Üst Lomber Vertebra Kırıklarında Konservatif Tedavinin Omurga Stabilitesi Üzerındeki Etkileri: Klinik Çalışma

Abstract

Amaç: Bu çalışmada torakolomber ortez ile tedavi edilen üst lomber vertebra kırığı olan hastalarda fonksiyonel iyileşmenin ve bu takip sonunda omurgada gelişebilecek olası instabilitenin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Konservatif olarak tedavi edilen L1 veya L2 vertebra kırığı olan hastalar çalışmaya dahil edildi. İlk ve konservatif tedavi sonrası çekilen bilgisayarlı tomografi görüntülerinde T12-L5 Cobb açısı, T12 ve S1 eğim açıları, disk yükseklikleri, L1-L5 omurga yüksekliği, kırık vertebra kifoz açısı, kırık vertebranın Hounsfield Ünitesi değeri ve kırık vertebranın üstündeki ve altındaki vertebra yüksekliği ölçüldü. Takip sonunda “Karnofsky Performance Scale (KPS)” skorları kaydedildi. Bulgular: Başlangıçta ölçülen T12-L5 Cobb açısı, kırık vertebra yüksekliği ve kırık vertebra çökme oranı takipte elde edilen değerlerden farklıydı. Kadın hastalarda kırık vertebranın başlangıç yüksekliği ve kırık seviyesindeki sagital spinal kanal çapı takip değerlerinden farklıydı. Ayrıca, erkek hastalarda ölçülen kırık vertebradaki başlangıç Hounsfield Ünitesi değerleri ve bu vertebranın yüksekliği takip değerlerinden farklıydı. Sonuç: Çökme oranı %20'den az olan hastalarda konservatif tedavi T12-L5 Cobb açısını ve kırık vertebranın yüksekliğini koruyamadı; ancak kırık vertebranın kifoz açısında ve çökme oranında artışı ve T12-L5 vertebral kolonun yüksekliğinde azalmayı önleyebildiği görüldü. Ayrıca, bu hastalarda KPS skorlarının 90 (70-100) olması bu hastaların bu tedaviden faydalanabildiğini düşündürdü.

Keywords

• Üst lomber vertebra
• vertebra kırığı
• konservatif tedavi

EFFECTS OF CONSERVATIVE TREATMENT ON SPINAL STABILITY IN UPPER LUMBAR VERTEBRAL FRACTURES: CLINICAL STUDY

Abstract

Objective: This study aimed to evaluate the functional recovery in patients with upper lumbar vertebral fractures treated with thoracolumbar orthoses and the possible instability that may develop in the spine at the end of this follow-up. Material and Methods: Patients with L1 or L2 vertebral fractures treated conservatively were included in the study. T12- L5 Cobb angle, T12 and S1 slope angles, disc heights, L1-L5 spine height, kyphosis angle of the fractured vertebra, Hounsfield Unit value of the fractured vertebra, and the height of the vertebra above and below the fractured vertebra were measured on the initial and post-treatment computed tomography images. “Karnofsky Performance Scale (KPS)” scores were recorded at the end of the follow-up. Results: Initially measured T12-L5 Cobb angle, fractured vertebra height, and fractured vertebra subsidence rate were different from the values obtained at follow-up. The initial height of the fractured vertebra and the sagittal spinal canal diameter at the fracture level differed from follow-up values in female patients. Additionally, initial Hounsfield Unit and height values in fractured vertebrae measured in male patients differed from follow-up values. Conclusion: Conservative treatment in patients with a collapse rate of less than 20% could not preserve the T12-L5 Cobb angle and the height of the fractured vertebra; however, it could prevent an increase in the kyphosis angle and collapse rate of the fractured vertebra and a decrease in the height of the T12-L5 vertebral column. Moreover, KPS scores of 90 (70-100) in these patients suggested that they could benefit from this treatment.

Keywords

• Upper lumbar vertebra
• vertebral fracture
• conservative treatment

References

1. Schuller A, Payr S, Pichler L et al. Radiographic outcomes of conservative and operative treatment in isolated L1 fractures. Medicina (Kaunas). 2023;59(4):695.
2. Bailey CS, Urquhart JC, Dvorak MF et al. Orthosis versus no orthosis for the treatment of thoracolumbar burst fractures without neurologic injury: a multicenter prospective randomized equivalence trial. Spine J. 2014;14(11):2557-2564.
3. Linhares D, Pinto BS, Ribeiro da Silva M, Neves N, Fonseca JA. Orthosis in thoracolumbar fractures: A systematic review and meta-analysis of randomized controlled trials. Spine (Phila Pa. 1976). 2020;45(22):E1523-E1531.
4. Urquhart JC, Alrehaili OA, Fisher CG et al. Treatment of thoracolumbar burst fractures: extended follow-up of a randomized clinical trial comparing orthosis versus no orthosis. J Neurosurg Spine. 2017;27(1):42-47.
5. Wallace N, McHugh M, Patel R, Aleem IS. Effects of bracing on clinical and radiographic outcomes following thoracolumbar burst fractures in neurologically intact patients: A meta-analysis of randomized controlled trials. JBJS Rev. 2019;7(9):e9.
6. Mulcahy MJ, Dower A, Tait M. Orthosis versus no orthosis for the treatment of thoracolumbar burst fractures: A systematic review. J Clin Neurosci. 2021;85:49-56.
7. Bakhsheshian J, Dahdaleh NS, Fakurnejad S, Scheer JK, Smith ZA. Evidence-based management of traumatic thoracolumbar burst fractures: a systematic review of nonoperative management. Neurosurg Focus. 2014;37(1): E1.
8. Hitchon PW, Abode-Iyamah K, Dahdaleh NS et al. Nonoperative management in neurologically intact thoracolumbar burst fractures: Clinical and radiographic outcomes. Spine (Phila Pa 1976). 2016;41(6):483-489.

9. Nau C, Pape HC, Jug M, Wendt K, Komadina R, Bloemers F. Thoracolumbar injuries: nonoperative treatment: indications, management. Eur J Trauma Emerg Surg. 2024;50(5):1951-1957.
10. Soultanis K, Thano A, Soucacos PN. Outcome of thoracolumbar compression fractures following non-operative treatment. Injury. 2021;52(12):3685-3690.
11. Stadhouder A, Buskens E, Vergroesen DA, Fidler MW, de Nies F, Oner FC. Nonoperative treatment of thoracic and lumbar spine fractures: a prospective randomized study of different treatment options. J Orthop Trauma. 2009;23(8):588-594.
12. van der Roer N, de Lange ES, Bakker FC, de Vet HC, van Tulder MW. Management of traumatic thoracolumbar fractures: a systematic review of the literature. Eur Spine J. 2005;14(6):527-534.
13. Rajasekaran S, Kanna RM, Schnake KJ, et al. Osteoporotic thoracolumbar fractures-how are they different? Classification and treatment algorithm. J Orthop Trauma. 2017;31 Suppl 4:S49-S56.
14. Rinonapoli G, Pace V, Ruggiero C, et al. Obesity and bone: A complex relationship. Int J Mol Sci. 2021;22(24):13662.
15. An Y, Li JN, Wang Y, Tian W, Li N. Association of overweight and obesity with vertebral fractures: a systematic review and meta-analysis. Minerva Endocrinol (Torino). 2023;48(4):459-472.