Download Free Medical Thoracic and Lumbar Spine Fractures and Dislocations PowerPoint Presentation

Thoracic and Lumbar Spine Fractures and Dislocations PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Check out this medical presentation on Orthopedic Surgery, which is titled "Thoracic and Lumbar Spine Fractures and Dislocations", to know about assessment and classification of thoracic and lumbar spine fractures and dislocations.

Tags : Orthopedic Surgery, Thoracic, Lumbar Spine, Fractures, Dislocations, assessment, classification

Published on : Jul 20, 2021 | Views : 2513 | Downloads : 3

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

Thoracic and Lumbar Spine Fractures and Dislocations: Assessment and Classification Jim A. Youssef, M.D. Original Authors: Christopher Bono, MD and Mitch Harris, MD; March 2004 Jim A. Youssef, MD; Revised January 2006 and May 2011
Slide 2-

Anatomy of Thoracic Spine Kyphosis is natural alignment Narrow spinal canal Facet orientation Rib factor on stability Conus at T12-L1
Slide 3-

Anatomy of Lumbar Spine Lordosis is natural alignment Larger vertebral bodies Facet orientation Cauda equina
Slide 4-

Thoracolumbar Junction Transition Zone Kyphosis Lordosis Mechanical Difference: Lumbar spine less stiff in flexion
Slide 5-

Transition Zone:Predisposed to Failure Little opportunity for force dispersion Central loading of T-L junction Not anatomically disposed to transfer force
Slide 6-

Patient Evaluation Pre-hospital care EMT personnel Initial assessment Transport and immobilization
Slide 7-

Patient Evaluation ABC’s of Trauma History Physical Examination Neurological Classification
Slide 8-

Clinical Assessment Inspection Palpation Neurological Evaluation ASIA Impairment Scale Sensory Evaluation Motor Evaluation Reflex Evaluation Bulbocavernosus, Babinski
Slide 9-

Clinical Assessment Associated Injuries Meyer, 1984 – 28% have other major organ system injuries Noncontiguous spine fractures 3-56% Always monitor Hematocrit GU: Foley recommended, check post-void residuals, if abnormal get cystometrogram GI: prepare for ileus.
Slide 10-

Radiographic Evaluation Trauma series includes: lateral cervical, chest, lateral thoracic, A/P and lateral lumbar and A/P pelvis Obtunded patients require further skeletal survey Mackersie et al J Trauma 1988
Slide 11-

Additional Imaging CT scan – bony injuries MRI – images spinal cord, intervertebral discs, ligamentous structures
Slide 12-

CT Scan L3 unstable burst fracture
Slide 13-

MRI Scan Thoracic fracture subluxation with increased signal in conus medullaris
Slide 14-

Thoracolumbar Fractures Controversies CLASSIFICATION!!!!! Indications for surgery Optimal time for surgery Best approach for surgery
Slide 15-

Classifications Necessary for…… Uniform method of description Directing treatment *** Facilitating outcome analysis Should be: Comprehensive Reproducible Usable Accurate
Slide 16-

Böhler 1930 Importance of injury mechanism Determines proper reduction maneuver Evaluated fractures using: Plain roentgenograms, anatomic dissection of fatalities 6 types of spinal fractures included in system Compression Flexion Extension Lateral flexion Shear Torsional Böhler, Fractures and Dislocation of the Spine, 1956 Böhler, Verlag von Wilhem Maudrich 1930
Slide 17-

Morphologic ClassificationWatson-Jones 38 Descriptive terms based on 252 films 7 types Examples: Wedge fracture (compression fx) Comminuted fracture (burst fx) Fracture dislocation Morphologic Classification 1930 ‘40 ‘50 ‘60 ‘70 ‘80 ‘90 2000 ‘10 CT evolved MRI evolved *
Slide 18-

