Thoracolumbar Burst Fractures

Rosenthal, Brett D.; Boody, Barrett; Jenkins, Tyler J.; Hsu, Wellington K.; Patel, Alpesh A.; Savage, Jason W.

doi:10.1097/bsd.0000000000000634

Cited by 46 publications

(55 citation statements)

References 62 publications

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“…Thoracolumbar fractures are the most common spine fractures, with burst fractures accounting for 10–20% of these fractures [ 1 – 3 ]. Thoracolumbar burst fracture (TLBF) often leads to neurological dysfunction and kyphosis [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

RETRACTED ARTICLE: Percutaneous pedicle screw fixation combined with selective transforaminal endoscopic decompression for the treatment of thoracolumbar burst fracture

et al. 2020

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Background The objective of this study was to evaluate the feasibility, safety, efficacy, and indications of percutaneous pedicle screw fixation (PPSF) combined with selective transforaminal endoscopic decompression (TED) in the treatment of thoracolumbar burst fracture (TBLF). Methods From August 2015 to October 2018, a total of 41 patients with single-segment TLBF (28 men and 13 women) were enrolled in this study. X-ray and computed tomography were obtained before surgery, 1 week after surgery, and 1 year after surgery to evaluate spinal recovery. In addition, we used the visual analog scale (VAS), the Oswestry Disability Index (ODI), the Japanese Orthopedic Association score (JOA), and the Frankel classification of neurological deficits to evaluate the effectiveness of the treatments. Results The average follow-up time was 22.02 ± 8.28 months. The postoperative Cobb angle, vertebral body compression ratio, vertebral wedge angle, mid-sagittal canal diameter compression ratio, and Frankel grade were significantly improved. There were also significant improvements in the VAS (7.61 ± 1.41 vs. 1.17 ± 0.80, P < 0.001), ODI (89.82 ± 7.44 vs. 15.71 ± 13.50, P < 0.001), and JOA (6.90 ± 2.91 vs. 24.90 ± 3.03, P < 0.001). Conclusions Our results showed that PPSF combined with selective TED in the treatment of TLBF had excellent efficacy, high safety, less secondary injury than other treatments, and a wide range of indications and that it could accurately distinguish patients who did not need spinal canal decompression after posterior fixation. PPSF combined with selective TED is therefore a good choice for the treatment of TLBF.

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Section: Introductionmentioning

confidence: 99%

RETRACTED ARTICLE: Percutaneous pedicle screw fixation combined with selective transforaminal endoscopic decompression for the treatment of thoracolumbar burst fracture

et al. 2020

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“…Traumatic vertebral body fractures of the thoracolumbar spine are common spinal injuries [ 1 , 2 ]. Burst fractures compromise about 20% of all the thoracolumbar fractures [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…There is a controversy on the management of thoracolumbar burst fractures [ 4 , 6 , 7 ]. Both surgical and conservative managements have own pros and cons [ 1 , 8 ]. A shorter period of bed rest, early correction of the deformity, and avoidance of later kyphotic deformity are some advantages of surgical treatment [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Predictors of the failure of conservative treatment in patients with a thoracolumbar burst fracture

et al. 2020

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Background There is a controversy about the management of patients with a thoracolumbar burst fracture. Despite the success of the conservative treatment in most of the cases, some patients failed the conservative treatment. The present study aimed to evaluate risk factors for the need for surgery during the follow-up period in these patients. Methods We retrospectively evaluated 67 patients with a traumatic thoracolumbar burst fracture who managed conservatively at our center between May 2014 and May 2019. Suggested variables as potential risk factors for the failure of conservative treatment including age, gender, body mass index (BMI), smoking, diabetes, vertebral body compression rate (VBCR), percentage of anterior height compression (PAHC), Cobb angle, interpedicular distance (IPD), canal compromise, and pain intensity as visual analog scale (VAS) were compared between patients with successful conservative treatment and those with failure of non-operative management. Results There were 41 males (61.2%) and 26 females (38.8%) with the mean follow-up time of 15.52 ± 5.30 months. Overall, 51 patients (76.1%) successfully completed conservative treatment. However, 16 cases (23.9%) failed the non-operative management. According to the binary logistic regression analysis, only age (risk ratio [RR], 2.21; 95% confidence interval [95%], 1.78–2.64; P = 0.019) and IPD (RR 1.97; 95% CI 1.61–2.33; P = 0.005) were the independent risk factors for the failure of the non-operative management. Conclusions Our results showed that older patients and those with greater interpedicular distance are at a higher risk for failure of the conservative treatment. As a result, a closer follow-up should be considered for them.

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“…Burst fractures are characterized as failure under compression of both the anterior and middle columns [1,2]. Thoracolumbar burst fractures at either or both endplates with the integrated posterior ligamentous complex, which are morphologically classified as type A3 or A4 by the AOSpine Classification, can be treated with posterior short-segment fixation without fusion [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Healing pattern classification for thoracolumbar burst fractures after posterior short-segment fixation

Liang

Liu

Liang

et al. 2020

BMC Musculoskelet Disord

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Background: Thoracolumbar burst fractures can be treated with posterior short-segment fixation. However, no classification can help to estimate whether the healed vertebral body will have sufficient stability after implant removal. We aimed to develop a Healing Pattern Classification (HPC) to evaluate the stability of the healed vertebra based on cavity size and location. Methods: Fifty-two thoracolumbar burst fracture patients treated with posterior short-segmental fixation without fusion and followed up for an average of 3.2 years were retrospectively studied. The HPC was divided into 4 types: type I-no cavity; type II-a small cavity with or without the violation of one endplate; type III-a large cavity with or without the violation of one endplate; and type IV-a burst cavity with the violation of both endplates or the lateral cortical shell. The intraobserver and interobserver intraclass correlation coefficients (ICCs) of the HPC were assessed. The demographic characteristics and clinical outcomes of the cohort were compared between the stable group (types I and II) and the unstable group (types III and IV). Logistic regression was conducted to evaluate risk factors for unstable healing. Results: The intraobserver and interobserver ICCs of the HPC were 0.86 (95% CI = 0.74-0.90) and 0.77 (95% CI = 0.59-0.86), respectively. While the unstable healing group (types III and IV) accounted for 59.6% of the patients, most of these patients were asymptomatic. The preoperative Load Sharing Classification (LSC) comminution score may predict the occurrence of unstable healing (OR = 8.4, 95% CI = 2.4-29.7). Conclusions: A reliable classification for assessing the stability of a healed vertebra was developed. With type I and II healing, the vertebra is considered stable, and the implant can be removed. With type III healing, the vertebra may have healing potential, but the implant should not be removed unless type II healing is achieved. With type IV healing, the vertebra is considered extremely unstable, and instrumentation should be maintained. Assessing the LSC comminution score preoperatively may help to predict unstable healing after surgery.

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Thoracolumbar Burst Fractures

Cited by 46 publications

References 62 publications

RETRACTED ARTICLE: Percutaneous pedicle screw fixation combined with selective transforaminal endoscopic decompression for the treatment of thoracolumbar burst fracture

RETRACTED ARTICLE: Percutaneous pedicle screw fixation combined with selective transforaminal endoscopic decompression for the treatment of thoracolumbar burst fracture

Predictors of the failure of conservative treatment in patients with a thoracolumbar burst fracture

Healing pattern classification for thoracolumbar burst fractures after posterior short-segment fixation

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