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Blais M, Shahidi B, Anderson B, O'Brien E, Moltzen C, Iannacone T, Eastlack RK, Mundis GM. The influence of ligament biomechanics on proximal junctional kyphosis and failure in patients with adult spinal deformity. JOR Spine 2023; 6:e1277. [PMID: 37780835 PMCID: PMC10540824 DOI: 10.1002/jsp2.1277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 07/04/2023] [Accepted: 08/03/2023] [Indexed: 10/03/2023] Open
Abstract
Purpose It is unknown whether the biomechanics of the posterior ligamentous complex (PLC) are impaired in individuals undergoing surgery for adult spinal deformity (ASD). Characterizing these properties may improve our understanding of proximal junctional kyphosis (PJK; defined as proximal junctional angle [PJA] of >10 deg from UIV-1 to UIV + 2), as well as proximal junctional failure (PJF; symptomatic PJK requiring revision). The purpose of this prospective observational study is to compare biomechanical properties of the PLC in individuals with ASD who do, and do not develop PJK or PJF within 1 year of spinal fusion surgery. Methods Intraoperative biopsies of PLC were obtained from 32 consecutive patients undergoing spinal fusions for ASD (>4 levels). Ligament peak force, tensile stress, tensile strain, and elastic modulus (EM) were measured with a materials testing system. Biomechanical properties and tissue dimensions were correlated with age, gender, BMI, vitamin D level, osteoporosis, sagittal alignment, PJA and change in PJA preoperatively, within 3 months, and at 1 year postoperatively. Results Longer ligaments were associated with greater PJA change at 3 months (p = 0.04), and thinner ligaments were associated with greater PJA change at 1 year (r = 0.57, p = 0.01). Greater EM was associated with greater PJA at both 3 months and 1 year (p = 0.03). Five participants had a change in PJA of >10 1 year postoperatively, and three participants demonstrated PJF. EM was significantly higher in individuals who required revision surgery (p = 0.003), and ligament length was greater (p = 0.03). Preoperative sagittal alignment was not related to incidence of revision surgery (p > 0.10). Conclusions The biomechanical properties of the PLC may be associated with higher risk for proximal failure. Ligaments that are longer, thinner, and less elastic are associated with higher postoperative PJA. Furthermore stiffer EM of the ligament is associated with the need for revision surgery.
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Affiliation(s)
- Micah Blais
- Department of Orthopaedic SurgeryScripps Clinic Medical GroupSan DiegoCaliforniaUSA
| | - Bahar Shahidi
- Department of Orthopaedic SurgeryUC San DiegoLa JollaCaliforniaUSA
| | - Brad Anderson
- Department of Orthopaedic SurgeryUC San DiegoLa JollaCaliforniaUSA
| | - Eli O'Brien
- Department of Orthopaedic SurgeryScripps Clinic Medical GroupSan DiegoCaliforniaUSA
| | - Courtney Moltzen
- Department of Orthopaedic SurgeryScripps Clinic Medical GroupSan DiegoCaliforniaUSA
| | - Tina Iannacone
- Department of Orthopaedic SurgeryScripps Clinic Medical GroupSan DiegoCaliforniaUSA
| | - Robert K. Eastlack
- Department of Orthopaedic SurgeryScripps Clinic Medical GroupSan DiegoCaliforniaUSA
| | - Gregory M. Mundis
- Department of Orthopaedic SurgeryScripps Clinic Medical GroupSan DiegoCaliforniaUSA
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Aly T. Correlation between presence of traumatic disco-ligamentous injuries as an MRI finding with the results of management of thoracolumbar and lumbar injuries. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2023; 30. [DOI: 10.1177/22104917221147690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
Introduction: Radiographic study plays an important role in diagnosis of acute vertebral injuries and helps in proper management of those patients. Magnetic resonance imaging (MRI) is the modality of choice for evaluation of ligamentous and other soft tissue structures, disc, spinal cord and occult osseous injuries. Due to high cost, it is necessary to detect the best use of this technique in the evaluation of thoracolumbar spinal injuries. The purpose of this study was to evaluate the importance of MRI as indicators for vertebral ligamentous injuries and intervertebral disc injuries or herniation in management of thoracolumbar and lumbar fractures. Methods: Retrospective study using radiological measurements. Seventy-two patients with thoracolumbar and lumbar fractures were included. Radiographic parameters detected were percentage of compression, kyphosis