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Thoracolumbar Trauma

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541. The load-sharing classification of thoracolumbar fractures: an in vitro biomechanical validation. (Abstract)

The load-sharing classification of thoracolumbar fractures: an in vitro biomechanical validation. An in vitro biomechanical investigation.The purpose of this study was to investigate the association between various load-sharing score and the acute flexibility of thoracolumbar fractures by measuring the 3-dimensional flexibility data.The load-sharing classification is a way to describe the injury severity of a spinal fracture and can be very useful in determining successful candidates (...) for the choice of operative approaches. However, this classification needs to be validated by biomechanical and more clinical studies before its widespread use. To date, no biomechanical study was available.Eighteen fresh bovine T12-L3 specimens were harvested and divided into 3 groups, and subjected to axial compressive impact with 63.8, 107.8, and 137.2 J energy, respectively. Radiograph films and computed tomography scans of the experimental spine were taken in neutral posture after trauma

2007 Spine

542. The influence of fracture mechanism and morphology on the reliability and validity of two novel thoracolumbar injury classification systems. (Abstract)

algorithms have been developed for the categorization and management of thoracolumbar injuries: the TLISS system emphasizing injury mechanism and the TLICS scheme involving injury morphology.The clinical and radiographic findings of 25 patients with thoracolumbar fractures were prospectively presented to 5 groups of surgeons with disparate levels of training and experience with spinal trauma. These injuries were consecutively scored, first using the TLISS and then 3 months later with the TLICS (...) on mechanism/morphology, integrity of the posterior ligaments, and proposed management (P < or = 0.01). The TLISS and TLICS schemes both exhibited excellent overall validity.Although both schemes were noted to have substantial reproducibility and validity, our results indicate the TLISS is more reliable than the TLICS, suggesting that the mechanism of trauma may be a more valuable parameter than fracture morphology for the classification and treatment thoracolumbar injuries. Since these injury

2007 Spine

543. The influence of posterior instrumentation on adjacent and transfixed facet joints in patients with thoracolumbar spinal injuries: a morphological in vivo study using computerized tomography osteoabsorptiometry. (Abstract)

The influence of posterior instrumentation on adjacent and transfixed facet joints in patients with thoracolumbar spinal injuries: a morphological in vivo study using computerized tomography osteoabsorptiometry. Subchondral mineralization of adjacent and transfixed facet joints was analyzed in patients with thoracolumbar spinal injuries, both before posterior instrumentation and after removal of the spinal implant.To examine the influence of posterior instrumentation on content and distribution (...) of subchondral mineralization as a correlate of the long-term load acting on the adjacent and transfixed zygapophysial joints.Posterior stabilization plays an important role in the treatment of spinal injuries and is a standard technique for the treatment of thoracolumbar spinal fractures. Studies have shown that stress and motion in the adjacent segments are altered in the presence of instrumentation.Twenty-three patients with thoracolumbar spinal injuries had computerized tomography (CT) during the course

2005 Spine

544. A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. (Abstract)

A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. A new proposed classification system for thoracolumbar (TL) spine injuries, including injury severity assessment, designed to assist in clinical management.To devise a practical, yet comprehensive, classification system for TL injuries that assists in clinical decision-making in terms of the need for operative versus nonoperative care (...) and surgical treatment approach in unstable injury patterns.The most appropriate classification of traumatic TL spine injuries remains controversial. Systems currently in use can be cumbersome and difficult to apply. None of the published classification schemata is constructed to aid with decisions in clinical management.Clinical spine trauma specialists from a variety of institutions around the world were canvassed with respect to information they deemed pivotal in the communication of TL spine trauma

2005 Spine

545. Clinical outcome and radiographic results after surgical treatment of post-traumatic thoracolumbar kyphosis following simple type A fractures. Full Text available with Trip Pro

surgical treatment using an anterior procedure alone (group 1, n = 10 patients) and using a one-stage combined anterior and posterior procedure (group 2, n = 15 patients) for post-traumatic thoracolumbar kyphosis after simple type A fractures. The main indication for surgery was pain. There were no statistically significant differences between the patients in the two groups concerning age, cause of injury, time interval between trauma and surgery, preoperative kyphosis and preoperative back pain score (...) Clinical outcome and radiographic results after surgical treatment of post-traumatic thoracolumbar kyphosis following simple type A fractures. The surgical management of post-traumatic thoracolumbar kyphosis remains controversial. The need for combined procedures is subject to debate, especially for post-traumatic kyphosis after simple type A fractures. The aim of this retrospective study was to evaluate radiographic findings, patient satisfaction and clinical outcome after mono-segmental

