Posterior Ligamentous Complex Injuries Are Related to Fracture Severity and Neurological Damage in Patients with Acute Thoracic and Lumbar Burst Fractures

Machino, Masaaki; Yukawa, Yasutsugu; Ito, Keigo; Kanbara, Shunsuke; Morita, Daigo; Kato, Fumihiko

doi:10.3349/ymj.2013.54.4.1020

Cited by 16 publications

(12 citation statements)

References 20 publications

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“…Therefore, bone healing is not complete. The “eggshell-like” vertebral body will further reduce the height of the injured vertebral body under the action of slight external force, which will eventually lead to the loss of the vertebral body height and even the failure of internal fixation [ 26 , 29 , 30 ]. In addition, due to the lack of ligament and annulus attachment, the collapsed central endplate cannot be fully repositioned, the intervertebral disc loses integrity, and gradual disc degeneration leads to loss of intervertebral disc height, stenosis of the intervertebral space, and increased kyphotic angle [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical effect of a novel transpedicular reducer for reduction and bone grafting combined with pedicle screw fixation for thoracolumbar burst fractures

Cai

Xin

Kong

et al. 2021

BMC Musculoskelet Disord

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Background Short-segment transpedicular screw fixation is a common method for the treatment of thoracolumbar burst fractures (TBFs),but this technique has many problems. Therefore,the purpose of this article is to observe and evaluate the clinical efficacy of a novel transpedicular reducer that we designed for fractured vertebral body reduction and bone grafting in the treatment of TBFs. Methods From July 2018 to November 2020, 70 cases of TBFs were included. Thirty-five patients were treated with the novel transpedicular reducer for reduction and bone grafting combined with pedicle screw fixation (observation group), and 35 patients were treated with short-segment transpedicular screw fixation (control group). Before the operation, after reduction, and 3 days, 3 months,and 12 months after the operation, the two groups were assessed, and compared with respect to the anterior and middle heights of the injured vertebrae, the ratios of the anterior and middle heights of the injured vertebral body to the respective heights of the adjacent uninjured vertebral bodies (AVBHr and MVBHr, respectively), and the Cobb angle of the patients. We compared the pain VAS score and quality of life GQOL-74 score at the last follow-up. Finally,we evaluated the distribution of bone grafts and bone healing 12 months after the operation. Results The anterior height, middle height, AVBHr, MVBHr, and Cobb angle of the injured vertebral body in the observation after reduction, and 3 days, 3 months and 12 months post-operatively were compared with those of the injured vertebral body before operation. All of these parameters were improved, and the difference was statistically significant (p < 0.05). These parameters in the observation group at the above time points were significantly better than thoes in the control group at the corresponding time points (p < 0.05). The VAS scores at the last follow-up were significantly better than those of the control group (p < 0.05), but the GQOL-74 score differences were not statistically significant (p > 0.05). The observation group showed no obvious defects on CT at 12 months after the operation, and the bone healing was good. Conclusion The novel transpedicular reducer for reduction and bone grafting combined with pedicle screw fixation for TBFs has good clinical efficacy.

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Section: Discussionmentioning

confidence: 99%

Clinical effect of a novel transpedicular reducer for reduction and bone grafting combined with pedicle screw fixation for thoracolumbar burst fractures

Cai

Xin

Kong

et al. 2021

BMC Musculoskelet Disord

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“…PLC injuries may lead to spinal instability, often coupled with noticeable spinal column deformity and neurological deficit. Recent studies suggest that in the majority of cases, MRI tends to overdiagnose PLC injury that would lead to an increase in unnecessary surgeries [25,26].…”

Section: Discussionmentioning

confidence: 99%

Radiographic Parameters in Diagnosis of Posterior Ligamentous Complex Injury

et al. 2020

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Background and Aim: Diagnosing the status of the posterior ligament complex (PLC) plays an essential role in the management of patients with thoracolumbar fractures. In this study, due to the inefficiency of existing imaging modalities in the accurate detection of PLC damage, we investigated the relevance of some imaging parameters to specific guidelines for rapid PLC injury detection. Methods and Materials/Patients: In this study, 50 patients with and 50 patients without PLC injury were included. MRI, CT scan, and radiographic imaging of the thoracolumbar spine (T12-L1) were evaluated. The thoracolumbar injury classification systems such as Denis, TLICS (Thoracolumbar Injury Classification and Scoring System), and McCormack Load Sharing and radiographic parameters such as Superior Inferior Endplate Angle (SIEA), Body Height (BH), Local Kyphosis (LK), Interspinous Distance (ISD), and Interpedicular Distance (IPD) were investigated in these patients for each imaging method. Statistical analysis was performed using SPSS (Version 21). Result: The ISD and LK and BHp (Body Height Posterior) were significant predictors of PLC injury. On radiographs, the mean LK with and without PLC damage was 25.67° and 20.92°, respectively (p<0.001). The ISD difference was 6.75 mm in cases with PLC damage and 2.84 mm in cases with an intact PLC (p<0.0001). In CT images, the mean LK was 25.77° in cases with PLC damage and 18.63° in cases with an intact PLC (p<0.037). The ISD difference was 4.14 mm in patients with PLC damage and 2.19 mm in patients without PLC damage (p<0.002). The BHp difference was 9.44 mm in cases with PLC damage and 11.09 mm in cases without PLC damage (p<0.002). Conclusion: The current study suggests formulating a predictive radiological index to identify PLC injury successfully. These guidelines can be very helpful in emergency room decision-makings, especially when the cost, availability, and time of performing MRI are important concerns in patients with multiple trauma.

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“…Assessment of PLC is important because its failure significantly influences the severity of the fracture (52). In a recent study MRI increased the severity of CT score of TL fractures in 31% of patients and in 22% changed the indication for conservative treatment (score <5 points) to indication for surgery (score ≥5 points) (53).…”

Section: Classification Systemsmentioning

confidence: 99%