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Cho Y, Kim YG. Clinical Features and Treatment Outcomes of Acute Multiple Thoracic and Lumbar Spinal Fractures : A Comparison of Continuous and Noncontinuous Fractures. J Korean Neurosurg Soc 2019; 62:700-711. [PMID: 31679319 PMCID: PMC6835143 DOI: 10.3340/jkns.2019.0093] [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] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/02/2019] [Indexed: 12/02/2022] Open
Abstract
Objective The treatment of multiple thoracolumbar spine fractures according to fracture continuity has rarely been reported. Herein we evaluate the clinical features and outcomes of multiple thoracolumbar fractures depending on continuous or noncontinuous status.
Methods From January 2010 to January 2016, 48 patients with acute thoracic and lumbar multiple fractures who underwent posterior fusion surgery were evaluated. Patients were divided into two groups (group A : continuous; group B : noncontinuous). We investigated the causes of the injuries, the locations of the injuries, the range of fusion levels, and the functional outcomes based on the patients’ general characteristics.
Results A total of 48 patients were enrolled (group A : 25 patients; group B : 23 patients). Both groups had similar pre-surgical clinical and radiologic features. The fusion level included three segments (group A : 4; group B : 5) or four segments (group A : 19; group B : 5). Group B required more instrumented segments than did group A. Group A scored 23.5 and group B scored 33.4 on the Korean Oswestry Disability Index (KODI) at the time of last follow-up. In both groups, longer fusion was associated with worse KODI score.
Conclusion In this study, due to the assumption of similar initial clinical and radiologic features in both group, the mechanism of multiple fractures is presumed to be the same between continuous and noncontinuous fractures. The noncontinuous fracture group had worse KODI scores in long-term follow-up, thought to be due to long fusion level. Therefore, we recommend minimizing the number of segments that are fused in multiple thoracolumbar and lumbar fractures when decompression is not necessary.
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Affiliation(s)
- Yongjae Cho
- Department of Neurosurgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Young Goo Kim
- Department of Neurosurgery, Ewha Womans University College of Medicine, Seoul, Korea
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Hoffman JR, Carpenter CR. Guarding Against Overtesting, Overdiagnosis, and Overtreatment of Older Adults: Thinking Beyond Imaging and Injuries to Weigh Harms and Benefits. J Am Geriatr Soc 2017; 65:903-905. [DOI: 10.1111/jgs.14737] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Jerome R. Hoffman
- Emergency Medicine; University of California Los Angeles; Los Angeles California
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Wang H, Liu X, Zhao Y, Ou L, Zhou Y, Li C, Liu J, Chen Y, Yu H, Wang Q, Han J, Xiang L. Incidence and pattern of traumatic spinal fractures and associated spinal cord injury resulting from motor vehicle collisions in China over 11 years: An observational study. Medicine (Baltimore) 2016; 95:e5220. [PMID: 27787384 PMCID: PMC5089113 DOI: 10.1097/md.0000000000005220] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 09/27/2016] [Accepted: 10/05/2016] [Indexed: 11/26/2022] Open
Abstract
To investigate the incidence and pattern of traumatic spinal fractures (TSFs) and associated spinal cord injury (SCI) resulting from motor vehicle collisions (MVCs).This was a cross-sectional study. We retrospectively reviewed 698 patients with TSFs resulting from MVCs admitted to our university-affiliated hospitals from 2001 to 2011. The incidence and pattern were summarized with respect to different age groups, fracture levels, and the role of patients.There were 464 males (66.5%) and 234 females (33.5%) aged 40.5 ± 13.8 years old. The most common roles of patients in MVCs were car drivers (189, 27.1%), pedestrians hurt by a car (155, 22.2%), and car passengers (145, 20.8%). The most common fracture levels were L1 (n = 198, 19.2%) and T12 (n = 116, 11.3%), followed by C2 (n = 86, 8.3%). A total of 298 (42.7%) patients suffered a spinal cord injury. The frequencies of SCIs decreased from 53.1% to 24.6% with increasing age. The patients in the 20 to 39 age group (45.3% of all patients) had the largest sex ratio (2.4) and highest frequency of complete SCIs (19.3%) and complications (3.2%). Motorcycle drivers had the youngest mean age (35.7 ± 10.2), largest sex ratio (10.4), and highest frequency of SCIs (56.0%) and complications (4.4%). Motorcycle passengers had the highest frequency of complete SCI (22.7%) and ASOIs (45.5%) and the largest mean injury severity scoring (ISS) (18.9 ± 9.6). The most common fracture levels of motorcycle drivers were C3-C7, while that of others were T11-L2.The most common role of patients who sustained TSFs were car drivers who were 20 to 39 years old. Motorcycle drivers had the highest frequency of SCIs and complications. Motorcycle passengers had the highest frequency of complete SCIs and ASOIs and the largest ISS. Therefore, we should pay more attention to MVC patients, especially car drivers and motorcycle drivers and passengers.
