | - Mehmet Zileli
- Department of Neurosurgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Salman Sharif
- Department of Neurosurgery, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Shahswar Arif
- Department of Neurosurgery, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK.,Medical University of Varna, Varna, Bulgaria
| | - Zarina Brady
- Department of Neurosurgery, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK.,Medical University of Varna, Varna, Bulgaria
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14
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Bérubé M, Moore L, Tardif PA, Berry G, Belzile É, Lesieur M, Paquet J. Low-value injury care in the adult orthopaedic trauma population: A systematic review. Int J Clin Pract 2021; 75:e15009. [PMID: 34816530 DOI: 10.1111/ijcp.15009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/19/2021] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Fifteen potentially low value practices in adult orthopaedic trauma care were previously identified in a scoping review. The aim of this study was to synthesise the evidence on these practices. METHODS We searched four databases for systematic reviews, randomised controlled trials (RCTs), cohort studies and case series that assessed the effectiveness of selected practices. Methodological quality was evaluated using the Measurement Tool to Assess Systematic Reviews version 2 (AMSTAR-2) for systematic reviews and the Critical Appraisal Checklist for Case Series. We evaluated risk of bias with the Cochrane revised tool for RCTs and the risk of bias in non-randomised studies of interventions tool for observational studies. We summarised findings with measures of frequency and association for primary outcomes. RESULTS Of the 30,670 records screened, 70 studies were retained. We identified high-level evidence of lack of effectiveness or harm for routine initial imaging of ankle injury, orthosis for A0-A3 thoracolumbar burst fracture in patients <60 years of age, cast or splint immobilisation for suspected scaphoid fracture negative on MRI or confirmed fifth metacarpal neck fracture, and routine follow-up imaging for distal radius and ankles fractures. However, evidence was mostly based on studies of low methodological quality or high risk of bias. CONCLUSION In this review, we identified clinical practices in orthopaedic injury care which are not supported by current evidence and whose use may be questioned. In future research, we should measure their frequency, assess practice variations and evaluate root causes to identify practices that could be targeted for de-implementation.
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Affiliation(s)
- Mélanie Bérubé
- Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de Recherche du CHU de Québec-Université Laval (Hôpital de l'Enfant-Jésus), Québec City, Québec, Canada
- Faculty of Nursing, Université Laval, Québec City, Québec, Canada
| | - Lynne Moore
- Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de Recherche du CHU de Québec-Université Laval (Hôpital de l'Enfant-Jésus), Québec City, Québec, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Pierre-Alexandre Tardif
- Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de Recherche du CHU de Québec-Université Laval (Hôpital de l'Enfant-Jésus), Québec City, Québec, Canada
| | - Gregory Berry
- Division of Orthopaedic Surgery, McGill University Health Center, Montréal, Québec, Canada
| | - Étienne Belzile
- Division of Orthopaedic Surgery, CHU de Québec-Université Laval, Québec City, Québec, Canada
| | - Martin Lesieur
- Division of Orthopaedic Surgery, CHU de Québec-Université Laval, Québec City, Québec, Canada
| | - Jérôme Paquet
- Division of Neurosurgery, CHU de Québec-Université Laval, Québec City, Québec, Canada
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15
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Cook E, Scantlebury A, Booth A, Turner E, Ranganathan A, Khan A, Ahuja S, May P, Rangan A, Roche J, Coleman E, Hilton C, Corbacho B, Hewitt C, Adamson J, Torgerson D, McDaid C. Surgery versus conservative management of stable thoracolumbar fracture: the PRESTO feasibility RCT. Health Technol Assess 2021; 25:1-126. [PMID: 34780323 DOI: 10.3310/hta25620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is informal consensus that simple compression fractures of the body of the thoracolumbar vertebrae between the 10th thoracic vertebra and the second lumbar vertebra without neurological complications can be managed conservatively and that obvious unstable fractures require surgical fixation. However, there is a zone of uncertainty about whether surgical or conservative management is best for stable fractures. OBJECTIVES To assess the feasibility of a definitive randomised controlled trial comparing surgical fixation with initial conservative management of stable thoracolumbar fractures without spinal cord injury. DESIGN External randomised feasibility study, qualitative study and national survey. SETTING Three NHS hospitals. METHODS A feasibility randomised controlled trial using block randomisation, stratified by centre and type of injury (high- or low-energy trauma) to allocate participants 1 : 1 to surgery or conservative treatment; a costing analysis; a national survey of spine surgeons; and a qualitative study with clinicians, recruiting staff and patients. PARTICIPANTS Adults aged ≥ 16 years with a high- or low-energy fracture of the body of a thoracolumbar vertebra between the 10th thoracic vertebra and the second lumbar vertebra, confirmed by radiography, computerised tomography or magnetic resonance imaging, with at least one of the following: kyphotic angle > 20° on weight-bearing radiographs or > 15° on a supine radiograph or on computerised tomography; reduction in vertebral body height of 25%; a fracture line propagating through the posterior wall of the vertebra; involvement of two contiguous vertebrae; or injury to the posterior longitudinal ligament or annulus in addition to the body fracture. INTERVENTIONS Surgical fixation: open spinal surgery (with or without spinal fusion) or minimally invasive stabilisation surgery. Conservative management: mobilisation with or without a brace. MAIN OUTCOME MEASURE Recruitment rate (proportion of eligible participants randomised). RESULTS Twelve patients were randomised (surgery, n = 8; conservative, n = 4). The proportion of eligible patients recruited was 0.43 (95% confidence interval 0.24 to 0.63) over a combined total of 30.7 recruitment months. Of 211 patients screened, 28 (13.3%) fulfilled the eligibility criteria. Patients in the qualitative study (n = 5) expressed strong preferences for surgical treatment, and identified provision of information about treatment and recovery and when and how they are approached for consent as important. Nineteen surgeons and site staff participated in the qualitative study. Key themes were the lack of clinical consensus regarding the implementation of the eligibility criteria in practice and what constitutes a stable fracture, alongside lack of equipoise regarding treatment. Based on the feasibility study eligibility criteria, 77% (50/65) and 70% (46/66) of surgeons participating in the survey were willing to randomise for high- and low-energy fractures, respectively. LIMITATIONS Owing to the small number of participants, there is substantial uncertainty around the recruitment rate. CONCLUSIONS A definitive trial is unlikely to be feasible currently, mainly because of the small number of patients meeting the eligibility criteria. The recruitment and follow-up rates were slightly lower than anticipated; however, there is room to increase these based on information gathered and the support within the surgical community for a future trial. FUTURE WORK Development of consensus regarding the population of interest for a trial. TRIAL REGISTRATION Current Controlled Trials ISRCTN12094890. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 62. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Elizabeth Cook
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | - Alison Booth
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Emma Turner
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | - Almas Khan
- Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - Sashin Ahuja
- Cardiff & Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - Peter May
- Barts Health NHS Trust, The Royal London Hospital, London, UK
| | - Amar Rangan
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Jenny Roche
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Elizabeth Coleman
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | - Belén Corbacho
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Joy Adamson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - David Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Catriona McDaid
- York Trials Unit, Department of Health Sciences, University of York, York, UK
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16
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de Sire A, Ammendolia A, Gimigliano A, Tiberi R, Cisari C, Invernizzi M. Spinal Orthoses Prescription for Vertebral Fragility Fractures by Italian Physical and Rehabilitation Medicine Physicians: The SPIN-VER Survey. Healthcare (Basel) 2021; 9:healthcare9070892. [PMID: 34356276 PMCID: PMC8303444 DOI: 10.3390/healthcare9070892] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 01/12/2023] Open
Abstract
Vertebral fragility fractures (VFFs) are the most common type of osteoporotic fractures, related to pain and disability. In this scenario, physical and rehabilitative medicine (PRM) physicians prescribe a patient-tailored rehabilitation plan, including spinal orthoses. However, there is a high heterogeneity in the clinical indications of spinal orthoses. Thus, the aim of this survey was to investigate common clinical practice in terms of the prescription of spinal orthoses. This nationwide cross-sectional survey recruited Italian PRM physicians commonly involved in the management of patients with VFFs. One hundred twenty-six PRM physicians completed the survey. The results showed that most PRM physicians prescribe spinal orthoses in outpatients suffering from VFFs (n = 106; 83.9%). The most prescribed spinal orthosis for acute VFF patients was the three-point rigid orthosis (n = 64; 50.8%), followed by the semirigid thoraco-lumbar orthosis (n: 20; 15.9%). However, most PRM physicians prescribed dynamic orthoses in outpatients with chronic VFFs (n = 66; 52.4%). Albeit that a correct management of VFFs is mandatory to improve pain and reduce disability, our findings highlighted uncertainty in the type of spinal orthosis prescription in both the acute and chronic VFF phase. Therefore, high-quality research trials are warranted to provide clear recommendations for the correct clinical management of VFF.
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Affiliation(s)
- Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
- Correspondence: ; Tel.: +39-096-171-2819
| | - Antonio Ammendolia
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
| | | | - Roberto Tiberi
- MyEvent SRL, Events Organization, Monte Porzio Catone, 00078 Rome, Italy;
| | - Carlo Cisari
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, 28100 Novara, Italy; (C.C.); (M.I.)
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, 28100 Novara, Italy; (C.C.); (M.I.)