Morphologic Classification Stable vs. UnstableNicoll 49 Based on review of 152 coal miners Recognized importance of posterior ligaments 4 fracture types: Stable = post ligaments intact Unstable = post elements disrupted Morphologic Classification 1930 ‘40 ‘50 ‘60 ‘70 ‘80 ‘90 2000 ‘10 CT evolved MRI evolved * Post elements important
Slide 19-

Holdsworth’62 Kelley & Whitesides ’68 Denis ‘83 McAfee ‘83 Ferguson & Allen’84 Anatomic Classification 2 or 3 Columns
Slide 20-

Anatomic Classification2 Column Theory Holdsworth 62 Six types- Nicols +2 Reviewed 1,000 patients Anterior- vertebral body, ALL, PLL Supports compressive loads Posterior- facets, arch, Inter-spinous ligamentous complex Resists tensile stresses Stressed importance of posterior elements If destabilized, must consider surgery Posterior Anterior
Slide 21-

Anatomic Classification3 Column TheoryDenis 83 Based on radiographic review of 412 cases 5 types, 20 subtypes Anterior- ALL , anterior 2/3 body Middle - post 1/3 body, PLL Posterior- all structures posterior to PLL Same as Holdsworth Posterior injury-not sufficient to cause instability Anterior Middle Posterior
Slide 22-

McAfee Classification Six types CT based-100 patients Middle column most important
Slide 23-

Load Sharing Classification McCormack, Spine 1994 Review of injuries fixed posteriorly (McCormack 94) Which failed? Could they be prevented? Suggests when to go anteriorly Morphologic Classification 1930 ‘40 ‘50 ‘60 ‘70 ‘80 ‘90 2000 ‘10 CT evolved MRI evolved * Post elements important 2 column 3 column, McAfee Mechanistic classifications Load Sharing
Slide 24-

Load Sharing Classification (McCormack 94) Devised method of predicting posterior failure 1-3 points assigned to the variables below Sum the points for a 3-9 scale <6 points posterior only >6 points anterior Comminution Fragment Displacement Kyphosis correction <30% 30-60% >60% 0-1mm 1-2mm >2mm <3° 4-9° >10°
Slide 25-

Mechanistic Classification AO Review of 1445 cases (Magerl, Gertzbein et al. European Spine Journal 1994) Based on direction of injury force 3 types,53 injury patterns Type A - Compression Type B - Distraction Type C - Rotational Morphologic Classification 1930 ‘40 ‘50 ‘60 ‘70 ‘80 ‘90 2000 ‘10 CT evolved MRI evolved * Post elements important 2 column 3 column, McAfee Mechanistic classifications Load Sharing AO Increasing severity
Slide 26-

AO Mechanistic ClassificationComplex subdivisions to include most fractures
Slide 27-

Classification of thoracic and lumbar spine fractures: problems of reproducibilityA study of 53 patients using CT and MRI Oner, European Spine Journal 2002 53 Patients AO & Denis Classifications 5 observers Cohen Test 0 = No Agreement 1.0 = Perfect Agreement
Slide 28-

Results AO Interobserver CT 0.31 MRI 0.28 CT/MRI 0.47 Denis Interobserver CT 0.60 MRI 0.52
Slide 29-

Vaccaro, A.R. et al, Spine 2005
Slide 30-

Spine Trauma Study Group Thoracolumbar Injury Classification and Severity Scale (TLICS)Three Part Description Injury Morphology Neurologic Status Integrity of PLC
Slide 31-

Injury Morphology Compression: prefix-axial, lateral, flexion, postfix-burst Distraction: prefix-extension, flexion postfix-compression, burst Translation/Rotation: prefix-flexion postfix-compression, burst
Slide 32-

Neurologic Status Intact Nerve Root Injury Cauda Equina Injury Cord Injury-Incomplete, Complete
Slide 33-

Posterior Ligamentous Complex Not disrupted in tension Disrupted in tension
Slide 34-

TreatmentSpine Trauma Severity ScoreDetermined by: Injury Morphology Neurology Ligamentous Integrity
Slide 35-

