The Natural History of Burst Fractures at the Thoracolumbar Junction

Willén, Jan; Anderson, J. R.; Toomoka, Kazuhiko; Singer, Kevin

doi:10.1097/00002517-199003000-00007

Cited by 102 publications

(57 citation statements)

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“…After fracture, an anteriorly eccentric compression may force the vertebra into kyphosis [12,17]. The radiographic geometry of the neutral position in our specimens had similar values to those found in clinical studies, including the anterior and posterior vertebral heights, and the angle of the local kyphosis [8,9,14,17,24,27,29]. Measuring the orientation of the specimen under a flexion moment in the neutral position is therefore justified.…”

Section: Discussionsupporting

confidence: 72%

“…Judgement of instability has been based on retrospective studies of the pathological anatomy of these fractures [6,18,28,29] or on clinical reviews of the outcome [25]. Various criteria have been proposed, for example a decrease in vertebral height of more than 50% [5,17], an anterior compression over 50% [27], and a kyphotic angle greater than 35° [24] or 15° [9].…”

Section: Discussionmentioning

confidence: 99%

“…Other studies have suggested that various geometric measurements on lateral radiographs represent the stability of the fracture [17,27,29]. McAfee et al considered that a decrease of 50% or more of vertebral body height seen on lateral radiographs indicated instability, but they did not describe their method of measurement [18].…”

Section: Introductionmentioning

confidence: 99%

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Significant roentgenographic parameters for evaluating the flexibility of acute thoracolumbar burst fractures

Lin

Panjabi

Oxland

1997

International Orthopaedics

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

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Significant roentgenographic parameters for evaluating the flexibility of acute thoracolumbar burst fractures

Lin

Panjabi

Oxland

1997

International Orthopaedics

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“…Knight et al [15] found the indications for conservative treatment as absence of neurological deficit, anterior height loss less than 20%, kyphosis less than 20°, spinal canal narrowing less than 20%, single-level fractures and associated multiple fractures. Willen et al [23] reported that satisfactory results were obtained with conservative treatment in types A and B compression fractures. On the other hand they advocated surgical treatment in fractures with more than 50% anterior height loss, spinal canal narrowing and rotational instability at the fracture level.…”

Section: Discussionmentioning

confidence: 99%

Conservative treatment of fractures of the thoracolumbar spine

Tezer

Ertürer

Öztürk

et al. 2005

International Orthopaedics (SICOT)

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We reviewed 48 patients with thoracolumbar fractures treated conservatively between 1988 and 1999. The average follow-up was 77.5 (31-137) months and average patient age (23 women, 25 men) was 46 (18-76) years. Twenty-nine patients suffered a fall from a height and 13 patients were injured in traffic accidents. Thirty-two patients had compression-type fractures and 16 bursttype fractures. There were no neurological deficits. Twentynine patients were treated by orthosis, 13 by body cast and six by bed rest. In addition to pain and functional scoring, we measured a number of radiographic parameters at the time of admission and at latest follow-up and compared the values. In patients with compression fractures there were significant changes in scoliosis angle and wedging index (p<0.05). The mean pain score was 1.66 and mean functional score 1.03. In patients with burst fractures, vertebral index, wedging index and height loss increased after treatment (p<0.05). The mean pain score was 1.26 and functional score 0.93. Compression fractures with kyphosis angle <30°are supposed to be stable and can be treated conservatively. If the kyphosis angle is more than 30°, magnetic resonance imaging (MRI) should be performed, and if the posterior ligamentous complex is damaged, surgery should be considered. In burst fractures, MRI should always be performed and conservative treatment should only be considered if there is no neurological deficit and the ligaments are intact.