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS, Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
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17
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Ma HH, Wu PH, Yao YC, Chou PH, Lin HH, Wang ST, Chang MC. Postoperative spinal orthosis may not be necessary for minimally invasive lumbar spine fusion surgery: a prospective randomized controlled trial. BMC Musculoskelet Disord 2021; 22:619. [PMID: 34253219 PMCID: PMC8276445 DOI: 10.1186/s12891-021-04490-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/22/2021] [Indexed: 11/23/2022] Open
Abstract
Background With the progress and success in minimally invasive surgery of transforaminal lumbar interbody fusion (MIS TLIF), the musculoskeletal injury was minimized. However, the role of postoperative orthosis in MIS TLIF has not been established and there is little evidence supporting the routine use of orthosis in MIS TLIF. Methods This is a prospective randomized clinical study. 90 patients who underwent MIS TLIF were randomly divided into groups A (with postoperative spinal orthosis) and B (without postoperative spinal orthosis). Patients were followed up for an average of 12.6 months. Clinical outcome was assessed using the Oswestry disability index (ODI) and visual analogue scale (VAS). Fusion rate was classified with the BSF scale system at postoperative 6-month, and 12-month. Results Both groups had similar patient demographics. The use of postoperative spinal orthosis had no significant influence on instrumentation-related complications or radiological parameters at each follow-up. Conclusions In this study, we conclude that postoperative spinal orthosis is not necessary for MIS TLIF. Patients without postoperative spinal orthosis had the same fusion rates and improvement of VAS and ODI scores.
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Affiliation(s)
- Hsuan-Hsiao Ma
- Department, of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Section. 2, Shi-pai Road, Taipei, 11217, Taiwan, ROC.,School, of Medicine, National Yang Ming Chiao Tung University University, Taipei City, Taiwan, ROC
| | - Pei-Hsi Wu
- Department, of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Section. 2, Shi-pai Road, Taipei, 11217, Taiwan, ROC.,School, of Medicine, National Yang Ming Chiao Tung University University, Taipei City, Taiwan, ROC
| | - Yu-Cheng Yao
- Department, of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Section. 2, Shi-pai Road, Taipei, 11217, Taiwan, ROC.,School, of Medicine, National Yang Ming Chiao Tung University University, Taipei City, Taiwan, ROC
| | - Po-Hsin Chou
- Department, of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Section. 2, Shi-pai Road, Taipei, 11217, Taiwan, ROC.,School, of Medicine, National Yang Ming Chiao Tung University University, Taipei City, Taiwan, ROC
| | - Hsi-Hsien Lin
- Department, of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Section. 2, Shi-pai Road, Taipei, 11217, Taiwan, ROC. .,School, of Medicine, National Yang Ming Chiao Tung University University, Taipei City, Taiwan, ROC.
| | - Shih-Tien Wang
- Department, of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Section. 2, Shi-pai Road, Taipei, 11217, Taiwan, ROC.,School, of Medicine, National Yang Ming Chiao Tung University University, Taipei City, Taiwan, ROC
| | - Ming-Chau Chang
- Department, of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Section. 2, Shi-pai Road, Taipei, 11217, Taiwan, ROC.,School, of Medicine, National Yang Ming Chiao Tung University University, Taipei City, Taiwan, ROC
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18
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Shahrestani S, Ballatori AM, Chen XT, Ton A, Buser Z, Wang JC. Identifying risks factors in thoracolumbar anterior fusion surgery through predictive analytics in a nationally representative inpatient sample. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 31:669-677. [PMID: 33948749 DOI: 10.1007/s00586-021-06857-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 03/16/2021] [Accepted: 04/23/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Anterior thoracolumbar (TL) surgical approaches provide more direct trajectories compared to posterior approaches. Proper patient selection is key in identifying populations that may benefit from anterior TL fusion. Here, we utilize predictive analytics to identify risk factors in anterior TL fusion in patients with trauma and deformity. METHODS In this retrospective cohort study of patients receiving anterior TL fusion (between and including T12/L1), population-based regression models were developed to identify risk factors using the National Readmission Database 2016-2017. Readmissions were analyzed at 30- and 90-day intervals. Risk factors included hypertension, obesity, malnutrition, smoking, alcohol use, long-term opioid use, and frailty. Multivariate regression models were developed to determine the influence of each risk factor on complication rates. RESULTS A total of 265 and 375 patients were identified for the scoliosis and burst fracture cohorts, respectively. In patients with scoliosis, alcohol use was found to increase the length of stay (LOS) (p = 0.00061) and all-payer inpatient cost following surgery (p = 0.014), and frailty was found to increase the inpatient LOS (p = 0.0045). In patients with burst fractures, malnutrition was found to increase the LOS (p < 0.0001) and all-payer cost (p < 0.0001), obesity was found to increase the all-payer cost (p = 0.012), and frailty was found to increase the all-payer cost (p = 0.031) and LOS (p < 0.0001). DISCUSSION Patient-specific risk factors in anterior TL fusion surgery significantly influence complication rates. An understanding of relevant risk factors before surgery may facilitate preoperative patient selection and postoperative patient triage and risk categorization.
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Affiliation(s)
- Shane Shahrestani
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. .,Department of Medical Engineering, California Institute of Technology, Pasadena, CA, USA. .,Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Alexander M Ballatori
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Xiao T Chen
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Andy Ton
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Zorica Buser
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. .,Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Jeffrey C Wang
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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19
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Mulcahy MJ, Dower A, Tait M. Orthosis versus no orthosis for the treatment of thoracolumbar burst fractures: A systematic review. J Clin Neurosci 2021; 85:49-56. [PMID: 33581789 DOI: 10.1016/j.jocn.2020.11.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
Management of patients with thoracolumbar burst fractures who do not have a neurologic injury has historically been controversial. Whilst management with an orthosis has gained popularity over surgical management, more recent evidence has suggested that even an orthosis may be unnecessary. A systematic review of the literature comparing orthosis with no orthosis in the management of thoracolumbar burst fractures in patients without neurological deficit was conducted. A risk of bias assessment was performed according to the Cochrane Collaboration Back Review Group. The quality of evidence was assessed according to the GRADE system. Two trials met the eligibility criteria. The functional outcomes, radiologic measures of kyphosis, pain scores, and quality of life scores were equivalent between the orthosis and the no orthosis groups. The level of evidence ranged from very low to moderate for the outcomes evaluated. The rate of complications and the rate of failure of treatment requiring surgery was low. Evidence from two small randomised controlled trials suggests that there are equivalent outcomes between treatment with and without an orthosis. Larger trials are needed to assess the treatment effect with greater confidence.
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Affiliation(s)
- Michael J Mulcahy
- Australian School of Advanced Medicine, Macquarie University, 2 Technology Place, NSW 2109, Australia.
| | - Ashraf Dower
- Sydney Medical School, University of Sydney, Camperdown, NSW 2006, Australia
| | - Matthew Tait
- Australian School of Advanced Medicine, Macquarie University, 2 Technology Place, NSW 2109, Australia
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20
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Orthosis in Thoracolumbar Fractures: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Spine (Phila Pa 1976) 2020; 45:E1523-E1531. [PMID: 32858744 DOI: 10.1097/brs.0000000000003655] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Systematic review and meta-analysis of randomized controlled trial (RCT). OBJECTIVE The aim of this study was to evaluate radiological and clinical outcomes of acute traumatic thoracolumbar fractures in skeletally mature patients treated with orthosis, versus no immobilization. SUMMARY OF BACKGROUND DATA Orthosis is traditionally used in conservative treatment of thoracolumbar fractures. However, recent studies suggest no benefit, and a possible negative impact in recovery. METHODS Databases were searched from inception to June 2019. Studies were selected in two phases by two blinded reviewers; disagreements were solved by consensus. Inclusion criteria were: RCT; only patients with acute traumatic thoracolumbar fractures; primary conservative treatment; comparison between orthosis and no orthosis. Exclusion criteria were inclusion of nonacute fractures, patients with other significant known diseases and comparison of groups different than use of an orthosis. Two independent reviewers performed data extraction and quality assessment. Fixed-effects models were used upon no heterogeneity, and random-effects model in the remaining cases. A previous plan for extraction of radiological (kyphosis progression; loss of anterior height) and clinical (pain; disability; length of stay) outcomes was applied. PRISMA guidelines were followed. RESULTS Eight articles/five studies were included (267 participants). None reported significant differences in pain, kyphosis progression, and loss of anterior height. One reported a better ODI with orthosis at 12 but not at 24 weeks. No other study reported differences in disability. All authors concluded an equivalence between treatments.Meta-analysis showed a significant increase of 3.47days (95% confidence interval 1.35-5.60) in mean admission time in orthosis group. No differences were found in kyphosis at 6 and 12 months; kyphosis progression between 0 to 6 and 0 to 12 months; loss of anterior height 0 to 6 months; VAS for pain at 6 months; VAS change 0 to 6 months. CONCLUSION Orthosis seems to add no benefit in conservative treatment of acute thoracolumbar fractures. This should be considered in guidelines and reviews of health care policies. LEVEL OF EVIDENCE 3.
