Importance of Radiography in Orthostatism in the Conduct of Thoracolombar Transition Fractures

Abstract

Objective: To evaluate the importance of radiography in the orthostatic position in the initial assessment of patients with thoracolumbar transition fractures and whether this image changes the surgical indication. Methods: Medical records and imaging tests of patients treated for thoracolumbar transition fractures from June 2018 to June 2019 were evaluated. Trauma patients between 18 and 60 years of age with fractures of T10 to L3 who had been indicated for conservative treatment were included. Cases of fractures considered unstable were excluded. Radiographs were taken with the patient in the supine position (supine X-ray), computed tomography (CT), and orthostatic radiography (orthostatic X-ray). Segmental kyphosis and degree of wedging were evaluated. The measurements were compared using the Wilcoxon test. The McNemar test was used to assess changes in conduct according to the criteria for surgical indication (kyphosis ≥ 25 ° and wedging ≥ 50%). Results: Fifty patients were evaluated, nine of whom (18%) were indicated for a change of conduct according to the orthostatic examinations and were submitted to surgical treatment. Vertebral kyphosis increased by 40.6% (p <0.001). The wedging increased by 25.62% (p <0.0001). Conclusion: Eighteen percent of the total number of patients who did not present instability criteria in radiographs in the supine position satisfied at least one of these criteria when the orthostatic X-ray was performed. Level of evidence 3B; Retrospective case series study.

The Importance of Orthostatic Radiography in the Management of Thoracolumbar Fractures: Case Report

“…4,12,13 The use of the simple plain radiographies in the orthostatic position may be useful to obtain additional information for the evaluation of stability, especially at the level of controversial fractures. 14,15 Current trauma protocols are based in radiographs and decubitus CT scans that limit the visualization of soft tissues; therefore, PLC injuries may not be detected. 16,17 Magnetic resonance imaging is the gold standard for detection of soft-tissue lesions or those 18,19 involving the intervertebral disks and spinal ligaments.…”