Vaccaro, A.R. et al., J. Spinal Disorders & Techniques 2005
Slide 36-

Point System Compression fx Axial, Flexion 1 Burst - add 1 Distraction injury 4 Translation / Rotation 3 Injury Morphology Select one
Slide 37-

Neurology-Point System Cauda equina Cord And conus medullaris Incomplete Complete Nerve root 3 3 2 2 Intact 0
Slide 38-

Posterior Soft Tissue Point System PLC (displaced in tension) Evaluated by MRI, CT, Plain X-rays, Exam Intact 0 Injured 3 Suspected/ Indeterminant 2
Slide 39-

MODIFIERS AS/ DISH/Metabolic bone disease Nonbraceable Sternal fracture Multiple rib fractures at same or adjacent levels as fracture Multiple trauma Coronal plane deformity Burns at site of anticipated incision
Slide 40-

Next Step - Direct TX Assign Points Conservative Surgery
Slide 41-

Treatment Injuries with 3 points or less = non operative Injuries with 4 points=Nonop vs Op Injuries with 5 points or more = surgery
Slide 42-

ExamplesFlexion Compression Fx Flexion compression (morphology) - 1 Intact (neurology) - 0 PLC (ligament) no injury - 0 Total 1 points- Non Op
Slide 43-

Compression Burst Fracture Flexion compression burst - 2 Intact ( neurology) - 0 PLC (ligament) no injury (0) Total 2 points-Non Op
Slide 44-

Compression Burst-Complete Neuro Injury Axial compression burst with distraction posterior ligamentous complex -4 Complete (neurology) - 2 PLC (ligament) injury - 3 Total 9 points-Surgery
Slide 45-

Compression Burst-Complete injury Axial compression burst-2 Complete (neurology)-2 PLC (ligament) Intact-0 Points 4-Non Op vs Op
Slide 46-

Translational/Rotation Injury Distraction, Translation/rotational, compression injury - 4 Complete (neurology) – 2 PLC injury - 3 Total 9 points-Surgery
Slide 47-

Surgical Decision making based off tenets of classification system Injury morphology Neurological status PLC integrity/injury stability Journal of Spinal Disorders & Techniques, 2006
Slide 48-

Reliability/treatment validity at single institution Treatment validity exceptional- 96.4% Moderate agreement for PLC (66%) and mechanism (60%) Spine, 2006
Slide 49-

Conflict: Mechanism vs Morphology
Slide 50-

The Journal of Spinal Disorders and Techniques Identifying objective findings on imaging studies and clinical examination instead of guessing injury mechanisms provides more valid understanding of injury classification
Slide 51-

Problems Inter-rater agreement on sub-scores was: Lowest for mechanisms followed by PLC Highest for neurological status Substantial for the management recommendation J. Neurosurgery Spine, 2006
Slide 52-

The Spine Journal, 2006 Status PLC Most reliable indicators: Vertebral body translation on plain radiographs Disrupted PLC components on T1 sagittal MRI Focal kyphosis in absence of vertebral body injury
Slide 53-

Assessment of Injury to the PLC in the Setting of on Normal Plain RadiographsLee, J., Vaccaro, A.R. et al. J Orthopaedic Trauma 2006Validation Study J. Orthopaedic Research Submitted 2006 STATUS PLC Disrupted PLC components i.e. ISL, SSL, LF; black stripe on T1 sagittal MRI , most important factor Diastasis of the facet joints on CT Fat suppressed T2 sagittal MRI
Slide 54-

IMPACT OF EXPERIENCE (attending surgeons, fellows, residents, and non-surgeon health care professionals). Most reliable among spine fellows, followed by attending spine surgeons. Lim, Coluna/Columna Journal, 2006
Slide 55-

IMPACT OF TRAINING Management component: reliability rose from κ = 0.46 (r=0.47) on first assessment to κ = 0.72 (r=0.91) on the 2nd assessment. Spine, 2007
Slide 56-