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21
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Su QH, Li YC, Zhang Y, Tan J, Cheng B. Assessment of load-sharing thoracolumbar injury: A modified scoring system. World J Clin Cases 2020; 8:5128-5138. [PMID: 33269249 PMCID: PMC7674748 DOI: 10.12998/wjcc.v8.i21.5128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/14/2020] [Accepted: 09/22/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Many classification systems of thoracolumbar spinal fractures have been proposed to enhance treatment protocols, but none have achieved universal adoption.
AIM To develop a new patient scoring system for cases with thoracolumbar injury classification and severity score (TLICS) = 4, namely the load-sharing thoracolumbar injury score (LSTLIS).
METHODS Based on thoracolumbar injury classification and severity score, this study proposes the use of the established load-sharing classification (LSC) to develop an improved classification system (LSTLIS). To prove the reliability and reproducibility of LSTLIS, a retrospective analysis for patients with thoracolumbar vertebral fractures has been conducted.
RESULTS A total of 102 cases were enrolled in the study. The scoring trend of LSTLIS is roughly similar as the LSC scoring, however, the average deviation based on the former method is relatively smaller than that of the latter. Thus, the robustness of the LSTLIS scoring method is better than that of LSC. LSTLIS can further classify patients with TLICS = 4, so as to assess more accurately this particular circumstance, and the majority of LSTLIS recommendations are consistent with actual clinical decisions.
CONCLUSION LSTLIS is a scoring system that combines LSC and TLICS to compensate for the lack of appropriate inclusion of anterior and middle column compression fractures with TLICS. Following preliminary clinical verification, LSTLIS has greater feasibility and reliability value, is more practical in comprehensively assessing certain clinical circumstances, and has better accuracy with clinically significant guidelines.
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Affiliation(s)
- Qi-Hang Su
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
- Department of Orthopedics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Yong-Chao Li
- Department of Orthopedics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Yan Zhang
- Department of Orthopedics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Jun Tan
- Department of Orthopedics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Biao Cheng
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
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Prajapati HP. Thoracolumbar Junction Fracture: Principle of Management. INDIAN JOURNAL OF NEUROTRAUMA 2020. [DOI: 10.1055/s-0040-1717211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractThe thoracolumbar junction (TLJ) is the most common site of traumatic spinal injury. Its management is a highly controversial area. There are no specific guidelines for management of these injuries. The primary goal of treatment of TLJ fractures involves protecting the spinal cord from further neural damage, obtaining the stability by reconstructing anatomical alignment of spinal column, and returning patients to workplace through early mobilization and rehabilitation. There is a great variation in evaluation of stability of these fractures, which is one of the crucial factors in deciding the treatment. Controversy also exists regarding conservative versus operative treatment, timing of intervention, anterior versus posterior approach, short versus long segment fixation, and bracing versus no bracing. This article had reviewed the conflicting results and recommendations for management of TLJ fractures of previously published reports in PubMed, PubMed Central, and Medline databases. We analyzed these related articles which addresses issues regarding evaluation of stability, indications for operative and conservative treatment, timing of surgery, surgical approach, and fusion length.
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Affiliation(s)
- Hanuman Prasad Prajapati
- Department of Neurosurgery, Uttar Pradesh University of Medical Sciences, Etawah, Uttar Pradesh, India
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23
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Fülling T, Bula P, Defèr A, Bonnaire FA. Dresdener Network Osteoporosis. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 159:438-446. [PMID: 32428959 DOI: 10.1055/a-1149-9588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE On a global scale the main focus of traumatological therapy lies in the treatment of unintentional injuries or victims of violence. People of all ages and through all economic groups can be affected. Due to demographic change in Western industrial countries, however, this focus increasingly shifts towards fragility fractures. In Europe osteoporosis is the most common bone disease in advanced age. Secondary prevention programs like the Fracture Liaison Service (FLS) are becoming increasingly prevalent, especially in Anglo-American health care systems. In German orthopedic and trauma wards and hospitals, however, the FLS is still relatively uncommon. This article will examine the question whether secondary prevention programs like FLS need to be established in the German health care system. This study aims at finding out, whether in the area of a medium sized German city there is a difference regarding the initiation of osteoporosis diagnosis and therapy between the regular aftercare by the general practitioner or the orthopedic surgeon and the aftercare by a specialist trained in osteology (Osteologe). MATERIALS AND METHODS For the open, randomized prospective study 70 patients with low energy fractures were recruited, who were older than 60 years and have been treated in our department. RESULTS 58 out of 70 patients have completed the study, which amounts to a follow-up of 82.9%. Limited mobility and a high degree of organizational effort were the main reasons for early termination of the study. While in the group with regular aftercare, only 2 out of 29 patients received a specific osteoporosis treatment, in group who were directly transferred to a specialist trained in osteology 17 out of 29 patients received specific treatment. After re-evaluation of group with regular aftercare in 21 out of 29 cases a specific osteoporosis treatment was recommended. CONCLUSIONS It could be established that there is a significant diagnosis and treatment gap regarding the aftercare of patients with fractures caused by osteoporosis between general practitioners or orthopedic surgeons on the one hand and the specialists trained in osteology on the other hand. To improve the aftercare of fracture patients, cross sectoral networks with a background in geriatrics and orthopedic-trauma surgery like a FLS need to be established in the German healthcare system.
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Affiliation(s)
- Tim Fülling
- Department of Trauma, Reconstructive and Hand Surgery, Dresden Municipal Hospital
| | - Philipp Bula
- Department of Trauma and Reconstructive Surgery, Orthopaedic, Plastic, Aesthetic and Hand Surgery, Gutersloh Municipal Hospital
| | | | - Felix Alois Bonnaire
- Department of Trauma, Reconstructive and Hand Surgery, Dresden Municipal Hospital
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Spiegl UJA, Schnake KJ, Hartmann F, Katscher S, Riehle M, Scheyerer MJ, Schmeiser G, Siekmann H, Osterhoff G. Traumatic Fractures of the Thoracic Spine. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 159:373-382. [PMID: 32392598 DOI: 10.1055/a-1144-3846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The majority of traumatic vertebral fractures occur at the thoracolumbar junction and the lumbar spine and less commonly at the mid-thoracic and upper thoracic spine. In accordance, a high number of articles are dealing with thoracolumbar fractures focusing on the thoracolumbar junction. Nonetheless, the biomechanics of the thoracic spine differ from the thoracolumbar junction and the lumbar vertebral spine. The aim of this review is to screen the literature dealing with acute traumatic thoracic vertebral fractures in patients with normal bone quality. Thereby, the diagnostic of thoracic vertebral body fractures should include a CT examination. Ideally, the CT should include the whole thoracic cage particularly in patients suffering high energy accidents or in those with clinical suspicion of concomitant thoracic injuries. Generally, concomitant thoracic injuries are frequently seen in patients with thoracic spine fractures. Particularly sternal fractures cause an increase in fracture instability. In case of doubt, long segment stabilization is recommended in patients with unstable mid- und upper thoracic fractures, particularly in those patients with a high grade of instability.
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Affiliation(s)
- Ulrich J A Spiegl
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital Leipzig
| | | | - Frank Hartmann
- Centre for Trauma and Orthopaedic Surgery, Ev. Stift St. Martin, Community Hospital Mittelrhein, Koblenz
| | | | - Marion Riehle
- Orthopaedic and Trauma Centre, Alb Fils Hospitals, Göppingen
| | - Max J Scheyerer
- Clinic and Outpatient Department for Orthopaedic and Trauma Surgery, Cologne University Hospital
| | | | | | - Georg Osterhoff
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital Leipzig
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Hanson G, Lyons KW, Fournier DA, Lollis SS, Martin ED, Rhynhart KK, Handel WJ, McGuire KJ, Abdu WA, Pearson AM. Reducing Radiation and Lowering Costs With a Standardized Care Pathway for Nonoperative Thoracolumbar Fractures. Global Spine J 2019; 9:813-819. [PMID: 31819846 PMCID: PMC6882098 DOI: 10.1177/2192568219831687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
STUDY DESIGN Retrospective observational study. OBJECTIVE There is marked variation in the management of nonoperative thoracolumbar (TL) compression and burst fractures. This was a quality improvement study designed to establish a standardized care pathway for TL fractures treated with bracing, and to then evaluate differences in radiographs, length of stay (LOS), and cost before and after the pathway. METHODS A standardized pathway was established for management of nonoperative TL burst and compression fractures (AOSpine classification type A1-A4 fractures). Bracing, radiographs, costs, complications, and LOS before and after pathway adoption were analyzed. Differences between the neurosurgery and orthopedic spine services were compared. RESULTS Between 2012 and 2015, 406 nonoperative burst and compression TL fractures were identified. A total of 183 (45.1%) were braced, 60.6% with a custom-made thoracolumbosacral orthosis (TLSO) and 39.4% with an off-the-shelf TLSO. The number of radiographs significantly reduced after initiation of the pathway (3.23 vs 2.63, P = .010). A total of 98.6% of braces were custom-made before the pathway; 69.6% were off-the-shelf after the pathway. The total cost for braced patients after pathway adoption decreased from $10 462.36 to $8928.58 (P = .078). Brace-associated costs were significantly less for off-the-shelf TSLO versus custom TLSO ($1352.41 vs $3719.53, respectively, P < .001). The mean LOS and complication rate did not change significantly following pathway adoption. The orthopedic spine service braced less frequently than the neurosurgery service (40.7% vs 52.2%, P = .023). CONCLUSIONS Standardized care pathways can reduce cost and radiation exposure without increasing complication rates in nonoperative management of thoracolumbar compression and burst fractures.