2004 European Spine Journal

546. Internet based multicenter study for thoracolumbar injuries: a new concept and preliminary results. (Abstract)

Internet based multicenter study for thoracolumbar injuries: a new concept and preliminary results. This article reports about the internet based, second multicenter study (MCS II) of the spine study group (AG WS) of the German trauma association (DGU). It represents a continuation of the first study conducted between the years 1994 and 1996 (MCS I). For the purpose of one common, centralised data capture methodology, a newly developed internet-based data collection system ( http (...) ://www.memdoc.org ) of the Institute for Evaluative Research in Orthopaedic Surgery of the University of Bern was used. The aim of this first publication on the MCS II was to describe in detail the new method of data collection and the structure of the developed data base system, via internet. The goal of the study was the assessment of the current state of treatment for fresh traumatic injuries of the thoracolumbar spine in the German speaking part of Europe. For that reason, we intended to collect large

2006 European Spine Journal

547. Anterior spinal fusion versus posterior spinal fusion for moderate lumbar/thoracolumbar adolescent idiopathic scoliosis: a prospective study. (Abstract)

), decreased blood transfusion (P = 0.006), reduced implants cost and hospitalization expenses (P = 0.000). Additionally, group A had shorter fusion levels than group B (p50 = 4 vs. p50 = 5, P = 0.003).ASF versus PSF comparison in treating moderate lumbar/thoracolumbar AIS did not show significant differences in regards to safety or efficacy but demonstrated shorter fusion levels, reduced surgical trauma and costs in ASF. (...) Anterior spinal fusion versus posterior spinal fusion for moderate lumbar/thoracolumbar adolescent idiopathic scoliosis: a prospective study. A prospective study.Comparison study of radiologic and clinical outcomes, efficiency, and cost between anterior spinal fusion (ASF) and posterior spine fusion (PSF) in surgical treatment of moderate lumbar/thoracolumbar adolescent idiopathic scoliosis (AIS).ASF and PSF indicated for lumbar and thoracolumbar adolescent idiopathic scoliosis surgical

2008 Spine

548. A prospective cohort study comparing the VAS spine score and Roland-Morris disability questionnaire in patients with a type A traumatic thoracolumbar spinal fracture. Full Text available with Trip Pro

A prospective cohort study comparing the VAS spine score and Roland-Morris disability questionnaire in patients with a type A traumatic thoracolumbar spinal fracture. The Roland Morris Disability Questionnaire (RMDQ-24) and the VAS spine score have been regularly used to measure functional outcome in patients with back pain. The RMDQ-24 is primarily used in degenerative disease of the spine and the VAS Spine is used in trauma patients. The aim of this study is to compare these scores and to see (...) if there is a correlation in patients with a traumatic thoracolumbar spinal fracture. Prospective cohort study comparing the RMDQ-24 and the VAS spine score in patients with a traumatic type A fracture thoracolumbar spine fracture. Fifteen non-operatively patients (group one) completed 118 questionnaires and 17 operatively treated patients (group two) completed 140 questionnaires. Group one scored an average of 6.6 and 65.9 for the RMDQ-24 and VAS Spine, in group two this was 5.1 and 82.9. Spearman's correlation test

2008 European Spine Journal

549. Reduction of bone retropulsed into the spinal canal in thoracolumbar vertebral body compression burst fractures. A prospective randomized comparative study between Harrington rods and two transpedicular devices. (Abstract)

Reduction of bone retropulsed into the spinal canal in thoracolumbar vertebral body compression burst fractures. A prospective randomized comparative study between Harrington rods and two transpedicular devices. This was a prospective, randomized study.To compare the ability of three methods of internal fixation (Harrington rods, AO internal fixator, posterior segmental fixator) to obtain reduction of intracanal fragments in thoracolumbar vertebral compression burst fractures.Sixty-seven acute (...) thoracolumbar compression burst fractures of T12 or L1 were randomized into three groups that were treated using one of the three methods. Reduction was accomplished indirectly by distraction applied using the fixation device.The spinal canal encroachment was calculated as a percentage of the estimated pre-injury value from serial transverse computed tomographic scans obtained on admission and immediately after surgery.The median preoperative sagittal encroachment of the spinal canal was 37% (range, 0-90