angle, vertebral translation and scoliosis angle. Computed tomography was used to detect the degree of spinal canal narrowing, MRI was used to evaluate the condition of posterior ligamentous complex and intervertebral disc injury or herniation. American Spinal Injury Association score was recorded. Results: There were 83% AO spine type A, 6% AO spine type B and 11% AO spine type C. Correlation between fracture type and neurological status with the posterior ligamentous complex injury was found to be significant: ( P = 0.0143 and P = 0.0344, respectively). Degree of vertebral body compression, kyphosis and scoliosis angles, vertebral body translation and spinal canal narrowing were found to be insignificant in correlation with posterior ligamentous complex injuries. Correlation of the above-mentioned parameters with disc injury or herniation was found to be insignificant except for kyphotic angle that was found to be significant in correlation with posttraumatic disc herniation ( P = 0.0219). Conclusion: MRI finding is of great value in management plan of thoracolumbar and lumbar fractures. Injury of posterior ligamentous complex is significantly correlated with fracture severity and the neurological function. But the intervertebral disc injury or herniation was not correlated to them except that the disc herniation was significantly correlated to kyphosis angle.
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Affiliation(s)
- Tarek Aly
- Orthopedic Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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3
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Leister I, Mittermayr R, Mattiassich G, Aigner L, Haider T, Machegger L, Kindermann H, Grazer-Horacek A, Holfeld J, Schaden W. The effect of extracorporeal shock wave therapy in acute traumatic spinal cord injury on motor and sensory function within 6 months post-injury: a study protocol for a two-arm three-stage adaptive, prospective, multi-center, randomized, blinded, placebo-controlled clinical trial. Trials 2022; 23:245. [PMID: 35365190 PMCID: PMC8973563 DOI: 10.1186/s13063-022-06161-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/07/2022] [Indexed: 12/14/2022] Open
Abstract
Background The pathological mechanism in acute spinal cord injury (SCI) is dual sequential: the primary mechanical lesion and the secondary injury due to a cascade of biochemical and pathological changes initiated by the primary lesion. Therapeutic approaches have focused on modulating the mechanisms of secondary injury. Despite extensive efforts in the treatment of SCI, there is yet no causal, curative treatment approach available. Extracorporeal shock wave therapy (ESWT) has been successfully implemented in clinical use. Biological responses to therapeutic shock waves include altered metabolic activity of various cell types due to direct and indirect mechanotransduction leading to improved migration, proliferation, chemotaxis, modulation of the inflammatory response, angiogenesis, and neovascularization, thus inducing rather a regeneration than repair. The aim of this clinical study is to investigate the effect of ESWT in humans within the first 48 h after an acute traumatic SCI, with the objective to intervene in the secondary injury phase in order to reduce the extent of neuronal loss. Methods This two-arm three-stage adaptive, prospective, multi-center, randomized, blinded, placebo-controlled study has been initiated in July 2020, and a total of 82 patients with acute traumatic SCI will be recruited for the first stage in 15 participating hospitals as part of a two-armed three-stage adaptive trial design. The focused ESWT (energy flux density: 0.1–0.19 mJ/mm2, frequency: 2–5 Hz) is applied once at the level of the lesion, five segments above/below, and on the plantar surface of both feet within the first 48 h after trauma. The degree of improvement in motor and sensory function after 6 months post-injury is the primary endpoint of the study. Secondary endpoints include routine blood chemistry parameters, the degree of spasticity, the ability to walk, urological function, quality of life, and the independence in everyday life. Discussion The application of ESWT activates the nervous tissue regeneration involving a multitude of various biochemical and cellular events and leads to a decreased neuronal loss. ESWT might contribute to an improvement in the treatment of acute traumatic SCI in future clinical use. Trial registration ClinicalTrials.govNCT04474106 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06161-8.