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Affiliation(s)
- Gregory Hanson
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA,Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Keith W. Lyons
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA,Geisel School of Medicine at Dartmouth, Hanover, NH, USA,Keith W. Lyons, Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03766, USA.
| | - Debra A. Fournier
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA,Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - S. Scott Lollis
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA,Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Eric D. Martin
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA,Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Kurt K. Rhynhart
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA,Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Wanda J. Handel
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA,Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Kevin J. McGuire
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA,Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - William A. Abdu
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA,Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Adam M. Pearson
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA,Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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Wallace N, McHugh M, Patel R, Aleem IS. Effects of Bracing on Clinical and Radiographic Outcomes Following Thoracolumbar Burst Fractures in Neurologically Intact Patients. JBJS Rev 2019; 7:e9. [DOI: 10.2106/jbjs.rvw.19.00006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Tan T, Rutges J, Marion T, Gonzalvo A, Mathew J, Fitzgerald M, Dvorak M, Schroeder G, Tee J. Anterior versus posterior approach in traumatic thoracolumbar burst fractures deemed for surgical management: Systematic review and meta-analysis. J Clin Neurosci 2019; 70:189-197. [PMID: 31431406 DOI: 10.1016/j.jocn.2019.07.083] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 06/22/2019] [Accepted: 07/29/2019] [Indexed: 01/11/2023]
Abstract
Uncertainties remain regarding the optimal surgical approach in the treatment of traumatic thoracolumbar burst fractures. We aim to compare the surgical, radiological and functional outcomes in anterior versus posterior approaches in patients with traumatic thoracolumbar burst fractures deemed for surgical management. A systematic review adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. Qualitative analysis and where suitable, meta-analysis were performed to compute pooled estimates of the differences between anterior and posterior approaches. A total of six studies (three observational, one prospective non-randomized trial, two randomized controlled trials) were included. There were no cases of postoperative neurological decline. Meta-analysis demonstrates a longer duration (Mean Difference (MD) + 81.68, 95% CI 39.20 to 123.16, p < 0.001) and increased estimated blood loss (MD + 426.27, 95% CI 119.84 to 732.70, p = 0.006) for the anterior approach. No difference between approaches was found regarding length of hospital stay, late postoperative kyphotic angle, construct failure rate, instrumentation revision rate, rate of return to work, and total hospital charges. Limitations include the small number of, and heterogeneity across studies. Given the similarities in neurological, radiological and functional outcomes between the two approaches, the longer duration and estimated blood loss in the anterior approach should be a point of consideration when selecting the surgical approach. There is an urgent need for contemporary, high quality research in this area.
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Affiliation(s)
- Terence Tan
- Department of Neurosurgery, The Alfred Hospital, Melbourne, Victoria, Australia; National Trauma Research Institute, Melbourne, Victoria, Australia.
| | - Joost Rutges
- Department of Orthopaedics, Erasmus MC, Rotterdam, Netherlands.
| | - Travis Marion
- Division of Orthopaedic Surgery, Northern Ontario School of Medicine, Ontario, Canada
| | - Augusto Gonzalvo
- Department of Neurosurgery, Austin Health, Melbourne, Victoria, Australia.
| | - Joseph Mathew
- National Trauma Research Institute, Melbourne, Victoria, Australia.
| | - Mark Fitzgerald
- National Trauma Research Institute, Melbourne, Victoria, Australia.
| | - Marcel Dvorak
- Department of Orthopaedics, Division of Spine, University of British Columbia and Vancouver General Hospital, Vancouver, British Columbia, Canada.
| | - Gregory Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, USA
| | - Jin Tee
- Department of Neurosurgery, The Alfred Hospital, Melbourne, Victoria, Australia; National Trauma Research Institute, Melbourne, Victoria, Australia.
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Hughes M, Ashour R, Rao J. Treatment of thoracolumbar burst fractures using orthosis versus no orthosis. BMJ Evid Based Med 2019; 24:70-71. [PMID: 30171021 DOI: 10.1136/bmjebm-2018-111036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Michael Hughes
- Orthopaedic Department, Countess of Chester Hospital, Chester, UK
| | - Rami Ashour
- Orthopaedic Department, Countess of Chester Hospital, Chester, UK
| | - Janardhan Rao
- Orthopaedic Department, Countess of Chester Hospital, Chester, UK
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Zhang J, Fan Y, He X, Du J, Hao D. Bracing after percutaneous vertebroplasty for thoracolumbar osteoporotic vertebral compression fractures was not effective. Clin Interv Aging 2019; 14:265-270. [PMID: 30787602 PMCID: PMC6368123 DOI: 10.2147/cia.s192821] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the effectiveness of bracing after percutaneous vertebroplasty (PVP) for thoracolumbar osteoporotic vertebral compression fractures (OVCF). METHODS This is a retrospective study where we recruited 138 patients with single-level thoracolumbar OVCF who underwent PVP from January 2018 to March 2018 without bracing after PVP (Group A). The visual analog score (VAS) and vertebral body compression ratio (VCR) were recorded at preoperation, on the second day, at 2 weeks, 1 month, and 6 months after operation. Oswestry Disability Index (ODI) was recorded at preoperation, 2 weeks, 1 month, and 6 months after operation. Propensity score matching identified 138 historical patients (Group B) as controls, who used rigid brace for 3 weeks after the surgery, from January 2017 to December 2017 using six independent variables (preoperation): age, sex, VAS, ODI, bone mineral density, and body mass index. The indicators and complications were compared between the two groups. RESULTS Compared with preoperation, VAS and VCR were significantly improved (P<0.05) in both groups on the second day after operation. At 2 weeks, 1 month, and 6 months after PVP operation, ODI, VAS, and VCR were all significantly improved than at preoperation (P<0.05). There were no statistical differences between the two groups in VAS and VCR on the second day, at 1 month and 6 months after PVP (P<0.05). There were no significant differences between Groups A and B in ODI at 2 weeks and 6 months after operation (P<0.05) but ODI for Group B at 1 month after operation was significantly higher than Group A (P<0.05). Eleven cases in Group A and 13 cases in Group B had poor pain relief on the second day after operation, and there were no significant differences in VAS and ODI between the two subgroups at 2 weeks, 1 month, and 6 months after PVP. There were no significant differences in the collapse and refracture rates between the two groups. CONCLUSION In summary, in terms of quality of life and complications after operation, postoperative bracing did not result in improved outcomes. Presence or absence of bracing did not relieve postoperative residual pain. In contrast, bracing for 3 weeks after operation reduced the quality of life in the short term.
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Affiliation(s)
- Jianan Zhang
- Department of Spine Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaan'xi Province, China,
| | - Yong Fan
- Department of Spine Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaan'xi Province, China,
| | - Xin He
- Department of Spine Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaan'xi Province, China,
| | - Jinpeng Du
- Department of Spine Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaan'xi Province, China,
| | - Dingjun Hao
- Department of Spine Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaan'xi Province, China,
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Hoh DJ, Qureshi S, Anderson PA, Arnold PM, John HC, Dailey AT, Dhall SS, Eichholz KM, Harrop JS, Rabb CH, Raksin PB, Kaiser MG, O'Toole JE. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Evaluation and Treatment of Patients With Thoracolumbar Spine Trauma: Nonoperative Care. Neurosurgery 2019; 84:E46-E49. [PMID: 30203096 DOI: 10.1093/neuros/nyy369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 07/12/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Thoracic and lumbar burst fractures in neurologically intact patients are considered to be inherently stable, and responsive to nonsurgical management. There is a lack of consensus regarding the optimal conservative treatment modality. The question remains whether external bracing is necessary vs mobilization without a brace after these injuries. OBJECTIVE To determine if the use of external bracing improves outcomes compared to no brace for neurologically intact patients with thoracic or lumbar burst fractures. METHODS A systematic review of the literature was performed using the National Library of Medicine PubMed database and the Cochrane Library for studies relevant to thoracolumbar trauma. Clinical studies specifically comparing external bracing to no brace for neurologically intact patients with thoracic or lumbar burst fractures were selected for review. RESULTS Three studies out of 1137 met inclusion criteria for review. One randomized controlled trial (level I) and an additional randomized controlled pilot study (level II) provided evidence that both external bracing and no brace equally improve pain and disability in neurologically intact patients with burst fractures. There was no difference in final clinical and radiographic outcomes between patients treated with an external brace vs no brace. One additional level IV retrospective study demonstrated equivalent clinical outcomes for external bracing vs no brace. CONCLUSION This evidence-based guideline provides a grade B recommendation that management either with or without an external brace is an option given equivalent improvement in outcomes for neurologically intact patients with thoracic and lumbar burst fractures. The decision to use an external brace is at the discretion of the treating physician, as bracing is not associated with increased adverse events compared to no brace. QUESTION Does the use of external bracing improve outcomes in the nonoperative treatment of neurologically intact patients with thoracic and lumbar burst fractures? RECOMMENDATION The decision to use an external brace is at the discretion of the treating physician, as the nonoperative management of neurologically intact patients with thoracic and lumbar burst fractures either with or without an external brace produces equivalent improvement in outcomes. Bracing is not associated with increased adverse events compared to not bracing. Strength of Recommendation: Grade B The full version of the guideline can be reviewed at: https://www.cns.org/guideline-chapters/congress-neurological-surgeons-systematic-review-evidence-based-guidelines/chapter_8.
