Predictive factors for postoperative deformity in thoracolumbar burst fractures. A statistical approach.

Anghel, Stelian; Petrișor, Marius; Buicu, Corneliu Florin; Dénes, Márton; Bățagă, Tiberiu

doi:10.3944/aott.2015.14.0274

Cited by 7 publications

(5 citation statements)

References 36 publications

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“…It is necessary to further investigate whether the insufficient muscular strength and poor control provided by the fatty infiltration of the LMM is the cause of LBP or vice versa. Recent studies have shown that atrophy and muscle weakening give rise to disc degeneration and cause pain and instability of the spine but other causes such as trauma are also incriminated [17, 18]. Furthermore it would be useful to confirm whether fat infiltration in the lumbar LMM is reversible and if so, to confirm the study of Kim, et al that the reversibility coincides with improvement of symptoms [19].…”

Section: Discussionmentioning

confidence: 99%

Correlation between multifidus fatty atrophy and lumbar disc degeneration in low back pain

Faur

Pătraşcu

Hărăgus

et al. 2019

BMC Musculoskelet Disord

113

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Background Chronic low back pain (LBP) is common and associated with lumbar disc herniation. The purpose of this study was to investigate if the grade of lumbar disc degeneration correlates with the degree of lumbar multifidus muscle (LMM) fatty atrophy. Methods A retrospective analysis on 16 males and 19 females with chronic LBP and a mean age of 47.2 years. Using MRI, the grade of lumbar intervertebral discs degeneration was assessed according to the Pfirrmann classification at L4/L5 and L5/S1 levels. Fatty infiltration of the LMM was graded as normal, mild, moderate and severe. Adobe Photoshop CS6 was used for qualitative image analysis by measuring the Cross-sectional area (CSA) of the pure fat component of LMM. Results There was a low correlation (R = 0.37) and significant association (ANOVA, p = 0.001, 95% CI 2.07–8.14) between the grade of lumbar disc degeneration and the degree of LMM fatty atrophy. Mean value of intervertebral disc degeneration was 2.9 for the L4/L5 level and 3.2 for L5/S1 respectively. The percentage of fat infiltration of the LMM at both studied levels showed a mean value of 22.91+/− 13.19% for L4/L5 and a higher mean value of 26.37+/− 12.89% for L5/S1. There were higher fatty atrophy scores in women and more disc degeneration in men. Conclusion The percentage of LMM atrophy is higher in the lower levels (L5/S1) and shows a low correlation with the grade of disc degeneration.

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Section: Discussionmentioning

confidence: 99%

Correlation between multifidus fatty atrophy and lumbar disc degeneration in low back pain

Faur

Pătraşcu

Hărăgus

et al. 2019

BMC Musculoskelet Disord

113

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“…3 In 1983, Francis Denis popularized the concept of middle column by dividing it into three columns, a concept widely used today. 1,3,17,21,24,25,33,34 Several other classifications have emerged since then. McCormack, in 1994, noted that some cases of burst fracture surgically treated with short-segment fixation did not present a good outcome and created a new classification called LSC.…”

Section: Discussionmentioning

confidence: 99%

“…It was only in 1970 that Sir Frank introduced the concept of two columns, describing the burst fracture for the first time 3 . In 1983, Francis Denis popularized the concept of middle column by dividing it into three columns, a concept widely used today 1,3,17,21,24,25,33,34 . Several other classifications have emerged since then.…”

