A New Classification of Thoracolumbar Injuries

Vaccaro, Alexander R.; Lehman, Ronald A.; Hurlbert, R. John; Anderson, Paul A.; Harris, Mitchel B.; Hedlund, Rune; Harrop, James S.; Dvorak, Marcel F.; Wood, Kirkham B.; Fehlings, Michael G.; Fisher, Charles G.; Zeiller, Steven C.; Anderson, D. Greg; Bono, Christopher M.; Stock, Gordon H.; Brown, Andrew; Kuklo, Timothy R.; Öner, F. Cumhur

doi:10.1097/01.brs.0000182986.43345.cb

Cited by 751 publications

(245 citation statements)

References 15 publications

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“…The Thoracolumbar Injury Classification and Severity Score (TLICS), introduced by the Spine Trauma Study Group in 2005, was intended to provide a clear, reliable system for classification of thoracolumbar injury29). The system assigns numerical values to each injury based on the categories of morphology of injury, integrity of the posterior ligamentous complex, and neurological involvement.…”

Section: Methodsmentioning

confidence: 99%

Predictive Factors for a Kyphosis Recurrence Following Short-Segment Pedicle Screw Fixation Including Fractured Vertebral Body in Unstable Thoracolumbar Burst Fractures

Kim

Jang

Hur

et al. 2014

J Korean Neurosurg Soc

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ObjectiveThe technique of short segment pedicle screw fixation (SSPSF) has been widely used for stabilization in thoracolumbar burst fractures (TLBFs), but some studies reported high rate of kyphosis recurrence or hardware failure. This study was to evaluate the results of SSPSF including fractured level and to find the risk factors concerned with the kyphosis recurrence in TLBFs.MethodsThis study included 42 patients, including 25 males and 17 females, who underwent SSPSF for stabilization of TLBFs between January 2003 and December 2010. For radiologic assessments, Cobb angle (CA), vertebral wedge angle (VWA), vertebral body compression ratio (VBCR), and difference between VWA and Cobb angle (DbVC) were measured. The relationships between kyphosis recurrence and radiologic parameters or demographic features were investigated. Frankel classification and low back outcome score (LBOS) were used for assessment of clinical outcomes.ResultsThe mean follow-up period was 38.6 months. CA, VWA, and VBCR were improved after SSPSF, and these parameters were well maintained at the final follow-up with minimal degree of correction loss. Kyphosis recurrence showed a significant increase in patients with Denis burst type A, load-sharing classification (LSC) score >6 or DbVC >6 (p<0.05). There were no patients who worsened to clinical outcome, and there was no significant correlation between kyphosis recurrence and clinical outcome in this series.ConclusionSSPSF including the fractured vertebra is an effective surgical method for restoration and maintenance of vertebral column stability in TLBFs. However, kyphosis recurrence was significantly associated with Denis burst type A fracture, LSC score >6, or DbVC >6.

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Section: Methodsmentioning

confidence: 99%

Predictive Factors for a Kyphosis Recurrence Following Short-Segment Pedicle Screw Fixation Including Fractured Vertebral Body in Unstable Thoracolumbar Burst Fractures

Kim

Jang

Hur

et al. 2014

J Korean Neurosurg Soc

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“…In AO/Magerl classification scale, it is believed that injuries classified as A1 and A2 (except from pincer fracture—A2.3) are stable ones and do not need surgical treatment—only Jevett long-roll brace [12]. In TLICS (Thoracolumbar Injury Classification System), almost all A1 and A2 AO/Magerl fractures are estimated as 3 or less points and treated as nonoperative [13, 14]. Both systems however do not pay attention to sagittal balance and persistent clinical ailments.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous extrapedicular vertebroplasty with expandable intravertebral implant in compression vertebral body fracture in pediatric patient—technical note