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Affiliation(s)
- Iris Leister
- ParaMove, SCI Research Unit, BG Trauma Center Murnau, Murnau, Germany, and Paracelus Medical University, Salzburg, Austria. .,Spinal Cord Injury Center, Clinical Research Unit, BG Trauma Center Murnau, Murnau, Germany. .,Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria. .,Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria.
| | - Rainer Mittermayr
- Ludwig-Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,AUVA Trauma Center Meidling, Vienna, Austria
| | - Georg Mattiassich
- Ludwig-Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Department of Orthopedics and Trauma Surgery, Klinik Diakonissen Schladming, Schladming, Austria
| | - Ludwig Aigner
- ParaMove, SCI Research Unit, BG Trauma Center Murnau, Murnau, Germany, and Paracelus Medical University, Salzburg, Austria.,Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria
| | - Thomas Haider
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Lukas Machegger
- Division of Neuroradiology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Harald Kindermann
- Department of Marketing and Electronic Business, University of Applied Sciences Upper Austria, Steyr, Austria
| | | | - Johannes Holfeld
- University Clinic of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Wolfgang Schaden
- Ludwig-Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,AUVA Trauma Center Meidling, Vienna, Austria
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Nakamae T, Kamei N, Fujimoto Y, Yamada K, Ujigo S, Adachi N. Spinous Process Fractures in Osteoporotic Vertebral Fractures: A Cross-Sectional Study. Spine Surg Relat Res 2022; 6:139-144. [PMID: 35478979 PMCID: PMC8995117 DOI: 10.22603/ssrr.2021-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/07/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction The purpose of this study was to assess radiological features and clinical scores of osteoporotic vertebral fracture (OVF) accompanied by spinous process fracture (SPF). Methods We included painful patients with single-level OVF with intravertebral cleft. SPF was detected using magnetic resonance imaging (MRI) and/or computed tomography (CT). The plain radiographs of the vertebral fractures were evaluated based on the wedging angle of the fractured vertebrae and vertebral instability. We investigated the clinical parameters of age, gender, visual analog scale (VAS) score for low back pain (LBP), Oswestry Disability Index (ODI), and the period from the onset of acute fracture. Results MRI and/or CT indicated among 195 patients of OVF with LBP, 41 patients (20.5%) had SPFs. SPFs were observed one level above the fractured vertebral body in 35 patients (85.4%) and at the same level as the fractured vertebral body in 6 patients (14.6%). The prevalence of vertebral fracture of thoracic spine in the SPF-positive group was significantly greater than that in the SPF-negative group. There were no significant differences in age, gender, VAS, ODI, the time period from the onset of acute LBP, wedging angle, and vertebral instability between the presence or absence of SPFs. Conclusions SPFs occurred in 20.5% of patients with OVF and LBP. In addition, SPFs often occurred one level above the fractured vertebra, and SPFs with OVF tended to be located in the thoracic spine.