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Affiliation(s)
- Daniel J Hoh
- Lillian S. Wells Department of Neurological Surgery, University of Florida, Gainesville, Florida
| | - Sheeraz Qureshi
- Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, New York
| | - Paul A Anderson
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, Wisconsin
| | - Paul M Arnold
- Department of Neurosurgery, University of Kansas School of Medicine, Kansas City, Kansas
| | - H Chi John
- Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Andrew T Dailey
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Sanjay S Dhall
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Kurt M Eichholz
- St. Louis Minimally Invasive Spine Center, St. Louis, Missouri
| | - James S Harrop
- Departments of Neurological Surgery and Orthopedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Craig H Rabb
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - P B Raksin
- Division of Neurosurgery, John H. Stroger, Jr Hospital of Cook County and Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois
| | - Michael G Kaiser
- Department of Neurosurgery, Columbia University, New York, New York
| | - John E O'Toole
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois
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Blunt Thoracolumbar-Spine Trauma Evaluation in the Emergency Department: A Meta-Analysis of Diagnostic Accuracy for History, Physical Examination, and Imaging. J Emerg Med 2018; 56:153-165. [PMID: 30598296 DOI: 10.1016/j.jemermed.2018.10.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 10/16/2018] [Accepted: 10/25/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Delayed diagnoses of unstable thoracolumbar spine (TL-spine) fractures can result in neurologic deficits and avoidable pain, so it is important for clinicians to reach prompt diagnostic decisions. There are no validated decision aids for determining which trauma patients warrant TL-spine imaging. OBJECTIVE Our aim was to quantify the diagnostic accuracy of the injury mechanism, physical examination, associated injuries, clinical decision aids, and imaging for evaluating blunt TL-spine trauma patients. METHODS A search strategy for studies including adult blunt TL-spine trauma using PubMed, Embase, Scopus, CENTRAL, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov was performed. Excluded studies lacked data to construct 2 × 2 tables, were duplicates, were not primary research, did not focus on blunt trauma, examined associated injuries without any utility in identifying TL-spine injuries, only studied cervical-spine fractures, were non-English, had a pediatric setting, or were cadaver/autopsy reports. Risk of bias was assessed using the Quality Assessment Tool for Diagnostic Accuracy Studies. Diagnostic predictors were analyzed with a meta-analysis of sensitivity, specificity, and likelihood ratios. RESULTS In blunt trauma patients in the emergency department, the weighted pretest probability of a TL-spine fracture was 15%. The estimates for detection of TL-spine fractures with plain film were: positive likelihood ratio (+LR) = 25.0 (95% confidence interval [CI] 4.1-152.2; I2 = 94%; p < 0.001) and negative likelihood ratio (-LR) = 0.43 (95% CI 0.32-0.59; I2 = 84%; p < 0.001), and for computed tomography (CT) were: +LR = 81.1 (95% CI 14.1-467.9; I2 = 87%; p < 0.001) and -LR = 0.04 (95% CI 0.02-0.08; I2 = 23%; p = 0.26). CONCLUSIONS CT is more accurate than plain films for detecting TL-spine fractures. Injury mechanism, physical examination, and associated injuries alone are not accurate to rule-in or rule-out TL-spine fractures.
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J. Spiegl U, Fischer K, Schmidt J, Schnoor J, Delank S, Josten C, Schulte T, Heyde CE. The Conservative Treatment of Traumatic Thoracolumbar Vertebral Fractures. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:697-704. [PMID: 30479250 PMCID: PMC6280041 DOI: 10.3238/arztebl.2018.0697] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 05/15/2018] [Accepted: 09/05/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND The conservative treatment of traumatic thoracolumbar vertebral fractures is often not clearly defined. METHODS This review is based on articles retrieved by a systematic search in the PubMed and Web of Science databases for publications up to February 2018 dealing with the conservative treatment of traumatic thoracolumbar vertebral fractures. The search initially yielded 3345 hits, of which 35 were suitable for use in this review. RESULTS It can be concluded from the available original clinical research on the subject, including three randomized controlled trials (RCTs), that the primary diagnostic evaluation should be with plain x-rays, in the standing position if possible. If a fracture is suspected on the plain films, computed tomography (CT) is indicated. Magnetic resonance imaging (MRI) is additionally advisable if there is a burst fracture. The spinal deformity resulting from the fracture should be quantified in terms of the Cobb angle. The choice of a conservative or operative treatment strategy is based on the primary stability of the fracture, the degree of deformity, the presence or absence of disc injury, and the patient's clinical state. Our analysis of the three RCTs implies that early functional therapy without a corset should be performed, although treatment in a corset may be appropriate to control pain. Follow-up x-rays should be obtained after mobilization and at one week, three weeks, six weeks, and twelve weeks. CONCLUSION Further comparative studies of the indications for surgery and specific conservative treatment modalities would be desirable.
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Affiliation(s)
- Ulrich J. Spiegl
- Department of Orthopedics, Trauma Surgery and Plastic Surgery, University Hospital of Leipzig, Leibzig, Germany
| | - Klaus Fischer
- Department of Physical and Rehabilitation Medicine, BG Hospital Bergmannstrost, Halle, Germany
| | | | | | - Stefan Delank
- Department of Orthopedic, Trauma and Reconstructive Surgery, University Hospital of Halle, Halle, Germany
| | - Christoph Josten
- Department of Orthopedics, Trauma Surgery and Plastic Surgery, University Hospital of Leipzig, Leibzig, Germany
| | - Tobias Schulte
- Department of General Orthopedic and Spine Surgery, St. Josef-Hospital Bochum, University Hospital of the Ruhr University of Bochum, Bochum, Germany
| | - Christoph-Eckhardt Heyde
- Department of Orthopedics, Trauma Surgery and Plastic Surgery, University Hospital of Leipzig, Leibzig, Germany
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Ankomah F, Ikpeze T, Mesfin A. The Top 50 Most-Cited Articles on Thoracolumbar Fractures. World Neurosurg 2018; 118:e699-e706. [DOI: 10.1016/j.wneu.2018.07.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/01/2018] [Accepted: 07/03/2018] [Indexed: 11/25/2022]
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Verheyden AP, Spiegl UJ, Ekkerlein H, Gercek E, Hauck S, Josten C, Kandziora F, Katscher S, Kobbe P, Knop C, Lehmann W, Meffert RH, Müller CW, Partenheimer A, Schinkel C, Schleicher P, Scholz M, Ulrich C, Hoelzl A. Treatment of Fractures of the Thoracolumbar Spine: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU). Global Spine J 2018; 8:34S-45S. [PMID: 30210959 PMCID: PMC6130107 DOI: 10.1177/2192568218771668] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
STUDY DESIGN consensus paper with systematic literature review. OBJECTIVE The aim of this study was to establish recommendations for treatment of thoracolumbar spine fractures based on systematic review of current literature and consensus of several spine surgery experts. METHODS The project was initiated in September 2008 and published in Germany in 2011. It was redone in 2017 based on systematic literature review, including new AOSpine classification. Members of the expert group were recruited from all over Germany working in hospitals of all levels of care. In total, the consensus process included 9 meetings and 20 hours of video conferences. RESULTS As regards existing studies with highest level of evidence, a clear recommendation regarding treatment (operative vs conservative) or regarding type of surgery (posterior vs anterior vs combined anterior-posterior) cannot be given. Treatment has to be indicated individually based on clinical presentation, general condition of the patient, and radiological parameters. The following specific parameters have to be regarded and are proposed as morphological modifiers in addition to AOSpine classification: sagittal and coronal alignment of spine, degree of vertebral body destruction, stenosis of spinal canal, and intervertebral disc lesion. Meanwhile, the recommendations are used as standard algorithm in many German spine clinics and trauma centers. CONCLUSION Clinical presentation and general condition of the patient are basic requirements for decision making. Additionally, treatment recommendations offer the physician a standardized, reproducible, and in Germany commonly accepted algorithm based on AOSpine classification and 4 morphological modifiers.
