Clinical and radiological outcome of non-surgical management of thoracic and lumbar spinal fracture-dislocations — a historical analysis in the era of modern spinal surgery

Joaquim, Andrei Fernandes; Schroeder, Gregory D.; Patel, Alpesh A.; Vaccaro, Alexander R.

doi:10.1080/10790268.2018.1474692

Cited by 7 publications

(9 citation statements)

References 12 publications

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“…Managing patients with complex posterior ligamentous injuries, like those with AO Spine type B or type C fractures, usually requires instrumented posterior fusion, as nonoperative management can lead to progressive kyphosis, increased pain, and potential neurological deterioration. 21 Palmisani et al 22 reported that MISS is generally used to treat type A fractures (more stable injuries), due to limitations achieving fusion using percutaneous screws or paraspinal approaches. Interestingly, the Wiltse approach provides a wider operative field than most MISS approaches, thereby allowing not only screw insertion but also better rod bending, along with the potential to correct kyphosis and indirect decompression, together with some room for posterior bone grafts.…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Versus Open Surgery for the Treatment of Types B and C Thoracolumbar Injuries: A PRISMA Systematic Review

et al. 2021

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Background: Thoracic and lumbar spine injuries may require surgical management, particularly AO Spine types B and C injuries. Open reduction and fixation using pedicle screws, with or without fusion and/or decompression, is the gold standard surgical treatment for unstable injuries. Recent advances in instrumentation design have resulted in lessinvasive surgeries. However, the literature is sparse about the effectiveness of these procedures for types B and C injuries. The objective is to compare the outcomes of conventional open surgery versus minimally invasive spine surgery (MISS) for the treatment of AO Spine types B and C thoracolumbar injuries.Methods: A systematic review of published literature in PubMed, Web of Science, and Scopus was performed to identify studies comparing outcomes achieved with open versus minimally invasive surgery in AO Spine types B and C thoracolumbar injury patients. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used.Results: Five retrospective case-control studies and 3 prospective studies met selection criteria. In general, most of the studies demonstrated that minimally invasive spine surgery is feasible for types B and C injuries, and associated with potential advantages like reduced blood loss, postoperative pain, and muscle injury, and shorter hospital stays. However, no differences were detected in major outcomes, like neurological status or disability.Conclusions: Published literature currently suggests that minimally invasive spine surgery is a valid alternative for treating types B and C thoracolumbar injuries. However, further comparative prospective randomized clinical trials are necessary to establish the superiority of one approach over the other.

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Section: Discussionmentioning

confidence: 99%

Minimally Invasive Versus Open Surgery for the Treatment of Types B and C Thoracolumbar Injuries: A PRISMA Systematic Review

et al. 2021

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“…Historical treatment of fracture-dislocation injuries with prolonged bed rest ( 10-13 weeks on average), generally results in residual deformity and pain syndromes. 33 Compared with modern case series, cases of fracture-dislocation, without neurological deficits, that are surgically treated generally have very satisfactory outcomes, most of the times with the patients returning to their normal activities. 33 Additionally, for patients with neurological deficits, some neurological improvement is documented, especially in those patients with incomplete spinal cord injuries.…”

Section: Discussionmentioning

confidence: 99%

“…33 Compared with modern case series, cases of fracture-dislocation, without neurological deficits, that are surgically treated generally have very satisfactory outcomes, most of the times with the patients returning to their normal activities. 33 Additionally, for patients with neurological deficits, some neurological improvement is documented, especially in those patients with incomplete spinal cord injuries. 8,31 Our review is limited, once it is based on results of case series and, thus, there is a lack of comparative treatment modalities.…”

Section: Discussionmentioning

confidence: 99%

“…These types of injury present severe ligamentous damage, and, thus, surgical treatment is recommended, regardless of the neurological status of the patient (N0 to N4), in order to avoid nonunion and late kyphotic deformities. [31][32][33] For neurologically-intact patients, surgery is indicated to restore spinal stability. For patients with neurological deficits, surgery is recommended not only to restore stability but also to decompress the neural tissue and optimize the spinal cord recovery, potentially improving neurological outcomes.…”

Section: Subtypes B2 B3 and Type-c Injuriesmentioning

confidence: 99%

“…Nonoperative management of ligamentous injury is associated with severe pain, spinal deformity, and late neurological deterioration. [31][32][33] ►Fig. 5 illustrates the decision-making process of subtypes B2-B3 and type C. In ►Fig.…”

Section: Subtypes B2 B3 and Type-c Injuriesmentioning

confidence: 99%

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Operative versus Non-Operative Management of Traumatic Thoracolumbar Injuries according to the AO Spine Thoracolumbar Spine Injury Classification System

Joaquim

2020

Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery

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Introduction The AOSpine Thoracolumbar Spine Injury Classification (AOSTSIC) system has been proposed to better characterize injury morphologies and improve the classification of thoracolumbar (TL) spine trauma. However, the indications for surgical treatment according to the AOSTSIC system are still debated. Additionally, the proposed Thoracolumbar AOSpine Injury Score (AOSIS) is quite complex, which may preclude its use in daily practice. The objective of this review is to discuss the AOSTSIC system and its indications for initial nonoperative versus surgical management of acute TL spine trauma. Methods We analyzed the literature for each injury type (and subtype, when pertinent) according to the AOSTSIC system as well as their potential treatment options. Results Patients with AOSTSIC subtypes A0, A1, and A2 are neurologically intact in the vast majority of the cases and initially managed nonoperatively. The treatment of A3- and A4-subtype injuries (burst fractures) in neurologically-intact patients is still debated with great controversy, with initially nonoperative management being considered an option in select patients. Surgery is recommended when there are neurological deficits or failure of nonoperative management, with the role of magnetic resonance findings in the Posterior Ligamentous Complex (PLC) evaluation still being considered controversial. Injuries classified as type B1 in neurologically-intact patients may be treated, initially, with nonoperative management, provided that there are no ligamentous injury and non-displacing fragments. Due to severe ligamentous injury, type-B and type-C injuries should be considered as unstable injuries that must be surgically treated, regardless of the neurological status of the patient. Conclusions Until further evidence, we provided an easy algorithm-based guide on the spinal trauma literature to help surgeons in the decision-making process for the treatment of TL spine injuries classified according to the new AOSTSIC system.

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Clinical application and cases examples of a new treatment algorithm for treating thoracic and lumbar spine trauma

Joaquim

Patel

Schroeder

et al. 2018

Spinal Cord Ser Cases

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Clinical and radiological outcome of non-surgical management of thoracic and lumbar spinal fracture-dislocations — a historical analysis in the era of modern spinal surgery

Cited by 7 publications

References 12 publications

Minimally Invasive Versus Open Surgery for the Treatment of Types B and C Thoracolumbar Injuries: A PRISMA Systematic Review

Minimally Invasive Versus Open Surgery for the Treatment of Types B and C Thoracolumbar Injuries: A PRISMA Systematic Review

Operative versus Non-Operative Management of Traumatic Thoracolumbar Injuries according to the AO Spine Thoracolumbar Spine Injury Classification System

Clinical application and cases examples of a new treatment algorithm for treating thoracic and lumbar spine trauma

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