1995 Spine Controlled trial quality: uncertain

550. Graded thoracolumbar spinal injuries: development of multidirectional instability Full Text available with Trip Pro

injuries of the thoracolumbar junction. A graded spinal trauma experiment was designed, in which the threshold of injury and injury progression were examined. Ten thoracolumbar human spine specimens (T11-L1) were traumatized using a high-speed incremental trauma model. The ROM and NZ, which indicate altered mechanical properties, were determined for three physiological motions: flexion/extension (FE), lateral bending (LB), and axial rotation (AR). The injury threshold was found to be 84 J (or 84 Nm (...) Graded thoracolumbar spinal injuries: development of multidirectional instability Injuries of the thoracolumbar spine are serious, disabling, and costly to society. These injuries vary from mild ligament tears to severe bony fractures. Increased range of motion (ROM) and neutral zone (NZ) have been suggested as indicators of the resulting clinical instability. The purpose of the present study was to investigate the relative sensitivities and merits of the ROM and NZ in relation to spinal

1998 European Spine Journal

551. Thoracolumbar distraction fractures in advanced pregnancy: a contribution of two case reports Full Text available with Trip Pro

Thoracolumbar distraction fractures in advanced pregnancy: a contribution of two case reports Thoracolumbar trauma in pregnant women is an important topic, though rarely discussed in the pertinent literature. Two consecutive cases of thoracolumbar distraction injuries in advanced pregnancy are presented. Conservative treatment failed in both cases; surgical management was necessary on a delayed basis using compression instrumentation. The similar features of the pattern of injury in the two

2000 European Spine Journal

552. The use of 'hybrid' allografts in the treatment of fractures of the thoracolumbar spine: first experience Full Text available with Trip Pro

fusion. 'Hybrid' fresh-frozen allografts from the femur or tibia were used in 11 adult patients with a mean age of 56.4 years (range: 30-78 years) to stabilize the thoracolumbar spine after anterior decompression for trauma. In one case two adjacent levels were fractured, in another case two fractures occurred at different levels. Fresh-frozen allografts of the femur (in ten cases) and tibia (one case), filled with autogenous cancellous bone graft or pieces of rib, were used to reconstruct (...) The use of 'hybrid' allografts in the treatment of fractures of the thoracolumbar spine: first experience Harvesting autogenous bone grafts of the iliac crest carries complications and lengthens operative times. Allografts are preferred to avoid these problems. Fusion after using allogenic bone grafts has been well studied, by examining trabeculations and remodelling on anteroposterior and lateral radiographs. However, the question remains whether one can rely on radiographs alone to determine

2000 European Spine Journal

553. Complications in surgical treatment of thoracolumbar injuries Full Text available with Trip Pro

Complications in surgical treatment of thoracolumbar injuries The range of surgical methods for operative treatment of thoracolumbar injuries, with their different ways of approach, grafts and techniques, remains wide. The authors present sources of error and specific complications based on their own experience and on the results of a multicenter study of the Spine Study Group of the German Trauma Association (DGU). A systematic overview of possible mistakes and complications is first presented (...) in anatomical order. A detailed analysis is then presented of the complications reported in a multicenter study, carried out prospectively between 1994 and 1996, on 682 patients operated for acute traumatic injuries of the thoracolumbar spine. In 101 cases (15%) at least one complication occurred intra- or postoperatively. In 41 patients (6%) a revision was performed, and in 60 patients (9%) complications without operative revision were observed. These complications were analysed according to the chosen

2002 European Spine Journal

554. Fate of the transpedicular intervertebral bone graft after posterior stabilisation of thoracolumbar fractures Full Text available with Trip Pro

influence on postoperative re-kyphosing. Twenty-nine patients with acute fractures of the thoracolumbar spine, treated between 1988 and 1995 at the Department of Trauma Surgery, Hannover Medical School, underwent posterior stabilisation and interbody fusion with transpedicular cancellous bone grafting. This study group was followed clinically and radiologically for a mean of 3.5 years. All patients underwent spiral CT scan with sagittal reconstruction after implant removal. Twenty-four type A, four type (...) Fate of the transpedicular intervertebral bone graft after posterior stabilisation of thoracolumbar fractures The authors present a retrospective clinical and radiological study addressing the outcome after posterior stabilisation of thoracolumbar fractures with intervertebral fusion via transpedicular bone grafting. The study included computed tomographic (CT) scan after implant removal for analysis of the intervertebral fusion and incorporation of the intervertebral bone graft and its

2002 European Spine Journal

555. Fluoroscopically assisted pedicle screw fixation for thoracic and thoracolumbar injuries: technique and short-term complications. (Abstract)

stabilization, but evidence of its accuracy and complications in the thoracic spine is lacking.Between 1997 and 2000, 41 consecutive patients with unstable cervicothoracic, thoracic, and thoracolumbar spine injuries were admitted to a regional, level 1 trauma center. These patients underwent posterior spine arthrodesis and pedicle screw instrumentation placed intraoperative multiplanar fluoroscopic imaging. Pedicle screw placement accuracy was determined by review of postoperative computed tomography scans (...) Fluoroscopically assisted pedicle screw fixation for thoracic and thoracolumbar injuries: technique and short-term complications. Retrospective review of charts and fluoroscopic, radiographic, and computed tomography images for 252 screws (41 patients).To describe a fluoroscopically assisted technique of thoracic pedicle screw insertion and to determine the technique's safety, short-term complications, and accuracy.Pedicle screw instrumentation is safe and effective for lumbar spine

