Surgical Treatment of Traumatic Fractures of the Thoracic and Lumbar Spine

Verlaan, Jorrit‐Jan; Diekerhof, Carel H.; Buskens, Erik; Tweel, Ingeborg van der; Verbout, Abraham J.; Dhert, W.J.A.; Oner, F. Cumhur

doi:10.1097/01.brs.0000116990.31984.a9

Cited by 386 publications

(155 citation statements)

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“…A total of 17.7% from the cohort of patients with AS and 20.0% from the patients with DISH deceased within 3 months after injury whereas the previously reported mortality in individuals treated surgically for traumatic spinal fractures was only 0.4% [124]. The mortality in the follow-up phase was higher in DISH patients than in AS patients, regardless of type of treatment received.…”

Section: Discussionmentioning

confidence: 78%

“…Worsening of neurological function due to inadequate immobilization, inconsiderate transfers or application of a hard collar on the cervical spine with pre-existing kyphotic deformity was reported in several articles [68,74,89,122]. Compared to studies describing (healthy and considerably younger) individuals sustaining traumatic spine fractures where only 0.08% of the patients deteriorated in neurological function, these numbers are of major concern [124]. It is suggested that patients with traumatic fractures of the ankylosed spine are not only susceptible to initial neurological deficit but also to secondary neurological deterioration due to highly unstable fracture configurations between the fused segments [11].…”

Section: Discussionmentioning

confidence: 99%

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Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications

2008

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The ankylosed spine is prone to fracture after minor trauma due to its changed biomechanical properties. Although many case reports and small series have been published on patients with ankylosing spondylitis (AS) suffering spine fractures, solid data on clinical outcome are rare. In advanced diffuse idiopathic skeletal hyperostosis (DISH), ossification of spinal ligaments also leads to ankylosis. The prevalence of AS is stable, but since DISH may become more widespread due to its association with age, obesity and type 2 diabetes mellitus, a systematic review of the literature was conducted to increase the current knowledge on treatment, neurological status and complications of patients with preexisting ankylosed spines sustaining spinal trauma. A literature search was performed to obtain all relevant articles concerning the outcome of patients with AS or DISH admitted with spinal fractures. Predefined parameters were extracted from the papers and pooled to study the effect of treatment on neurological status and complications. Ninety-three articles were included, representing 345 AS patients and 55 DISH patients. Most fractures were localized in the cervical spine and resulted from low energy impact. Delayed diagnosis often occurred due to patient and doctor related factors. On admission 67.2% of the AS patients and 40.0% of the DISH patients demonstrated neurologic deficits, while secondary neurological deterioration occurred frequently. Surgical or nonoperative treatment did not alter the neurological prospective for most patients. The complication rate was 51.1% in AS patients and 32.7% in DISH patients. The overall mortality within 3 months after injury was 17.7% in AS and 20.0% in DISH. This review suggests that the clinical outcome of patients with fractures in previously ankylosed spines, due to AS or DISH, is considerably worse compared to the general trauma population. Considering the potential increase in prevalence of DISH cases, this condition may render a new challenge for physicians treating spinal injuries.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications

2008

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“…The advantages of this technique include less surgical dissection, blood loss, and time in surgery, and as a result, decreased perioperative morbidity. However, loss of reduction and instrumentation failure associated with this technique is well described in the literature 15–9. These failures have been attributed to poor bone quality, inadequate anterior column support, and insufficient points of fixation.…”

Section: Discussionmentioning

confidence: 99%

“…Posterior transpedicular pedicle screw fixation is widely used for obtaining internal fixation for management of the unstable spine mainly caused by trauma, and burst fractures comprise 10–20% of such injuries 1. The aims of surgery in these fracture cases include decompression of the neural components, fracture reduction, and providing a stable fixation until arthrodesis is achieved.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical efficacy of monoaxial or polyaxial pedicle screw and additional screw insertion at the level of fracture, in lumbar burst fracture: An experimental study

Wang

Liu

et al. 2012

IJOO

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Background:Use of a pedicle screw at the level of fracture, also known as an intermediate screw, has been shown to improve clinical results in managing lumbar fracture, but there is a paucity of biomechanical studies to support the claim. The aim of this study was to evaluate the effect of adding intermediate pedicle screws at the level of a fracture on the stiffness of a short-segment pedicle fixation using monoaxial or polyaxial screws and to compare the strength of monoaxial and polyaxial screws in the calf spine fracture model.Materials and Methods:Flexibility of 12 fresh-frozen calf lumbar spine specimens was evaluated in all planes. An unstable burst fracture model was created at the level of L3 by the pre-injury and dropped-mass technique. The specimens were randomly divided into monoaxial pedicle screw (MPS) and polyaxial pedicle screw (PPS) groups. Flexibility was retested without and with intermediate screws (MPSi and PPSi) placed at the level of fracture in addition to standard screws placed at L2 and L4.Results:The addition of intermediate screws significantly increased the stability of the constructs, as measured by a decreased range of motion (ROM) in flexion, extension, and lateral bending in both MPS and PPS groups (P < 0.05). There was neither any significant difference in the ROM in the spines of the two groups before injury, nor a difference in the ROM between the MPSi and PPSi groups (P > 0.05), but there was a significant difference between MPS and PPS in flexion and extension in the short-segment fixation group (P < 0.05).Conclusions:The addition of intermediate screws at the level of a burst fracture significantly increased the stability of short-segment pedicle screw fixation in both the MPS and PPS groups. However, in short-segment fixation group, monoaxial pedicle screw exhibited more stability in flexion and extension than the polyaxial pedicle screw.

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“…К причинам возникно-вения посттравматических деформа-ций относят неадекватно применен-ный метод консервативного лечения, позднее выявление переломов позво-ночника вследствие тяжести политрав-мы, сочетанной травмы, недиагности-рованные и нелеченные переломы позвонков [17,24].Посттравматические деформации приводят к нарушению сагиттального баланса туловища и возникновению болевых синдромов, функциональной несостоятельности грудного, пояснич-ного отделов позвоночника и космети-чески неприемлемых деформаций [18]. …”

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Staged Surgical Treatment of Posttraumatic Deformities in the Thoracic and Lumbar Spine

Рерих¹,

Borzykh²

2016

Hir. pozvonoč.

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Несмотря на успехи в хирургии повреждений грудного и пояснич-ного отделов позвоночника, вопрос поздних последствий травм грудных и поясничных позвонков остается актуальным. К причинам возникно-вения посттравматических деформа-ций относят неадекватно применен-ный метод консервативного лечения, позднее выявление переломов позво-ночника вследствие тяжести политрав-мы, сочетанной травмы, недиагности-рованные и нелеченные переломы позвонков [17,24].Посттравматические деформации приводят к нарушению сагиттального баланса туловища и возникновению болевых синдромов, функциональной несостоятельности грудного, пояснич-ного отделов позвоночника и космети-чески неприемлемых деформаций [18].

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Surgical Treatment of Traumatic Fractures of the Thoracic and Lumbar Spine

Abstract: In general, surgical treatment of traumatic spine fractures is safe and effective. Surgical techniques can only be compared using randomized controlled trials.

Cited by 386 publications

References 145 publications

Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications

Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications

Biomechanical efficacy of monoaxial or polyaxial pedicle screw and additional screw insertion at the level of fracture, in lumbar burst fracture: An experimental study

Staged Surgical Treatment of Posttraumatic Deformities in the Thoracic and Lumbar Spine

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