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Functional And Clinical Outcome Of Acute Traumatic Thoracolumbar Spinal Fractures

Year 2018, Volume: 10 Issue: 1, 16 - 23, 01.04.2018

Abstract

Aim: Disruptions of the thoracolumbar spine are often a result of high-energy injuries, the majority caused by motor vehicle accidents and falls. The sequelae of traumatic fractures of thoracolumbar spine injuries may be devastating, including paralysis, pain, deformity, and loss of function. Available therapeutic options for thoracolumbar vertebral fractures include conservative therapy, decompression, posterior reduction and instrumentation, and percutaneous vertebral augmentation procedures VAP with vertebroplasty or kyphoplasty. This study aims to see the acute spinal fractures surgical management’s outcomes. Materials and Methods: Between January 2013 and August 2014, a total of 90 patients 47 males, 43 females; mean age: 53.68±17.96 years; range, 16 to 87 years who were admitted to hospital with traumatic spinal injury were included. A careful neurological examination of both motor and sensory systems was performed. High-resolution spinal computed tomography CT was performed. A total of 43 consecutive patients treated with instrumentation for unstable spinal fractures and 47 patients with compression or burst vertebra fractures treated with VAP were followed. Pain was assessed using the Wong-Baker Face Scale WFS . Results: Of all patients, 39 had osteoporosis T score < -2.5 . The injury types were traffic accident 32.2% , falling from a height 60% , and penetrating trauma 7.8% . A total of 24 patients had neurological deficits. Five of them were paraplegic. The mean postoperative pain score decreased and the majority of the patients returned to work earlier. The mean preoperative pain score was 5.51 ±0.50 , while the mean postoperative pain score was 2.38 ±0.57 . After early stabilization, the motor strength scores improved. The mean preoperative motor strength PREMS was 3.84 ±1.36 , while the mean postoperative motor strength POSTMS was 4.081 ±1.30 . After stabilization surgery, one patient died due to pulmonary embolism and one patient had an infection with serosal fluid leakage in the surgical site. No other patients were lost to follow-up. We correlated the pain scores with stabilization group parameters osteoporosis, number of fractured vertebrae, motor strength . In the osteoporosis group, there was no correlation between pain and the procedure performed. But both preoperative and postoperative motor strength were negatively correlated with pain scores P < 0.05 . The postoperative pain score was higher when the number of fractured vertebrae increased p < 0.05 . Osteoporosis and postoperative motor strength were the independent predictors of postoperative pain. Conclusion: In this study, both VAP and stabilization procedures reduced the mean pain scores and helped with earlier mobilization. The patients with incomplete spinal cord injuries with progressive deficits requiring decompression and instrumentation were treated as soon as they were medically stable, usually within the earliest time of injury, and this improved the postoperative motor strength.

