Bracing for thoracolumbar fractures

Chang, Victor; Holly, Langston T.

doi:10.3171/2014.4.focus1477

Cited by 54 publications

(43 citation statements)

References 43 publications

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“…The specific part of the vertebra that was injured was not consistently available. The percentage of patients treated conservatively with bracing is not discernable from the registry; however, the role for bracing is unclear in osteoporotic TLS fractures . Finally, based on historical trends, as a result of decreased institutional participation over time, the registry would be expected to have missed approximately 6.6% of older adult admissions with traumatic injuries over the 10‐year time period.…”

Section: Discussionmentioning

confidence: 99%

Spinal Fractures in Older Adult Patients Admitted After Low‐Level Falls: 10‐Year Incidence and Outcomes

Jawa

Singer

Rutigliano

et al. 2016

J American Geriatrics Society

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Section: Discussionmentioning

confidence: 99%

Spinal Fractures in Older Adult Patients Admitted After Low‐Level Falls: 10‐Year Incidence and Outcomes

Jawa

Singer

Rutigliano

et al. 2016

J American Geriatrics Society

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“…

neurosurgical focus

Neurosurg Focus 39 (4):E2, 2015T raumaTic thoracolumbar fractures account for roughly 90% of all spinal fractures, 7,29 with an estimated 160,000 occurring annually in North America alone. 29 Across published reports, the annual fracture incidence ranges from 23 to 90 per 100,000 people, and the age distribution is bimodal, with the first peak being found in young adults between 15 and 29 years of age and the second peak in adults older than 65 years.

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confidence: 99%

“…As with all spinal fractures, those within the lumbar spine can take on a variety of patterns 15 and can range from stable to unstable; most fractures therefore have both operative and nonoperative management options. 1,7,41 The decision to operate is traditionally based on such factors as fracture morphology, integrity of the posterior ligamentous complex, and neurological presentation. 16,39 For the elderly, however, there must also be a careful consideration of perioperative risk (including preexisting comorbidities, premorbid quality of life, and goals of care) versus potential benefit.…”

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confidence: 99%

Perioperative morbidity and mortality after lumbar trauma in the elderly

Winkler¹,

Yue²,

Birk³

et al. 2015

FOC

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OBJECT Traumatic fractures of the thoracolumbar spine are common injuries, accounting for approximately 90% of all spinal trauma. Lumbar spine trauma in the elderly is a growing public health problem with relatively little evidence to guide clinical management. The authors sought to characterize the complications, morbidity, and mortality associated with surgical and nonsurgical management in elderly patients with traumatic fractures of the lumbar spine. METHODS Using the National Sample Program of the National Trauma Data Bank, the authors performed a retrospective analysis of patients ≥ 55 years of age who had traumatic fracture to the lumbar spine. This group was divided into middle-aged (55–69 years) and elderly (≥ 70 years) cohorts. Cohorts were subdivided into nonoperative, vertebroplasty or kyphoplasty, noninstrumented surgery, and instrumented surgery. Univariate and multivariable analyses were used to characterize and identify predictors of medical and surgical complications, mortality, hospital length of stay, ICU length of stay, number of days on ventilator, and hospital discharge in each subgroup. Adjusted odds ratios, mean differences, and associated 95% CIs were reported. Statistical significance was assessed at p < 0.05, and the Bonferroni correction for multiple comparisons was applied for each outcome analysis. RESULTS Between 2003 and 2012, 22,835 people met the inclusion criteria, which represents 94,103 incidents nationally. Analyses revealed a similar medical and surgical complication profile between age groups. The most prevalent medical complications were pneumonia (7.0%), acute respiratory distress syndrome (3.6%), and deep venous thrombosis (3%). Surgical site infections occurred in 6.3% of cases. Instrumented surgery was associated with the highest odds of each complication (p < 0.001). The inpatient mortality rate was 6.8% for all subjects. Multivariable analyses demonstrated that age ≥ 70 years was an independent predictor of mortality (OR 3.16, 95% CI 2.77–3.60), whereas instrumented surgery (multivariable OR 0.38, 95% CI 0.28–0.52) and vertebroplasty or kyphoplasty (OR 0.27, 95% CI 0.17–0.45) were associated with decreased odds of death. In surviving patients, both older age (OR 0.32, 95% CI 0.30–0.34) and instrumented fusion (OR 0.37, 95% CI 0.33–0.41) were associated with decreased odds of discharge to home. CONCLUSIONS The present study confirms that lumbar surgery in the elderly is associated with increased morbidity. In particular, instrumented fusion is associated with periprocedural complications, prolonged hospitalization, and a decreased likelihood of being discharged home. However, fusion surgery is also associated with reduced mortality. Age alone should not be an exclusionary factor in identifying surgical candidates for instrumented lumbar spinal fusion. Future studies are needed to confirm these findings.

