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Thoracolumbar Trauma

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521. Timing of thoracolomber spine stabilization in trauma patients; impact on neurological outcome and clinical course. A real prospective (rct) randomized controlled study. (Abstract)

Timing of thoracolomber spine stabilization in trauma patients; impact on neurological outcome and clinical course. A real prospective (rct) randomized controlled study. Optimal timing of stabilization for spinal injuries is discussed controversially. The goal of this study is to investigate the neurological recovery and its influencing factors in thoracolumbar spine fractures after surgical decompression and stabilization within 8 h of spinal cord injury versus surgery which is performed (...) additional systemic complications in patients with thoracolumbar spinal cord injuries. Thus early stabilization of thoracolumbar spine fractures within 8 h after trauma appears to be favorable.

2008 Archives of orthopaedic and trauma surgery Controlled trial quality: uncertain

522. Apoptosis of human intervertebral discs after trauma compares to degenerated discs involving both receptor-mediated and mitochondrial-dependent pathways. (Abstract)

Apoptosis of human intervertebral discs after trauma compares to degenerated discs involving both receptor-mediated and mitochondrial-dependent pathways. Post-traumatic disc degeneration with consecutive loss of reduction and kyphosis remains a debatable issue within both the operative and nonoperative treatment regimen of thoracolumbar spine fractures. Intervertebral disc (IVD) cell apoptosis has been suggested to play a vital role in promoting the degeneration process. To evaluate and compare (...) apoptosis-regulating signaling mechanisms, IVDs were obtained from patients with thoracolumbar spine fractures (n = 21), patients suffering from symptomatic IVD degeneration (n = 6), and from patients undergoing surgical resection of a primary vertebral tumor (n = 3 used as control samples). All tissues were prospectively analyzed in regards to caspase-3/7, -8, and -9 activity, apoptosis-receptor expression levels, and gene expression of the mitochondria-bound apoptosis-regulating proteins Bax and Bcl-2

2008 Journal of Orthopaedic Research

523. Determination of inter-spinous process distance in the lumbar spine : Evaluation of reference population to facilitate detection of severe trauma Full Text available with Trip Pro

Determination of inter-spinous process distance in the lumbar spine : Evaluation of reference population to facilitate detection of severe trauma Fracture of a spinal segment with minimal or no compression of the vertebral body can be highly unstable. Screening for such an injury in the lumbar spine is often obstructed in a multi-injured patient, because of difficulty in obtaining adequate sagittal radiographs. The position of the spinous processes in relation to each other is the key (...) could obviate this problem. A new, simple and reproducible radiographic tool is presented for screening of an eventual rupture of posterior structures of the lumbar spine. This method is based on measurements of the variation in interspinal process distance between adjacent levels in lumbar spine in a normal population. Two hundred normal AP radiographs of non-injured thoracolumbar spine were studied. The interspinal process distance was measured as the distance between the cranial ends

1999 European Spine Journal

524. Trauma to the thoracic and lumbar spine in the adolescent Full Text available with Trip Pro

Trauma to the thoracic and lumbar spine in the adolescent During adolescence the spine undergoes rapid growth and changes in anatomy and biomechanical properties. Fractures of the adolescent spine are relatively uncommon but may give rise to serious problems. This review describes thoracolumbar fractures in adolescents with respect to epidemiology, anatomy, mechanisms of injury, clinical and radiologic assessment, and nonoperative and operative treatment. The treatment of these injuries follows

2001 Canadian Journal of Surgery

525. Current concepts of gunshot wound treatment: a trauma surgeon's perspective. (Abstract)

Current concepts of gunshot wound treatment: a trauma surgeon's perspective. Trauma remains a significant and persistent public health problem, accounting for 90,000 deaths and 20 million people disabled annually. Current concepts of appropriate triage and emergency treatment of gunshot wounds are addressed from a trauma surgeon's perspective. Recent studies regarding prehospital transport policy, and acute diagnostic studies allow optimal treatment guidelines to be formulated. Specifically (...) , rapid transport rather than prolonged on-scene treatment (including maneuvers such as formal thoracolumbar immobilization) should be given the highest priority. Also, routine arteriography (another time-consuming and invasive procedure) in the treatment of gunshot wounds to the extremity is no longer the standard of care.