DIFFERENCES BETWEEN SPECIALTIES Inter-rater reliability: “injury mechanism” higher in neurosurgeons Assessment of PLC, neurological status- higher in orthopaedic surgeons Reliability total score/management recommendations similar Overall, differences subtle J Spinal Disorders, 2006
Slide 57-

DIFFERENCES IN NATIONALITIES Inter-rater reliability for mechanism higher among non-US surgeons Reliability for PLC, neurological status, management higher among US surgeons World J Emerg Surg, 2007
Slide 58-

Management of Thoracic and Lumbar Injuries CONTROVERSIAL!!!!
Slide 59-

Non-Operative Treatment of Thoracic Spine Injuries Brace or Cast Treatment Compression Fractures Stable Burst Fractures Pure Bony Flexion-Distraction Injury
Slide 60-

85 pts reviewed to determine late outcome of non-op management Chronic pain predominant in 69.4% 25% of subjects had changed jobs (most full to part) 48% of subjects filed lawsuits concerning injury Pain intensity correlated with angle of kyphosis But not w/magnitude of anterior column deformity Bed rest alone adequately manages traumatic, uncomplicated thoracolumbar wedge fractures Folman and Gepstein, J Orthop Trauma, 2003
Slide 61-

No correlation was found between radiological &functional parameters Vertebral column deformity that occurred after the injury was stable in 2-column; progressive in 3-column Significant remodeling of canal encroachment (CE) proportional to initial amount of CE but not related to age & radiology Agus, Eur J Spine, 2005 Evaluated 29 pts with 2- or 3-column-injured thoracolumbar burst fractures
Slide 62-

62% showing good or excellent outcome 38% showing moderate or poor outcome Significant effects on clinical outcome: Load-sharing classification, posttraumatic kyphosis & overall  lumbopelvic lordosis Surgical reconstruction appropriate treatment in more severe fractures Koller, Eur Spine J, 2008 Evaluated 21 pts; 9.5 yr f/u
Slide 63-

Surgical Management of Thoracolumbar Injuries Unstable burst fractures Purely ligamentous Facet dislocations Translational injuries Neurologic deficit
Slide 64-

Delayed diagnosis in 28 pts (19%) Differences b/w surgical & non:  in pulmonary complications & length of hospital stay in non-op pts. Surgical pts had highly significantly less pain Radiographic studies should be performed Choice of treatment in pts with multiple injuries is not different from that in pts with no asscd injuries Dai, J Trauma, 2004 147 pts w/acute thoracolumbar fractures: 1988 to 1997 Min. 3yr f/u; 4 pts died during hospital stay
Slide 65-

Lack of evidence demonstrating superiority of one approach over the other No evidence linking posttraumatic kyphosis to clinical outcomes Strong need for improved clinical research methodology to be applied to this patient population Thomas, J Neurosurg Spine, 2006 Evaluated scientific literature on operative & non-op treatments
Slide 66-

Reviewed 37 pts Accuracy of plain radiographs improved w/experience of observers Impact of disagreement on treatment plan was significant Plain radiography alone is not adequate Dai, Spine, 2008
Slide 67-

Extended anterolateral fixation is biomechanically comparable to circumferential fusion Extension of anterior instrumentation & fusion 1-level above and below the unstable segment can result in near equivalent stability to a 2-stage circumferential procedure Acosta, J Neurosurg Spine, 2008 Biomechanical comparison of 3 fixation techniques for unstable thoracolumbar fractures. Induced at L1: 1) Short-segment anterolateral fixation 2) Circumferential fixation 3) Extended anterolateral fixation
Slide 68-

Angular stable plate system showed higher primary and secondary stability In specimens with lower BMD, the use of angular stable systems substantially increased stability Disch, Spine, 2008
Slide 69-