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Affiliation(s)
- Hongwei Wang
- Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA
- Correspondence: Hongwei Wang, Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA, Shenyang, 110016 Liaoning, China (e-mail: )
| | - Xinwei Liu
- Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA
| | - Yiwen Zhao
- State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Science, Shenyang, Liaoning
| | - Lan Ou
- Department of Radiology, Southwest Hospital
| | - Yue Zhou
- Department of Orthopedics, Xinqiao Hospital, the Third Military Medical University, Chongqing, China
| | - Changqing Li
- Department of Orthopedics, Xinqiao Hospital, the Third Military Medical University, Chongqing, China
| | - Jun Liu
- Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA
| | - Yu Chen
- Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA
| | - Hailong Yu
- Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA
| | - Qi Wang
- Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA
| | - Jianda Han
- State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Science, Shenyang, Liaoning
| | - Liangbi Xiang
- Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA
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Takami M, Okada M, Enyo Y, Iwasaki H, Yamada H, Yoshida M. Noncontiguous double-level unstable spinal injuries. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 27:79-86. [DOI: 10.1007/s00590-016-1855-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 09/06/2016] [Indexed: 11/29/2022]
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Erkan S, Tosyalı K, Özalp T, Yercan H, Okcu G. The analysis of functional and radiographic outcomes of conservative treatment in patients with low lumbar burst fractures. Injury 2015; 46 Suppl 2:S36-40. [PMID: 26021660 DOI: 10.1016/j.injury.2015.05.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Burst fractures of the low lumbar spine constitute approximately one percent of all lumbar fractures. There is still no consensus on the optimal treatment of low lumbar burst factures. We aimed to evaluate the functional and radiographic outcomes of conservative treatment in patients with low lumbar burst fracture. METHODS 15 patients (11 males, 4 females; mean age 32±8) who had low lumbar spine burst fracture treated with a custom-moulded thoracolumbosacral orthosis (TLSO) with a thigh extension were enrolled. The mean follow-up period was 22±6 months. 14 patients were neurologically intact and one had isolated nerve root injury. There were 24% type A fractures and 76% type B fractures according to the Denis classification system. Functional outcomes were evaluated by using Oswestry Disability Index (ODI), Short-Form 36 (SF-36) and Visual Analogue Scale (VAS). Radiographic outcome was analyzed by measuring anterior vertebral height loss, kyphosis angle, amount of canal retropulsion. Functional and radiographic outcomes were reviewed initially and at 1, 3, 6, 12 months, and at the latest follow-up. Functional and radiographic improvements were analyzed statistically. RESULTS The mean bracing period was 11.9±1.7 weeks. The mean initial ODI, SF-36, and VAS score of the patients was 78.3±9.6, 23.7±8.9, and 8.7±0.7, respectively. The mean ODI, SF-36, and VAS score of the patients at the final follow-up was 26.4±6.5, 68.1±11.2, and 2.8±1.7, respectively. The improvement in functional outcomes was measured to be significant (p<0.05 for ODI, SF-36 and VAS). The mean initial anterior vertebral height loss, kyphosis angle, amount of canal retropulsion was found to be 27.2%±9.6%, -6.8°±3.2°, 37.4%±10.2%, respectively. The mean anterior vertebral height loss, kyphosis angle, and amount of canal retropulsion at the final follow-up was 23.1%±.6.7%, -4.2°±2.4°, 19.6%±7.7%, respectively. Among the radiographic outcomes, only the amount of canal retropulsion improved statistically (p=0.042). CONCLUSION Conservative treatment using a custom-moulded thoracolumbosacral orthosis with a thigh extension is a safe and effective method in patients with low lumbar spine burst fractures and can improve functional and radiographic outcomes.