References

  • Mc Donald JW, Sadowsky C. Spinal-cord injury. Lancet 2002; 359(9304):417-425.
  • Wyndaele M, Wyndaele JJ. Incidence, prevalence and epidemiology of spinal cord injury: what learns a worldwide literature survey?. Spinal Cord 2006; 44: 523-9.
  • El Masri WS. Traumatic Spinal cord injury, the relationship between pathology and clinical implications. Trauma 2006;8: 29-46.
  • Papanastassiou ID, Filis A, Gerochristou Maria A, Vrionis Frank D. Controversial issues in kyphoplasty and vertebroplasty in osteoporotic vertebral fractures. Biomed Res Int. 2014; 2014: 934206.
  • Lamy O, Uebelhart B, Aubry-Rozier B. Risks and benefits of percutaneous vertebroplasty or kyphoplasty in the management of osteoporotic vertebral fractures. Osteoporosis Int 2014; 25:807-19.
  • The European Prospective Osteoporosis Study (EPOS) group. Incidence of vertebral fracture in Europe: results from the European prospective Osteoporosis study (EPOS). J Bone Miner Res 2002; 17:716-24.
  • Verlaan JJ. Introduction to the surgical treatment of traumatic thoracolumbar fractures. In:Verlaan JJ, ed.Less invasive surgical treatment of traumatic thoracolumbar fractures. Utrecht, The Netherlands: UMC Utrecht: Zuidam & Uithof, 2004: 9-24
  • Meves R, Avanzi O. Correlation among canal compromise, neurologic deficit and injury severity in thoracolumbar burst fractures. Spine 2006; 31: 2137 - 41.
  • Mc Lain RF. Functional outcomes after surgery for spinal fractures: return to work and activity. Spine 2004; (29):470-77.
  • Kirkham Wood B, Weishi L, Darren Lebl S, Avraam P. Review article Management of thorocalumbar spine fractures. The Spine Journal 2014; 14(1):145-64.
  • Denis F. The three-column spine and its significance in the classifications of acute thoracolumbar spinal injuries. Spine 1983; 8: 817-31.
  • Dai LY, Jiang SD, Wang XY, et al. A review of the management of thoracolumbar burst fractures. Surg Neurol 2007; 67: 221-31.
  • Kado DM, Duong T, Stone KL, et al. Incident vertebral fractures and mortality in older women: a prospective study. Osteoporosis International 2003; 14(7)589-94.
  • Edidin AA, Ong KL, Lau E, Kurtz SM. Life expectancy following diagnosis of a vertebral compression fracture. Osteoporosis International 2013; 24(2):451-8.
  • Lee HM, Park SY, Lee SH, Suh SW, Hong JY. Comparative analysis of clinical outcomes in patients with osteoporotic vertebral compression fractures. Conservative treatment versus balloon kyphoplasty. The Spine Journal 2012; 12(11):998-05
  • Röllinghoff M, Siewe J, Zarghooni K, et al. Effectiveness, security and height restoration on fresh compression fractures a comparative prospective study of vertebroplasty and kyphoplasty. Minimal invasive Neurosurgery 2009; 52 (5-6):233-7.
  • Papanatasssiou ID, Filis A, Aghayev K, Kokkalis Z, Gerochristou M, Vrionis F. Adverse prognostic factors and optimal intervention time balloon kyphoplasty/ vertebroplasty in osteoporotic fractures. Biomed Res. International 2014; 2014:7 pages 925683.
  • Chen C, Wei H, Zhang W, et al. Comparative study of kyphoplasty for chronic painful osteoporotic vertebral compression fractures via unipedicular versus bipedicular approach. Journal of Spinal Disorders and Techniques 2011; 24 (7):E62- E65.
  • Rebolledo BJ, Gladnick BP, Unnanuntana A, Nguyen JT, Kepler CK, Lane JM. Comparison of unipedicular and bipedicular balloon kyphoplasty for treatment of osteoporotic vertebral compression fractures : a prospective randomised study. The Bone & Joint Journal 2013; 95(3):401-6.
  • Rampersaud YR, Annand N, Dekutoski MB. Use of minimally invasive surgical techniques in the management of thoracolumbar trauma. Spine 2006; 3:S96-102
  • Papanastassiou ID, Philips FM, Van Meirhaeghe J, et al. Comparing effects of kyphoplasty, vertebroplasty, and non-surgical management in a systematic review of randomized and non-randomized controlled studies. European Spine Journal 2012; 21(9):1826-43.
  • Klazen CAH, Lohle PNM, De Vries J, et al. Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (VERTOS II): an open-label randomised trial. The Lancet. 2010; 376(9746):1085-92.
  • Omidi-Kashani F, Samini F, Hasankhani EG, Kachooei AR, Toosi KZ, Golhasani-Keshtan F. Does percutaneous kyphoplasty have better functional outcome than vertebroplasty in single level osteoporotic compression fractures? A comparative prospective study. Journal of Osteoporosis 2013;5: 690329.
  • Kumar K, Nguyen R, Bishop S. A comparative analysis of results of vertebroplasty and kyphoplasty in osteoporotic vertebral compression fractures. Neurosurgery 2010; 67 (supplement3):171-88.
  • Wood K, Butterman G, Method A, et al. Operative compare with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit: a prospective, randomised study. J Bone Joint Surg Am 2003; 85:773-81.
  • Veralaan JJ, Dieckerhof CH, Buskens E ,et al. Surgical treatment of traumatic fractures of the thoracic and lumbar spine: a systematic review of the literature on techniques, complications, a outcome. Spine 2004; 29:803-14.
  • Leypold BG, Flanders AE, Schwartz ED, Burns AS. The impact of methylprednisolone on lesion severity following spinal cord injury. Spine 2007; 32:373-381.