Difficult to establish the ideal surgical approach Anterior decompression assocd w/ recovery of motor strength & bowel/bladder fxn;  pain & improve neuro status Stand-alone anterior constructs:  complications &  likely to have revision More definite evidence required to determine best surgical strategy Whang, J Am Acad Orthop Surg, 2008
Slide 70-

Conclusions on Treatment Surgically treating incomplete neuro deficits potentiates improvement and rehabilitation Complete neuro deficits may benefit from operative treatment to allow mobilization Little chance of developing neuro deficits with nonoperative treatment
Slide 71-

Surgery:Anterior versus Posterior Anterior More predictable decompression Saves levels Questionable improved recovery of neuro function Gertzbein,1992 – may be indicated in bladder dysfunction McAfee, 1985 – neuro recovery in 70 patients Posterior Less morbidity Failures with short –segment constructs Usually requires more levels Less blood loss Transpedicular anterior column bone grafting may protect posterior construct
Slide 72-

Thank You
Slide 73-

Bibliography Meyer PR Jr, Sullivan DE. Injuries to the spine. Emerg Med Clin North Am. 1984 May;2(2):313-29. Mackersie RC, Shackford SR, Garfin SR, Hoyt DB. Major skeletal injuries in the obtunded blunt trauma patient: a case for routine radiologic survey J Trauma. 1988 Oct;28(10):1450-4. Bohler L. Die techniek de knochenbruchbehandlung imgrieden und im kriege. Verlag von Wilhelm Maudrich 1930 (in German) Bohler L. Mechanisms of fracture and dislocation of the spine in the treatment of fractures. 5 th English ed. Fractures and dislocation of the spine. Bohler L, editor. Vol. 1. Grune and Straton, Inc: New York; 1956. p. 300-29. Watson-Jones R. The results of postural reduction of the fractures of the spine. J Bone Joint Surg Am 20 (3): 567. Nicoll EA. Fracture-dislocation of the dorsolumbar spine. J Bone Joint Surg Br. 1949;31:376-394. Holdsworth F. W. The Spinal Cord. Basic Aspects and Surgical Considerations. J Bone Joint Surg Br 1962 44-B: 968-969. Kelly and T.E. Whitesides, Jr., Treatment of lumbodorsal fracture-dislocations. Ann Surg 167 (1968), pp. 705–709. Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine. 1983 Nov-Dec;8(8):817-31. McAfee PC, Yuan HA, Fredrickson BE, Lubicky JP. The value of computed tomography in thoracolumbar fractures. An analysis of one hundred consecutive cases and a new classification. J Bone Joint Surg Am. 1983 Apr;65(4):461-73. Ferguson RL, Allen BL Jr. A mechanistic classification of thoracolumbar spine fractures. Clin Orthop Relat Res. 1984 Oct;(189):77-88. McCormack T, Karaikovic E, Gaines RW. The load sharing classification of spine fractures. Spine. 1994 Aug 1;19(15):1741-4. Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J. 1994;3(4):184-201. Öner, FC, Ramos, LM, Simmermacher, RK, Kingma, PT, Diekerhof, CH, Dhert, WJ et al. (2002) "Classification of thoracic and lumbar spine fractures: problems of reproducibility: a study of 53 patients using CT and MRI" Eur Spine J 11: 235-45 Vaccaro, AR, Zeiller, SC, Hulbert, RJ, Anderson, PA, Harris, M, Hedlund, R et al. (2005) "The thoracolumbar injury severity score: a proposed treatment algorithm" J Spinal Disord Tech 18: 209-15 Vaccaro AR, Lim MR, Hurlbert RJ, Lehman RA Jr, Harrop J, Fisher DC, Dvorak M, Anderson