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Affiliation(s)
- Serkan Erkan
- Celal Bayar University, Faculty of Medicine, Department of Orthopaedics and Traumatology, Manisa, Turkey.
| | - Koray Tosyalı
- Celal Bayar University, Faculty of Medicine, Department of Orthopaedics and Traumatology, Manisa, Turkey
| | - Taçkın Özalp
- Celal Bayar University, Faculty of Medicine, Department of Orthopaedics and Traumatology, Manisa, Turkey
| | - Hüseyin Yercan
- Celal Bayar University, Faculty of Medicine, Department of Orthopaedics and Traumatology, Manisa, Turkey
| | - Güvenir Okcu
- Celal Bayar University, Faculty of Medicine, Department of Orthopaedics and Traumatology, Manisa, Turkey
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Evaluation of the risk of noncontiguous fractures of the spine in blunt trauma. J Trauma Acute Care Surg 2013; 75:135-9. [PMID: 23940857 DOI: 10.1097/ta.0b013e3182984a08] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is significant debate over the risk of additional noncontiguous (NC) fractures among blunt trauma patients with an identified spinal column injury, often prompting routine full-spine imaging. We sought to determine the incidence of NC spinal fractures and the relationship between injury pattern and mechanism. METHODS A review of all adult blunt trauma patients from the 2010 National Trauma Data Bank with a spine fracture. Patient demographics, mechanism of injury, and frequencies of all combinations of spinal fractures were analyzed. RESULTS Among 654,052 blunt trauma patients, 83,338 (13%) had a diagnosed spine fracture. The mean (SD) Injury Severity Score (ISS) was 15 (11). Of these, 7% (5,496) sustained spinal cord injury, and 17% (14,413) underwent spinal surgery during their index hospitalization. Among those with spinal column fractures, the overall incidence of NC fractures was 19% and was associated with severe truncal injuries, primarily involving the chest. The relative incidences of cervical, thoracic, and lumbar fractures were 41% (34,480), 37% (30,383), and 43% (35,778), respectively. Rates of NC fractures of the spine included 9% cervicothoracic (7,406), 4% cervicolumbar (3,415), and 10% thoracolumbar (7,929). The slight majority (57%) of patients with spinal fractures sustained high-velocity trauma compared with 43% associated with low-velocity trauma. However, NC fractures of the spine were strongly associated with high-velocity trauma. CONCLUSION Spine fractures are relatively common with blunt trauma, and approximately 20% of patients with a spinal column fracture will have an NC fracture. NC fractures were associated with other severe injuries and should be mainly suspected and investigated in high-velocity mechanisms.
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Multiple-level noncontiguous spinal fractures: difference between the young and the elderly. ACTA ACUST UNITED AC 2013; 26:E272-6. [PMID: 23511651 DOI: 10.1097/bsd.0b013e31828674b1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
STUDY DESIGN We retrospectively reviewed the hospital records of all patients with multiple-level noncontiguous spinal fractures (MLNSF) at university-affiliated hospitals between January 2001 and May 2011 (n=213). The variables assessed included age, sex, spinal fracture mechanism, anatomic distribution, neurological deficit, and associated injury. OBJECTIVE The purpose of our study was to better understand the patterns of MLNSF, with an emphasis on comparing young and elderly patients. SUMMARY OF BACKGROUND DATA There are many studies on the characteristics of noncontiguous spinal fractures, but these existing studies do not differentiate between young and elderly patients with noncontiguous spinal fractures. RESULTS A total of 213 patients with MLNSF were enrolled, of whom 57.3% (122/213) were male and 67.1% (143/213) were young patients (age less than 60 y). Accidental falls from a high height and road traffic crashes were the most common injuries leading to spinal fractures (44.1% and 22.4%, respectively) among young patients, whereas osteoporotic spinal fractures and accidental falls from a low height (38.6% and 28.6%, respectively) were the most common causes of spinal injuries among elderly patients. The most common region suffering MLNSF among young patients was the thoracic+lumbar region (36.4%), followed by the cervical+thoracic region (23.8%). Among elderly patients, the thoracic+lumbar region (52.9%) followed by the thoracic+thoracic region (35.7%) were the most common regions suffering MLNSF. The frequency of neurological deficit was significantly different between the young and the elderly patients (57.3% and 21.4%, respectively). A total of 73 (51.0%, 73/143) young patients had associated nonspinal injuries, and 9 (12.9%, 9/70) elderly patients had such injuries. CONCLUSIONS Of all the patients with MLNSF, the risk of noncontiguous spinal fractures with neurological deficit and associated injuries in the elderly patients was lower than that among young patients. The thoracic+lumbar region was the most common region of injury among all patients, and the cervical+thoracic region was more commonly injured among young patients. Clinicians should make their diagnoses and direct their injury prevention strategies according to the characteristics of MLNSF in a specific age group.
