Erişkin Torakolomber Bileşke Kırıklarında Posterior Segmental Stabilizasyon: Tek Cerrahın Tek Merkezli Deneyimi

Öz

Torakolomber bileşke kırıkları (TLBK), sıklıkla nörolojik defisitler ve iç organ yaralanmaları ile birlikte görülen kritik omurga travmalarıdır. Bu retrospektif çalışmada, Mayıs 2022 - Eylül 2024 tarihleri arasında posterior segmental enstrümantasyon cerrahisi uygulanan 21 erişkin hasta değerlendirildi. Demografik özellikler, travma mekanizmaları, nörolojik durum, kırık sınıflamaları ve cerrahi sonuçlar analiz edildi. Belirgin kanal basısı olan 14 hastada laminektomi uygulanırken, posterior elemanları sağlam olan olgularda kısa segment enstrümantasyon tercih edildi. Takip sürecinde çoğu hastada anlamlı ağrı azalması ve nörolojik iyileşme gözlendi. Nörolojik defisitli hastalarda erken dönemde yapılan cerrahi dekompresyon ve stabilizasyon daha iyi klinik sonuçlarla ilişkili bulundu. Posterior segmental enstrümantasyon güvenilir bir tedavi seçeneği olup kısa ve uzun segment tekniklerinin karşılaştırıldığı uzun dönem çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• Torakolomber fraktür
• Torakolomber Bileşke
• Posterior Segmental Enstrümantasyon
• Yetişkin Omurga Travması

Posterior Segmental Stabilization of Adult Thoracolumbar Junction Fractures: Single-Surgeon, Single-Center Experience

Öz

Thoracolumbar junction fractures (TLJF) are critical spinal injuries frequently associated with neurological deficits and internal organ trauma. This retrospective study evaluated 21 adult patients with TLJF who underwent posterior segmental instrumentation between May 2022 and September 2024. Demographic features, trauma mechanisms, neurological status, fracture classifications, and surgical outcomes were analyzed. Laminectomy was performed in 14 patients with significant canal compromise, while short-segment posterior instrumentation was preferred in cases with intact posterior elements. During follow-up, most patients showed significant pain reduction and neurological improvement. Early surgical decompression and stabilization in neurologically compromised patients were associated with better clinical outcomes. Posterior segmental instrumentation remains a reliable treatment method, though long-term studies comparing short- and long-segment stabilization are needed.

Anahtar Kelimeler

• Thoracolumbar fracture
• Thoracolumbar Junction
• Posterior Segmental Instrumentation
• Adult Spinal Trauma

Kaynakça

1. 1. Stagnara P, De Mauroy JC, Dran G, et al. Reciprocal angulation of vertebral bodies in a sagittal plane: approach to references for the evaluation of kyphosis and lordosis. Spine (Phila Pa 1976). 1982;7(4):335-42.
2. 2. Oliver M, Inaba K, Tang A, et al. The changing epidemiology of spinal trauma: a 13-year review from a Level I trauma centre. Injury. 2012;43(8):1296-300.
3. 3. Ray WZ, Krisht KM, Dailey AT, Schmidt MH. Clinical outcomes of unstable thoracolumbar junction burst fractures: combined posterior short-segment correction followed by thoracoscopic corpectomy and fusion. Acta Neurochir (Wien). 2013;155(7):1179-86.
4. 4. Calenoff L, Chessare JW, Rogers LF, Toerge J, Rosen JS. Multiple level spinal injuries: importance of early recognition. AJR Am J Roentgenol. 1978;130(4):665-9.
5. 5. Kaufman RP, Ching RP, Willis MM, Mack CD, Gross JA, Bulger EM. Burst fractures of the lumbar spine in frontal crashes. Accid Anal Prev. 2013;59:153-63.
6. 6. Watson-Jones R. The results of postural reduction of fractures of the spine. J Bone Joint Surg Am. 1938;20(3):567-586.
7. 7. Nicoll EA. Fractures of the dorso-lumbar spine. J Bone Joint Surg Br. 1949;31B(3):376-94.
8. 8. Böhler L. The Technique in the treatment of bone fractures in Griedenund in war Vienna, Austria. Verlag von: Wilheim Maudrich, 1930. p.9-11.

