Stabilization of 2-Column Thoracolumbar Fractures With Orthoses

Rubery, Paul T.; Brown, Robert M.; Prasarn, Mark L.; Small, John; Conrad, Bryan P.; Horodyski, MaryBeth; Rechtine, Glenn R.

doi:10.1097/brs.0b013e3182804c73

Cited by 8 publications

(5 citation statements)

References 13 publications

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“…Eight of these studies [ 23 – 30 ] reported angulation in cervical injuries (Table 2 ), three [ 26 – 28 ] reported translation (linear movement) in cervical injuries (Table 3 ), and three [ 31 , 32 , 34 ] reported angulation in thoraco-lumbar injuries (Table 4 ). Some of the investigators found considerable movement in globally unstable injuries, e.g., during logroll, especially in the lower thoracic and upper lumbar segments.…”

Section: Resultsmentioning

confidence: 99%

Does turning trauma patients with an unstable spinal injury from the supine to a lateral position increase the risk of neurological deterioration? – A systematic review

Hyldmo

Vist

Feyling

et al. 2015

Scand J Trauma Resusc Emerg Med

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BackgroundAirway protection and spinal precautions are competing concerns in the treatment of unconscious trauma patients. The placement of such patients in a lateral position may facilitate the acquisition of an adequate airway. However, trauma dogma dictates that patients should be transported in the supine position to minimize spinal movement. In this systematic review, we sought to answer the following question: Given an existing spinal injury, will changing a patient’s position from supine to lateral increase the risk of neurological deterioration?MethodsThe review protocol was published in the PROSPERO database (Reg. no. CRD42012001190). We performed literature searches in PubMed, Medline, EMBASE, the Cochrane Library, CINAHL and the British Nursing Index and included studies of traumatic spinal injury, lateral positioning and neurological deterioration. The search was updated prior to submission. Two researchers independently completed each step in the review process.ResultsWe identified 1,164 publications. However, none of these publications reported mortality or neurological deterioration with lateral positioning as an outcome measure. Twelve studies used movement of the injured spine with lateral positioning as an outcome measure; eleven of these investigations were cadaver studies. All of these cadaver studies reported spinal movement during lateral positioning. The only identified human study included eighteen patients with thoracic or lumbar spinal fractures; according to the study authors, the logrolling technique did not result in any neurological deterioration among these patients.ConclusionsWe identified no clinical studies demonstrating that rotating trauma patients from the supine position to a lateral position affects mortality or causes neurological deterioration. However, in various cadaver models, this type of rotation did produce statistically significant displacements of the injured spine. The clinical significance of these cadaver-based observations remains unclear. The present evidence for harm in rotating trauma patients from the supine position to a lateral position, including the logroll maneuver, is inconclusive.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-015-0143-x) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Does turning trauma patients with an unstable spinal injury from the supine to a lateral position increase the risk of neurological deterioration? – A systematic review

Hyldmo

Vist

Feyling

et al. 2015

Scand J Trauma Resusc Emerg Med

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“…In their study, they confirmed that extension orthosis had no effect on motion at the spinal fracture site. [36] Those biomechanical studies explain how orthosis failed to provide an adequate immobilization at fracture site, and therefore, are not capable to prevent the loss of kyphotic angle.…”

Section: Discussionmentioning

confidence: 99%

Orthosis for thoracolumbar burst fractures without neurologic deficit: A systematic review of prospective randomized controlled trials

Alcala-Cerra

Paternina-Caicedo

Díaz-Becerra

et al. 2014

J Craniovert Jun Spine

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Background:Traditionally, conservative treatment of thoracolumbar (TL) burst fractures without neurologic deficit has encompassed the application of an extension brace. However, their effectiveness on maintaining the alignment, preventing posttraumatic deformities, and improving back pain, disability and quality of life is doubtful.Objective:The objective was to identify and summarize the evidence from randomized controlled trials (RCTs) to determine whether bracing patients who suffer TL fractures adds benefices to the conservative manage without bracing.Materials and Methods:Seven databases were searched for relevant RCTs that compared the clinical and radiological outcomes of orthosis versus no-orthosis for TL burst fractures managed conservatively. Primary outcomes were: (1) Loss of kyphotic angle; (2) failure of conservative management requiring subsequent surgery; and (3) disability and pain outcomes. Secondary outcomes were defined by health-related quality of life and in-hospital stay.Results:Based on predefined inclusion criteria, only two eligible high-quality RCTs with a total of 119 patients were included. No significant difference was identified between the two groups regarding loss of kyphotic angle, pain outcome, or in-hospital stay. The pooled data showed higher scores in physical and mental domains of the Short-Form Health Survey 36 in the group treated without orthosis.Conclusion and Recommendation:The current evidence suggests that orthosis could not be necessary when TL burst fractures without neurologic deficit are treated conservatively. However, due to limitations related with number and size of the included studies, more RCTs with high quality are desirable for making recommendations with more certainty.

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“…Compression stockings or intermittent pneumatic compression devices were used for deep vein thrombosis prophylaxis during bed rest. The patients wore the thoracolumbosacral orthosis (TLSO) for 8-12 weeks [12][13][14]. Nonoperative treatment failure was defined as the need for surgery because of persistent severe back pain [15][16][17] and/or new or worsening neurological deficits during nonoperative treatment.…”

Section: Methodsmentioning

confidence: 99%

How Should Patients with a Thoracolumbar Injury Classification and Severity Score of 4 Be Treated?

Lee

Kim

Seo

et al. 2021

JCM

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The thoracolumbar injury classification and severity score (TLICS) system help surgeons decide whether patients should undergo initial operative treatment or nonoperative treatment. However, the best treatment for patients with TLICS 4 fracture remains unknown. The aim of this study was to identify the risk factors for nonoperative treatment failure in patients with TLICS 4 fracture and establish treatment standards for TLICS 4 fractures. This study included 44 patients with TLICS 4 fracture who initially received nonoperative treatment. We divided these patients into two groups: the successful nonoperative treatment group included 18 patients, and the operative treatment group after nonoperative treatment failure included 26 patients. In multiple logistic regression analysis, spinal canal compromise (odd ratio = 1.316) and kyphotic angle (odd ratio = 1.416) were associated with nonoperative treatment failure in patients with TLICS 4 fracture. Other factors, including age, sex, BMI, initial VAS score, and loss of vertebral body height, were not significantly associated with nonoperative treatment failure in these patients. Spinal canal compromise and kyphotic angle were associated with nonoperative treatment failure in patients with TLICS 4 fracture. Therefore, we recommend the surgeon observe spinal canal compromise and kyphotic angle more carefully when deciding on the treatment of patients with TLICS 4 fracture.

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Stabilization of 2-Column Thoracolumbar Fractures With Orthoses

Cited by 8 publications

References 13 publications

Does turning trauma patients with an unstable spinal injury from the supine to a lateral position increase the risk of neurological deterioration? – A systematic review

Does turning trauma patients with an unstable spinal injury from the supine to a lateral position increase the risk of neurological deterioration? – A systematic review

Orthosis for thoracolumbar burst fractures without neurologic deficit: A systematic review of prospective randomized controlled trials

How Should Patients with a Thoracolumbar Injury Classification and Severity Score of 4 Be Treated?

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