A Clinically Useful Classification of Traumatic Intervertebral Disk Lesions

Sander, Anna; Laurer, Helmut; Lehnert, Thomas; Saman, Abdul; Eichler, Katrin; Vogl, Thomas J.; Marzi, Ingo

doi:10.2214/ajr.12.8748

Cited by 53 publications

(57 citation statements)

References 16 publications

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“…However, the posttraumatic MRI consisted of short tau inversion recovery (STIR) sequences only and was not repeated during the further course. Thus, a sufficient analysis of intervertebral disc lesions was not possible [7,8]. Generally, our patients had a history of only low-to moderate-energy traumata.…”

Section: Discussionmentioning

confidence: 96%

“…An MRI at the latest follow-up would be desirable in order to get more information on the intervertebral discs adjacent to the fractured vertebral body and the impact of posttraumatic disc lesions on the reduction loss. A posttraumatic MRI including T1 and T2 sequences would improve the quality of disc analysis [7]. Minor screw loosening cannot be completely ruled out, particularly after a cement-augmented pedicle screw implantation technique.…”

Section: Discussionmentioning

confidence: 99%

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Which anatomic structures are responsible for the reduction loss after hybrid stabilization of osteoporotic fractures of the thoracolumbar spine?

Spiegl

Ahrberg²,

Anemüller³

et al. 2020

BMC Musculoskelet Disord

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Introduction: Hybrid stabilization is an accepted therapy strategy for unstable osteoporotic thoracolumbar fractures. However, a moderate reduction loss has been reported and it remains unclear which anatomic structure is responsible for the reduction loss. Methods: This retrospective study was performed at a level I trauma center. Patients aged 61 and older were stabilized using hybrid stabilization after suffering acute and unstable osteoporotic vertebral body fractures at the thoracolumbar spine. Posterior stabilization was done short-segmental and minimal invasive with cement-augmentation of all pedicle screws. The minimum follow-up has been 2 years. The outcome parameters were the reduction loss and the relative loss of height of both intervertebral discs adjacent to the fractured vertebral body, the fractured vertebral body and a reference disc (intervertebral disc superior of the stabilization) between the postoperative and latest lateral radiographs. Additionally, implant positioning and loosening was analyzed. Results: 29 mainly female (72%) patients (73.3 ± 6.0 years) were included. Fractures consisted of 26 incomplete burst fractures and 3 complete burst fractures of the thoracolumbar junction (Th11-L2: 86%) and the midlumbar spine. The mean follow-up time was 36 months (range: 24-58 months). The mean reduction loss was 7.7°(range: 1-25). The relative loss of heights of both intervertebral discs adjacent to the fractured vertebral body, the reference disc, and the central vertebral body were significant. Thereby, the relative loss of the superior disc height was significant higher compared to the reference disc. Additionally, only the relative loss of central vertebral body height and reduction loss correlated significantly. There were no signs of implant loosening in any patient. Conclusions: The mean reduction loss was moderate 3 years after hybrid stabilization of unstable osteoporotic vertebral fractures of the thoracolumbar spine. A significant loss of both adjacent disc heights and the central vertebral body was seen, with the highest loss in the superior adjacent disc significantly outranging the reference disc. The superior adjacent intervertebral disc and the central part of the fractured vertebral body seem to be responsible for the majority of reduction loss.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Which anatomic structures are responsible for the reduction loss after hybrid stabilization of osteoporotic fractures of the thoracolumbar spine?

