Is There an Association With Spino-Pelvic Relationships and Clinical Outcome of Type A Thoracic and Lumbar Fractures Treated Non-Surgically?

Abstract

Background: The objective was to evaluate if there is an association of the spino-pelvic relationships and the global spinal alignment with the outcome of AO type A injuries treated nonsurgically. Methods: This is a retrospective case series. Patients treated nonsurgically for AOSpine type A fractures (T1-L5) with at least 1 year follow-up identified. A standing antero-posterior and lateral 36-inch radiographs and measures of spino-pelvic relationships and sagittal alignment were obtained, as well as clinical assessment using the visual analog scale, the Short-Form 36 (SF-36) questionnaire, the Oswestry Disability Index (ODI), and labor status. Results: Twenty-two patients with 33 fractures were included (L1 was the most injured level with 18.2%). There were 17 men (77.2%) and the mean age was 47.1 years. Follow-up ranged from 12 to 60 months (mean of 27.8 months). There were 22 type A1 (66.7%), 3 type A2 (9%), 6 type A3 (18%), and 2 type A4 (6%) fractures. The ODI ranged from 4% to 58%, with a mean of 24.4%. The SF-36 physical health score ranged from 23 to 82.25 (mean 49.59), and the mental health score ranged from 14.75 to 94.25 (mean 63.28). No association was identified between the spino-pelvic measurements, global alignment, and patient-reported outcomes. Conclusions: Type A fractures had a clinically relevant amount of long-term disability even when surgical treatment is not required. Spino-pelvic relationships and final global spinal alignment did not associate with outcome measurements.

Operative versus Non-Operative Management of Traumatic Thoracolumbar Injuries according to the AO Spine Thoracolumbar Spine Injury Classification System

“…7 Pain and some degree of disability may persist in some cases. 10 Comparative studies randomizing operative and nonoperative stable injuries are necessary to evaluate the benefits of pain control and the level of disability.…”

“…[6][7][8][9] However, some patients may still have chronic pain after the treatment of these fractures, despite being mechanically stable. 10 Neurological Deficits (Radicular -N2, Incomplete -N3 and Complete -N4)…”

AOSpine—Spine Trauma Classification System: The Value of Modifiers: A Narrative Review With Commentary on Evolving Descriptive Principles

“…For example, one study found that it accurately predicted treatment 99% of nonoperative cases, but it only accurately predicted treatment in 46.6% of patients in the operative treatment group. 27 The main drawback of this system is that it relies on interpretation of stability of the posterior ligamentous complex on MRI, which inherently varies between surgeons. The AOSpine thoracolumbar classification attempts to simplify fracture classification and guide treatment by creating hierarchical, morphologic criteria.…”

Alinhamento espinopélvico em pacientes com fratura toracolombar explosão

“…[5][6][7][9][10][11] No entanto, poucos estudos analisaram parâmetros espinopélvicos globais dos pacientes com FTE. 12,13 Nossa hipótese é que o alinhamento espinopélvico de indivíduos que tiveram FTE esteja alterado em relação à população assintomática em razão do aumento da CTL.…”