Thoracolumbar fracture dislocation (AO type C injury): A systematic review of surgical reduction techniques

Kumar, Sandeep; Patralekh, Mohit Kumar; Boruah, Tankeshwar; Kareem, Shaffaf Abdul; Kumar, Akhilesh; Kumar, Ramesh

doi:10.1016/j.jcot.2019.09.016

Cited by 21 publications

(39 citation statements)

References 35 publications

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“…Meticulous care should be taken during the surgical reduction of the injuries to avoid iatrogenic vascular and neurological lesions. Sapan Kumar et al [37] have summerised the published literature papers on the surgical management of thoracolumbar fracture-dislocations and described the reduction maneuvers used in detail. In our case, the realignment was made with reduction forceps applied on spinous process of L2 and L4.…”

Section: Discussionmentioning

confidence: 99%

“…As only spinous processes are manually distracted, theoretically lesser risk of neurological insult is there. Disadvantages are higher risk of cut-out of the towel clips through spinous processes, particularly in osteoporosis cases, and hence failure to achieve reduction [37]. Rishi MK et al [38] insisted on critical steps to ensure safe surgical reduction of the spine: Unilateral exposure and temporary fixation, use of high-speed burr and drill to create screw track, avoid torque forces while inserting the screws, perform a laminectomy before reducing the dislocation, use of gentle reduction maneuvers with persuaders and rod rotation under direct visualization of the spinal cord.…”

Section: Discussionmentioning

confidence: 99%

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Thoracolumbar Spine Fracture-Dislocation without Neurological Deficit: A Case Report and Review of the Literature

Ilunga¹,

Diop²,

Faye³

et al. 2021

OJO

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Background: Thoracolumbar spine fracture-dislocations are very unstable and usually secondary to high energy trauma. Due to disruption of the entire vertebrae columns, the absence of neurological deficit is exceptional. Aim: The purpose of this work is to report our experience in the management of this entity in a context of limited resources and to make a review of the literature. Case presentation: A 30-year-old man was admitted with a severe low back pain after a traffic accident. Neurological functions were intact after examination. Radiological assessments revealed a complete L3-L4 fracture-dislocation. The patient underwent an open posterior reduction and internal long segment fixation. The post-operative was marked by a surgical site infection treated with surgical debridement and targeted antibiotic therapy. The neurological functions were preserved. Conclusion: Fracture-dislocations of the thoracolumbar spine are caused by high energy trauma and are remarkably unstable lesions. When they are associated with intact neurorological functions, reduction and stabilization of these fractures are a challenge.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Thoracolumbar Spine Fracture-Dislocation without Neurological Deficit: A Case Report and Review of the Literature

Ilunga¹,

Diop²,

Faye³

et al. 2021

OJO

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“…Удосконалення методів хірургічних втручань та накопичення клінічного матеріалу сприяли тому, що нині єдиним прийнятним результатом хірургічного втручання є відновлення осі хребта і декомпресія структур хребтового каналу незалежно від ступеня вихідної деформації, рівня неврологічних розладів та давності травми [13]. М.P.…”

Section: результати та їх обговоренняunclassified

“…Дані літератури свідчать про успішне застосування передніх, задніх і комбінованих підходів [8,14,24,25,17]. При цьому зазначено, що для СП класичні п'ять AOSpine методів вправлення ушкоджень типу С за TLSICS практично не застосовують [13]. Щодо СП без можливості вправлення, то в більшості випадків використовують ізольований задній або задньо-передньо-задній доступ.…”

Section: результати та їх обговоренняunclassified

Surgical management of traumatic irreducible spondyloptosis of thoracolumbar junction