DG, Zeiller SC, Lee JY, Fehlings MG, Oner FC; Spine Trauma Study Group. Surgical decision making for unstable thoracolumbar spine injuries: results of a consensus panel review by the Spine Trauma Study Group. J Spinal Disord Tech. 2006 Feb;19(1):1-10. Vaccaro AR, Baron EM, Sanfilippo J, Jacoby S, Steuve J, Grossman E, DiPaola M, Ranier P, Austin L, Ropiak R, Ciminello M, Okafor C, Eichenbaum M, Rapuri V, Smith E, Orozco F, Ugolini P, Fletcher M, Minnich J, Goldberg G, Wilsey J, Lee JY, Lim MR, Burns A, Marino R, DiPaola C, Zeiller L, Zeiler SC, Harrop J, Anderson DG, Albert TJ, Hilibrand AS. Reliability of a novel classification system for thoracolumbar injuries: the Thoracolumbar Injury Severity Score. Spine. 2006 May 15;31(11 Suppl):S62-9; discussion S104. Anand N MD, Vaccaro AR MD, Lim MR MD, Lee JY MD, Arnold P MD, Harrop JS MD, Ratlif J MD, Rampersaud R MD, Bono CM MD. Evolution of Thoracolumbar Trauma Classification Systems: Assessing the Conflict Between Mechanism and Morphology of Injury. Topics in Spinal Cord Injury Rehabilitation Volume 12, Number 1/Summer 2006 - Acute SCI Management: Basic Science and Nonoperative Care: 70-78. Schweitzer KM Jr, Vaccaro AR, Lee JY, Grauer JN; Spine Trauma Study Group. Confusion regarding mechanisms of injury in the setting of thoracolumbar spinal trauma: a survey of The Spine Trauma Study Group (STSG). J Spinal Disord Tech. 2006 Oct;19(7):528-30. Harrop JS, Vaccaro AR, Hurlbert RJ, Wilsey JT, Baron EM, Shaffrey CI, Fisher CG, Dvorak MF, Oner FC, Wood KB, Anand N, Anderson DG, Lim MR, Lee JY, Bono CM, Arnold PM, Rampersaud YR, Fehlings MG; Spine Trauma Study Group. Intrarater and interrater reliability and validity in the assessment of the mechanism of injury and integrity of the posterior ligamentous complex: a novel injury severity scoring system for thoracolumbar injuries. Invited submission from the Joint Section Meeting On Disorders of the Spine and Peripheral Nerves, March 2005. J Neurosurg Spine. 2006 Feb;4(2):118-22. Vaccaro AR, Lee JY, Schweitzer KM Jr, Lim MR, Baron EM, Oner FC, Hulbert RJ, Hedlund R, Fehlings MG, Arnold P, Harrop J, Bono CM, Anderson PA, Anderson DG, Harris MB, Spine Trauma Study Group . Assessment of injury to the posterior ligamentous complex in thoracolumbar spine trauma. Spine J. 2006 Sep-Oct;6(5):524-8. Epub 2006 Jul 11. Lee JY; Vaccaro AR; Schweitzer KM; Lim MR; Baron EM; Rampersaud R; Oner F C; Hulbert R J; Hedlund R; Fehlings MG; Arnold P; Harrop J; Bono CM; Anderson PA; Patel A; Anderson D G; Harris MB Assessment of injury to the thoracolumbar posterior ligamentous complex in the setting of normal-appearing plain radiography. The spine journal : official journal of the North American Spine Society 2007;7(4):422-7.Lim M, Vaccaro AR, Lee J, Jacoby S, SanFilippo J, Oner FC, Hulbert J, Fehlings M, Arnold P, Harrop J, Bono C, Anderson P, Anderson DG, Baron E. The Thoracolumbar Injury Severity Scale and Score (TLISS): Inter-physician and inter-disciplinary validation of a new paradigm for the treatment of thoracolumbar spine trauma, Coluna/Columna (Brazil), 5(3):157-64, 2006. Patel AA, Vaccaro AR, Albert TJ, Hilibrand AS, Harrop JS, Anderson DG, Sharan A, Whang PG, Poelstra KA, Arnold P, Dimar J, Madrazo I, Hegde S. The adoption of a new classification system: time-dependent variation in interobserver reliability of the thoracolumbar injury severity score classification system. Spine. 