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Affiliation(s)
- Toshio Nakamae
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Naosuke Kamei
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | | | - Kiyotaka Yamada
- Department of Orthopaedic Surgery, JA Hiroshima General Hospital
| | - Satoshi Ujigo
- Department of Orthopaedic Surgery, JA Hiroshima General Hospital
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
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Saadeh YS, Strong MJ, Muhlestein WE, Koduri S, Park P. Commentary: Posterior Nerve-Sparing Corpectomy With Ventral Cage Reconstruction for a Lumbar Burst Fracture: A Video Illustration: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2022; 22:e102-e103. [PMID: 35007239 DOI: 10.1227/ons.0000000000000061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 09/19/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Yamaan S Saadeh
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
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Cai M, Xin Z, Kong W, Du Q, Ji W, Wu F, Li J, He J, Liao W. Clinical effect of a novel transpedicular reducer for reduction and bone grafting combined with pedicle screw fixation for thoracolumbar burst fractures. BMC Musculoskelet Disord 2021; 22:540. [PMID: 34126973 PMCID: PMC8204475 DOI: 10.1186/s12891-021-04423-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Short-segment transpedicular screw fixation is a common method for the treatment of thoracolumbar burst fractures (TBFs),but this technique has many problems. Therefore,the purpose of this article is to observe and evaluate the clinical efficacy of a novel transpedicular reducer that we designed for fractured vertebral body reduction and bone grafting in the treatment of TBFs. METHODS From July 2018 to November 2020, 70 cases of TBFs were included. Thirty-five patients were treated with the novel transpedicular reducer for reduction and bone grafting combined with pedicle screw fixation (observation group), and 35 patients were treated with short-segment transpedicular screw fixation (control group). Before the operation, after reduction, and 3 days, 3 months,and 12 months after the operation, the two groups were assessed, and compared with respect to the anterior and middle heights of the injured vertebrae, the ratios of the anterior and middle heights of the injured vertebral body to the respective heights of the adjacent uninjured vertebral bodies (AVBHr and MVBHr, respectively), and the Cobb angle of the patients. We compared the pain VAS score and quality of life GQOL-74 score at the last follow-up. Finally,we evaluated the distribution of bone grafts and bone healing 12 months after the operation. RESULTS The anterior height, middle height, AVBHr, MVBHr, and Cobb angle of the injured vertebral body in the observation after reduction, and 3 days, 3 months and 12 months post-operatively were compared with those of the injured vertebral body before operation. All of these parameters were improved, and the difference was statistically significant (p < 0.05). These parameters in the observation group at the above time points were significantly better than thoes in the control group at the corresponding time points (p < 0.05). The VAS scores at the last follow-up were significantly better than those of the control group (p < 0.05), but the GQOL-74 score differences were not statistically significant (p > 0.05). The observation group showed no obvious defects on CT at 12 months after the operation, and the bone healing was good. CONCLUSION The novel transpedicular reducer for reduction and bone grafting combined with pedicle screw fixation for TBFs has good clinical efficacy.
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Affiliation(s)
- Menghan Cai
- Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563099, Guizhou, China
| | - Zhijun Xin
- Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563099, Guizhou, China
| | - Weijun Kong
- Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563099, Guizhou, China
| | - Qian Du
- Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563099, Guizhou, China
| | - Wenjun Ji
- Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563099, Guizhou, China
| | - Fujun Wu
- Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563099, Guizhou, China
| | - Jin Li
- Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563099, Guizhou, China
| | - Jialin He
- Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563099, Guizhou, China
| | - Wenbo Liao
- Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563099, Guizhou, China.
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Alan N, Donohue J, Ozpinar A, Agarwal N, Kanter AS, Okonkwo DO, Hamilton DK. Load-Sharing Classification Score as Supplemental Grading System in the Decision-Making Process for Patients With Thoracolumbar Injury Classification and Severity 4. Neurosurgery 2021; 89:428-434. [PMID: 34038938 DOI: 10.1093/neuros/nyab179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 03/30/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Patients with Thoracolumbar Injury Classification and Severity (TLICS) score of 4 fall into a gray zone between surgical and conservative management. The integrity of posterior ligamentous complex (PLC) evaluated by magnetic resonance imaging (MRI) contributes to surgical decision-making. Load-sharing classification (LSC) may provide a modifier to further guide decision-making in these patients. OBJECTIVE To evaluate associations between LSC score and MRI acquisition, compromise of PLC on MRI, and surgical intervention in TLICS 4 patients. METHODS A cohort of 111 neurologically intact patients with isolated thoracolumbar burst fracture with TLICS 4 was evaluated. LSC score was determined based on degree of comminution (1-3), apposition (1-3), and kyphosis (1-3), total composite score of 3 to 9. RESULTS Overall, 44 patients underwent MRI, 15 had PLC injury, and 32 (28.8%) underwent surgery. LSC score was higher in patients who had an MRI (median 6 vs 3, P < .001) and patients who had surgery (median 7 vs 4, P < .001). In univariate logistic regression, LSC score was associated with MRI acquisition (odds ratio [OR] 1.7; 1.32-2.12; P < .001), presence of PLC injury on MRI (OR 1.5; 1.2-2.0; P = .002) and, in multivariate logistic regression, undergoing surgical intervention (OR 3.7; 2.3-5.9; P < .001), independent of MRI or PLC injury. CONCLUSION LSC score in neurologically intact patients with isolated thoracolumbar burst fracture with TLICS 4 was independently associated with operative intervention. The application of LSC may further guide decision-making in this patient group.
