Neurologic Injury and Recovery Patterns in Burst Fractures at the T12 or L1 Motion Segment

Dall, Bruce E.; Stauffer, Edouard

doi:10.1097/00003086-198808000-00021

Cited by 45 publications

(22 citation statements)

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“…On the other hand, many other studies have found little correlation between the initial neurological impairment and the degree of spinal canal narrowing, as was also observed in the present study [2,5,6,10,12,13,15,18,19]. Mohanty et al [18] analyzed 45 cases of thoracolumbar or lumbar burst fractures treated nonoperatively.…”

Section: Discussionsupporting

confidence: 51%

“…In their study of 22 consecutive cases of thoracolumbar fractures with accompanying neurological injury managed by posterior instrumentation, Lemons et al [14] reported that patients who underwent transpedicular decompression did not significantly differ from those who did not with respect to follow-up neurological score or percentage of neurological recovery. Dall et al [5] reported on 14 cases with burst fractures at the T12 or L1 treated by nonoperative, posterior fusion only or by anterior decompression combined with fusion. They reported that neurological recovery did not correlate significantly with treatment method or with the amount of canal decompression.…”

Section: Canal Decompressionmentioning

confidence: 99%

“…Although theoretical arguments have been advanced in support of the efficacy of surgical decompression, supporting data are inconclusive or lacking, especially with respect to the relationship between the degree of spinal canal compromise and neurological recovery. Indeed, several reports have indicated that restoration of the spinal canal does not affect the extent of neurological recovery [2,5,9,21,23]. The purpose of this study was to investigate the spinal canal remodeling and the clinical outcome of posterior stabilization without decompression for thoracolumbar burst fractures.…”

Section: Introductionmentioning

confidence: 99%

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Clinical results of posterior stabilization without decompression for thoracolumbar burst fractures: is decompression necessary?

2011

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The purpose of this study is to investigate the clinical outcome of posterior stabilization without decompression for thoracolumbar burst fractures. Thirty-one consecutive cases of thoracolumbar fractures involving T11-L2 stabilized by a pedicle screw system were reviewed. Neither reduction of the height of a fractured body nor any decompression procedure was added during surgery. Twenty-two patients had incomplete paraplegia; one patient had complete paraplegia. Neurological recovery and remodeling of the spinal canal were evaluated. Neurological status was evaluated at the time of injury, just before and after surgery, and at final follow-up. The degree of spinal canal compromise was assessed using axial CT scan images. The duration of follow-up averaged 39.6 months. The mean spinal canal compromise at the time of injury was 41.6%, and no significant correlation was observed between the degree of canal compromise and the severity of the neurological deficit. Within 2-3 weeks, spinal canal remodeling had started in all patients whose spinal canal compromise was more than 30%, and canal compromise had decreased significantly 3-4 weeks after injury. Seventeen of 22 patients with incomplete paraplegia had already shown partial neurological recovery even before surgery. At the final follow-up, all patients with incomplete paraplegia had improved by at least one modified Frankel grade. This study suggests that the effect of decompressing thoracolumbar fractures with neurological deficits remains unclear and questions the need to operate simply to remove retropulsed bone fragments. Posterior stabilization without decompression should constitute appropriate surgical treatment for these fractures.

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Section: Discussionsupporting

confidence: 51%

Section: Canal Decompressionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical results of posterior stabilization without decompression for thoracolumbar burst fractures: is decompression necessary?

2011

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“…Both the methodology and the outcome were analysed. Table II 7,11,18,30,33,39,42,43,45,54,56,59 Forty-six studies reported surgical treatment alone and eight described both operative and non-operative management 6,21,23,29,32,37,45,63 without randomisation or a description of the methods of selection. Six papers discussed conservative management only.…”

Section: Methodsmentioning

confidence: 99%

Does ‘Canal Clearance’ Affect Neurological Outcome After Thoracolumbar Burst Fractures?

Boerger

Limb

Dickson

2000

The Journal of Bone and Joint Surgery. British volume

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Surgical decompression of the spinal canal is presently accepted worldwide as the method of treatment for thoracolumbar burst fractures with neurological deficit in the belief that neurological recovery may be produced or enhanced. Our clinical and laboratory experience, however, indicates that the paralysis occurs at the moment of injury and is not related to the position of the fragments of the fracture on subsequent imaging. Since the preoperative geometry of the fracture may be of no relevance, our hypothesis, backed by more than two decades of operative experience, is that alteration of the canal by 'surgical clearance' does not affect the neurological outcome.We have reviewed the existing world literature in an attempt to find evidence-based justification for the variety of surgical procedures used in the management of these fractures. We retrieved 275 publications on the management of burst fractures of which 60 met minimal inclusion criteria and were analysed more closely. Only three papers were prospective studies; the remainder were retrospective descriptive analyses. None of the 60 articles included control groups. The design of nine studies was sufficiently similar to allow pooling of their results, which failed to establish a significant advantage of surgical over non-surgical treatment as regards neurological improvement. Significant complications were reported in 75% of papers, including neurological deterioration. Surgical treatment for burst fracture in the belief that neurological improvement can be achieved is not justified, although surgery may still occasionally be indicated for structural reasons. This information should not be withheld from the patients. There are many different classifications of thoracolumbar spinal injuries but the most popular is that of Denis 1 which is based on the three-column theory as considered in the sagittal plane. The three columns are the anterior, which comprises the front half of the bodies and the anterior longitudinal ligament, the middle, namely the back half of the bodies and the posterior longitudinal ligament, and the posterior, which includes the laminae, facet joints and spinous processes plus the ligaments and muscles attached to them. The more columns which are damaged the more unstable is the injury. Four fundamental types of fracture can be distinguished: 1) a simple, stable anterior wedge compression fracture with compression of the anterior column; 2) distraction injuries, referred to as seat-belt injuries; 3) burst fractures with compression of both the anterior and middle columns; and, finally, 4) fracture-dislocations of the spine which are unstable and involve all three columns.Burst fractures are produced by vertical compressive loads, usually with some degree of flexion, since the anterior column is squashed down more than the middle column. Although bone bursts in all directions, one of the compelling images of a burst fracture can be seen on transverse CT which shows bone retropulsed into the spinal canal. Such scans may show a range o...

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“…Типы взрывных переломов: А -перелом, проходящий через краниальную и каудальную замыкательные пластинки; В -перелом, проходящий через краниальную замыкательную пластин-ку; С -перелом, проходящий через нижнюю замыкатель- Взрывные переломы составляют 14 % от всех тяжелых переломов позвоночника; 30-60 % из них осложнены нев-рологическим дефицитом; до 50 % из последних выявля-ются в области грудопоясничного перехода. Взрывные переломы Th 10 -L 2 позвонков -наиболее частая причина возникновения неврологического дефицита [48,52,133,148]. Характерной особенностью взрывных переломов тел позвонков является их неврологическая нестабильность, имеющая место даже при отсутствии неврологической симптоматики.…”

Section: классификации повреждений грудного и поясничного отделов позunclassified

Injuries of the Thoracic and Lumbar Spine

Ramikh¹,

Tsivyan²

2008

Hir. pozvonoč.

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Neurologic Injury and Recovery Patterns in Burst Fractures at the T12 or L1 Motion Segment

Cited by 45 publications

References 0 publications

Clinical results of posterior stabilization without decompression for thoracolumbar burst fractures: is decompression necessary?

Clinical results of posterior stabilization without decompression for thoracolumbar burst fractures: is decompression necessary?

Does ‘Canal Clearance’ Affect Neurological Outcome After Thoracolumbar Burst Fractures?

Injuries of the Thoracic and Lumbar Spine

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