How Should Patients with a Thoracolumbar Injury Classification and Severity Score of 4 Be Treated?

Lee, Nam-Hun; Kim, Sung Kyu; Seo, Hyoung‐Yeon; Park, Eric T; Jang, Won-Young

doi:10.3390/jcm10214944

Cited by 3 publications

(3 citation statements)

References 23 publications

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“…To determine whether this difference is clinically significant, a predetermined MCID of 3.8° was used. Since there is no widely accepted MCID for this variable, an anchor-based method was employed, as described in a 2021 article by Lee et al, 9 which reported that a difference of 3.8° or higher correlated with clinical outcomes. Upon applying this MCID to our analysis, the confidence intervals of the pooled effect estimate of kyphotic angulation were found to include 3.8°, raising doubts about its clinical significance.…”

Section: Discussionmentioning

confidence: 99%

“…The minimal clinically important difference (MCID) of pain VAS, ODI, RMDQ, and kyphotic angulation were defined as 11, 7 7.8, 7 5, 8 and 3.8°, respectively. 9 …”

Section: Methodsmentioning

confidence: 99%

“…The minimal clinically important difference (MCID) of pain VAS, ODI, RMDQ, and kyphotic angulation were defined as 11, 7 7.8, 7 5, 8 and 3.8°, respectively. 9 Subsequently, the concepts of the above definitions were used to formulate a search strategy. We searched Medline, EMBASE, Web of Science, and Google Scholar, as illustrated in Figure 1.…”

Section: Definitions and Search Strategymentioning

confidence: 99%

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Surgical Versus Non-Surgical Treatment for Thoracolumbar Burst Fractures Without Neurological Deficit: A Systematic Review and Meta-Analysis

Chou

Hsu

Chai

2023

Global Spine Journal

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Study Design A systematic review and meta-analysis. Objective To update the systematic review comparing the outcomes between surgical and non-surgical treatment for thoracolumbar burst fractures without neurological deficit. Methods We registered a protocol in PROSPERO (ID: CRD42021291769) and searched Medline, Embase, Web of Science, and Google Scholar databases. Surgical and non-surgical treatments were compared in patients with thoracolumbar burst fractures without neurological deficits. Predefined outcomes at ≥6 months included pain (defined as a visual analog scale [VAS] of 0-100), functional outcomes (Oswestry Disability Index [ODI] of 0-50 and Roland-Morris Disability Questionnaire [RMDQ] of 0-24), and kyphotic angulation. Results Nineteen studies involving 1056 patients were included in the analyses. For outcomes at ≥6 months, little to no difference was found in pain VAS score (mean difference, .95 [95% confidence interval {CI}, -6.02 to 7.92]; 827 participants; 15 studies; I2 = 92%), ODI (mean difference, -1.40 [95% CI, -5.11 to 2.31]; 446 participants; 7 studies; I2 = 79%), and RMDQ (mean difference, -.73 [95% CI, -5.13 to 3.66]; 216 participants; 5 studies; I2 = 77%). The kyphotic angulation in the surgery group was 6.35° lower than that in the non-surgery group (mean difference, -6.56° [95% CI, -10.26° to -2.87°]; 527 participants; ten studies; I2 = 86%). The trial sequential analysis indicated all outcomes reached adequate statistical power. The certainty of the evidence for all 4 outcomes was very low. For the analysis of minimally invasive procedures compared to traditional open surgeries, a statistically significant subgroup difference was found for VAS and ODI ( P < .01 and P < .04, respectively). Conclusion Surgical and non-surgical treatments showed little or no difference in outcomes at ≥6 months. This review provides a conclusion with adequate statistical power by including non-randomized studies. However, non-randomized studies also lowered the certainty of the evidence to a very low level.

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Section: Discussionmentioning

confidence: 99%

“…The minimal clinically important difference (MCID) of pain VAS, ODI, RMDQ, and kyphotic angulation were defined as 11, 7 7.8, 7 5, 8 and 3.8°, respectively. 9 …”

Section: Methodsmentioning

confidence: 99%

Section: Definitions and Search Strategymentioning

confidence: 99%

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Surgical Versus Non-Surgical Treatment for Thoracolumbar Burst Fractures Without Neurological Deficit: A Systematic Review and Meta-Analysis

Chou

Hsu

Chai

2023

Global Spine Journal

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Research Progress of Finite Element Analysis in the Field of Thoracolumbar Fractures

郭

2024

ACM

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UBE decompression combined with percutaneous pedicle screw internal fixation for thoracolumbar burst fracture with secondary spinal stenosis: a technical note

Bai,

Qiu,

Wei

et al. 2024

Preprint

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Objective:The purpose of this study was to present the surgical technique of UBE decompression combined with percutaneous pedicle screws for the treatment of thoracolumbar burst fractures with secondary spinal stenosis. Background: Thoracolumbar burst fracture is a common traumatic disease in spinal surgery, the incidence of Atype fracture is the highest in the AO classification of thoracolumbar burst fracture, accounting for about 70% of the fracture, which is most common in the A1 and A3 fractures [1], and the fracture of the A3 fracture often occurs in the fracture block to the intra-vertebral canal displacement, resulting in secondary stenosis. The traditional approach is posterior open surgery pedicle screws combined with direct visualization for decompression, which requires extensive stripping of paravertebral muscles and resection of more bone, and is more traumatic [2], which is not in line with the current development concept of minimally invasive spine. The UBE technique in spinal endoscopy is currently a hot spot in the development of minimally invasive spine [3], and we attempted to utilize UBE decompression combined with percutaneous pedicle screws to treat thoracolumbar burst fracture with spinal stenosis, which provides a new option for the surgical treatment of thoracolumbar burst fracture with spinal stenosis. Methods: We included five patients with thoracolumbar burst fractures with secondary spinal stenosis admitted to our hospital between January 2023 and January 2024, who were treated with sub-UBE decompression combined with percutaneous pedicle screw internal fixation by our team. The degree of correction of spinal deformity was assessed using the sagittal Cobb angle and the percentage of height of the anterior margin of the vertebral body, the rate of canal encroachment was used to assess the decompression of the spinal canal, and the recovery of the patients' ability to live was assessed using the VAS and JOA scales. Results：the results showed that the average operative length of the patients was 154.2mins, and the average intraoperative bleeding was 90ml; the sagittal Cobb angle averaged 22.23° preoperatively, and 6.10° at 3 days postoperatively; the anterior vertebral body height ratio averaged 36.77% preoperatively, and 91.16% at 3 days postoperatively; and the residual spinal canal volume averaged 52.01% preoperatively, and 91.58% at 3 days postoperatively; VAS score averaged 7 preoperatively and 2 at 3 days postoperatively; JOA score averaged 8.4 preoperatively and 22.4 at 3 days postoperatively. Conclusions：UBE decompression combined with percutaneous pedicle screws is effective in the treatment of thoracolumbar burst fractures with secondary spinal stenosis and is a safe, minimally invasive surgical option for this patient population.

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How Should Patients with a Thoracolumbar Injury Classification and Severity Score of 4 Be Treated?

Cited by 3 publications

References 23 publications

Surgical Versus Non-Surgical Treatment for Thoracolumbar Burst Fractures Without Neurological Deficit: A Systematic Review and Meta-Analysis

Surgical Versus Non-Surgical Treatment for Thoracolumbar Burst Fractures Without Neurological Deficit: A Systematic Review and Meta-Analysis

Research Progress of Finite Element Analysis in the Field of Thoracolumbar Fractures

UBE decompression combined with percutaneous pedicle screw internal fixation for thoracolumbar burst fracture with secondary spinal stenosis: a technical note

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