Erdinç ACAR
(Konya Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi, Ortopedi ve Travmatoloji El ve Üst Ekstremite Cerrahisi Anabilim Dalı, Konya, Türkiye)
(Ankara Üniversitesi, Tıp Fakültesi, Ortopedi Kliniği, Ankara, Türkiye)
Yıl: 2019Cilt: 18Sayı: 1ISSN: 2149-5807 / 2149-6048Sayfa Aralığı: 9 - 16İngilizce

91 0
Evaluation of Postoperative Clinical and Radiological Outcomes of Thoracolumbar Vertebral Fractures
Aim: The aim of this study was to measure a variety of clinical and radiological outcomes in a group of patients with thoracolumbar fractures who underwent surgery at a single center.Materials and Methods: We retrospectively analyzed 50 consecutive patients who underwent surgery for thoracolumbar vertebral fractures between September 2000 and December 2011. We assessed clinical outcomes with the visual analogue scale (VAS) for pain, Oswestry disability ındex (ODI), and Frankel scale. We measured radiological outcomes using the sagittal index (SI), Local Kyphosis Angle (LKA), and anterior corpus height loss (ACHL).Results: Preoperative, postoperative, and final visit mean VAS values were 82 mm, 60 mm, and 13.5 mm, and mean ODI values were 65%, 40%, and 15%, respectively. These clinical outcome improvements were all statistically significant (p<0.05). Similarly, mean SI values were 20°, 14°, and 15°, mean LKA values were 17°, 9°, and 13°, and mean ACHL values were 45%, 25%, and 28%, respectively. The preoperative to postoperative radiological outcome improvements were all statistically significant (p<0.05), whereas the postoperative to final visit measures actually demonstrated loss of correction, although these changes were not statistically significant.Conclusion: Although major progress has been made in the treatment of thoracolumbar vertebral fractures, the lack of standardized, verified clinical and radiological outcome measures continues to pose a challenge to the accurate assessment of the results of management.
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  • Schlegel J, Bayley J, Yuan H, Fredricksen B. Timing of surgical decompression and fixation of acute spinal fractures. J Orthop Trauma. 1996;10:323-30.
  • Singh K, Vaccaro A. Thoracic and lumbar trauma. In: Bono C, Garfin S, eds. Orthopaedic Surgery Essentials: Spine. Philadelphia: Lippincott, Williams& Wilkins; 2004.p.45-57.
  • Weringer P, Schultz A, Hertz H. Conservative management of thoracolumbar and lumbar spine compression and burst fractures: functional and radiographic outcomes in 136 cases treated by closed reduction and casting. Arch Orthop Trauma Surg 2009;129:207-19.
  • Verlaan JJ, Diekerhof CH, Buskens E, van der Tweel I, Verbout AJ, Dhert WJA, et al. Surgical treatment of traumatic fractures of the thoracic and lumbar spine: a systematic review of the literature on techniques, complications, and outcome. Spine 2004;29:803-14.
  • Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. In: Banaszkiewicz P, Kader D, eds. Classic Papers in Orthopaedics. London: Springer-Verlag; 2014.p.289-92.
  • Zdeblick TA, Sasso RC, Vaccaro AR, Chapman JR, Harris MB. Surgical treatment of thoracolumbar fractures. Instr Course Lect. 2009;58:639-44.
  • Stambough JL. Posterior instrumentation for thoracolumbar trauma. Clin Orthop Relat Res. 1997;335:73-88.
  • Altay M, Ozkurt B, Aytekin CN, Ozturk AM, Doğan O, Tabak AY. Treatment of unstable thoracolumbar junction burst fractures with short- or long-segment posterior fixation in Magerl type A fractures. Eur Spine J 2007;16:1145-55.
  • Zdeblick TA, Sasso RC, Vaccaro AR, Chapman JR, Harris MB. Surgical treatment of thoracolumbar fractures. Instr Course Lect. 2009;58:639-44.
  • Vaccaro AR, Lehman RA, Hurlbert RJ, Anderson PA, Harris M, Hedlund R, et al. A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine. 2005;30:2325-33.
  • Andress H-J, Braun H, Helmberger T, Schürmann M, Hertlein H, Hartl WH. Long-term results after posterior fixation of thoracolumbar burst fractures. Injury. 2002;33:357-65.
  • Accosta FL, Buckley JM, Xu Z, Lotz JC, Ames CP. Biomechanical comparison of three fixation techniques for unstable thoracolumbar burst fractures – laboratory investigation. J Neurosurg Spine. 2008;8:341-6. Disch AC, Knop C, Schaser KD, Blauth M, Schmoetz W. Angular stable anterior plating following thoracolumbar corpectomy reveals superior segmental stability compared to conventional polyaxial plate fixation. Spine. 2008;33:1429-37.
  • Hseih CT, Chen GJ, Wu Cc, Su YH. Complete fracture - dislocation of the thoracolumbar spine without paraplegia. Am J Emerg Med. 2008;26:633. e5-633.e7.
  • Kerwin AJ, Frykberg ER, Schinco MA, Griffen MM, Arce CA, Nguyen TQ, et al. The effect of early surgical treatment of traumatic spine injuries on patient mortality. J Trauma Inj Infect Crit Care. 2007;63:1308-13.
  • Copay AG, Glassman SD, Subach BR, Berven S, Schuler TC, Carreon LY. Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and Pain Scales. Spine J. 2008;8:968-74.