Section: Discussionmentioning

confidence: 99%

Thoracolumbar Burst Fracture: McCormack Load-sharing Classification

Filgueira

Imoto

Silva

et al. 2020

Spine

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Study Design. A systematic review and single-arm meta-analysis of randomized clinical trials.Objective. The aim of this study was to evaluate whether the load-sharing classification (LSC) is reliable to predict the best surgical approach for thoracolumbar burst fracture (TBF). Summary of Background Data. There is no previous review evaluating the efficacy of the use of LSC as a guide in the surgical treatment of burst fractures. Methods. On April 19 th , 2019, a broad search was performed in the following databases: EMBASE, PubMed, Cochrane, SCO-PUS, Web of Science, LILACS, and gray literature. This study was registered on the International Prospective Register of Systematic Reviews. We included clinical trials involving patients with TBF undergoing posterior surgical treatment, classified by load-sharing score, and that enabled the analysis of the outcomes loss of segmental kyphosis and implant failure (IF). We performed random-or fixed-effects models meta-analyses depending on the data homogeneity. Heterogeneity between studies was estimated by I 2 and t 2 statistics. Results. The search identified 189 references, out of which nine studies were eligible for this review. All articles presenting LSC up to 6 proved to be reliable in indicating that only posterior instrumentation is necessary, without screw failures or loss of kyphosis correction. For cases where the LSC was >6, only 2.5% of the individuals presented IF upon posterior approach alone. For loss of kyphosis correction, only 5% of patients had this outcome where LSC >6. For both outcomes together, we had 6% of postoperative problems (I 2 ¼ 77%, t 2 < 0.0015, P < 0.01). Conclusion. Load-sharing scores up to 6 are 100% reliable, only requiring posterior instrumentation for stabilization. For scores >6, the risk of implant breakage and loss of kyphosis correction in posterior fixation alone is low. Thus, other factors should be considered to define the best surgical approach to be adopted.

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“…1 Some degree of deformity is common after spine trauma, regardless of the treatment. 2-13 According to White et al and Whitesides, even a small degree of kyphosis, by increasing the moment arm, can lead to a progressive deformity over the years 14,15 ; however, at which point a posttraumatic deformity of the spine becomes clinically “relevant” or symptomatic is still up for debate. This “Spinal Posttraumatic Deformity” (SPTD) can require extensive surgery with high risk of complications and is more aggressive than treatment of the primary injury itself.…”

Section: Introductionmentioning

confidence: 99%

The Current Status of Spinal Posttraumatic Deformity: A Systematic Review

Gendt

Vercoulen

Joaquim

et al. 2020

Global Spine Journal

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Study Design: Systematic Review. Objective: To systematically analyze the definitions and descriptions in literature of “Spinal Posttraumatic Deformity” (SPTD) in order to support the development of a uniform and comprehensive definition of clinically relevant SPTD. Methods: A literature search in 11 international databases was performed using “deformity” AND “posttraumatic” and its synonyms. When an original definition or a description of SPTD (Patient factors, Radiological outcomes, Patient Reported Outcome Measurements and Surgical indication) was present the article was included. The retrieved articles were assessed for methodological quality and the presented data was extracted. Results: 46 articles met the inclusion criteria. “Symptomatic SPTD” was mentioned multiple times as an entity, however any description of “symptomatic SPTD” was not found. Pain was mentioned as a key factor in SPTD. Other patient related parameters were (progression of) neurological deficit, bone quality, age, comorbidities and functional disability. Various ways were used to determine the amount of deformity on radiographs. The amount of deformity ranged from not deviant for normal to >30°. Sagittal balance and spinopelvic parameters such as the Pelvic Incidence, Pelvic Tilt and Sacral Slope were taken into account and were used as surgical indicators and preoperative planning. The Visual Analog Scale for pain and the Oswestry Disability Index were used mostly to evaluate surgical intervention. Conclusion: A clear-cut definition or consensus is not available in the literature about clinically relevant SPTD. Our research acts as the basis for international efforts for the development of a definition of SPTD.

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Predictive factors for postoperative deformity in thoracolumbar burst fractures. A statistical approach.

Abstract: All valid regression models displayed modest explanatory power, suggesting that factors other than those taken into consideration are involved.

Cited by 7 publications

References 36 publications

Correlation between multifidus fatty atrophy and lumbar disc degeneration in low back pain

Correlation between multifidus fatty atrophy and lumbar disc degeneration in low back pain

Thoracolumbar Burst Fracture: McCormack Load-sharing Classification

The Current Status of Spinal Posttraumatic Deformity: A Systematic Review

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