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Affiliation(s)
- Akhil P. Verheyden
- Clinic for Trauma, Orthopaedic and Spine Surgery, Lahr, Germany,These authors contributed equally to this article.,Akhil P. Verheyden, Clinic for Trauma, Orthopaedic and Spine Surgery, Lahr, 77933, Germany.
| | - Ulrich J. Spiegl
- Klinik für Orthopädie, Unfallchirurgie und plastische Chirurgie, Leipzig, Germany,These authors contributed equally to this article
| | | | - Erol Gercek
- Zentrum für Unfallchirurgie und Orthopädie, Koblenz, Germany
| | - Stefan Hauck
- Clinic for Trauma, Orthopaedic and Spine Surgery, Lahr, Germany
| | - Christoph Josten
- Klinik für Orthopädie, Unfallchirurgie und plastische Chirurgie, Leipzig, Germany
| | - Frank Kandziora
- Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, Frankfurt am Main, Germany
| | - Sebastian Katscher
- Leitender Arzt Orthopädie / Unfallchirurgie, Sana Klinikum Borna, Borna, Germany
| | - Philipp Kobbe
- Sektion Becken- und Wirbelsäulenchirurgie, Uniklinik RWTH Aachen, Aachen, Germany
| | - Christian Knop
- Klinik für Unfallchirurgie und Orthopädie, Klinikum Stuttgart, Katharinenhospital, Stuttgart, Germany
| | - Wolfgang Lehmann
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Goettingen, Göttingen, Germany
| | - Rainer H. Meffert
- Klinik und Poliklinik für Unfall-, Hand-, Plastische- und Wiederherstellungschirurgie, Universitätsklinik Würzburg, Würzburg, Germany
| | - Christian W. Müller
- Unfallchirurgische Klinik, Medizinische Hochschule Hannover, Hannover, Germany
| | | | - Christian Schinkel
- Klinik für Unfallchirurgie, Handchirurgie und Orthopädie, Klinikum Memmingen, Memmingen, Germany
| | - Philipp Schleicher
- Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, Frankfurt am Main, Germany
| | - Matti Scholz
- Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, Frankfurt am Main, Germany
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Kwon WK, Oh JK, Cho JM, Kwon TH, Park YK, Moon HJ, Kim JH. Non-Operatively Treated Thoracolumbar Burst Fracture with Posterior Ligamentous Complex Injury: Case Report and Consideration on the Limitation of Thoracolumbar Injury Classification and Severity (TLICS) Score. JOURNAL OF TRAUMA AND INJURY 2018. [DOI: 10.20408/jti.2018.31.2.76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Woo-Keun Kwon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
- Department of Focused Training Center for Trauma, Departments of Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jong-Keon Oh
- Department of Focused Training Center for Trauma, Departments of Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
- Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jun-Min Cho
- Department of Focused Training Center for Trauma, Departments of Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
- Department of General Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Taek-Hyun Kwon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Youn-Kwan Park
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hong Joo Moon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Joo Han Kim
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Abstract
Thoracolumbar burst fractures are high-energy vertebral injuries, which commonly can be treated nonoperatively. Consideration of the injury pattern, extent of comminution, neurological status, and integrity of the posterior ligamentous complex may help determine whether operative management is appropriate. Several classification systems are contingent upon these factors to assist with clinical decision-making. A multitude of operative procedures have been shown to have good radiographic and clinical outcomes with extended follow-up, and treatment choice should be based on the individual's clinical and radiographic presentation.
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Healy A, Farmer S, Pandyan A, Chockalingam N. A systematic review of randomised controlled trials assessing effectiveness of prosthetic and orthotic interventions. PLoS One 2018; 13:e0192094. [PMID: 29538382 PMCID: PMC5851539 DOI: 10.1371/journal.pone.0192094] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 01/16/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Assistive products are items which allow older people and people with disabilities to be able to live a healthy, productive and dignified life. It has been estimated that approximately 1.5% of the world's population need a prosthesis or orthosis. OBJECTIVE The objective of this study was to systematically identify and review the evidence from randomized controlled trials assessing effectiveness and cost-effectiveness of prosthetic and orthotic interventions. METHODS Literature searches, completed in September 2015, were carried out in fourteen databases between years 1995 and 2015. The search results were independently screened by two reviewers. For the purpose of this manuscript, only randomized controlled trials which examined interventions using orthotic or prosthetic devices were selected for data extraction and synthesis. RESULTS A total of 342 randomised controlled trials were identified (319 English language and 23 non-English language). Only 4 of these randomised controlled trials examined prosthetic interventions and the rest examined orthotic interventions. These orthotic interventions were categorised based on the medical conditions/injuries of the participants. From these studies, this review focused on the medical condition/injuries with the highest number of randomised controlled trials (osteoarthritis, fracture, stroke, carpal tunnel syndrome, plantar fasciitis, anterior cruciate ligament, diabetic foot, rheumatoid and juvenile idiopathic arthritis, ankle sprain, cerebral palsy, lateral epicondylitis and low back pain). The included articles were assessed for risk of bias using the Cochrane Risk of Bias tool. Details of the clinical population examined, the type of orthotic/prosthetic intervention, the comparator/s and the outcome measures were extracted. Effect sizes and odds ratios were calculated for all outcome measures, where possible. CONCLUSIONS At present, for prosthetic and orthotic interventions, the scientific literature does not provide sufficient high quality research to allow strong conclusions on their effectiveness and cost-effectiveness.
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Affiliation(s)
- Aoife Healy
- School of Life Sciences and Education, Staffordshire University, Stoke On Trent, United Kingdom
| | - Sybil Farmer
- School of Life Sciences and Education, Staffordshire University, Stoke On Trent, United Kingdom
| | - Anand Pandyan
- School of Life Sciences and Education, Staffordshire University, Stoke On Trent, United Kingdom
- School of Health & Rehabilitation, Keele University, Keele, United Kingdom
| | - Nachiappan Chockalingam
- School of Life Sciences and Education, Staffordshire University, Stoke On Trent, United Kingdom
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Minimally invasive fixation techniques for thoracolumbar fractures: comparison between percutaneous pedicle screw with intermediate screw (PPSIS) and percutaneous pedicle screw with kyphoplasty (PPSK). EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:849-858. [DOI: 10.1007/s00590-018-2122-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 01/11/2018] [Indexed: 10/18/2022]
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Smits AJ, Deunk J, Stadhouder A, Altena MC, Kempen DHR, Bloemers FW. Is postoperative bracing after pedicle screw fixation of spine fractures necessary? Study protocol of the ORNOT study: a randomised controlled multicentre trial. BMJ Open 2018; 8:e019596. [PMID: 29331975 PMCID: PMC5781062 DOI: 10.1136/bmjopen-2017-019596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The most common surgical treatment of traumatic spine fractures is through a posterior approach using pedicle screws and rods. Postoperative treatment protocols including the use of postoperative orthoses however differ between hospitals and surgeons. A three-point hyperextension orthosis is designed to support proper posture and unload the anterior column. Some motion remains when wearing an orthosis, and its main value in postoperative treatment is therefore believed to be pain relief and patient confidence. This could consequently shorten recovery time. On the other hand, an orthosis could also lead to muscle weakness and slow down recovery. Any orthosis-related complications might also be avoided. Additionally, recent studies on conservative fracture treatment show no difference in radiological outcomes with or without an orthosis. To date, no randomised studies have been performed on the use of postoperative orthoses. METHODS AND ANALYSIS Patients undergoing posterior fixation with pedicle screws for a traumatic thoracolumbar fracture (T7-L4) will be included in this randomised controlled multicentre non-inferiority trial. Forty-six patients will be randomised 1:1 to one of the two parallel groups; one group will wear a postoperative orthosis for 6 weeks followed by 6 weeks of weaning and one group will not wear an orthosis. The primary outcome is pain at 6 weeks reported on the Numerical Rating Scale. Secondary outcomes consist of pain on other moments, analgesic use, complications and length of hospital stay, quality of life (EuroQuol 5 Dimensions), back pain-related function (Oswestry Disability Index) and radiological outcomes with a follow-up of 1 year. Orthosis compliance is monitored weekly in the orthosis group. ETHICS AND DISSEMINATION The institutional review board (METc VUmc) approved this study on 11 October 2016 under case number 2016.389. After completion of the trial, the results will be offered to an international scientific journal for peer-reviewed publication. TRIAL REGISTRATION NUMBER NCT03097081 and NTR6285; Pre-results.
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Affiliation(s)
- Arjen Johannes Smits
- Department of Trauma Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Jaap Deunk
- Department of Trauma Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Agnita Stadhouder
- Department of Orthopedic Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Mark Cornelis Altena
- Department of Orthopedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | | | - Frank Willem Bloemers
- Department of Trauma Surgery, VU University Medical Center, Amsterdam, The Netherlands
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Onyia CU. Letter to the Editor. Treatment of thoracolumbar burst fractures: extended follow-up of a randomized clinical trial comparing orthosis versus no orthosis. J Neurosurg Spine 2018; 28:128-129. [DOI: 10.3171/2017.5.spine17511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Toyoda H, Takahashi S, Hoshino M, Takayama K, Iseki K, Sasaoka R, Tsujio T, Yasuda H, Sasaki T, Kanematsu F, Kono H, Nakamura H. Characterizing the course of back pain after osteoporotic vertebral fracture: a hierarchical cluster analysis of a prospective cohort study. Arch Osteoporos 2017; 12:82. [PMID: 28942501 DOI: 10.1007/s11657-017-0377-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 09/14/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED This study demonstrated four distinct patterns in the course of back pain after osteoporotic vertebral fracture (OVF). Greater angular instability in the first 6 months after the baseline was one factor affecting back pain after OVF. PURPOSE Understanding the natural course of symptomatic acute OVF is important in deciding the optimal treatment strategy. We used latent class analysis to classify the course of back pain after OVF and identify the risk factors associated with persistent pain. METHODS This multicenter cohort study included 218 consecutive patients with ≤ 2-week-old OVFs who were enrolled at 11 institutions. Dynamic x-rays and back pain assessment with a visual analog scale (VAS) were obtained at enrollment and at 1-, 3-, and 6-month follow-ups. The VAS scores were used to characterize patient groups, using hierarchical cluster analysis. RESULTS VAS for 128 patients was used for hierarchical cluster analysis. Analysis yielded four clusters representing different patterns of back pain progression. Cluster 1 patients (50.8%) had stable, mild pain. Cluster 2 patients (21.1%) started with moderate pain and progressed quickly to very low pain. Patients in cluster 3 (10.9%) had moderate pain that initially improved but worsened after 3 months. Cluster 4 patients (17.2%) had persistent severe pain. Patients in cluster 4 showed significant high baseline pain intensity, higher degree of angular instability, and higher number of previous OVFs, and tended to lack regular exercise. In contrast, patients in cluster 2 had significantly lower baseline VAS and less angular instability. CONCLUSIONS We identified four distinct groups of OVF patients with different patterns of back pain progression. Understanding the course of back pain after OVF may help in its management and contribute to future treatment trials.
