Multiple Noncontiguous Spine Fractures at Four Levels in a Neurologically Intact Patient

Jorgensen, David R.; Joseph, James

doi:10.1097/00005373-199610000-00027

Cited by 8 publications

(5 citation statements)

References 10 publications

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“…6,7 Fourteen patients (29.78%) had no neurological injury and the remaining 70.22% had some type of injury, either complete or partial. This tells us that in most of the cases the prognosis is unfavorable according to Jorjersen et al 8 We took into account that the patients with partial spinal cord type neurological damage retain better motor function that those with a complete lesion, however, this indicates a high degree of disability and generates changes in the biopsychosocial environment of the patients and the means to perform their work, which is similar to the global literature where authors report a frequency of neurological damage in this group of patients of up to 70%.…”

Section: Discussionmentioning

confidence: 93%

Multiple Vertebral Fractures at the “Dr. Manuel Dufoo” Spine Clinic

et al. 2018

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Objective: To establish the frequency of presentation of multiple vertebral fractures and evaluate the relationship between the postsurgical condition and the initial neurological lesion, as well as to report the associated injuries in this group of patients. Methods: We conducted a review of patients with spinal trauma and a diagnosis of multiple vertebral fractures who were admitted to the "Dr. Manuel Dufoo Olvera" Spine Clinic of the Secretary of Health of Mexico City from January 1, 2014 to June 30, 2017. The multiple fractures were classified as either contiguous or non-contiguous, according to the number of vertebral bodies and levels affected. The statistical analysis was conducted using formulas of descriptive statistics and the information was then tabulated and graphed to assess the relationship between the anatomical classification and the degree of neurological injury. Results: We observed 530 patients, of whom 47 met the criteria. Thirty-one (65.95%) of the cases corresponded to contiguous fractures and 16 cases (34.05%) to non-contiguous fractures. Fourteen patients (29.78%) with neurological integrity were classified as ASIA D, 20 patients (42.58%) with complete lesion as ASIA A, 7 seven patients (14.89%) as ASIA B, and 6 patients (12.76%) with partial injury as ASIA C. Conclusions: The correlation between the classification of vertebral injuries and the presence of neurological lesion did not show significant differences between contiguous and non-contiguous fractures. Level of Evidence II; Retrospective.

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Section: Discussionmentioning

confidence: 93%

Multiple Vertebral Fractures at the “Dr. Manuel Dufoo” Spine Clinic

et al. 2018

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“…Key procedures in the surgical management of vertebra fractures include decompression of neural elements and restoration of vertebral alignment. Early surgical stabilization shortens the hospital stay, early rehabilitation, and reduces rates of complications due to prolonged bed-rest, such as pneumonia, decubitus ulcers, and muscle atrophy [ 8 9 10 ]. Treatment strategy for MNSF and related surgical complications are not different than single level fractures.…”

Section: Discussionmentioning

confidence: 99%

“…Lian et al [ 2 ] compared three treatment modalities of conservative treatment, surgical therapy for a single lesion and surgical therapy for both lesions in a vertebral MNSF series of 30 patients and found the best clinical and radiological outcome in the surgically managed group [ 3 ]. Jorgensen and Joseph [ 8 ] reported that excessive kyphosis and resultant chronic pain developed in a case with Th11 and L2 compression fractures, since they were not able to manage surgically due to severe infectious findings. In the present series early surgical approach provided early mobilization at every patient, which prevented prospective systemic complications due to immobility.…”

Section: Discussionmentioning

confidence: 99%

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Multilevel Noncontiguous Spinal Fractures: Surgical Approach towards Clinical Characteristics

et al. 2015

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Study DesignThe study retrospectively investigated 15 cases with multilevel noncontiguous spinal fractures (MNSF).PurposeTo clarify the evaluation of true diagnosis and to plane the surgical treatment.Overview of LiteratureMNSF are defined as fractures of the vertebral column at more than one level. High-energy injuries caused MNSF, with an incidence ranging from 1.6% to 16.7%. MNSF may be misdiagnosed due to lack of detailed neurological and radiological examinations.MethodsPatients with metabolic, rheumatologic diseases and neoplasms were excluded. Despite the presence of a spinal fracture associated clearly with the clinical picture, all patients were scanned within spinal column by direct X-rays, computed tomography and magnetic resonance imaging. When there were ≥5 intact vertebrae between two fractured vertebral segments, each fracture region was managed with a separated stabilization. In cases with ≤4 intact segments between two fractured levels, both fractures were fixed with the same rod and screw system.ResultsThere were 32 vertebra fractures in 15 patients. Eleven (73.3%) patients were male and age ranged from 20 to 64 years (35.9±13.7 years). Eleven cases were the American Spinal Injury Association (ASIA) E, 3 were ASIA A, and one was ASIA D. Ten of the 15 (66.7%) patients returned to previous social status without additional deficit or morbidity. The remaining 5 (33.3%) patients had mild or moderate improvement after surgery.ConclusionsThe spinal column should always be scanned to rule out a secondary or tertiary vertebra fracture in vertebral fractures associated with high-energy trauma. In MNSF, each fracture should be separately evaluated for decision of surgery and planned approach needs particular care. In MNSF with ≤4 intact vertebra in between, stabilization of one segment should prompt the involvement of the secondary fracture into the system.

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“…Since the first description of the condition, 21 many authors have recognized and discussed this type of injury. 1,2,[5][6][7][10][11][12][13][14][15][16][17][18][19][20]22,24,25 Although multiple level, noncontiguous injuries of the spine occur in 1.6% to 16.7% of patients with spine trauma, they must be anticipated in a severely injured patient. 10,18 Calenoff et al 5 reviewed 710 patients with spinal injuries and found an incidence of 4.5% multiple noncontiguous vertebral injuries.…”

Section: Discussionmentioning

confidence: 99%

Multiple Level Noncontiguous Fractures of the Spine

Korres

Boscainos

Papagelopoulos

et al. 2003

Clinical Orthopaedics &Amp; Related Research

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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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Multiple Noncontiguous Spine Fractures at Four Levels in a Neurologically Intact Patient

Cited by 8 publications

References 10 publications

Multiple Vertebral Fractures at the “Dr. Manuel Dufoo” Spine Clinic

Multiple Vertebral Fractures at the “Dr. Manuel Dufoo” Spine Clinic

Multilevel Noncontiguous Spinal Fractures: Surgical Approach towards Clinical Characteristics

Multiple Level Noncontiguous Fractures of the Spine

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