Akut Travmatik Torakolomber Omurga Kiriklarinin Fonksiyonel Ve Klinik Sonuçlari

Year 2018, Volume: 10 Issue: 1, 16 - 23, 01.04.2018

Abstract

Amaç:Torakolomber omurga TLO yaralanmaları genellikle yüksek enerjili kazalarla; çoğunlukla da araba kazaları ve yüksekten düşmeler nedeniyle oluşmaktadır. Travmatik TLO kırık yaralanma sekelleri; fonksiyon kaybı, deformite, ağrı ve paralizi gibi yıkıcı olabilir. TLO kırıklarının mevcut tedavi seçimleri; konservatif tedavi, dekompresyon, arkadan düzeltme, enstrümentasyon ve perkutan vertebra büyütme usulleri vertebroplasti ve kifoplasti ’dir. Bu çalışma akut spinal kırıklarının cerrahi tedavi sonuçlarını göstermeyi amaçlamaktadır. Materyal ve metod: Çalışma Ocak 2013- Ağustos 2014 arası hastanemize başvuran travmatik omurga yaralanmalı 90 hastayı içermektedir 47 erkek, 43 kadın, ortalama yaş 53.68±17.96, yaş aralığı 16 ile 87 arasıdır . Hastaların ayrıntılı nörolojik muayeneleri yapıldı ve yüksek çözünürlüklü bilgisayarlı tomografi ile tarandı. Toplam 43 ardışık hastaya hareketli omurga kırıkları için entrümentasyon tedavisi uygulandı. Kırk yedi hasta, sıkıştırma veya patlamalı omurga kırıkları için vertebral yükseltme yöntemi ile tedavi edildi. Ağrı; Wong-Baker yüz skalası kullanılarak değerlendirildi. Bulgular: Tüm hastaların otuz dokuzunda osteoporoz mevcut idi T skor