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Lian XF, Zhao J, Hou TS, Yuan JD, Jin GY, Li ZH. The treatment for multilevel noncontiguous spinal fractures. INTERNATIONAL ORTHOPAEDICS 2006; 31:647-52. [PMID: 17043863 PMCID: PMC2266655 DOI: 10.1007/s00264-006-0241-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2006] [Accepted: 07/21/2006] [Indexed: 11/27/2022]
Abstract
We report the outcome of 30 patients with multilevel noncontiguous spinal fractures treated between 2000 and 2005. Ten cases were treated conservatively (group A), eight cases were operated on at only one level (group B), and 12 cases were treated surgically at both levels (group C). All cases were followed up for 14-60 months (mean 32 months). Initial mobilisation with a wheelchair or crutches in group A was 9.2 +/- 1.1 weeks, which was significantly longer than groups B and C with 6.8+/-0.7 weeks and 3.1 +/- 0.4 weeks, respectively. Operative time and blood loss in group C were significantly more than group B. The neurological deficit improved in six cases in group A (60%), six in group B (75%) and eight in group C (80%). Correction of kyphotic deformity was significantly superior in groups C and B at the operated level, and increasing deformity occurred in groups A and B at the non-operated level. From the results we believe that three treatment strategies were suitable for multilevel noncontiguous spinal fractures, and individualised treatment should be used in these patients. In the patients treated surgically, the clinical and radiographic outcomes are much better.
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Affiliation(s)
- Xiao Feng Lian
- Department of Orthopedics, Changhai Hospital, No. 174, Changhai Road, Shanghai, 200433 People’s Republic of China
| | - Jie Zhao
- Department of Orthopedics, Changhai Hospital, No. 174, Changhai Road, Shanghai, 200433 People’s Republic of China
| | - Tie Sheng Hou
- Department of Orthopedics, Changhai Hospital, No. 174, Changhai Road, Shanghai, 200433 People’s Republic of China
| | - Jian Dong Yuan
- Department of Orthopedics, Changhai Hospital, No. 174, Changhai Road, Shanghai, 200433 People’s Republic of China
| | - Gen Yang Jin
- Department of Orthopedics, Changhai Hospital, No. 174, Changhai Road, Shanghai, 200433 People’s Republic of China
| | - Zhong Hai Li
- Department of Orthopedics, Changhai Hospital, No. 174, Changhai Road, Shanghai, 200433 People’s Republic of China
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Dai LY, Yao WF, Cui YM, Zhou Q. Thoracolumbar fractures in patients with multiple injuries: diagnosis and treatment-a review of 147 cases. ACTA ACUST UNITED AC 2004; 56:348-55. [PMID: 14960979 DOI: 10.1097/01.ta.0000035089.51187.43] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The initial evaluation and treatment of patients with multiple injuries are challenging. However, little is known about thoracolumbar fractures in patients with multiple injuries. We aimed to determine the incidence of missed injuries of the thoracolumbar spine in patients with multiple injuries, to examine the reasons for the delay in diagnosis, and to study the selection of treatment options in the management and timing of surgical intervention. METHODS One hundred forty-seven consecutive patients with acute thoracolumbar fractures and multiple trauma at the authors' hospital between 1988 and 1997 were retrospectively reviewed. The incidence of missed injuries of the thoracolumbar spine and the reasons for the delay in diagnosis were determined. All these patients were observed for a minimum of 3 years after surgery, except four who died during their hospital stay. RESULTS Delayed diagnosis of thoracolumbar fractures was made in 28 patients (19%). There was an increased incidence of pulmonary complications (p < 0.01) and increased length of hospital stay (p < 0.05) in patients treated nonoperatively compared with patients treated operatively. Although no significant differences in the recovery rate of neurologic function (p > 0.05) were noted between the groups, the surgical patients had highly significantly less pain compared with the nonoperative patients (p < 