Patterns of Collapse in Thoracolumbar Burst Fractures

Alkhalifa, Fahad; Adjei, Nana; Yee, Albert; Finkelstein, Joel

doi:10.1097/01.bsd.0000177957.11603.5c

Cited by 22 publications

(22 citation statements)

References 15 publications

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“…Th ese formulae are considerably diff erent from those associated with non-surgically treated fractured vertebrae, cited above [9]. At the same time, it is apparent that the variation between the diff erent spinal segments for the same surgery type is smaller.…”

Section: Discussionmentioning

confidence: 76%

“…As we have mentioned before, Fahad K. Al-Khalifa et al [9] found that the collapse of a fractured vertebra treated non-surgically may be to a certain extent predicted, applying the equation K f = K i + 0.5*K i for a T11-L1 level frac- tured vertebra, and K f = K i + 4° for a L2-L3 level fractured vertebra. For example, given a fracture displaying an initial kyphotic angle of 20° -which is considered by some authors as surgery treatment indication [21,22], for a T11-L1 segment position, according to the equation, the kyphotic angle would increase up to 30°.…”

Section: Discussionmentioning

confidence: 99%

“…Earlier research papers have determined that anatomically distinct spinal segments denote diff erent specifi c biomechanical behaviors and have identifi ed diff erent collapse patterns of the vertebral body for conservatively treated burst fractures in various spine areas [9].…”

Section: Discussionmentioning

confidence: 99%

“…In their work, Fahad K. Al-Khalifa et al [9] determined specifi c best-fi t regression equations for the collapse pattern in the case of conservatively treated burst fractures, correlating the initial and post-treatment kyphosis angles. Th us, they depicted the equation K f = K i + 0.5K i for burst fracture at T11-L1 level and the equation K f = K i +4 for the burst fracture at L2-L3 level (where K i is the kyphosis angle measured at the time of admission and K f is the kyphosis angle at the last follow up, which was at least one year from the trauma).…”

Section: Introductionmentioning

confidence: 99%

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The Loss of Correction in Thoracolumbar Burst Fracture Treated by Surgery. Can We Predict It?

Anghel

Dénes

2014

Acta Medica Marisiensis

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Objective: This paper aims to differentially depict potential patterns of the loss of correction in surgically treated thoraco-lumbar burst fractures. These may eventually serve to foreseeing and even forestalling loss of correction. Methods: The study focused on 253 patients with surgically treated thoraco-lumbar fractures. This cohort of patients was clustered in four subgroups according to the fracture spine segment (T11-L1 or L1-L2) and surgery type (short segment fi xation or anterior approach). Relevant recorded and processed data were the fracture level, post-operative (Kpo) and last follow-up (Kf) kyphosis angle values. Correlation, regression and determination testing were performed for the last follow-up kyphosis angle and post-operative kyphosis angle, and regression equations were determined for each subgroup of patients. Results:The patterns of loss of correction were described through the following equations: K f = 0.95*K po + 3.2° for the T11-L1 level fractured vertebrae treated by posterior short segment fi xation; K f = 0.98*K po + 3.4° for the L1-L2 level fractured vertebrae treated by posterior short segment fi xation; K f = 1.1*K po + 1.6° for the T11-L1 level fractured vertebrae treated by anterior approach; and K f = 0.7*K po + 2.8° for the L1-L2 level fracture vertebrae treated by anterior approach. Conclusions:The loss of correction may be predicted, to a certain extent, for thoraco-lumbar fractured vertebrae treated surgically. The bestfi t equations depicted for both type of surgery (short segment fi xation and anterior approach) and both spinal segments (T11-L1 and L2-L3) are signifi cantly different than the equations delineated for the collapse of non-surgically treated fractures.

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Loss of Correction in Thoracolumbar Burst Fracture Treated by Surgery. Can We Predict It?