9. 9. Ferguson RL, Allen BL Jr. A mechanistic classification of thoracolumbar spine fractures. Clin Orthop Relat Res. 1984;(189):77-88.
10. 10. Holdsworth F. Fractures, dislocations, and fracture-dislocations of the spine. J Bone Joint Surg Am. 1970 Dec;52(8):1534-51.
11. 11. Kelly RP, Whitesides TE Jr. Treatment of lumbodorsal fracture-dislocations. Ann Surg. 1968;167(5):705-17.
12. 12. Denis F. The three-column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976). 1983;8(8):817-31.
13. 13. 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;65(4):461-73.
14. 14. McCormack T, Karaikovic E, Gaines RW. The load sharing classification of spine fractures. Spine (Phila Pa 1976). 1994;19(15):1741-4.
15. 15. 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.
16. 16. Vaccaro AR, Lehman RA Jr, Hurlbert RJ, et al. A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine (Phila Pa 1976). 2005;30(20):2325-33.
17. 17. Vaccaro AR, Oner C, Kepler CK, et al. AOSpine Spinal Cord Injury & Trauma Knowledge Forum. AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine (Phila Pa 1976). 2013;38(23):2028-37.
18. 18. Park HJ, Lee SY, Park NH, et al. Modified thoracolumbar injury classification and severity score (TLICS) and its clinical usefulness. Acta Radiol. 2016;57(1):74-81.
19. 19. Moller A, Hasserius R, Redlund-Johnell I, Ohlin A, Karlsson MK. Nonoperatively treated burst fractures of the thoracic and lumbar spine in adults: a 23- to 41-year follow-up. Spine J. 2007;7(6):701-7.
20. 20.Hitchon PW, Torner J, Eichholz KM, Beeler SN. Comparison of anterolateral and posterior approaches in the management ofthoracolumbar burst fractures. J Neurosurg Spine.2006;5(2):117-25. doi: 10.3171/spi.2006.5.2.117. PMID:16925077.
21. 21.Guler A. Conservative Treatment of Thoracolumbar JunctionFractures: choosing a corset. Turk Neurosurg Soc Bull SpinalPeripheral Nerve Surg. 2019; 85(1):36-44.
22. 22.Karjalainen M, Aho AJ, Katevuo K. Painful spine after stable fractures of the thoracic and lumbar spine. What benefit fromthe use of extension brace? Ann Chir Gynaecol. 1991;80(1):45-8.
23. 23.Karimi M. The effects of orthosis on thoracolumbar fracture healing: A review of the literature. J Orthop. 2015;17;12(Suppl2):S230-7.
24. 24.Giele BM, Wiertsema SH, Beelen A, et al. No evidence for theeffectiveness of bracing in patients with thoracolumbarfractures. Acta Orthop. 2009;80(2):226-32.
25. 25.Girardo M, Cinnella P, Gargiulo G, Viglierchio P, Rava A,Aleotti S. Surgical treatment of osteoporotic thoraco-lumbar compressive fractures: the use of pedicle screw withaugmentation PMMA. Eur Spine J. 2017;26(Suppl 4):546-551.
26. 26.Mohanty SP, Venkatram N. Does neurological recovery inthoracolumbar and lumbar burst fractures depend on the extentof canal compromise? Spinal Cord. 2002;40(6):295-9.
27. 27.Boerger TO, Limb D, Dickson RA. Does 'canal clearance'affect neurological outcome after thoracolumbar burstfractures? J Bone Joint Surg Br. 2000;82(5):629-35.
28. 28.Nau C, Pape HC, Jug M, Wendt K, Komadina R, Bloemers F.Thoracolumbar injuries: non operative treatment: indications,management. Eur J Trauma Emerg Surg. 2024;50(5):1951-1957.
29. 29.Pasahan R, Dogan S. Approaches to Thoracolumbar JunctionFractures. Turk Norosir Derg. 2020;30(3):428-431
30. 30.Chen ZQ, Xie JT, Gu XM, et al. Posterior short-segmentpedicle screw fixation combined with vertebroplasty for the treatment of thoracolumbar burst fractures. Zhongguo Gu Shang. 2010;23(2):102-6.
31. 31.McDonough PW, Davis R, Tribus C, Zdeblick TA. Themanagement of acute thoracolumbar burst fractures withanterior corpectomy and Z-plate fixation. Spine (Phila Pa1976). 2004;1;29(17):1901-8; discussion 1909.
32. 32.Kim BG, Dan JM, Shin DE. Treatment of thoracolumbarfracture. Asian Spine J. 2015;9(1):133-46. doi:10.4184/asj.2015.9.1.133. Epub 2015 Feb 13.
33. 33.Schreiber U, Bence T, Grupp T, et al. Is a single anterolateralscrew-plate fixation sufficient for the treatment of spinalfractures in the thoracolumbar junction? A biomechanical invitro investigation. Eur Spine J. 2005;14(2):197-204.
34. 34.Scholz M, Kandziora F, Tschauder T, Kremer M, Pingel A.Prospective randomized controlled comparison of posterior vs.posterior-anterior stabilization of thoracolumbar incompletecranial burst fractures in neurological intact patients: theRASPUTHINE pilot study. Eur Spine J. 2018;27(12):3016-3024.
35. 35.Çetin E, Öner A. Comparison of Short Segment Pedicle ScrewFixation Including the Fractured Vertebra Versus LongSegment Fixation in Thoracolumbar Fractures. J Acad ResMed. 2020;10(1):32-35.
36. 36.Piccone L, Cipolloni V, Nasto LA, et al. Thoracolumbar burstfractures associated with incomplete neurological deficit inpatients under the age of 40: Is the posterior approach enough?Surgical treatment and results in a case series of 10 patientswith a minimum follow-up of 2 years. Injury. 2020;51(2):312-316.
37. 37.Waddell WH, Gupta R, Stephens BF 2nd. ThoracolumbarSpine Trauma. Orthop Clin North Am. 2021;52(4):481-489.
38. 38.Katsuura Y, Osborn JM, Cason GW. The epidemiology ofthoracolumbar trauma: A meta-analysis. J Orthop.2016;21;13(4):383-8.
39. 39.Fernández-de Thomas RJ, De Jesus O. Thoracolumbar SpineFracture. In: StatPearls [Internet]. Treasure Island (FL):StatPearls Publishing; 2024 Jan–.