ObjectiveThis study proposed a new classification system for Chronic Symptomatic Osteoporotic Thoracolumbar Fracture (CSOTF) based on fracture morphology. Research on CSOTF has increased in recent years. However, the lack of a standard classification system has resulted in inconveniences regarding communication, research and treatment. Previous studies of CSOTF classification exhibit different defects, and none of these studies are widely accepted.MethodsWe collected 368 cases of CSOTF in our hospital from January 2010 to June 2017 and systematically analyzed the imaging data of all patients to develop a classification system. Imaging examinations included dynamic radiography, computed tomography scans and magnetic resonance imaging. Ten investigators systematically studied and fully understood the classification system grading 40 cases on two occasions, examined 1 month apart. Kappa coefficients (κ) were calculated to determine intraobserver and interobserver reliability.ResultsThe new classification system for CSOTF was divided into types I-V according to whether the CSOTF exhibited dynamic instability, spinal stenosis or kyphosis deformity. Intra- and interobserver reliability were excellent for all types (κ = 0.83 and 0.85, respectively).ConclusionsThe new classification system for CSOTF demonstrated excellent reliability in this initial assessment. The system is convenient for communication and research, but wide clinical application are needed to confirm its effectiveness and guide clinical treatment.
Background In spine surgery, postoperative epidural hematoma and wound infections can have devastating neurologic compromise. Closed drainage is commonly used for prevention of postoperative hematoma, infection, and associated neurologic impairment after lumbar decompression, but it remains unclear whether closed drainage reduces postoperative complications and improves clinical outcomes or not. The purpose of this study was to determine the efficacy of closed drainage in reducing complications and improving clinical outcomes after single-level lumbar discectomy. Methods 420 patients with single-level lumbar disc herniation were recruited between March 2012 and March 2015 (169 females and 251 males, age 50.0±6.4 years). Patients were randomly assigned to either closed drainage group (214 patients) or non-drainage group (206 patients). The rates of postoperative complications (fever, symptomatic epidural hematoma, wound infections, and requiring revision surgery) were compared between the two groups using a chi square test or Fisher exact test. Pain intensity was evaluated by VAS. Functional ability was measured for all the patients using ODI. The lower extremity VAS score and ODI score were evaluated preoperatively, postoperatively, and at the last follow-up. The operation area VAS scores were evaluated preoperative, postoperative day 1, week 1, week 2, month 1, and at the last follow-up. The scoring results were compared between the two groups using a t test. Results The difference in postoperative fever between patients in the closed drainage group (18.7%) and non-drainage group (28.2%) was statistically significant ( p <0.05). This is mainly due to the difference of patients with fever less than 38.5 °C . There was no significant difference in symptomatic epidural hematoma, infection rate, and re-operation rate when the two groups were compared. Only compared the postoperative day 1 operation area VAS score, the closed drainage group (5.1±0.8) was better than the non-drainage group (6.0±0.7) and with a significant statistical difference ( p <0.05). The left scoring results compared between the two groups were not significant difference ( p >0.05). Conclusions We believe that closed drainage can be beneficial to reduce postoperative fever rate and alleviate postoperative operation area pain in the early postoperative period, but it has no effect on preventing postoperative occurrence of symptomatic epidural hematoma, wound infections, need for revision surgery; and improving clinical outcomes in single-level lumbar discectomy.
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