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Affiliation(s)
- Nima Alan
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Joseph Donohue
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Alp Ozpinar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Adam S Kanter
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - D Kojo Hamilton
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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8
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[Risk factors of recurrent kyphosis in thoracolumbar burst fracture patients treated by short segmental pedicle screw fixation]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2021; 53. [PMID: 33550352 PMCID: PMC7867990 DOI: 10.19723/j.issn.1671-167x.2021.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To analyze the risk factors of recurrent kyphosis after removal of short segmental pedicle screw fixation in patients with thoracolumbar burst fractures. METHODS Retrospective analysis was conducted of 144 cases of thoracolumbar burst fractures without neurological impairment treated in Peking University Third Hospital from January 2010 to December 2017. There were 74 males and 70 females, with an average age of (39.1±13.2) years. The distribution of the injured vertebrae was T12: 42, L1: 72 and L2: 30, with fracture types of A3: 90, B1: 25 and B2: 29. The patients were divided into two groups: Recurrent kyphosis group (n=92) and non-recurrent kyphosis group (n=52). SPSS 26.0 software was used for univariate analysis and Logistic regression analysis. RESULTS The average follow-up time was 28 (20-113) months. The imaging indexes of pre-operation, 3 days post-operation, 12 months post-operation and the last follow-up were measured and compared. Anterior vertebral body height, segmental kyphosis, vertebral wadge angle and Gardner deformity were significantly improved after operation (P < 0.05), and there were some degrees of loss in the 1-year follow-up; anterior vertebral body height and vertebral wadge angle were no longer changed after the removal of the screws; however, segmental kyphosis and Gardner deformity were still aggravated after the removal of the screws (P < 0.05). There were some degrees of collapse of the height of the upper and lower discs during the follow-up. Univariate analysis showed that there were statistically significant differences (P < 0.05) between the two groups in gender, age (36.9 years vs. 43.0 years), upper disc injury, CT value (174 vs. 160), segmental kyphosis (16.6° vs. 13.3°), vertebral wadge angle (16.7° vs. 13.6°), Gardner deformity (19.1° vs. 15.2°) and ratio of anterior vertebral body height (0.65 vs. 0.71). Logistic regression analysis showed that male (OR: 2.88, 95%CI: 1.196-6.933), upper disc injury (OR: 2.962, 95%CI: 1.062-8.258) and injured vertebral wedge angle were risk factors of recurrent kyphosis after removal of internal fixation for thoracolumbar burst fracture (P < 0.05). CONCLUSION The patients with thoracolumbar burst fracture can obtain satisfactory effect immediately after posterior short segmental pedicle screw fixation, however, there may be some degree of loss during the follow-up. Male, upper disc injury and injured vertebral wedge angle are the risk factors of recurrent kyphosis after removal of internal fixation for thoracolumbar burst fracture.