2003 Clinical Orthopaedics and Related Research

526. Clinical Analysis of Video-assisted Thoracoscopic Spinal Surgery in the Thoracic or Thoracolumbar Spinal Pathologies Full Text available with Trip Pro

thoracosopic surgery (VATS) to treat various thoracic and thoracolumbar pathologies from April 2000 to July 2006. The lesions consisted of spinal trauma (13 cases), thoracic disc herniation (4 cases), tuberculous spondylitis (1 case), post-operative thoracolumbar kyphosis (1 case) and thoracic tumor (1 case). The level of operation included upper thoracic lesions (3 cases), midthoracic lesions (6 cases) and thoracolumbar lesions (11 cases). We classified the procedure into three groups: stand-alone (...) Clinical Analysis of Video-assisted Thoracoscopic Spinal Surgery in the Thoracic or Thoracolumbar Spinal Pathologies Thoracoscopic spinal surgery provides minimally invasive approaches for effective vertebral decompression and reconstruction of the thoracic and thoracolumbar spine, while surgery related morbidity can be significantly lowered. This study analyzes clinical results of thoracoscopic spinal surgery performed at our institute.Twenty consecutive patients underwent video-assisted

2007 Journal of Korean Neurosurgical Society

527. Comments on “Management of traumatic thoracolumbar fractures ...” Full Text available with Trip Pro

Comments on “Management of traumatic thoracolumbar fractures ...” 15692826 2005 12 14 2018 11 13 0940-6719 14 6 2005 Aug European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society Eur Spine J Comments on "Management of traumatic thoracolumbar fractures ...". 535 Knop C C Department of Trauma Surgery and Sports Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 (...) Surg Am. 1980 Dec;62(8):1324-8 7440611 Acta Orthop Scand. 1982 Jun;53(3):369-81 7090761 Ann Acad Med Singapore. 1982 Apr;11(2):203-6 7137898 Clin Orthop Relat Res. 1984 Oct;(189):142-9 6478691 Spine (Phila Pa 1976). 1988 Jan;13(1):33-8 3381135 J Trauma. 1988 Aug;28(8):1188-94 3411642 Unfallchirurg. 1991 Jan;94(1):40-4 2028264 Spine (Phila Pa 1976). 1991 Aug;16(8 Suppl):S440-4 1838448 J Spinal Disord. 1990 Mar;3(1):39-46 2151984

2005 European Spine Journal

528. Is fusion necessary for surgically treated burst fractures of the thoracolumbar and lumbar spine?: a prospective, randomized study. (Abstract)

Is fusion necessary for surgically treated burst fractures of the thoracolumbar and lumbar spine?: a prospective, randomized study. A prospective clinical trial was conducted.To compare the results of fusion versus nonfusion for surgically treated burst fractures of the thoracolumbar and lumbar spine.The operative results of surgically treated burst fractures with short segmental fixation have been well documented. There is no report comparing the results of fusion and nonfusion.Fifty-eight (...) patients were included in this study, with the inclusion criteria as follows: neurologically intact spine with a kyphotic angle > or = 20 degrees, decreased vertebral body height > or = 50% or a canal compromise > or = 50%, incomplete neurologic deficit with a canal compromise 50%, complete neurologic deficit, and multilevel spinal injury or multiple traumas. All patients were randomly assigned to fusion or nonfusion groups, and operative treatment with posterior reduction and instrumentation

2006 Spine Controlled trial quality: uncertain

529. Surgeon equipoise as an inclusion criterion for the evaluation of nonoperative versus operative treatment of thoracolumbar spinal injuries. (Abstract)

are assessed to compare competing treatment regimens. Surgeon equipoise served as an inclusion criterion.Patients with closed or open thoracolumbar spinal fracture with or without neurological impairment, presenting to one of two different trauma centers between 1991 and 2005 (N = 760).Homogeneity of baseline clinical and demographic data and distribution of prognostic risk factors between the operative and the nonoperative cohort.Patients treated for spine fractures at two University hospitals practicing (...) Surgeon equipoise as an inclusion criterion for the evaluation of nonoperative versus operative treatment of thoracolumbar spinal injuries. Prospective studies have failed to demonstrate the superiority of either operative or nonoperative treatment of thoracolumbar fractures. Similar to other surgical fields, research has been limited by the variability in surgical interventions, difficult recruitment, infrequent pathology, and the urgency of interventions.To outline factors precluding

2008 The Spine Journal

530. Assessment of injury to the thoracolumbar posterior ligamentous complex in the setting of normal-appearing plain radiography. (Abstract)

Assessment of injury to the thoracolumbar posterior ligamentous complex in the setting of normal-appearing plain radiography. The posterior ligamentous complex (PLC) is thought to contribute significantly to the stability of thoracolumbar spine. Obvious translation or dislocation of an interspace clearly denotes injury to the PLC. A recent survey of the Spine Trauma Study Group indicated that plain radiographic findings, if present, are most helpful in determining PLC injury. However, confusion (...) exists when plain radiography shows injury to the anterior spinal column without significant kyphosis or widening of the posterior interspinous space.The objective of this study is to identify imaging parameters that may suggest a disruption of the posterior ligamentous complex of the thoracolumbar spine in the setting of normal-appearing plain radiographs. This study was performed, in part, as a pilot study to determine critical imaging parameters to be included in a future prospective, randomized