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“…Compression failure of both the anterior and the middle columns can cause burst fracture under axial loads (11,31). The optimal approach to treat burst fractures remains controversial (7,23,24,27).…”

Section: Introductionmentioning

confidence: 99%

Application of a crescent-shaped pmma strut in anterior spinal reconstruction of thoracolumbar and lumbar burst fractures: a new technique

Wan

Kang²,

Fei³

2011

Turkish Neurosurgery

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AIm: Our aim was to evaluate the safety and efficacy of the novel crescent-shaped PMMA strut for anterior spinal reconstruction and fusion in patients with thoracolumbar bust fractures. The surgical results using this technique are reviewed. mAterIAl and methOds: Six patients suffering thoracolumbar and lumbar fracture using a crescent-shaped PMMA strut combined with fixation for reconstruction of the anterior spinal column. Postoperative radiographic, included plain x-ray and 3-D computed tomography (CT) imaging, evaluated fusion status postoperatively. Pain relief and neurological status was assessed by comparing Frankel Score and Vision Analogue Score (VAS) pre-and postoperatively.results: All six patients achieved immediate stabilization. No patient needs additional posterior instrumentation stabilization due to loss of sagittal alignment and kyphosis deformity. All patients achieved significant relief of back pain, improvement of neurological function, correction of preoperative deformity and excellent bone fusion results documented on plain x-rays and 3-D CT reconstruction imaging. There were no complications of neurological worsening, wound infection, subsidence and dislodgement of PMMA strut, or anterior instrumentation failure during the follow-up. COnClusIOn:The crescent-shaped PMMA strut is an alternative for anterior spinal reconstruction and fusion in patients with thoracolumbar burst fracture. However, the long-term clinical effects and possible complications need further evaluation.KeywOrds: Burst fracture, Polymethylmethacrylate, Crescent-shaped, Anterior reconstruction ÖZ AmAÇ: Torakolomber bölgede patlama kırığı olan hastalarda rekonstrüksiyonu ve füzyonu sağlamak için kullanılan polimetilmetakrilattan yapılma, hilal şeklinde olan yapının etkinliğinin ve güvenilirliğinin saptanması için bu tekniğin kullanıldığı hastaların cerrahi sonuçlarının ortaya konması. yÖntem ve GereÇler: Polimetilmetakrilattan yapılma, hilal şeklindeki enstrüman, torakolomber bölgede patlama kırığı olan 6 hastada anterior kolonun rekonstrüksiyonunu ve füzyonunu sağlamak için kullanılmıştır; bu hastalara aynı zamanda stabilizasyon işlemi de yapılmıştır. Radyolojik olarak; düz grafiler ve 3 boyutlu bilgisayarlı tomografilerle füzyon ve rekonstrüksiyon gelişimi incelenmiştir. Ayrıca tüm hastalara ameliyat öncesi ve sonrası dönemde Frankel ölçütlemesi ve Görsel ağrı ölçütlemesi yapılmıştır.BulGulAr: Tüm hastalarda erken dönemde stabilizasyon gerçekleşmiştir. Hastaların hiçbirinde sagital plan bozulması ve kifoz gelişimi olmamıştır, bu nedenle fazladan bir posterior stabilizasyona gerek duyulmamıştır. Üç boyutlu bilgisayarlı tomografi ve normal x-ray grafilerinde hastalarda mükemmel füzyon geliştiği ve deformitelerinin düzeldiği görüldü; bunun yanı sıra, hastaların hepsinde bel ağrısı geçti, nörolojik fonksiyonları daha iyi hale geldi. Hastalarda nörolojik kötüleşme, Polimetilmetakrilattan yapılma hilal şeklindeki enstrümanın gömülmesi ya da uzerinde çıkması, yara infeksiyonu ve anterior enstrümanın yetmezliği gibi bi...

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The Natural History of Burst Fractures at the Thoracolumbar Junction

Cited by 102 publications

References 0 publications

Significant roentgenographic parameters for evaluating the flexibility of acute thoracolumbar burst fractures

Significant roentgenographic parameters for evaluating the flexibility of acute thoracolumbar burst fractures

Conservative treatment of fractures of the thoracolumbar spine

Application of a crescent-shaped pmma strut in anterior spinal reconstruction of thoracolumbar and lumbar burst fractures: a new technique

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