Thoracolumbar spine trauma: Evaluation and surgical decision-making

Joaquim, Andrei Fernandes; Patel, Alpesh A.

doi:10.4103/0974-8237.121616

Cited by 37 publications

(14 citation statements)

References 43 publications

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“… 8 9 13 14 Potential explanations for the inconsistencies are that many different surgical indications can be found in the spine trauma literature for treatment of stable burst fractures, such as loss of vertebral body height, segmental kyphosis, vertebral body comminution, canal compromise, among many others. 16 The TLICS did not consider any one of these factors for guiding surgical treatment, as none have shown any evidence-based relationship with patients' outcome. 1 …”

Section: Discussionmentioning

confidence: 99%

Thoracolumbar Injury Classification and Injury Severity Score System: A Literature Review of Its Safety

Joaquim

Bastos

Torres

et al. 2015

Global Spine Journal

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Study Design Systematic literature review. Objective The Thoracolumbar Injury Classification and Severity Score System (TLICS) is widely used to help guide the treatment of thoracolumbar spine trauma. The purpose of this study is to evaluate the safety of the TLICS in clinical practice. Methods Using the Medline database without time restriction, we performed a systematic review using the keyword “Thoracolumbar Injury Classification,” searching for articles utilizing the TLICS. We classified the results according to their level of evidence and main conclusions. Results Nine articles met our inclusion and exclusion criteria. One article evaluated the safety of the TLICS based on its clinical application (level II). The eight remaining articles were based on retrospective application of the score, comparing the proposed treatment suggested by the TLICS with the treatment patients actually received (level III). The TLICS was safe in surgical and nonsurgical treatment with regards to neurologic status. Some studies reported that the retrospective application of the TLICS had inconsistencies with the treatment of burst fractures without neurologic deficits. Conclusions This literature review suggested that the TLICS use was safe especially with regards to preservation or improvement of neurologic function. Further well-designed multicenter prospective studies of the TLICS application in the decision making process would improve the evidence of its safety. Special attention to the TLICS application in the treatment of stable burst fractures is necessary.

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Section: Discussionmentioning

confidence: 99%

Thoracolumbar Injury Classification and Injury Severity Score System: A Literature Review of Its Safety

Joaquim

Bastos

Torres

et al. 2015

Global Spine Journal

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“…42 An anterior approach can also be considered if we use the McCormack classification system 17 and a result of seven or more points is obtained.…”

Section: Surgical Treatment: Indication and Optionsmentioning

confidence: 99%

“…As a general rule, patients with PLC injuries (unstable burst fractures, flexion/distraction injuries and fracture-dislocations) require posterior instrumentation and fusion. 42 An anterior approach can also be considered if we use the McCormack classification system 17 and a result of seven or more points is obtained.…”

Section: Surgical Treatment: Indication and Optionsmentioning

confidence: 99%

Thoracolumbar fractures without neurological impairment

et al. 2016

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An appropriate protocol and unified management of thoracolumbar fractures without neurological impairment has not been well defined.This review attempts to elucidate some controversies regarding diagnostic tools, the ability to define the most appropriate treatment of classification systems and the evidence for conservative and surgical methods based on the recent literature.Cite this article: Vilà-Canet G, García de Frutos A, Covaro A, Ubierna MT, Caceres E. Thoracolumbar fractures without neurological impairment: a review of diagnosis and treatment. EFORT Open Rev 2016;1:332-338. DOI: 10.1302/2058-5241.1.000029

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“…Spine fractures compromise approximately 6% of all fractures worldwide [ 1 , 2 ]. Surgical treatments are proposed to patients with unstable traumatic pathologies, with or without neurological deficit [ 3 ]. While traditional open surgical treatments are commonly used, they may result in considerable blood loss, complications, extended hospital stays, and delayed functional recovery [ 4 – 7 ].…”

Section: Introductionmentioning

confidence: 99%

Instrumentation Removal following Minimally Invasive Posterior Percutaneous Pedicle Screw-Rod Stabilization (PercStab) of Thoracolumbar Fractures Is Not Always Required

Manson

El-Mughayyar

Bigney

et al. 2020

Advances in Orthopedics

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Study Design. Clinical case series. Background. Percutaneous stabilization for spinal trauma confers less blood loss, reduces postoperative pain, and is less invasive than open stabilization and fusion. The current standard of care includes instrumentation removal. Objective. 1. Reporting patient outcomes following minimally invasive posterior percutaneous pedicle screw-rod stabilization (PercStab). 2. Evaluating the results of instrumentation retention. Methods. A prospective observational study of 32 consecutive patients receiving PercStab without direct decompression or fusion. Baseline data demographics were collected. Operative outcomes of interest were operative room (OR) time, blood loss, and length of hospital stay. Follow-up variables of interest included patient satisfaction, Numeric Rating Scales for Back and Leg (NRS-B/L) pain, Oswestry Disability Index (ODI), and return to work. Clinical outcome data (ODI and NRS-B/L) were collected at 3, 12, 24 months and continued at a 24-month interval up to a maximum of 8 years postoperatively. Results. 81.25% of patients (n = 26) retained their instrumentation and reported minimal disability, mild pain, and satisfaction with their surgery and returned to work (mean = 6 months). Six patients required instrumentation removal due to prominence of the instrumentation or screw loosening, causing discomfort/pain. Instrumentation removal patients reported moderate back and leg pain until removal occurred; after removal, they reported minimal disability and mild pain. Neither instrumentation removal nor retention resulted in complications or further surgical intervention. Conclusions. PercStab without instrumentation removal provided high patient satisfaction, mild pain, and minimal disability and relieved the patient from the burden of finances and resources allocation of a second surgery.

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Thoracolumbar spine trauma: Evaluation and surgical decision-making

Cited by 37 publications

References 43 publications

Thoracolumbar Injury Classification and Injury Severity Score System: A Literature Review of Its Safety

Thoracolumbar Injury Classification and Injury Severity Score System: A Literature Review of Its Safety

Thoracolumbar fractures without neurological impairment

Instrumentation Removal following Minimally Invasive Posterior Percutaneous Pedicle Screw-Rod Stabilization (PercStab) of Thoracolumbar Fractures Is Not Always Required

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