A Comparison of Three Different Methods of Fixation in the Management of Thoracolumbar Fractures

Panteliadis, Pavlos; Musbahi, Omar; Muthian, Senthil; Goyal, Shivam; Montgomery, Alexander

doi:10.14444/4032

Cited by 5 publications

(14 citation statements)

References 23 publications

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“…Similarly, Sapakas, et al found a statistical significant difference when comparing SSPSF to LSPSF in terms of follow up Cobb's angle with favourable measures found in LSPSF group [16]. Panteliadis, et al compared three modalities for posterior spinal fixation in thoracolumbar burst fractures (1 level above and 1 level below, 2 above and 1 below, and 2 above and 2 below the fracture) and found that better correction maintained in the 2 above and 2 below group compared to the others but with no statistically significant difference [20].…”

Section: Discussionmentioning

confidence: 99%

Short Segment vs. Long Segment Posterior Spinal Fixation of Unstable Thoracolumbar Burst Fractures: A Retrospective Cohort Study

S¹,

O²,

O³

et al. 2022

J Orthop Surg Tech

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Background: Fractures of the thoracolumbar (TL) vertebrae are common. Optimal surgical management aims to enhance movement and provide long-term stability. Short segment posterior spinal fixation (SSPSF) provides better movement, has less economic burden, but superiority over long segment posterior spinal fixation (LSPSF) remains uncertain. The aim of this study was to report the difference between SSPSF versus LSPSF with regards to loss of correction measured with Cobb's angle in patients with single level unstable burst TL vertebral fractures. Methods:This was a retrospective cohort study including patients who presented between August 2012 to July 2015 at King Saud Medical City, Saudi Arabia-a level I trauma centre. Cobb's angles were measured by two independent assessors immediately post-operative and at one-year follow up. The differences in Cobb's angles were compared for all included patients, and in subgroups of patients that underwent fusion and in the subgroup of patients that underwent LSPSF only.Results: There were 39 patients included with a burst type fracture and completed 1-year follow-up. Ten patients underwent SSPSF and 29 underwent LSPSF. The mean age was 35 (SD 15.7) years, the most common mechanism of injury was a motor vehicle crash (32; 85.1%) and the L1 (20; 51.3%) was the most commonly injured vertebra. Among patients who underwent SSPSF, Cobb's angles were significantly higher immediately post-surgery (9.0 vs. 0.35 degrees; p < 0.001) and at 1-year after surgery (16.5 vs. 3.46 degrees; p < 0.001). Change in Cobb's angle at 1-year follow-up was 7.5 (SD 3.6) degrees among SSPSF group, compared to 3.1 (SD 4.8) degrees in the LSPSF group (p < 0.001). The differences persisted when patients who underwent SSPF were compared to those that underwent LSPSF without fusion. Among patients who underwent LSPSF, no differences were observed between those who underwent fusion versus those that did not. Conclusion:LSPSF appeared superior to SSPSF for maintaining Cobb's angle at 1-year post-surgery. Further research on parameters describing clinical and patient reported outcomes following different fixation modalities are needed to determine the most appropriate surgical technique.

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Section: Discussionmentioning

confidence: 99%

Short Segment vs. Long Segment Posterior Spinal Fixation of Unstable Thoracolumbar Burst Fractures: A Retrospective Cohort Study

S¹,

O²,

O³

et al. 2022

J Orthop Surg Tech

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“…Recent studies examining TL trauma topics have also begun to routinely use AOSpine TLICS for the classification of the study of the subject's injuries. [42][43][44] Overall, AOSpine TLICS/TL AOSIS represents the culmination of an international effort to combine the AO/ Magerl system and TLICS into a universally accepted TL trauma classification system with an emphasis on fracture morphology, neurological status, and a score-based treatment algorithm. While intra and interrater reliability remains a potential concern, the international spine community has demonstrated an early willingness to embrace AOSpine TLICS/TL AOSIS during the first decade since its development, and future work will certainly continue to build upon this foundation.…”

Section: Aospine Thoracolumbar Spine Injury Classification Systemmentioning

confidence: 99%

“…Nagi and Sakr41 also demonstrated in 2022 that the current management of TL trauma adheres slightly more closely to TL AOSIS (88.6%) than TLICS (85.7%). Recent studies examining TL trauma topics have also begun to routinely use AOSpine TLICS for the classification of the study of the subject’s injuries 42–44…”

Section: Historic Overviewmentioning

confidence: 99%

Thoracolumbar Injury Classification Systems

Lightsey

Giberson-Chen

Crawford

et al. 2023

Spine

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Study Design. Narrative review. Objective. To describe the evolution of acute traumatic thoracolumbar (TL) injury classification systems; to promote standardization of concepts and vocabulary with respect to TL injuries. Summary of Background Data. Over the past century, numerous TL classification systems have been proposed and implemented, each influenced by the thought, imaging modalities, and surgical techniques available at the time. While much progress has been made in our understanding and management of these injuries, concepts, and terms are often intermixed, leading to potential confusion and miscommunication. Methods. We present a narrative review of the current state of the literature regarding classification systems for TL trauma. Results. The evolution of TL classification systems has broadly been characterized by a transition away from descriptive categorizations of fracture patterns to schema incorporating morphology, stability, and neurological function. In addition to these features, more recent systems have demonstrated the importance of predictive/prognostic capability, reliability, validity, and generalizability. The Arbeitsgemeinschaft fur Osteosynthesenfragen Spine Thoracolumbar Injury Classification System/Thoracolumbar Arbeitsgemeinschaft fur Osteosynthesenfragen Spine Injury Score represents the most modern and recently updated system, retiring past concepts and terminology in favor of clear, internationally agreed upon descriptors. Conclusions. Advancements in our understanding of blunt TL trauma injuries have led to changes in management. Such advances are reflected in modern, dedicated classification systems. Over time, various key factors have been acknowledged and incorporated. In an effort to promote standardization of thought and language, past ideas and terminology should be retired.

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“…При повреждении без неврологических симптомов прибегают к довольно новой методике: транскутанной транспедикулярной фиксации полиаксиальными винтами (рис. 1), которая выполняется из нескольких разрезов до 1,5 см (их число зависит от числа устанавливаемых транспедикулярных винтов) [5]. Предварительно перед операцией возможно проводить закрытую репозицию, реклинацию, основанную на механизме лигаментотаксиса (устранение смещения отломков и деформации позвоночного канала путем открытой репозиции и манипуляции с помощью транспедикулярного фиксатора).…”

Section: малоинвазивные методы хирургического леченияunclassified

“…Реконструкция передней колонны позвоночника ранее проводилась через довольно травматичные и технически сложные ретроперитонеальный, трансторакальный, транслюмбальный доступы, в том числе и с необходимостью резекции ребер или пересечения диафрагмы. В настоящее время технологии позволяют выполнять данный этап вмешательства, используя малоинвазивные методы: торакоскопические и лапароскопические, позволяющие проводить переднюю декомпрессию, замещение поврежденных тел позвонков и межпозвонковых дисков опорными реконструктивными устройствами [5]. Данная методика является технически сложной и требует определенного уровня подготовки хирурга, но значительно снижает травматичность вмешательства, интенсивность послеоперационного болевого синдрома, дает возможность начать максимально раннюю активизацию пациента (рис.…”

Section: малоинвазивные методы хирургического леченияunclassified