Spiegl

Ahrberg²,

Anemüller³

et al. 2020

BMC Musculoskelet Disord

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“…B. Absturztrauma oder Verkehrsunfall) und/oder dem Traumamechanismus auf die Wirbelsäule (z. B. Flexions-oder Extensionsbewegung) [1][2][3][4][6][7][8][9][10][11].…”

Section: Gutachtliche Beurteilung Des Traumatischen Bandscheibenvorfaunclassified

“…Zeitnah zum Unfallereignis erstellte Dokumente haben eine höhere Aussagekraft als später erstellte. MRT-Untersuchungen haben die beste Sensitivität für den Beweis eines frischen Bandscheibenschadens und der zu fordernden Verletzungen der umgebenden Schutzstrukturen [6,10]. Röntgenbilder dagegen ermöglichen nur Aussagen über vorbestehende degenerative Veränderungen, Frakturen und diskoligamentäre Zerreißungen [15,38].…”

Section: Erstschadenunclassified

Gutachtliche Beurteilung des traumatischen Bandscheibenvorfalls

et al. 2017

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In numerous legal areas, expert assessments are needed to clarify the causality of herniated discs: Was the damage caused by an accident? The literature mentions specific requirements regarding the trauma mechanism as well as temporal criteria, which prescribe the causality test. These are essentially high-energy traumas with immediate functional impairments. Accident-related MRI examinations are of paramount importance in the expert assessment process to confirm the primary body harm. In examining the causality constituting liability, competitive causes must be assessed. Since the legal requirements of the causality test differ in civil and social law, legal norms need to be taken into account. We present a test scheme that supports the assessment process through entry, implementation and decision-making levels.

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“…Sander et al haben MRTs von 204 Patienten mit thorakolumbalen Wirbelsäulenverletzungen nachuntersucht und eine 4-gradige Klassifikation der Bandscheibenläsion vorgestellt. Bei der Verlaufskontrolle nach einem Jahr haben sie eine zunehmende Degeneration der Bandscheibe festgestellt[13].…”

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Traumatische und posttraumatische Deformität der thorakalen und lumbalen Wirbelsäule

Pajenda

Mousavi

2019

Die Wirbelsäule

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ZusammenfassungDie frische traumatische Deformität der thorakalen und lumbalen Wirbelsäule bedarf einer gründlichen Analyse des Verletzungsmusters. Die systematische Anwendung von Frakturklassifikationen liefert ausreichend Hinweise auf die Instabilität der Fraktur. Die Art der erforderlichen Versorgung ist vom Ausmaß der Wirbelkörper- und Bandscheibendestruktion sowie der Verletzung der dorsal zuggurtenden Elemente der Wirbelsäule abhängig. Die Entwicklung neuer Operationsmethoden, wie der endoskopisch-assistierten Chirurgie, sowie besserer Implantate haben neue Ansätze für das Management von schweren Wirbelkörperfrakturen ermöglicht.Die posttraumatische Kyphose entsteht infolge einer in Fehlstellung verheilten Fraktur oder nach Bildung einer Pseudarthrose. Abhängig vom Grad der zu korrigierenden Deformität stehen die Möglichkeiten einer anatomischen Rekonstruktion des Wirbelsäulenprofils über die kombinierten dorso-ventralen Zugänge und die dorsal verkürzenden Osteotomien wie Smith Petersen Osteotomie, Ponte Osteotomie oder Pedikelsubtraktionsosteotomie mit unterschiedlichem Korrekturpotential zur Auswahl. Mit einer individuellen Risikoanalyse und adäquaten Operationsplanung können die Komplikationen reduziert und zufriedenstellende Ergebnisse erreicht werden.

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A Clinically Useful Classification of Traumatic Intervertebral Disk Lesions

Abstract: This novel classification may improve communication between spine surgeons and radiologists as well as facilitate clinical decision making in spine surgery. Further studies need to be conducted to verify clinical relevance.

Cited by 53 publications

References 16 publications

Which anatomic structures are responsible for the reduction loss after hybrid stabilization of osteoporotic fractures of the thoracolumbar spine?

Which anatomic structures are responsible for the reduction loss after hybrid stabilization of osteoporotic fractures of the thoracolumbar spine?

Gutachtliche Beurteilung des traumatischen Bandscheibenvorfalls

Traumatische und posttraumatische Deformität der thorakalen und lumbalen Wirbelsäule

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