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Kadom N, Palasis S, Pruthi S, Biffl WL, Booth TN, Desai NK, Falcone RA, Jones JY, Joseph MM, Kulkarni AV, Marin JR, Milla SS, Mirsky DM, Myseros JS, Reitman C, Robertson RL, Ryan ME, Saigal G, Schulz J, Soares BP, Tekes A, Trout AT, Whitehead MT, Karmazyn B. ACR Appropriateness Criteria® Suspected Spine Trauma-Child. J Am Coll Radiol 2019; 16:S286-S299. [DOI: 10.1016/j.jacr.2019.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 02/07/2019] [Indexed: 12/29/2022]
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10
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Jiang L, Zhang H, Chen H, Wu Q. Kyphotic Angle of the Motion Segment Most Accurately Predicts Injury to the Ligamentous Complex on Computed Tomography Scan of Thoracolumbar Fractures. World Neurosurg 2018; 118:e405-e413. [DOI: 10.1016/j.wneu.2018.06.202] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 06/22/2018] [Accepted: 06/23/2018] [Indexed: 01/17/2023]
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Grelat M, Madkouri R, Comby PO, Fahed E, Lemogne B, Thouant P. Mid-Term Clinical and Radiological Outcomes After Kyphoplasty in the Treatment of Thoracolumbar Traumatic Vertebral Compression Fractures. World Neurosurg 2018; 115:e386-e392. [PMID: 29678706 DOI: 10.1016/j.wneu.2018.04.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 04/07/2018] [Accepted: 04/09/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND The management of thoracolumbar posttraumatic compression fractures varies widely among centers, and there is no real consensus as to the optimum approach. The objective of our retrospective study was to detect the progression of vertebral kyphosis in nonosteoporotic patients treated by balloon kyphoplasty (KPB) who presented with recent compression fractures of the thoracolumbar region. METHODS In this retrospective study, we investigated the evolution of vertebral and regional kyphosis in 77 patients treated by KPB for compression vertebral fractures (Magerl A) between 2007 and 2011. All treated patients, even those lost to follow-up, were included in our statistical analysis. RESULTS In the 77 patients, a 2.4° deterioration of vertebral kyphosis (P = 0.0004) and a 4.5° worsening of regional kyphosis (P < 0.0001) were observed at the end of the follow-up period. No statistical correlation between the worsened kyphosis and the deterioration of long-term pain was identified. The mean visual analog scale score was 2.5, associated with very low disability on functional scores. A3-2 and A3-3 fractures are characterized by worsening vertebral and regional kyphosis. CONCLUSIONS The paucity of studies of posttraumatic vertebral compression fractures in the scientific literature explains the lack of consensus regarding the optimum treatment approach. Postoperative results with KPB favor vertebral and regional kyphosis stability. KPB remains indicated in this situation except in cases of for burst fracture.
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Affiliation(s)
- Michael Grelat
- Department of Neurosurgery, Dijon University Hospital, Dijon, France.
| | - Rachid Madkouri
- Department of Neurosurgery, Dijon University Hospital, Dijon, France
| | | | - Elie Fahed
- Department of Neurosurgery, Dijon University Hospital, Dijon, France
| | - Brivael Lemogne
- Department of Neuroradiology, Dijon University Hospital, Dijon, France
| | - Pierre Thouant
- Department of Neuroradiology, Dijon University Hospital, Dijon, France
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Ruiz Santiago F, Tomás Muñoz P, Moya Sánchez E, Revelles Paniza M, Martínez Martínez A, Pérez Abela AL. Classifying thoracolumbar fractures: role of quantitative imaging. Quant Imaging Med Surg 2016; 6:772-784. [PMID: 28090452 DOI: 10.21037/qims.2016.12.04] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
This article describes different types of vertebral fractures that affect the thoracolumbar spine and the most relevant contributions of the different classification systems to vertebral fracture management. The vertebral fractures types are based on the three columns model of Denis that includes compression, burst, flexion-distraction and fracture-dislocation types. The most recent classifications systems of these types of fractures are reviewed, including the Thoracolumbar Injury Classification and Severity score (TLICS) and the Arbeitsgemeinschaft für Osteosynthesefragen Spine Thoracolumbar Injury Classification and Severity score (AOSpine-TLICS). Correct classification requires a quantitative imaging approach in which several measurements determine TLICS or AOSpine-TLICS grade. If the TLICS score is greater than 4, or the AOSpine-TLICS is greater than 5, surgical management is indicated. In this review, the most important imaging findings and measurements on radiography, multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) are described. These include degree of vertebral wedging and percentage of vertebral height loss in compression fractures, degree of interpedicular distance widening and spinal canal stenosis in burst fractures, and the degree of vertebral translation or interspinous widening in more severe fractures types, such as flexion-distraction and fracture-dislocation. These findings and measurements are illustrated with schemes and cases of our archives in a didactic way.