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Affiliation(s)
- Hiromitsu Toyoda
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Masatoshi Hoshino
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Kazushi Takayama
- Department of Orthopaedic Surgery, Seikeikai Hospital, 1-1-1 Minamiyasui-cho, Sakai-ku, Osaka, 590-0064, Japan
| | - Kazumichi Iseki
- Department of Orthopaedic Surgery, Sato Hospital, 1-2-23 Higashinakahama, Joto-ku, Osaka, 536-0023, Japan
| | - Ryuichi Sasaoka
- Department of Orthopaedic Surgery, Yodogawa Christian Hospital, 1-7-50 Kunijima, Higashiyodogawa-ku, Osaka, 533-0024, Japan
| | - Tadao Tsujio
- Department of Orthopaedic Surgery, Shiraniwa Hospital, 1-7-50 Shiraniwadai, Ikoma, Nara, 630-0136, Japan
| | - Hiroyuki Yasuda
- Department of Orthopaedic Surgery, Osaka General Hospital of West Japan Railway Company, 1-2-22 Matsuzaki-Cho, Abeno-ku, Osaka, 545-0053, Japan
| | - Takeharu Sasaki
- Department of Orthopaedic Surgery, Nishinomiya Watanabe Hospital, 10-22 Murokawa-Cho, Nishinomiya, Hyogo, 662-0863, Japan
| | - Fumiaki Kanematsu
- Department of Orthopaedic Surgery, Saiseikai Nakatsu Hospital, 2-10-39 Shibata, Kita-Ku, Osaka, 530-0012, Japan
| | - Hiroshi Kono
- Department of Orthopaedic Surgery, Ishikiri Seiki Hospital, 2-10-39 Yayoi-Cho, Higashiosaka, Osaka, 579-8026, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
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Abstract
Although less common than other musculoskeletal injuries, spinal trauma may lead to significantly more disability and costs. During the last 2 decades there was substantial improvement in our understanding of the basic patterns of spinal fractures leading to more reliable classification and injury severity assessment systems but also rapid developments in surgical techniques. Despite these advancements, there remain unresolved issues concerning the management of these injuries. At this moment there is persistent controversy within the spinal trauma community, which can be grouped under 6 headings. First of all there is still no unanimity on the role and timing of medical and surgical interventions for patients with associated neurologic injury. The same is also true for type and timing of surgical intervention in multiply injured patients. In some common injury types like odontoid fractures and burst type (A3-A4) fractures in thoracolumbar spine, there is wide variation in practice between operative versus nonoperative management without clear reasons. Also, the role of different surgical approaches and techniques in certain injury types are not clarified yet. Methods of nonoperative management and care of elderly patients with concurrent complex disorders are also areas where there is no consensus. In this overview article the main reasons for these controversies are reviewed and the possible ways for resolutions are discussed.
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Piazza M, Sinha S, Agarwal P, Mallela A, Nayak N, Schuster J, Stein S. Post-operative bracing after pedicle screw fixation for thoracolumbar burst fractures: A cost-effectiveness study. J Clin Neurosci 2017; 45:33-39. [PMID: 28800928 DOI: 10.1016/j.jocn.2017.07.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 07/21/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE While frequently prescribed to patients following fixation for spine trauma, the utility of spinal orthoses during the post-operative period is poorly described in the literature. In this study, we calculated rates of reoperation and performed a decision analysis to determine the utility of bracing following pedicle screw fixation for thoracic and lumbar burst fractures. METHODS Pubmed was searched for articles published between 2005 and 2015 for terms related to pedicle screw fixation of thoracolumbar fractures. Additionally, a database of neurosurgical patients operated on within the authors institution was also used in the analysis. Incidences of significant adverse events (wound revision for either dehiscence or infection or re-operation for non-union or instability due to hardware failure) were determined. Pooled means and variances of reported parameters were obtained using a random-effects, inverse variance meta-analytic model for observational data. Utilities for surgical outcome and complications were assigned using previously published values. RESULTS Of the 225 abstracts reviewed, 48 articles were included in the study, yielding a total of 1957 patients. After including patients from the institutional registry, together a total of 2081 patients were included in the final analysis, 1328 of whom were braced. Non-braced patients were older then braced patients, although this only approached significance (p=0.051). Braced patients had significantly lower rates of re-operation for non-union or clinically significant hardware failure (1.3% vs. 1.8%, p<0.001) although the groups had comparable rates of operative wound dehiscence and infection (p=1.000). These two approaches yielded comparable utility scores (p=0.120). Costs between braced and non-braced patients were comparable excluding the cost of the brace (p=0.256); hence, the added cost of the brace suggests that bracing post-operatively is not a cost effective measure. CONCLUSIONS Bracing following operative stabilization of thoracolumbar fracture does not significantly improve stability, nor does it increase wound complications. Moreover, our data suggests that post-operative bracing may not be a cost-effective measure.
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Affiliation(s)
- Matthew Piazza
- Hospital of the University of Pennsylvania, Department of Neurosurgery, 3400 Spruce Street, 3 Silverstein Pavilion, Philadelphia, PA 19104, United States.
| | - Saurabh Sinha
- Hospital of the University of Pennsylvania, Department of Neurosurgery, 3400 Spruce Street, 3 Silverstein Pavilion, Philadelphia, PA 19104, United States
| | - Prateek Agarwal
- Hospital of the University of Pennsylvania, Department of Neurosurgery, 3400 Spruce Street, 3 Silverstein Pavilion, Philadelphia, PA 19104, United States
| | - Arka Mallela
- Hospital of the University of Pennsylvania, Department of Neurosurgery, 3400 Spruce Street, 3 Silverstein Pavilion, Philadelphia, PA 19104, United States
| | - Nikhil Nayak
- Hospital of the University of Pennsylvania, Department of Neurosurgery, 3400 Spruce Street, 3 Silverstein Pavilion, Philadelphia, PA 19104, United States
| | - James Schuster
- Hospital of the University of Pennsylvania, Department of Neurosurgery, 3400 Spruce Street, 3 Silverstein Pavilion, Philadelphia, PA 19104, United States
| | - Sherman Stein
- Hospital of the University of Pennsylvania, Department of Neurosurgery, 3400 Spruce Street, 3 Silverstein Pavilion, Philadelphia, PA 19104, United States
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Rometsch E, Spruit M, Härtl R, McGuire RA, Gallo-Kopf BS, Kalampoki V, Kandziora F. Does Operative or Nonoperative Treatment Achieve Better Results in A3 and A4 Spinal Fractures Without Neurological Deficit?: Systematic Literature Review With Meta-Analysis. Global Spine J 2017; 7:350-372. [PMID: 28815163 PMCID: PMC5546683 DOI: 10.1177/2192568217699202] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Systematic literature review with meta-analysis. OBJECTIVE Thoracolumbar (TL) fractures can be treated conservatively or surgically. Especially, the treatment strategy for incomplete and complete TL burst fractures (A3 and A4, AOSpine classification) in neurologically intact patients remains controversial. The aim of this work was to collate the clinical evidence on the respective treatment modalities. METHODS Searches were performed in PubMed and the Web of Science. Clinical and radiological outcome data were collected. For studies comparing operative with nonoperative treatment, the standardized mean differences (SMD) for disability and pain were calculated and methodological quality and risk of bias were assessed. RESULTS From 1929 initial matches, 12 were eligible. Four of these compared surgical with conservative treatment. A comparative analysis of radiological results was not possible due to a lack of uniform reporting. Differences in clinical outcomes at follow-up were small, both between studies and between treatment groups. The SMD was 0.00 (95% CI -0.072, 0.72) for disability and -0.05 (95% CI -0.91, 0.81) for pain. Methodological quality was high in most studies and no evidence of publication bias was revealed. CONCLUSIONS We did not find differences in disability or pain outcomes between operative and nonoperative treatment of A3 and A4 TL fractures in neurologically intact patients. Notwithstanding, the available scores have been developed and validated for degenerative diseases; thus, their suitability in trauma may be questionable. Specific and uniform outcome parameters need to be defined and enforced for the evaluation of TL trauma.