Nekhlopochyn¹,

Verbov²,

Cheshuk³

et al. 2021

Ukr Neurosurg J

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Introduction. The thoracolumbar junction is the most common location of traumatic spinal injuries. It accounts for 50-60% of all thoracic and lumbar spine injuries. Spondyloptosis is rather rare, but one of the most severe types of traumatic injury, that is characterized by a severe damage of spinal axis in one or more planes. Traumatic spondyloptosis is classified as reducible and irreducible, depending on the possibility of intraoperative restoration of the spinal axis without resection of the damaged vertebra. Objective. To determine the optimal surgical technique for traumatic irreducible spondyloptosis of thoracolumbar junction. Materials and methods. A retrospective analysis of the patients’ database treated at the Romodanov Neurosurgery Institute, Ukraine was performed over the past 4 years (2017 to 2020) to identify all cases with traumatic irreducible spondyloptosis of the thoracolumbar junction. Results. Treatment outcomes of five patients aged 18 to 52 years (mean age 31.2 years) were analyzed. The minimum period from the moment of injury to surgery was 14 days, the maximum was 3 months and 2 days (on average 42.2 days). At the time of admission all patients had a neurological deficit that corresponds to the functional class A on the American spine injury associatin ASIA scale of severity of spinal cord injury. The TLICS (Thoracolumbar injury classification and severity) score was 8 points. All the patients had the injury of lateral spondyloptosis: in three cases as an isolated displacement only in the coronal plane, in two – as a combined one - in the coronal and sagittal plane. Surgical intervention in all cases was performed from the posterior approach. As a body replacement system in 2 patients, a vertical cylindrical implant (Mesh) was used, in 3 patients - a telescopic body replacing implant. The method of bicortical implantation of pedicle screws was applied. The transpedicular system was strengthened by two cross links of the rod-to-rod type. In all cases the restoration of spinal axis was achieved in both the coronal and sagittal planes. Follow-up examinations were carried out 2, 6 and 12-18 months of the postoperative period. Regression of neurological disorders was registered in two patients, in one case to ASIA B, in the other to ASIA C. Conclusions. Isolated posterior approach has demonstrated high efficacy in the surgical management of traumatic irreducible spondyloptosis of the thoracolumbar junction both in restoring the axis of the spine and in ensuring the stability of fusion.

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“…Spinal cord injuries play a major role in traumatic injuries which directly affects the patient's morbidity mortality and quality of life of the patients. Vertebral fractures are seen in 3% of polytrauma patients [1] . Spinal cord injuries occur due to the primary injury by the direct force or secondarily by ischemia, inflammation, or compression by fractured vertebral segments.…”

Section: Introductionmentioning

confidence: 99%

Rare association of traumatic diaphragmatic hernia with spinal cord injury: A case report

Rathnayaka

Pathinathan

Sivamynthan

et al. 2021

International Journal of Surgery Case Reports

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Introduction and importance The traumatic diaphragmatic hernia could be missed in the background of spinal fractures due to neurological weakness. We report the first case of the management of thoracolumbar fracture-dislocation associated with diaphragmatic injury. Presentation of case 53-year-old male transferred from local hospital following fallen from a motorbike on the 4th day after the injury. He was paraplegic from L1 below with sacral root involvement. Further imaging showed fracture-dislocation of the vertebral body at the T12-L1 level and anterior displacement of T11 on T12. The left-sided diaphragmatic hernia was detected by chest x-ray with bowel shadows in the left hemithorax. Emergency laparotomy and diaphragmatic repair followed by a posterior spinal exploration and pedicle screw fixation were done. Early mobilization was done after spinal fixation and the patient is successfully continuing rehabilitation. Clinical discussion Thoracolumbar fracture-dislocation associated with the traumatic diaphragmatic hernia is rare. Clinical diagnosis of associated visceral injuries could be delayed due to the neurological deficit of the patient. An initial concern was to repair the life-threatening diaphragmatic hernia. Even current studies showed improved neurological function from early spinal surgery, spinal fixation had to delay as surgery needs a prone position. Conclusion Early identification and management of traumatic diaphragmatic hernia are life-saving and allows early surgical intervention for the spine. Early reduction and fixation are associated with improved neurological function and will allow early mobilization and reduce hospital and ICU stay.

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Thoracolumbar fracture dislocation (AO type C injury): A systematic review of surgical reduction techniques

Cited by 21 publications

References 35 publications

Thoracolumbar Spine Fracture-Dislocation without Neurological Deficit: A Case Report and Review of the Literature

Thoracolumbar Spine Fracture-Dislocation without Neurological Deficit: A Case Report and Review of the Literature

Surgical management of traumatic irreducible spondyloptosis of thoracolumbar junction

Rare association of traumatic diaphragmatic hernia with spinal cord injury: A case report

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