References

  • Mc Donald JW, Sadowsky C. Spinal-cord injury. Lancet 2002; 359(9304):417-425.
  • Wyndaele M, Wyndaele JJ. Incidence, prevalence and epidemiology of spinal cord injury: what learns a worldwide literature survey?. Spinal Cord 2006; 44: 523-9.
  • El Masri WS. Traumatic Spinal cord injury, the relationship between pathology and clinical implications. Trauma 2006;8: 29-46.
  • Papanastassiou ID, Filis A, Gerochristou Maria A, Vrionis Frank D. Controversial issues in kyphoplasty and vertebroplasty in osteoporotic vertebral fractures. Biomed Res Int. 2014; 2014: 934206.
  • Lamy O, Uebelhart B, Aubry-Rozier B. Risks and benefits of percutaneous vertebroplasty or kyphoplasty in the management of osteoporotic vertebral fractures. Osteoporosis Int 2014; 25:807-19.
  • The European Prospective Osteoporosis Study (EPOS) group. Incidence of vertebral fracture in Europe: results from the European prospective Osteoporosis study (EPOS). J Bone Miner Res 2002; 17:716-24.
  • Verlaan JJ. Introduction to the surgical treatment of traumatic thoracolumbar fractures. In:Verlaan JJ, ed.Less invasive surgical treatment of traumatic thoracolumbar fractures. Utrecht, The Netherlands: UMC Utrecht: Zuidam & Uithof, 2004: 9-24
  • Meves R, Avanzi O. Correlation among canal compromise, neurologic deficit and injury severity in thoracolumbar burst fractures. Spine 2006; 31: 2137 - 41.
  • Mc Lain RF. Functional outcomes after surgery for spinal fractures: return to work and activity. Spine 2004; (29):470-77.
  • Kirkham Wood B, Weishi L, Darren Lebl S, Avraam P. Review article Management of thorocalumbar spine fractures. The Spine Journal 2014; 14(1):145-64.
  • Denis F. The three-column spine and its significance in the classifications of acute thoracolumbar spinal injuries. Spine 1983; 8: 817-31.
  • Dai LY, Jiang SD, Wang XY, et al. A review of the management of thoracolumbar burst fractures. Surg Neurol 2007; 67: 221-31.
  • Kado DM, Duong T, Stone KL, et al. Incident vertebral fractures and mortality in older women: a prospective study. Osteoporosis International 2003; 14(7)589-94.
  • Edidin AA, Ong KL, Lau E, Kurtz SM. Life expectancy following diagnosis of a vertebral compression fracture. Osteoporosis International 2013; 24(2):451-8.
  • Lee HM, Park SY, Lee SH, Suh SW, Hong JY. Comparative analysis of clinical outcomes in patients with osteoporotic vertebral compression fractures. Conservative treatment versus balloon kyphoplasty. The Spine Journal 2012; 12(11):998-05
  • Röllinghoff M, Siewe J, Zarghooni K, et al. Effectiveness, security and height restoration on fresh compression fractures a comparative prospective study of vertebroplasty and kyphoplasty. Minimal invasive Neurosurgery 2009; 52 (5-6):233-7.
  • Papanatasssiou ID, Filis A, Aghayev K, Kokkalis Z, Gerochristou M, Vrionis F. Adverse prognostic factors and optimal intervention time balloon kyphoplasty/ vertebroplasty in osteoporotic fractures. Biomed Res. International 2014; 2014:7 pages 925683.
  • Chen C, Wei H, Zhang W, et al. Comparative study of kyphoplasty for chronic painful osteoporotic vertebral compression fractures via unipedicular versus bipedicular approach. Journal of Spinal Disorders and Techniques 2011; 24 (7):E62- E65.
  • Rebolledo BJ, Gladnick BP, Unnanuntana A, Nguyen JT, Kepler CK, Lane JM. Comparison of unipedicular and bipedicular balloon kyphoplasty for treatment of osteoporotic vertebral compression fractures : a prospective randomised study. The Bone & Joint Journal 2013; 95(3):401-6.
  • Rampersaud YR, Annand N, Dekutoski MB. Use of minimally invasive surgical techniques in the management of thoracolumbar trauma. Spine 2006; 3:S96-102
  • Papanastassiou ID, Philips FM, Van Meirhaeghe J, et al. Comparing effects of kyphoplasty, vertebroplasty, and non-surgical management in a systematic review of randomized and non-randomized controlled studies. European Spine Journal 2012; 21(9):1826-43.
  • Klazen CAH, Lohle PNM, De Vries J, et al. Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (VERTOS II): an open-label randomised trial. The Lancet. 2010; 376(9746):1085-92.
  • Omidi-Kashani F, Samini F, Hasankhani EG, Kachooei AR, Toosi KZ, Golhasani-Keshtan F. Does percutaneous kyphoplasty have better functional outcome than vertebroplasty in single level osteoporotic compression fractures? A comparative prospective study. Journal of Osteoporosis 2013;5: 690329.
  • Kumar K, Nguyen R, Bishop S. A comparative analysis of results of vertebroplasty and kyphoplasty in osteoporotic vertebral compression fractures. Neurosurgery 2010; 67 (supplement3):171-88.
  • Wood K, Butterman G, Method A, et al. Operative compare with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit: a prospective, randomised study. J Bone Joint Surg Am 2003; 85:773-81.
  • Veralaan JJ, Dieckerhof CH, Buskens E ,et al. Surgical treatment of traumatic fractures of the thoracic and lumbar spine: a systematic review of the literature on techniques, complications, a outcome. Spine 2004; 29:803-14.
  • Leypold BG, Flanders AE, Schwartz ED, Burns AS. The impact of methylprednisolone on lesion severity following spinal cord injury. Spine 2007; 32:373-381.
There are 27 citations in total.

Details

Primary Language Turkish
Journal Section Research Article
Authors

Aykut Akpınar This is me

Uzay Erdoğan This is me

Ali Osman Akdemir This is me

Publication Date April 1, 2018
Published in Issue Year 2018 Volume: 10 Issue: 1

Cite

Vancouver Akpınar A, Erdoğan U, Akdemir AO. Akut Travmatik Torakolomber Omurga Kiriklarinin Fonksiyonel Ve Klinik Sonuçlari. Maltepe tıp derg. 2018;10(1):16-23.