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Affiliation(s)
- Elke Rometsch
- AO Foundation, AO Clinical Investigation and Documentation (AOCID), Dübendorf, Switzerland,Elke Rometsch, AO Foundation, AO Clinical Investigation and Documentation (AOCID), Stettbachstrasse 6, 8600 Dübendorf, Switzerland.
| | | | - Roger Härtl
- NY Presbyterian Hospital–Weill Cornell Medical College, NY, USA
| | | | | | - Vasiliki Kalampoki
- AO Foundation, AO Clinical Investigation and Documentation (AOCID), Dübendorf, Switzerland
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Incomplete burst fractures of the thoracolumbar spine: a review of literature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:3187-3198. [DOI: 10.1007/s00586-017-5126-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 04/10/2017] [Accepted: 05/06/2017] [Indexed: 12/12/2022]
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Urquhart JC, Alrehaili OA, Fisher CG, Fleming A, Rasoulinejad P, Gurr K, Bailey SI, Siddiqi F, Bailey CS. Treatment of thoracolumbar burst fractures: extended follow-up of a randomized clinical trial comparing orthosis versus no orthosis. J Neurosurg Spine 2017; 27:42-47. [PMID: 28409669 DOI: 10.3171/2016.11.spine161031] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE A multicenter, prospective, randomized equivalence trial comparing a thoracolumbosacral orthosis (TLSO) to no orthosis (NO) in the treatment of acute AO Type A3 thoracolumbar burst fractures was recently conducted and demonstrated that the two treatments following an otherwise similar management protocol are equivalent at 3 months postinjury. The purpose of the present study was to determine whether there was a difference in long-term clinical and radiographic outcomes between the patients treated with and those treated without a TLSO. Here, the authors present the 5- to 10-year outcomes (mean follow-up 7.9 ± 1.1 years) of the patients at a single site from the original multicenter trial. METHODS Between July 2002 and January 2009, a total of 96 subjects were enrolled in the primary trial and randomized to two groups: TLSO or NO. Subjects were enrolled if they had an AO Type A3 burst fracture between T-10 and L-3 within the previous 72 hours, kyphotic deformity < 35°, no neurological deficit, and an age of 16-60 years old. The present study represents a subset of those patients: 16 in the TLSO group and 20 in the NO group. The primary outcome measure was the Roland Morris Disability Questionnaire (RMDQ) score at the last 5- to 10-year follow-up. Secondary outcome measures included kyphosis, satisfaction, the Numeric Rating Scale for back pain, and the 12-Item Short-Form Health Survey (SF-12) Mental and Physical Component Summary (MCS and PCS) scores. In the original study, outcome measures were administered at admission and 2 and 6 weeks, 3 and 6 months, and 1 and 2 years after injury; in the present extended follow-up study, the outcome measures were administered 5-10 years postinjury. Treatment comparison between patients in the TLSO group and those in the NO group was performed at the latest available follow-up, and the time-weighted average treatment effect was determined using a mixed-effects model of longitudinal regression for repeated measures averaged over all time periods. Missing data were assumed to be missing at random and were replaced with a set of plausible values derived using a multiple imputation procedure. RESULTS The RMDQ score at 5-10 years postinjury was 3.6 ± 0.9 (mean ± SE) for the TLSO group and 4.8 ± 1.5 for the NO group (p = 0.486, 95% CI -2.3 to 4.8). Average kyphosis was 18.3° ± 2.2° for the TLSO group and 18.6° ± 3.8° for the NO group (p = 0.934, 95% CI -7.8 to 8.5). No differences were found between the NO and TLSO groups with time-weighted average treatment effects for RMDQ 1.9 (95% CI -1.5 to 5.2), for PCS -2.5 (95% CI -7.9 to 3.0), for MCS -1.2 (95% CI -6.7 to 4.2) and for average pain 0.9 (95% CI -0.5 to 2.2). CONCLUSIONS Compared with patients treated with a TLSO, patients treated using early mobilization without orthosis maintain similar pain relief and improvement in function for 5-10 years.
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Affiliation(s)
- Jennifer C Urquhart
- Division of Orthopaedics, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, Lawson Health Research Institute, and London Health Sciences Centre, London, Ontario; and
| | - Osama A Alrehaili
- Division of Orthopaedics, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, Lawson Health Research Institute, and London Health Sciences Centre, London, Ontario; and
| | - Charles G Fisher
- Vancouver Hospital and Health Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alyssa Fleming
- Division of Orthopaedics, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, Lawson Health Research Institute, and London Health Sciences Centre, London, Ontario; and
| | - Parham Rasoulinejad
- Division of Orthopaedics, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, Lawson Health Research Institute, and London Health Sciences Centre, London, Ontario; and
| | - Kevin Gurr
- Division of Orthopaedics, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, Lawson Health Research Institute, and London Health Sciences Centre, London, Ontario; and
| | - Stewart I Bailey
- Division of Orthopaedics, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, Lawson Health Research Institute, and London Health Sciences Centre, London, Ontario; and
| | - Fawaz Siddiqi
- Division of Orthopaedics, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, Lawson Health Research Institute, and London Health Sciences Centre, London, Ontario; and
| | - Christopher S Bailey
- Division of Orthopaedics, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, Lawson Health Research Institute, and London Health Sciences Centre, London, Ontario; and
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Raymundo BV, Raymundo BM, Eli VDJ, Betten HÁM. CONSERVATIVE TREATMENT FOR THORACOLUMBAR SPINE BURST FRACTURES. COLUNA/COLUMNA 2017. [DOI: 10.1590/s1808-185120171602172277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To identify the category of evidence and the strength of recommendation for the conservative treatment of thoracolumbar spine burst fractures. Method: A systematic review was conducted from April 2014 to June 2015, selecting articles according to their prospective design, related to thoracolumbar spine burst fractures and their treatment. These studies were published in the electronic bibliographic databases from January 2009 to January 2015. Results: A total of 9,504 articles were found in a free search, of which 7 met the selection criteria and were included for analysis in a study of a total of 435 patients, of whom 72 underwent surgical treatment and 363 received some type of conservative treatment, showing predominantly level of evidence "1b", with strength of recommendation type "A". Conclusions: According to the evidence obtained, the conservative treatment is a choice for patients with stable burst fracture in a single level of thoracolumbar spine and with no neurological injury.
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Harrop JS, Rymarczuk GN, Vaccaro AR, Steinmetz MP, Tetreault LA, Fehlings MG. Controversies in Spinal Trauma and Evolution of Care. Neurosurgery 2017; 80:S23-S32. [DOI: 10.1093/neuros/nyw076] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 01/30/2017] [Indexed: 11/13/2022] Open
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Takahashi S, Hoshino M, Takayama K, Iseki K, Sasaoka R, Tsujio T, Yasuda H, Sasaki T, Kanematsu F, Kono H, Toyoda H, Nakamura H. Time course of osteoporotic vertebral fractures by magnetic resonance imaging using a simple classification: a multicenter prospective cohort study. Osteoporos Int 2017; 28:473-482. [PMID: 27577726 DOI: 10.1007/s00198-016-3737-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 08/10/2016] [Indexed: 11/30/2022]
Abstract
UNLABELLED This study revealed the time course of osteoporotic vertebral fracture by magnetic resonance imaging using a simple classification. Signal changes were associated with the compression degree and mobility of the fractured vertebral body. This classification showed sufficient reliability in categorizing magnetic resonance imaging findings of osteoporotic vertebral fractures. INTRODUCTION Magnetic resonance imaging (MRI) is useful in diagnosing osteoporotic vertebral fractures (OVFs). This study investigated the time course of OVFs by MRI using a simple classification. METHODS This multicenter cohort study was performed from 2012 to 2015. Consecutive patients with ≤2-week-old OVFs were enrolled in 11 institutions. MRI was performed at enrollment and at 1-, 3-, 6-, and 12-month follow-up. Signal changes on T1-weighted imaging (T1WI), T2WI, and short τ inversion recovery (STIR) were classified according to signal intensity. Height and angular motion of vertebral bodies were also measured. RESULTS The 6-month follow-up was completed by 153 patients. At enrollment, fractured vertebrae signal changes were 43 % diffuse and 57 % confined low on T1WI; on T2WI, 56, 24, and 5 % were confined low, high, and diffuse low, respectively; on STIR, 100 % were high. On T1WI, diffuse low remained most common (90 % at 1 month and 60 % at 3 months) until 6 and 12 months, when most were confined low (54 and 52 %, respectively). On T2WI, confined low remained most common (decreasing to 41 % at 12 months). On STIR, high signal change was shown in 98, 87, and 64 % at 3, 6, and 12 months, respectively. At 3, 6, and 12 months, diffuse low signal change was associated with significantly lower vertebral height, and high signal change was associated with significantly greater angular motion. CONCLUSIONS MRI signal changes were associated with the compression degree and angular motion of fractured vertebrae. This classification showed sufficient reliability in categorizing MRI findings of OVFs.
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Affiliation(s)
- S Takahashi
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
| | - M Hoshino
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - K Takayama
- Department of Orthopaedic Surgery, Seikeikai Hospital, Sakai, Osaka, Japan
| | - K Iseki
- Department of Orthopaedic Surgery, Sato Hospital, Osaka, Japan
| | - R Sasaoka
- Department of Orthopaedic Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - T Tsujio
- Department of Orthopaedic Surgery, Shiraniwa Hospital, Ikoma, Nara, Japan
| | - H Yasuda
- Department of Orthopaedic Surgery, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
| | - T Sasaki
- Department of Orthopaedic Surgery, Nishinomiya Watanabe Hospital, Nishinomiya, Hyogo, Japan
| | - F Kanematsu
- Department of Orthopaedic Surgery, Saiseikai Nakatsu Hospital, Osaka, Japan
| | - H Kono
- Department of Orthopaedic Surgery, Ishikiri Seiki Hospital, Higashi Osaka, Osaka, Japan
| | - H Toyoda
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - H Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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