Thoracolumbar Fractures in Patients with Multiple Injuries: Diagnosis and Treatment???A Review of 147 Cases

Dai, Li-Yang; Yao, Wei-Fang; Chen, Yimin; Zhou, Qing

doi:10.1097/01.ta.0000035089.51187.43

Cited by 104 publications

(59 citation statements)

References 39 publications

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“…Although early spinal stabilization in thoracic and lumbar fractures is associated with shorter hospital stay, less complications and more neurological recovery, timing of surgical fixation of unstable fractures remains controversial [11,21,30,32,49,53].…”

Section: Introductionmentioning

confidence: 99%

Timing of thoracic and lumbar fracture fixation in spinal injuries: a systematic review of neurological and clinical outcome

2006

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Abstracts A systematic review of all available evidence on the timing of surgical fixation for thoracic and lumbar fractures with respect to clinical and neurological outcome was designed. The purpose of this review is to clarify some of the controversy about the timing of surgical fracture fixation in spinal trauma. Better neurological outcome, shorter hospital stay and fewer complications have been reported after early fracture fixation. But there are also studies showing no difference in neurological outcome when compared to late treatment. Mortality is another controversial point since a recent report of higher mortality in early treated patients. A systematic review of the literature was preformed. Ten articles were included. Early fracture fixation is associated with less complications, shorter hospital and ICU stay. The effect of early treatment on the neurological outcome remains unclear due to the contradictory results of the included studies. Early thoracic and lumbar fracture fixation results in improvement of clinical outcome, but the effect on neurological outcome remains controversial.

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Section: Introductionmentioning

confidence: 99%

Timing of thoracic and lumbar fracture fixation in spinal injuries: a systematic review of neurological and clinical outcome

2006

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“…A região torácica é acometida em 9 a 16 % dos casos 3 . Em geral, na etiologia das fraturas tóraco-lombares a queda é relatada com frequência relativa inferior da apresentada neste estudo 4,5 , o que provavelmente reflete uma característica peculiar da população atendida. O Hospital Santa Marcelina localiza-se na periferia leste da cidade de São Paulo, onde existe uma grande concentração de moradias de alvenaria e freqüentemente a cobertura é constituída por uma laje sem proteção nos seus limites.…”

Section: Discussionunclassified

“…A radiografia simples é importante não só para avaliar a integridade do alinhamento vertebral e da altura dos corpos vertebrais, mas também para o diagnós-tico de lesões em outros níveis 5 . No estudo de Vaccaro et al, 10,5% de 327 pacientes com fraturas de coluna múltiplas apresentaram fraturas que não eram contí-guas, recomendando a investigação rotineira de toda coluna através da radiografia em pacientes com lesões espinhais 11 .…”

Section: Discussionunclassified

Classificação das fraturas tóraco-lombares baseada em investigação por imagem: avaliação de 33 casos

Rios

Martins

Zanon-Colange

et al. 2006

Arq. Neuro-Psiquiatr.