2007 Feb 1;32(3):E105-10. Raja Rampersaud Y, Fisher C, Wilsey J, Arnold P, Anand N, Bono CM, Dailey AT, Dvorak M, Fehlings MG, Harrop JS, Oner FC, Vaccaro AR. Agreement between orthopedic surgeons and neurosurgeons regarding a new algorithm for the treatment of thoracolumbar injuries: a multicenter reliability study.J Spinal Disord Tech. 2006 Oct;19(7):477-82. Ratliff J, Anand N, Vaccaro AR, Lim MR, Lee JY, Arnold P, Harrop JS, Rampersaud R, Bono CM, Gahr RH; Trauma Study Group Spine. Regional variability in use of a novel assessment of thoracolumbar spine fractures: United States versus international surgeons. World J Emerg Surg. 2007 Sep 7;2:24. Bracken MB, Shepard MJ, Collins WF, Holford TR, Young W, Baskin DS, Eisenberg HM, Flamm E, Leo-Summers L, Maroon J, et al. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the Second National Acute Spinal Cord Injury Study. N Engl J Med. 1990 May 17;322(20):1405-11. Folman Y, Gepstein R. Late outcome of nonoperative management of thoracolumbar vertebral wedge fractures. J Orthop Trauma. 2003 Mar;17(3):190-2. Ağuş H, Kayali C, Arslantaş M. Nonoperative treatment of burst-type thoracolumbar vertebra fractures: clinical and radiological results of 29 patients. Eur Spine J. 2005 Aug;14(6):536-40. Epub 2004 May 28. Koller H, Acosta F, Hempfing A, Rohrmüller D, Tauber M, Lederer S, Resch H, Zenner J, Klampfer H, Schwaiger R, Bogner R, Hitzl W. Long-term investigation of nonsurgical treatment for thoracolumbar and lumbar burst fractures: an outcome analysis in sight of spinopelvic balance. Eur Spine J. 2008 Aug;17(8):1073-95. Epub 2008 Jun 25. Dai LY, Yao WF, Cui YM, Zhou Q. Thoracolumbar fractures in patients with multiple injuries: diagnosis and treatment-a review of 147 cases. J Trauma. 2004 Feb;56(2):348-55. Thomas KC, Bailey CS, Dvorak MF, Kwon B, Fisher C. Comparison of operative and nonoperative treatment for thoracolumbar burst fractures in patients without neurological deficit: a systematic review. J Neurosurg Spine. 2006 May;4(5):351-8. Dai LY, Wang XY, Jiang LS, Jiang SD, Xu HZ. Plain radiography versus computed tomography scans in the diagnosis and management of thoracolumbar burst fractures. Spine. 2008 Jul 15;33(16):E548-52. Acosta FL Jr, 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 Apr;8(4):341-6. Disch AC, Knop C, Schaser KD, Blauth M, Schmoelz W. Angular stable anterior plating following thoracolumbar corpectomy reveals superior segmental stability compared to conventional polyaxial plate fixation. Spine. 2008 Jun 1;33(13):1429-37. Whang PG, Vaccaro AR. Thoracolumbar fractures: anterior decompression and interbody fusion. J Am Acad Orthop Surg. 2008 Jul;16(7):424-31. Gertzbein SD, Crowe PJ, Fazl M, Schwartz M, Rowed D. Canal clearance in burst fractures using the AO internal fixator. Spine. 1992 May;17(5):558-60. McAfee PC, Bohlman HH. Complications following Harrington instrumentation for fractures of the thoracolumbar spine. J Bone Joint Surg Am. 1985 Jun;67(5):672-86.
Slide 74-

Thank you Return to Spine Index E-mail OTA about Questions/Comments If you would like to volunteer as an author for the Resident Slide Project or recommend updates to any of the following slides, please send an e-mail to ota@aaos.org