Functional And Clinical Outcome Of Acute Traumatic Thoracolumbar Spinal Fractures

Yıl 2018, Cilt: 10 Sayı: 1, 16 - 23, 01.04.2018

Aykut Akpınar Uzay Erdoğan Ali Osman Akdemir

Öz

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.

Anahtar Kelimeler

spinal cord injury, functional/clinical outcome, kyphoplasty, vertebroplasty

Akut Travmatik Torakolomber Omurga Kiriklarinin Fonksiyonel Ve Klinik Sonuçlari

Öz

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

Anahtar Kelimeler

Omurilik yaralanması, fonksiyonelklinik sonuçlar, vertebroplasti, kifoplasti

Kaynakça

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