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RESUMO -As fraturas das regiões torácica e lombar da coluna vertebral constituem amplo espectro de diferentes tipos de lesões resultantes de mecanismos fisiopatológicos distintos. A fim de se reduzir as controvérsias existentes a respeito da conduta destas lesões é necessária a utilização de uma classificação que permita a sua correta caracterização. Neste estudo avaliamos retrospectivamente 33 pacientes portadores de fraturas tóraco-lombares com o objetivo de categorizar e avaliar os fatores relacionados a esta patologia. O mecanismo de trauma mais freqüente foi queda de altura, presente em 24 casos. Na maioria dos pacientes (57,6%) as fraturas localizaram-se na transição tóraco-lombar (T12-L1) e o quadro neurológico mais freqüente foi o déficit sensitivo-motor completo abaixo da lesão, em 45,45% dos casos. A apresentação neurológica foi mais grave nos pacientes com lesões torácicas em relação às lesões lombares (teste de Fischer, p=0,039). Uma correlação positiva foi observada entre a severidade do quadro neurológico e a gravidade da lesão segundo a classificação de Magerl (r de Pearson=0,85, p<0,001). Concluímos que as fraturas tóraco-lombares são lesões graves considerando a apresentação neurológica inicial e que é necessária a utilização de uma classificação ampla e adequada como a utilizada no presente estudo. PALAVRAS-CHAVE: coluna vertebral, fraturas da coluna vertebral, lesão medular, classificação. Classification of thoracolumbar spine fractures based on a complete imaging investigation in 33 patientsABSTRACT -The thoracolumbar spine fractures constitute a wide spectrum of resultant lesions, with distinct injury mechanisms. In order to reduce the controversies concerning about the management of these fractures, a universally accepted classification is necessary. In this study we evaluated retrospectively 33 patients with thoracolumbar spine fracture, with the goal of categorize and evaluate the factors related to this pathology. A complete radiological investigation, complaining of plain radiography, computed tomography and magnetic ressonance imaging, was used to classify these fractures. Fall was the more common mechanism, present in 24 cases. In 57.6% of the patients, the fractures located at thoracolumbar transition (T12-L1) and the more frequent neurological presentation was total deficit, present in 45.45%. The neurological presentation was more serious in patients with thoracic lesions regarding lumbar lesions (Fischer's test, p=0.039). A positive correlation was observed between severity of the neurological presentation and gravity of the lesion according to Magerl's classification (Pearson's method, r=0.85, p<0.001). In conclusion, thoracolumbar spine fractures are serious lesions considering the initial neurological presentation; a wide and accurate classification, as we used, is necessary to describe these injuries and may help resolve some of the controversies concerning the management of these lesions.KEY WORDS: thoracolumbar spine fracture, spinal cord injury, classification.As fraturas t...

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“…The highest incidence of spinal fractures happened at the thoracolumbar region because of its special anatomical features [6]. It is considered that a vertebral height loss of more than 50 %, a local sagittal angle (LSA) (Fig.…”

Section: Discussionmentioning

confidence: 99%

A comparison of three different surgical procedures in the treatment of type A thoracolumbar fractures: a randomized controlled trial

Lyu¹,

Chen

Tang

et al. 2016

International Orthopaedics (SICOT)

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Purpose The aim of the study was to evaluate the efficacy of three different surgical procedures in the treatment of type A thoracolumbar fractures. Materials and methods Between September 2012 and January 2015, a total of 90 patients with type A thoracolumbar fractures were randomly assigned into three groups of 30 each. Patients in group A, B, and C were treated with threelevel percutaneous fixation, two-level percutaneous fixation, and three-level open fixation, respectively. Blood loss, duration of surgery, VAS scores, Cobb angles, and anterior height ratios of fractured vertebrae were collected for statistical analysis.Results The average follow-up was 17.7 months. Postoperative Cobb angles were significantly corrected and anterior height ratios of fractured vertebrae were well restored in all three groups (p < 0.01). Back pain was efficiently relieved according to VAS score change (p < 0.01). There were significant differences in values of blood loss and post-operative VAS scores (at three months) between group A and group C (p < 0.01). No significant difference concerning post-operative anterior height ratios of fractured vertebrae, Cobb angles and correction losses was observed between group A and group B (p = 0.580, 0.840, 0.215, respectively). Conclusion Percutaneous fixation not only provides the same reduction effect as open fixation, but also has an advantage of causing less operation related trauma which is beneficial to post-operative rehabilitation. The efficacy of three-level percutaneous fixation and two-level percutaneous fixation in the treatment of type A thoracolumbar fractures is not significantly different.

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Thoracolumbar Fractures in Patients with Multiple Injuries: Diagnosis and Treatment???A Review of 147 Cases

Cited by 104 publications

References 39 publications

Timing of thoracic and lumbar fracture fixation in spinal injuries: a systematic review of neurological and clinical outcome

Timing of thoracic and lumbar fracture fixation in spinal injuries: a systematic review of neurological and clinical outcome

Classificação das fraturas tóraco-lombares baseada em investigação por imagem: avaliação de 33 casos

A comparison of three different surgical procedures in the treatment of type A thoracolumbar fractures: a randomized controlled trial

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