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“…Although the scientific evidence on the effectiveness of most non-pharmacological treatments in VCF is conflicting [21, 55–57], a multimodal approach, using both pharmacological and non-pharmacological treatments, is strongly recommended for pain treatment in older patients. Non-pharmacologic treatment including physiotherapy has considerably less frequent and less severe adverse events, and is central in improving pain, muscle strength, posture and mobility in these patients.…”

Section: Discussionmentioning

confidence: 99%

Management of vertebral compression fracture in general practice: BEACH program

et al. 2017

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ImportanceThe pain associated with vertebral compression fractures can cause significant loss of function and quality of life for older adults. Despite this, there is little consensus on how best to manage this condition.ObjectiveTo describe usual care provided by general practitioners (GPs) in Australia for the management of vertebral compression fractures.Design, setting and participantsData from the Bettering the Evaluation And Care of Health (BEACH) program collected between April 2005 and March 2015 was used for this study. Each year, a random sample of approximately 1,000 GPs each recorded information on 100 consecutive encounters. We selected those encounters at which vertebral compression fracture was managed. Analyses of management options were limited to encounters with patients aged 50 years or over.Main outcome(s) and measure(s)i) patient demographics; ii) diagnoses/problems managed; iii) the management provided for vertebral compression fracture during the encounter. Robust 95% confidence intervals, adjusted for the cluster survey design, were used to assess significant differences between group means.ResultsVertebral compression fractures were managed in 211 (0.022%; 95% CI: 0.018–0.025) of the 977,300 BEACH encounters recorded April 2005– March 2015. That provides a national annual estimate of 26,000 (95% CI: 22,000–29,000) encounters at which vertebral fractures were managed. At encounters with patients aged 50 years or over (those at higher risk of primary osteoporosis), prescription of analgesics was the most common management action, particularly opioids analgesics (47.1 per 100 vertebral fractures; 95% CI: 38.4–55.7). Prescriptions of paracetamol (8.2; 95% CI: 4–12.4) or non-steroidal anti-inflammatory drugs (4.1; 95% CI: 1.1–7.1) were less frequent. Non-pharmacological treatment was provided at a rate of 22.4 per 100 vertebral fractures (95% CI: 14.6–30.1). At least one referral (to hospital, specialist, allied health care or other) was given for 12.3 per 100 vertebral fractures (95% CI: 7.8–16.8).Conclusions and relevanceThe prescription of oral opioid analgesics remains the common general practice approach for vertebral compression fractures management, despite the lack of evidence to support this. Clinical trials addressing management of these fractures are urgently needed to improve the quality of care patients receive.

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Bracing for thoracolumbar fractures

Cited by 54 publications

References 43 publications

Spinal Fractures in Older Adult Patients Admitted After Low‐Level Falls: 10‐Year Incidence and Outcomes

Spinal Fractures in Older Adult Patients Admitted After Low‐Level Falls: 10‐Year Incidence and Outcomes

Perioperative morbidity and mortality after lumbar trauma in the elderly

Management of vertebral compression fracture in general practice: BEACH program

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