Anghel

Dénes

2014

Acta Medica Marisiensis

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“…The conservative treatment of vertebral fractures requires sequential radiographic followup to evaluate the potential deterioration of posttraumatic lordosis and loss of vertebral height [10–13]. Changes to the individual treatment protocols and possible secondary surgical intervention often rely on the accurate assessment of the segmental and/or overall Cobb angle.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Sagittal Spine Lordosis by Supine Computed Tomography and Upright Conventional Radiographs in Patients with Spinal Trauma

Bouaicha

Lamanna

Jentzsch

et al. 2014

BioMed Research International

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Study Design. Retrospective data analysis. Objective. To compare the sagittal lordosis of the lumbar spine by supine computed tomography (CT) and upright conventional radiographs. Summary of Background Data. There is sparse data about position and modality dependent changes of radiographic measurements in the sagittal lumbar spine. Methods. The anatomical and functional Cobb angles of the thoracolumbar spine in 153 patients with spinal injury were measured by conventional upright sagittal radiographs and supine CT scans. Patients were assigned either to group A (n = 101), with radiologically confirmed vertebral fractures, or to group B (n = 52), without any osseous lesions. The interchangeability of the two imaging modalities was calculated using a ±3° and 5° range of acceptance. Results. Group A showed a mean intraindividual difference of −3.8° for both the anatomical and the functional Cobb angle. Only 25.7% and 27.7% of the 101 patients showed a difference within the tolerated ±3° margin. Using the ±5° limits, only 46 and 47 individuals fell within the acceptable range, respectively. In the patients in group B, the mean intraindividual difference was −2.1° for the anatomical and −1.5° for the functional Cobb angle. Of the 52 patients, only 14 and 13 patients, respectively demonstrated an intraindividual difference within ±3°. With regard to a threshold of ±5°, both the functional and anatomical values were within the defined margins in only 25 (48%) patients. Conclusion. The use of supine CT measurements as a baseline assessment of the sagittal lordosis of the injured thoracolumbar spine does not appear to be appropriate when upright conventional sagittal plane radiographs are used for follow-up measurements.

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Long-term investigation of nonsurgical treatment for thoracolumbar and lumbar burst fractures: an outcome analysis in sight of spinopelvic balance

et al. 2008

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The nonsurgical treatment of thoracolumbar (TLB) and lumbar burst (LB) fractures remains to be of interest, though it is not costly and avoids surgical risks. However, a subset of distinct burst fracture patterns tend to go with a suboptimal radiographic and clinical long-term outcome. Detailed fracture pattern and treatment-related results in terms of validated outcome measures are still lacking. In addition, there are controversial data on the impact of local posttraumatic kyphosis that is associated, in particular, with nonsurgical treatment. The assessment of global spinal balance following burst fractures has not been assesed, yet. Therefore, the current study intended to investigate the radiographical and clinical long-term outcome in neurologically intact patients with special focus on the impact of regional posttraumatic kyphosis, adjacent-level compensatoric mechanisms, and global spine balance on the clinical outcome. For the purpose of a homogenous sample, strong in- and exclusion criteria were applied that resulted in a final study sample of 21 patients with a mean follow-up of 9.5 years. Overall, clinical outcome evaluated by validated measures was diminished, with 62% showing a good or excellent outcome and 38% a moderate or poor outcome in terms of the Greenough Low Back Outcome Scale. Notably, vertebral comminution in terms of the load-sharing classification, posttraumatic kyphosis, and an overall decreased lumbopelvic lordosis showed a significant effect on clinical outcome. A global and segmental curve analysis of the spine T9 to S1 revealed significant alterations as compared to normals. But, the interdependence of spinopelvic parameters was not disrupted. The patients' spinal adaptability to compensate for the posttraumatic kyphotic deformity varied in the ranges dictated by pelvic geometry, in particular the pelvic incidence. The study substantiates the concept that surgical reconstruction and maintenance of a physiologically shaped spinal curve might be the appropriate treatment in the more severely crushed TLB and LB fractures.

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Patterns of Collapse in Thoracolumbar Burst Fractures

Cited by 22 publications

References 15 publications

The Loss of Correction in Thoracolumbar Burst Fracture Treated by Surgery. Can We Predict It?

The Loss of Correction in Thoracolumbar Burst Fracture Treated by Surgery. Can We Predict It?

Comparison of the Sagittal Spine Lordosis by Supine Computed Tomography and Upright Conventional Radiographs in Patients with Spinal Trauma

Long-term investigation of nonsurgical treatment for thoracolumbar and lumbar burst fractures: an outcome analysis in sight of spinopelvic balance

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