A review of the management of thoracolumbar burst fractures

Dai, Li-Yang; Jiang, Sheng‐Dan; Wang, Xiangyang; Jiang, Lei‐Sheng

doi:10.1016/j.surneu.2006.08.081

Cited by 182 publications

(156 citation statements)

References 101 publications

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“…The treatment of stable thoracolumbar burst fractures without neurologic deficit remains controversial [3,4]. The use of pedicle screws for posterior spinal stabilization has been established worldwide and multiple studies suggest that this procedure is a safe and effective method for thoracolumbar fractures [5]. Although improvements in surgical treatments are on track, clinical study on the intervertebral disc (IVD) degeneration relating to the fractured vertebra is nascent.…”

Section: Introductionmentioning

confidence: 99%

Radiological study on disc degeneration of thoracolumbar burst fractures treated by percutaneous pedicle screw fixation

et al. 2012

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Objective To examine disc degeneration at levels adjacent and next adjacent to the fractured vertebra and to analyses, if the disc degeneration is determined by the endplate fracture. Summary of background data Thoracolumbar burst fracture is one of the most common spinal injuries. The diagnostic (clinical and imaging) approach and treatment of a fractured vertebra is well established; however, some controversy remains. The associated disc degeneration is less well known after 9-12 months of the short segment pedicle screw fixations. There is a major controversy whether spinal trauma with vertebral endplate fractures can result in posttraumatic disc degeneration. No study to date, however, has assessed disc degeneration of the AO type A3 thoracolumbar fractures without neurologic deficits after pedicle screw fixations. Methods Twenty-six patients with single-level AO type A3 thoracolumbar fractures and no neurological deficit were treated by using postural reduction and short segment percutaneous pedicle screw fixation. No laminectomy and fusion were performed. Implants were removed 9-12 months after the first operation. The thoracolumbar magnetic resonance imaging (MRI) was used to assess disc degeneration at levels adjacent and next adjacent to the fractured vertebra before the first operation and after the second operation in a retrospective study.Results After the instrumentation removal, new disc degeneration was usually found at level adjacent to the cranial endplate of fractured vertebra by MRI examination in 24 patients. The average Pfirrmann grade of degenerative discs adjacent to the cranial fractured endplates deteriorated from 2.1 pre-operatively to 3.4 after the second operation. No change of disc degeneration was seen at the caudal disc space adjacent to the fractured vertebra and the levels next adjacent to the fractured vertebra. The discs next adjacent to the fractured vertebra were showed to be relatively normal without changes of degeneration during the study period. Conclusions Disc degeneration usually occurs at level adjacent to the fractured endplate of thoracolumbar burst fractures. Endplate fracture is strongly associated with disc degeneration. No correlation between fixation level and disc degeneration is seen in this study.

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Section: Introductionmentioning

confidence: 99%

Radiological study on disc degeneration of thoracolumbar burst fractures treated by percutaneous pedicle screw fixation

et al. 2012

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“…Burst fractures are radiographically characterized by posterior vertebral body angle exceeding 100°, reduction in posterior vertebral height, widened interpedicle distance, posterior cortical line disruption, and posterior vertebral body break, which may be associated with varying degrees of canal stenosis [6,25]. However evaluation of such fractures on plain radiographs alone can result in misdiagnosis, with associated ligamentous injuries being missed and approximately 25% of burst fractures being misdiagnosed as compression fractures [8,17]. The treatment of burst fractures with neurologic deficits is controversial as decompression might not result in resolution of the deficits and neurologic status (and the degree of compression) might improve with time, regardless of decompression [30,31].…”

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confidence: 99%

“…Proponents of nonoperative management argue that avoiding surgery decreases associated costs and surgical complications including infection, hardware-related complications, and iatrogenic injury [11,12,14,34,38,44]. Indications for operative treatment may include neurologic deficit, unstable fracture, severe kyphosis greater than 35°, canal compromise greater than 50%, or posterior ligamentous complex injury [18,38]. Other arguments for surgery include decreased rates of neurologic deterioration, improved kyphosis correction, and facilitation of early mobilization that may decrease complications from prolonged bed rest [1,5,45].…”

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“…Several systematic reviews of nonoperative versus operative treatment for thoracolumbar burst fractures without a neurologic deficit have been published [18,46,48,55]. However, Dai et al [18], Thomas et al [46], and van der Roer et al [48], based their conclusions primarily on descriptive summaries, included observational studies, and did not perform meta-analyses.…”

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confidence: 99%

“…However, Dai et al [18], Thomas et al [46], and van der Roer et al [48], based their conclusions primarily on descriptive summaries, included observational studies, and did not perform meta-analyses. Similarly, the review by Yi et al [55] included only one randomized control trial (RCT), thus limiting its power and clinical utility.…”

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Nonoperative versus Operative Treatment for Thoracolumbar Burst Fractures Without Neurologic Deficit: A Meta-analysis

Gnanenthiran¹,

Adie²,

Harris³

2012

Clinical Orthopaedics &Amp; Related Research

149

121

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Short or long fusion after thoracolumbar burst fractures does not alter selected gait parameters: a preliminary study

Öken

Yildirim

Öken³

et al. 2011

Journal Orthopaedic Research

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We evaluated the gait characteristics of patients who had short or long-segment fusion after thoracolumbar burst fractures. The study included 12 patients (5 male, 7 female) who had vertebral fusion after traumatic thoracolumbar region (T12-L2) burst fractures. Patients were divided into two groups based on fixation type (short or long segment). Twelve healthy age and sex-matched subjects (seven male, five female) served as controls. Quantitative gait data, including all time-distance (walking velocity, cadence, step time, step length, double support time), kinematic (joint rotation angles of pelvis, hip, knee, and ankle), and kinetic data (moments of hip in sagittal and coronal plane) were collected. Three patients had a T12, six patients an L1, and three patients had an L2 lesion. Patients in the two groups were similar in terms of age, sex, and time since operation. No significant differences were found in the time-distance, kinematic, and kinetic gait characteristics between the two groups. This preliminary study reveals that the gait characteristics of patients with short and long-segment fusion after thoracolumbar burst fractures were similar to those of healthy subjects and did not differ from each other. However, the present results should be interpreted with caution due to the small sample size. Future studies with larger groups are needed to provide additional data to validate these findings. ß

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A review of the management of thoracolumbar burst fractures

Cited by 182 publications

References 101 publications

Radiological study on disc degeneration of thoracolumbar burst fractures treated by percutaneous pedicle screw fixation

Radiological study on disc degeneration of thoracolumbar burst fractures treated by percutaneous pedicle screw fixation

Nonoperative versus Operative Treatment for Thoracolumbar Burst Fractures Without Neurologic Deficit: A Meta-analysis

Short or long fusion after thoracolumbar burst fractures does not alter selected gait parameters: a preliminary study

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