0.01). The relationship between the timing of thoracolumbar surgery and complications failed to show statistical significance (p > 0.05). Neither the severity of injury nor the timing of surgery had any significant effect on the recovery rate (p > 0.05). CONCLUSION Patients with blunt trauma caused by high-energy impact injuries are much more likely to have thoracolumbar fractures even if injuries elsewhere have been noted. Further radiographic studies of the thoracolumbar spine should be performed if there is any question related to a thorough and systematic examination. Choice of treatment options of thoracolumbar fractures in patients with multiple injuries is not different from that in patients with no associated injuries to other systems. Appropriate timing of thoracolumbar fracture fixation in patients with multiple injuries should not be dependent on a rigid protocol.
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Affiliation(s)
- Li-Yang Dai
- Department of Orthopaedic Surgery, Xinhua Hospital, Shang-hai Second Medical University, Shanghai, China.
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Korres DS, Boscainos PJ, Papagelopoulos PJ, Psycharis I, Goudelis G, Nikolopoulos K. Multiple level noncontiguous fractures of the spine. Clin Orthop Relat Res 2003:95-102. [PMID: 12782864 DOI: 10.1097/01.blo.0000068362.47147.a2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
From 1970 to 2000, 81 patients with noncontiguous fractures of the spine were evaluated. Of these 81 patients, 36 had a neurologic deficit. Sixty-six patients with stable injuries were treated conservatively, whereas 15 patients with unstable injuries required surgical stabilization. There was no neurologic deterioration either in the patients who had surgical stabilization or in the patients who were treated conservatively. Thirteen patients with an A score on the American Spinal Injury Association neurologic impairment scale did not improve and had a high mortality rate (61.5%). Although multiple level noncontiguous fractures of the spine are uncommon, they constitute a threat to neurologic function, and therefore warrant radiographic evaluation of the entire spine with multiple injuries.
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Affiliation(s)
- Dimitrios S Korres
- First Orthopaedic Department, Medical School of Athens University, KAT Hospital, Greece.
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Abstract
Fifty-four patients with low lumbar spinal fractures were retrospectively reviewed. Of these, there were 25 compression fractures, 21 burst fractures, three flexion-distraction fractures and five fracture-dislocations. Three patients had a complete neurological lesion, 17 sustained an incomplete neurological injury, and 34 were neurologically intact. Twenty-six patients were treated non-operatively and 28 underwent surgery. All patients were followed up for l-12 years. Forty-three patients (79.6%) have returned to their former employment or activity level. Four patients had experienced significant improvement but suffered from some limitation of activity. Five patients were unable to stand up and walk without support although they had some degree of improvement. Two remained completely paralyzed. There were no differences in neurologic function between patients treated non-operatively or operatively (P>0.05). The patients treated operatively had significantly less pain compared to the patients treated non-operatively (P<0.01). Because of the unique anatomy and biomechanics, fractures of the low lumbar spine are different from those in the remaining regions of spine. Most compression fractures are stable, and therefore conservative management is indicated. Surgery should be performed in those with burst fractures or flexion-distraction fractures, with severe spinal stenosis or kyphotic deformity, and fracture-dislocation.
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Affiliation(s)
- Li-Dai Dai
- Department of Orthopaedic Surgery, Xinhua Hospital, Shanghai Second Medical University, 1665 Kongjiang Road, 200092, Shanghai, PR China.
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