2007 The Spine Journal

531. Surgical management of posttraumatic thoracolumbar kyphosis. (Abstract)

Surgical management of posttraumatic thoracolumbar kyphosis. Spine trauma is relatively common, and each year approximately 10,000 to 17,000 people in the United States will sustain a spinal cord injury and approximately 150,000 to 160,000 will fracture their spinal column. Posttraumatic spinal deformity is a common potential complication of spinal injury and poses one of the greatest challenges in spinal surgery.To provide a comprehensive and current review of posttraumatic deformity focusing

2008 The Spine Journal

532. Thoracoscopic transdiaphragmatic approach to thoracolumbar junction fractures. (Abstract)

Thoracoscopic transdiaphragmatic approach to thoracolumbar junction fractures. Anterior approaches to the thoracocolmbar junction (TLJ) are often required to restore anterior column deficiency after spinal trauma. Conventional open approaches are often associated with significant morbidity, and hence there is a need for a minimally invasive approach to TLJ fractures.To report the feasibility and effectiveness of the thoracoscopic transdiaphragmatic approach (TTA) in the management of TLJ (...) fractures.A retrospective analysis of 212 patients undergoing surgery at two institutions by the TTA with neurological outcomes, fusion rates and complications.This is a two-institution study of 212 patients managed by TTA, from Berufsgenossenschaftliche Unfallklinik Marnau, a regional trauma facility located in Murnau, Bavaria, Germany, and from Stanford University, Stanford, California from May 1996 to June 2002. Patient ages ranged from 16 to 75 years (mean, 36 years) and included 158 males and 62

2004 The Spine Journal

533. Practice management guidelines for the screening of thoracolumbar spine fracture. (Abstract)

Practice management guidelines for the screening of thoracolumbar spine fracture. Fractures to the thoracolumbar spine (TLS) commonly occur because of major trauma mechanisms. In one series, 4.4% of all patients arriving at a Level I trauma center were diagnosed as having TLS fracture. Approximately 19% to 50% of these fractures in the TLS region will be associated with neurologic damage to the spinal cord. To date there are no randomized studies and only a few prospective studies specifically (...) addressing the subject. The Eastern Association for the Surgery of Trauma organization Practice Management Guidelines committee set out to develop an EBM guideline for the diagnosis of TLS fractures.A computerized search of the National Library of Medicine and the National Institutes of Health MEDLINE database was undertaken using the PubMed Entrez (www.pubmed.gov) interface. The primary search strategy was developed to retrieve English language articles focusing on diagnostic examination of potential

2007 Journal of Trauma

534. The clinical presentation of pediatric thoracolumbar fractures: a prospective study. (Abstract)

The clinical presentation of pediatric thoracolumbar fractures: a prospective study. Thoracolumbar spine (TLS) fractures are rare in the pediatric population but may result in significant morbidity, necessitating a prompt diagnosis. No formal recommendations have been made for screening pediatric trauma patients for TLS fractures; early diagnosis has traditionally relied on clinical parameters extrapolated from adult data.From March 2004 to April 2005 patients presenting to a level one (...) pediatric trauma center were consecutively enrolled. Clinicians were asked to assess eligible patients and prospectively state their TLS examination findings and degree of clinical suspicion for fracture.A total of 228 patients were enrolled (mean age of 8.2 years), 16 with TLS fractures. Clinical performance of the TLS spine examination diagnosed a fracture with a sensitivity of 81% (95% CI: 0.57, 0.93), specificity of 68% (0.62, 0.74), and odds ratio of 9.38 (2.59, 34.01). A clinician's degree

2008 Journal of Trauma

535. The clinical presentation of pediatric thoracolumbar fractures. (Abstract)

-June 2001) were studied. Data were collected in a standardized fashion, as part of the trauma registry, and extracted for retrospective analysis, including: patient demographics, clinical acuity, mechanism of injury, injury scores, and length of stay.There were 96 patients with thoracolumbar fractures (TLF) and 96 control patients (NTLF) enrolled in our study. The groups were significantly different (p < 0.05) regarding several variables including: median age (11 years TLF, 7.5 years NTLF), Revised (...) Trauma Score (7.84 for TLF, 7.55 for NTLF), need for hospital admission (60% TLF, 86% NTLF), PICD admission (23% TLF, 56% NTLF), general surgical procedures (18%TLF, 34% NTLF), Injury Severity Score (8 TLF, 10NTLF). Patients were not different regarding gender, Glasgow Coma Scale, hospital days, or mortality. An abnormal thoracolumbar spine examination was noted in 77 TLF patients and 20 NTLF patients, the sensitivity was 87% (95% CI: 78-93) and the specificity was 75% (95% CI: 65-84). The most