et al. 2016

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PurposeThe aim of the article is to present the new extrapedicular percutaneous technique for posttraumatic vertebral column fracture.MethodsA 15-year-old boy needed a surgical Th8 posttraumatic vertebral body (VB) compressive fracture reduction due to insufficient conservative treatment and consistent severe clinical symptoms. After 6 months of external Jevett long-roll brace stabilization, progressive sagittal balance disturbance of thoracic kyphosis was measured and persistent clinical symptoms were observed. It was decided to present a surgical technique method allowing to attempt to reduce VB fracture, rebalance the vertebral column (VC) without any motion limitation, and decrease clinical symptoms. The procedure was performed percutaneously from extrapedicular approach with intravertebral implant (Spine Jack®—Vexim™) and cement (Interface®—Vexim™) under fluoroscopic imaging (Ziehm™ 8000®).ResultsThe whole procedure was uneventful. Now, the child is free from clinical symptoms and the partial reduction of VB fracture was achieved. The patient has been followed for 3 months. In the control CT scans, the VB fracture reduction is stable and no progression of thoracic kyphosis angle is observed. Furthermore since the surgical procedure, the patient is clinical symptom free.ConclusionThe extrapedicular percutaneus technique of VB fracture reduction with intravertebral fixation allowed to partially reduce the VB compressive fracture, rebalance the VC without any motion limitation, avoid external long-roll brace, and eliminate clinical symptoms. The procedure is minimally invasive, fast, and clinically effective. However, the technique should be restricted only to carefully selected clinical cases.

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“…For treatment of cases with neurological injuries, internal fixation after decompression has been widely accepted. The choice of treatment in the absence of a neurological deficit depends on the Thoracolumbar Injury Classification and Severity Score (TLICS) scores[3],[4]. However, for patients with thoracolumbar biomechanical changes as a result of a certain degree of spinal deformity, low back pain and even neurological symptoms may occur over time, which may seriously jeopardize their work and daily life.…”

Section: Introductionmentioning

confidence: 99%

Surgical outcomes of mini-open Wiltse approach and conventional open approach in patients with single-segment thoracolumbar fractures without neurologic injury

Yang

Xie

et al. 2015

J Biomed Res

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This study aimed to introduce a novel mini-open pedicle screw fixation technique via Wiltse approach, and compared it with the traditional posterior open method. A total of 72 cases of single-segment thoracolumbar fractures without neurologic injury underwent pedicle screw fixation via two different approaches. Among them, 37 patients were treated using posterior open surgery, and 35 patients received mini-open operation via Wiltse approach. Crew placement accuracy rate, operative time, blood loss, postoperative drainage, postoperative hospitalization time, radiation exposure time, postoperative improvement in R value, Cobb's angle and visual analog scale (VAS) scores of the two methods were compared. There were no significant differences in the accuracy rate of pedicle screw placement, radiation exposure and postoperative R value and Cobb's angle improvement between the two groups. However, the mini-open method had obvious advantages over the conventional open method in operative time, blood loss, postoperative drainage, postoperative hospitalization time, and postoperative improvement in VAS. The mini-open pedicle screw technique could be applied in treatment of single-segment thoracolumbar fracture without neurologic injury and had advantages of less tissue trauma, short operative and rehabilitative time on the premise of guaranteed accuracy rate and no increased radiation exposure.

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A New Classification of Thoracolumbar Injuries

Cited by 751 publications

References 15 publications

Predictive Factors for a Kyphosis Recurrence Following Short-Segment Pedicle Screw Fixation Including Fractured Vertebral Body in Unstable Thoracolumbar Burst Fractures

Predictive Factors for a Kyphosis Recurrence Following Short-Segment Pedicle Screw Fixation Including Fractured Vertebral Body in Unstable Thoracolumbar Burst Fractures

Percutaneous extrapedicular vertebroplasty with expandable intravertebral implant in compression vertebral body fracture in pediatric patient—technical note

Surgical outcomes of mini-open Wiltse approach and conventional open approach in patients with single-segment thoracolumbar fractures without neurologic injury

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