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Affiliation(s)
- Fernando Ruiz Santiago
- Radiology Department, Hospital of Traumatology, Carretera de Jaen SN, Granada 18014, Spain
| | - Pablo Tomás Muñoz
- Radiology Department, Ciudad Sanitaria Virgen de las Nieves (Hospital Complex University of Granada), Avenida de las Fuerzas Armadas 2, Granada 18014, Spain
| | - Elena Moya Sánchez
- Radiology Department, Ciudad Sanitaria Virgen de las Nieves (Hospital Complex University of Granada), Avenida de las Fuerzas Armadas 2, Granada 18014, Spain
| | - Marta Revelles Paniza
- Radiology Department, Ciudad Sanitaria Virgen de las Nieves (Hospital Complex University of Granada), Avenida de las Fuerzas Armadas 2, Granada 18014, Spain
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Lee S, Park MS, Kim YC, Kim TH. Osteoporotic thoracolumbar junctional fracture accompanied by spinous process fracture without posterior ligament injury: its clinical and radiologic significances. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:3478-3485. [PMID: 27260251 DOI: 10.1007/s00586-016-4634-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 04/27/2016] [Accepted: 06/01/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the clinical and radiologic outcome of osteoporotic thoracolumbar junctional fracture accompanied by spinous process fracture (SPF) without posterior ligament injury. METHODS A total of 391 patients with single-level osteoporotic thoracolumbar junctional (T10-L2) fracture were selectively enrolled. The patients were divided into two groups by absence (group I) or presence (group II) of SPF. Clinical and radiologic parameters were compared between the two groups. RESULTS Group I comprised of 332 patients with only vertebral body fracture, and group II comprised of 59 patients with both vertebral body and SPFs. In all cases of group II, SPFs were located just one level above the fractured vertebral body, and the injury of the posterior ligament was not found. At the time of injury, group II patients showed worse outcomes in anterior vertebral body compression percentage, kyphotic Cobb angle, cranial disk status, and the rate of the initial neurologic injury. Kyphotic alignment changes during 1-year follow-up were compared between the conservative subgroups of groups I and II. At the time of injury, there were no statistical differences in anterior vertebral body compression percentage and Cobb angle between the two conservative subgroups. However, the difference was significant after 1-year follow-up. Comparison of kyphotic alignment change at 12 months after diagnosis within group II was done according to the treatment method. Vertebroplasty subgroup in group II did not show benefit even in preventing such kyphotic alignment change, whereas instrumentation subgroup in group II showed lordotic alignment restoration despite more severe kyphotic alignment at the time of injury. CONCLUSIONS Osteoporotic thoracolumbar junctional fracture accompanied by spinous process fracture without posterior ligament injury represented more severe injury with flexion forces on the anterior column and tensile forces on the posterior column, and was related with more severe posttraumatic kyphotic changes during the 12-month follow-up.
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Affiliation(s)
- Seonjong Lee
- Spine Center, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896, Pyeongchon-Dong, Anyang City, Gyeonggi-Do, 431-070, Korea
| | - Moon Soo Park
- Spine Center, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896, Pyeongchon-Dong, Anyang City, Gyeonggi-Do, 431-070, Korea
| | - Yong-Chan Kim
- Spine Center, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896, Pyeongchon-Dong, Anyang City, Gyeonggi-Do, 431-070, Korea
| | - Tae-Hwan Kim
- Spine Center, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896, Pyeongchon-Dong, Anyang City, Gyeonggi-Do, 431-070, Korea.
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