  • van Middendorp JJ, Goss B, Urquhart S, Atresh S, Williams RP, Schuetz M. Diagnosis and prognosis of traumatic spinal cord injury. Global Spine J. 2011;1:1-8.
  • Keynan O, Fisher CG, Vaccaro A, Fehlings MG,Öner FC, Dietz J, et al. Radiographic measurement parameters in thoracolumbar fractures: a systematic review and consensus statement of the spine trauma study group. Spine. 2006;31:E156-E165.
  • Bono CM, Vaccaro AR, Hurlbert RJ, Arnold P, Öner, FC, Harrop J, et al. Validating a newly proposed classification system for thoracolumbar spine trauma: looking to the future of the thoracolumbar injury classification and severity score. J Orthop Trauma. 2006;20:567-72.
  • Lee JY, Vaccaro AR, Lim MR, Öner FC, Hulbert RJ, Hedlund R, et al. Thoracolumbar injury classification and severity score: a new paradigm for the treatment of thoracolumbar spine trauma. J Orthop Sci. 2005;10:671-75.
  • Vaccaro AR, Baron EM, Sanfilippo J, Jacoby S, Steuve J, Grossman E, et al. Reliability of a novel classification system for thoracolumbar injuries: the Thoracolumbar Injury Severity Score. Spine. 2006;31(11 Suppl):S62-S69, S104.
  • Schoenfeld A, Bono CM. Measuring spine fracture outcomes: Common scales and checklists. Injury. 2011;42:265-70.
  • Knop C, Fabian HF, Bastian L, Blauth M. Late results of thoracolumbar fractures after posterior instrumentation and transpedicular bone grafting. Spine. 2001;26:88-99.
  • Oner FC, Ramos LMP, Simmermacher RKJ, Kingma P, Diekerhof C, Dhert W, et al. Classification of thoracic and lumbar spine fractures: problems of reproducibility - A study of 53 patients using CT and MRI. Eur Spine J. 2002;11:235-45.
  • He QY, Xu JZ. Short segmental pedicle screw fixation combined with percutaneous vertebroplasty in treatment of nonadjacent thoracolumbar fractures. Chin J Traumatol. 2009;12:138-41.
  • Liao JC, Fan KF, Chen WJ, Chen LH, Chen LH, Kao HK. Transpedicular bone grafting following short-segment posterior instrumentation for acute thoracolumbar burst fracture. Orthop. 2009;32:493.
  • Sasso RC, Renkens K, Hanson D, Reilly T, McGuire RA, Best NM. Unstable thoracolumbar burst fractures: anterior-only versus short-segment posterior fixation. J. Spinal Disord Tech. 2006;19:242-8.
  • Tezeren G, Gumus C, Bulut O, Tukenmez M, Oztemur Z, Sever G. Anterior versus modified combined instrumentation for burst fractures of the thoracolumbar spine: a biomechanical study in calves. J Orthop Surg. 2008;16:281-4.
  • Wang XY, Dai LY, Xu HZ, Chi YL. Kyphosis recurrence after posterior short-segment fixation in thoracolumbar burst fractures. J Neurosurg Spine. 2008;8:246-54.
  • Liu S, Li H, Liang C, Long H, Yu B, Chen B. Monosegmental transpedicular fixation for selected patients with thoracolumbar burst fractures. J Spinal Disord Tech. 2009;22:38-44.
  • Toyone T, Tanaka T, Kato D, Kaneyama R, Otsuka M. The treatment of acute thoracolumbar burst fractures with transpedicular intracorporeal hydroxyapatite grafting following indirect reduction and pedicle screw fixation: a prospective study. Spine. 2006;31:E208-14.
  • Glasser JA, Estes WJ. Distal short segment fixation of thoracolumbar and lumbar injuries. Iowa Orthop J. 1998;18:87-90.
  • Oda T, Panjabi MM. Pedicle screw adjustments affect stability of thoracolumbar burst fracture. Spine. 2001;26:2328-33.
  • Ferguson RL, Allen BJ. A mechanistic classification of thoracolumbar spine fractures. Clin Orthop Relat Res. 1984;189:77-88.
  • Boerger TO, Limb D, Dickson RA. Does ‘canal clearance’ affect neurological outcome after thoracolumbar burst fractures? Bone Joint J. 2000;82:629-35.
  • Ağuş H, Kayali C, Arslantaş M. Nonoperative treatment of burst-type thoracolumbar vertebral fractures: clinical and radiological results of 29 patients. Eur Spine J. 2005;14:536-40.
  • Dai L, Jia L, Zhao D, Xu Y. [Remodeling of the spinal canal after thoracolumbar burst fractures: significance of nonoperative management]. Zhonghua Wai Ke Za Zhi [Chin J Surg]. 2000;38:610-12.
  • Mikles MR, Stchur RP, Graziano GP. Posterior instrumentation for thoracolumbar fractures. J Am Acad Orthop Surg. 2004;12:424-35.
  • Vaccaro AR, Kim DH, Brodke DS, Harris M, Chapman JR, Schildhauver T. Diagnosis and management of thoracolumbar spine fractures. Instr Course Lect. 2004;53:359-73.
  • Danisa OA, Shaffrey CI, Jane JA, Whitehill R, Wang GJ, Szabu TA, et al. Surgical approaches for the correction of unstable thoracolumbar burst fractures: a retrospective analysis of treatment outcomes. J Neurosurg. 1995;83:977-83.

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