2006 Journal of Trauma

536. Isolated thoracolumbar transverse process fractures: call physical therapy, not spine. (Abstract)

trauma, TVPFx have been diagnosed with far greater frequency. Yet, where no associated spine injuries are found initially, such isolated TVPFx appear to be benign.We retrospectively reviewed the diagnosis and management of TVPFx in a large Level I trauma center in the period between 2002 and 2005. Of 314 patients with TVPFx who survived more than 48 hours, 17% had fractures of the weight-bearing columns of the thoracolumbar spine noted on the same CT scan and were excluded from study. The management (...) Isolated thoracolumbar transverse process fractures: call physical therapy, not spine. Historically, thoracolumbar spine transverse process fractures (TVPFx) found on "plain films" of the spine were occasionally associated with occult, mechanically significant vertebral fractures. Thus, "log-roll precautions" have been used pending formal spine evaluation and further imaging. As integrated helical computed tomography (CT) scans of the torso have become routine screening tools in high-energy

2007 Journal of Trauma

537. Risk of thoracolumbar fractures doubled in victims of motor vehicle collisions with cervical spine fractures. (Abstract)

Risk of thoracolumbar fractures doubled in victims of motor vehicle collisions with cervical spine fractures. An association between cervical fractures and thoracolumbar fractures after blunt trauma has long been assumed, but not adequately demonstrated. We sought to determine the actual association between these injuries in a large nationwide data set.The National Trauma Databank (NTDB) was queried for victims of blunt vehicular trauma with at least minimal injury. An odds ratio was calculated (...) without cervical spine fracture only 6.91% (11,859) had a thoracolumbar fracture. The odds ratio (OR) for a thoracolumbar fracture in the presence of a cervical spine fracture was 2.02 (p < 0.0001) (95% confidence interval 1.9318-2.1201).These data confirm a strong association between cervical spine fractures and thoracolumbar fractures after blunt vehicular trauma, and support the practice of imaging the complete spine when a cervical fracture is identified.

2006 Journal of Trauma

538. Posterior approach vertebrectomy in the thoracolumbar spine with expandable cage reconstruction: indications and techniques based on eight cases. (Abstract)

Posterior approach vertebrectomy in the thoracolumbar spine with expandable cage reconstruction: indications and techniques based on eight cases. We present a series of eight patients undergoing circumferential neural decompression and stabilization of the thoracolumbar spine via a single midline posterior approach, with complete vertebrectomy for a variety of indications. Four had primary tumours, two secondary tumours, one patient had tuberculosis and one had delayed deformity due to trauma (...) a sound construct. The flexibility of this approach in the thoracolumbar spine, some of the biomechanical advantages and pitfalls are considered.

2008 British Journal of Neurosurgery

539. Thoracolumbar flexion-distraction injuries: associated morbidity and neurological outcomes. Full Text available with Trip Pro

for IAI. Presence of a lumbar injury due to a motor vehicle crash in the presence of a lapbelt sign was positively associated with IAI. There was no increase in complications in the subpopulation of patients with concurrent SCI and FDI.Both IAI and SCI remain commonly associated with FDI of the thoracolumbar spinal column. The presence of an abdominal wall contusion (lapbelt sign) is a strong indicator of IAI. Adherence to an established trauma algorithm can minimize the risk of delayed diagnosis (...) Thoracolumbar flexion-distraction injuries: associated morbidity and neurological outcomes. Retrospective study, prospectively gathered databases.To assess abdominal comorbidities, missed injuries, and complications associated with thoracolumbar flexion-distraction injuries (FDI).From 1989 to 2003, 153 patients with flexion-distraction type injuries were identified. Predominant injury mechanisms consisted of motor vehicle crashes, falls, and motorcycle crashes.Spinal injuries were categorized

2008 Spine

540. Variability in rates of arthrodesis for patients with thoracolumbar spine fractures with and without associated neurologic injury. (Abstract)

arthrodesis in thoracolumbar fracture patients with and without neurologic injury. Variability in fusion rate for thoracolumbar spine trauma appears to be lower than that reported for elective spine procedures, especially in the presence of a neurologic injury. (...) Variability in rates of arthrodesis for patients with thoracolumbar spine fractures with and without associated neurologic injury. Retrospective cohort study using a large clinical database.Assess hospital-based rates of thoracolumbar spine arthrodesis within the United States for patients with a thoracolumbar spine fracture.Substantial variation has been documented in per capita rates of elective lumbar spinal arthrodesis. Similar data regarding rates of arthrodesis for traumatic thoracolumbar

2007 Spine

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