Spontaneous Remodeling of the Spinal Canal After Conservative Management of Thoracolumbar Burst Fractures

Klerk, Luuk W. L. de; Fontijne, W. P. J.; Stijnen, Theo; Braakman, R.; Tanghe, H. L. J.; Linge, B. Van

doi:10.1097/00007632-199805010-00018

Cited by 94 publications

(46 citation statements)

References 27 publications

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“…Stabilization of the lesion site without decompression is, thus, a treatment option for this condition. Some studies have reported that treatment with immobilization without decompression, such as conservative management using a plaster body cast, vertebroplasty, or posterior in situ stabilization, could result in neurological improvement with progression of bone union [3,5,30]. These findings suggest that spinal instability is related to the pathogenesis of neurological deficits.…”

Section: Discussionmentioning

confidence: 99%

Factors affecting neurological deficits and intractable back pain in patients with insufficient bone union following osteoporotic vertebral fracture

et al. 2009

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The purpose of this study was to examine factors affecting the severity of neurological deficits and intractable back pain in patients with insufficient bone union following osteoporotic vertebral fracture (OVF). Reports of insufficient union following OVF have recently increased. Patients with this lesion have various degrees of neurological deficits and back pain. However, the factors contributing to the severity of these are still unknown. A total of 45 patients with insufficient union following OVF were included in this study. Insufficient union was diagnosed based on the findings of vertebral cleft on plain radiography or CT, as well as fluid collection indicating high-intensity change on T2-weighted MRI. Multivariate logistic regression analysis was performed to determine the factors contributing to the severity of neurological deficits and back pain in the patients. Age, sex, level of fracture, duration after onset of symptoms, degree of local kyphosis, degree of angular instability, ratio of occupation by bony fragments, presence or absence of protrusion of flavum, and presence or absence of ossification of the anterior longitudinal ligament (OALL) in the adjacent level were used as explanatory variables, while severity of neurological deficits and back pain were response variables. On multivariate analysis, factors significantly affecting the severity of neurological deficits were angular instability of more than 15°[adjusted odds ratio (OR), 9.24 (95% confidence interval, CI 1.49-57.2); P \ 0.05] and ratio of occupation by bony fragments in the spinal canal of more than 42% [adjusted OR 9.23 (95%CI 1.15-74.1); P \ 0.05]. The factor significantly affecting the severity of back pain was angular instability of more than 15°[ adjusted OR 14.9 (95%CI 2.11-105); P \ 0.01]. On the other hand, presence of OALL in the adjacent level reduced degree of back pain [adjusted OR 0.14 (95%CI 0.03-0.76); P \ 0.05]. In this study, pronounced angular instability and marked posterior protrusion of bony fragments in the canal were factors affecting neurological deficits. In addition, marked angular instability was a factor affecting back pain. These findings are useful in determining treatment options for patients with insufficient union following OVF.

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Section: Discussionmentioning

confidence: 99%

Factors affecting neurological deficits and intractable back pain in patients with insufficient bone union following osteoporotic vertebral fracture

et al. 2009

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“…Such remodeling has been reported for operatively and nonoperatively treated patients, occurring as a result of resorption of intracanal bone fragments [19,24,32,34,42,50,52,54]. Although concerns have been raised regarding inadequate remodeling in an observational study [32], Mumford et al [34] reported substantial remodeling in effectively all canals with greater than 50% compromise in nonoperative trials.…”

Section: Discussionmentioning

confidence: 99%

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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“…16,20 ± 24 de Klerk et al 24 observed that the process of remodeling usually takes place during the ®rst year after injury; after this period, there is little further remodeling. It is for this reason that we analyzed the follow-up canal compromise at 1 year.…”

Section: Discussionmentioning

confidence: 99%

Does neurological recovery in thoracolumbar and lumbar burst fractures depend on the extent of canal compromise?

Mohanty

Venkatram

2002

Spinal Cord

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Study design: Prospective study. Objectives: Forty-®ve consecutive cases of thoracolumbar and lumbar burst fractures treated non-operatively were analyzed to correlate the extent of canal compromise at the time of injury with (i) the initial neurologic de®cit and (ii) with the extent of neurological recovery at 1 year. The eect of spinal canal remodeling on neurological recovery was also analyzed. Setting: University teaching hospital in south India. Methods: The degree of spinal canal compromise and canal remodeling were assessed from computed tomography scans. The neurologic status was assessed by Frankel's grading. Results: The mean canal compromise in patients with neurologic de®cit was 46.2% while in patients with no neurological de®cit it was 36.3%. The mean spinal canal compromise in patients with neurological recovery was 46.1% and 48.4% in those with no recovery. The amount of canal remodeling in patients who recovered was 51.7% and 46.1% in the patients who did not recover. None of these dierences was statistically signi®cant. Conclusion: This study shows that there is no correlation between the neurologic de®cit and subsequent recovery with the extent of spinal canal compromise in thoracolumbar burst fractures.

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Spontaneous Remodeling of the Spinal Canal After Conservative Management of Thoracolumbar Burst Fractures

Abstract: Conservative management of thoracolumbar burst fractures is followed by a marked degree of spontaneous redevelopment of the deformed spinal canal. Therefore, this study provides a new argument in favor of the conservative management of thoracolumbar burst fractures.

Cited by 94 publications

References 27 publications

Factors affecting neurological deficits and intractable back pain in patients with insufficient bone union following osteoporotic vertebral fracture

Factors affecting neurological deficits and intractable back pain in patients with insufficient bone union following osteoporotic vertebral fracture

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

Does neurological recovery in thoracolumbar and lumbar burst fractures depend on the extent of canal compromise?

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