Thoracolumbar fractures without neurological impairment

Abstract

An appropriate protocol and unified management of thoracolumbar fractures without neurological impairment has not been well defined.This review attempts to elucidate some controversies regarding diagnostic tools, the ability to define the most appropriate treatment of classification systems and the evidence for conservative and surgical methods based on the recent literature.Cite this article: Vilà-Canet G, García de Frutos A, Covaro A, Ubierna MT, Caceres E. Thoracolumbar fractures without neurological impairment: a review of diagnosis and treatment. EFORT Open Rev 2016;1:332-338. DOI: 10.1302/2058-5241.1.000029

Correlations between Sagittal Parameters and Functional Scores in 65-Year-Old Osteoporotic Females with Vertebral Body Fracture under Low-Energy Mechanism

“…A previous study revealed the promising potential of integrating shockwave therapy into LBP rehabilitation protocols, considering its anti-inflammatory, pain-relieving, muscle-relaxing, and nerve-fiber-remodeling effects [22]. Currently, no conclusive evidence supporting the superiority of any specific conservative management protocol is available [23], and the methods recommended by various guidelines are inconsistent [24]. Moreover, some conservative treatments lack robust evidence for support, and their efficacy remains unknown [25,26].…”

“…These interventions may be considered for individuals with painful VCFs characterized by significant kyphotic deformity or disability, particularly when patients do not respond to initial conservative management within a 4-6-week timeframe [21,31]. Studies have also suggested that surgery is a viable option for patients who were initially treated conservatively but are experiencing a progressive increase in kyphosis (>10 • compared with discharge X-ray) [23]. However, no clear consensus is currently available on the timing of surgical intervention in the management of VCFs.…”

Treatment of Osteoporotic Thoracolumbar Burst Fractures by Bilateral Pedicle Vertebroplasty Combined With Postural Reduction

“…However, for the majority of AO Spine type A3/A4 elderly osteoporotic thoracolumbar burst fractures are often complicated with basic diseases such as chronic bronchitis, emphysema, coronary atherosclerotic heart disease, or severe trauma and combined injury, and cannot tolerate open surgery under general anesthesia. Their own osteoporosis is easy to be treated by internal xation, which may lead to nail removal or loosening and falling off, and the need for second-stage removal and internal xation surgery, which not only increases the trauma, prolongs the operation time, but also increases medical costs [11][12][13][14][15].…”

Manejo quirúrgico en pacientes adultos con fractura toracolumbar. Revisión sistemática

“…Además, el sistema AO/OTA considera el patrón de la fractura como las fracturas causadas por compresión axial (tipo A), distracción (tipo B) o rotación (tipo C), y la presencia o ausencia de involucramiento neurológico. 10 Más recientemente se ha propuesto el sistema de Compendio de Clasificación de Fracturas y Dislocaciones (FDCC) como un sistema de clasificación exhaustivo y actualizado para las fracturas toracolumbares. Este sistema se basa en los principios del sistema AO/OTA, pero incluye una mayor refinación y consideraciones adicionales como la dirección de desplazamiento y la presencia de fracturas expansivas.…”

“…El sistema FDCC también está diseñado para proporcionar un lenguaje común y un marco para la clasificación de las fracturas vertebrales, lo que ayuda a mejorar la comunicación y la colaboración entre los profesionales de la salud. 9,10 Por último, el sistema de gravedad de lesiones toracolumbares (TLICS, por sus siglas en inglés) es un sistema de clasificación más nuevo para las fracturas toracolumbares que fue introducido a principios del año 2000 (Tabla 1). Comparado con clasificaciones más antiguas como el sistema Denis y el sistema AO/OTA, el TLICS ofrece ventajas.…”