2003 Spine

556. Functional outcome in patients with thoracolumbar burst fractures treated with dorsal instrumentation and transpedicular cancellous bone grafting. Full Text available with Trip Pro

Functional outcome in patients with thoracolumbar burst fractures treated with dorsal instrumentation and transpedicular cancellous bone grafting. The aim of the study was to develop an insight into the impairments in spinal fracture patients, operatively treated with an internal fixator, and also into their ability to participate in daily living, return to work and quality of life as defined by the World Health Organization. Nineteen patients operated for a type A fracture of the thoracolumbar (...) (healthy) age group could be identified in any variable of the SF36. A high correlation was seen between RMDQ, VAS Spine Score and the SF36 categories. No correlation was found between the anterior wedge angle and the regional angle on the one hand, and functional capacity tests or questionnaire scores on the other. Of the patients in paid employment before the trauma, 87% had returned to work at follow-up. About 50% of the patients had been obliged to change the intensity of their work or the kind

2003 European Spine Journal

557. Reliability of a novel classification system for thoracolumbar injuries: the Thoracolumbar Injury Severity Score. (Abstract)

injury classification and facilitate treatment decision making. Before being widely adopted, the reliability of the TLISS must be studied.A total of 71 cases of thoracolumbar spinal trauma were distributed on CD-ROM to 5 attending spine surgeons, including clinical/radiographic data, details of the TLISS, and a scoring sheet in which cases would be scored using the system. The surgeons were later assigned the task with the cases reordered. Intraobserver and interobserver reliability was calculated (...) Reliability of a novel classification system for thoracolumbar injuries: the Thoracolumbar Injury Severity Score. Prospective study of 5 spine surgeons rating 71 clinical cases of thoracolumbar spinal injuries using the Thoracolumbar Injury Severity Score (TLISS) and then re-rating the cases in a different order 1 month later.To determine the reliability of the TLISS system.The TLISS is a recently introduced classification system for thoracolumbar spinal column injures designed to simplify

2006 Spine

558. Radiographic abnormalities in the thoracolumbar spine of young elite skiers. Full Text available with Trip Pro

Radiographic abnormalities in the thoracolumbar spine of young elite skiers. An increased frequency of radiologic abnormalities in the thoracolumbar spine has been reported among young athletes in various sports, but there are no data concerning ski sports. To evaluate the incidence of these abnormalities in young elite skiers, we compared 120 skiers younger than 17 years old (alpine skiers, ski jumpers, and Nordic cross-country skiers) with a random sample of 39 control subjects of the same (...) endplate lesions than did the control subjects. This finding might be attributable to excessive loading and repetitive trauma of the immature spine under high velocity, especially in the forward bent posture.

2001 American Journal of Sports Medicine Controlled trial quality: uncertain

559. Endoscopic treatment of spinal trauma at the thoracolumbar junction Full Text available with Trip Pro

Endoscopic treatment of spinal trauma at the thoracolumbar junction Attempts of treating unstable fractures of the thoracolumbar junction by posterior reduction and fixation alone often result in a significant loss of correction, especially in lesions where a severe destruction of the vertebral body and the intervertebral disc is present. The conventional open approaches like classic thoraco-phreno-lumbotomy produces additional iatrogenic trauma at the lateral chest and abdominal wall which (...) not rarely leads to intercostal neuralgia, as well as post-thoracotomy syndromes. The endoscopic trans-diaphragmatic approach described below opens up the whole thoracolumbar junction to a minimally invasive procedure allowing one to perform all the procedures needed for a full reconstruction of the anterior column of the spine like corpectomy, decompression, vertebral body replacement and anterior plating. The key to address also the subdiaphragmal and retroperitoneal section of the thoracolumbar

2007 Indian journal of orthopaedics

560. Assessment of injury to the posterior ligamentous complex in thoracolumbar spine trauma. (Abstract)

Assessment of injury to the posterior ligamentous complex in thoracolumbar spine trauma. Posterior ligamentous complex (PLC), consisting of supraspinous ligament (SSL), interspinous ligament (ISL), ligamentum flavum (LF), and the facet joint capsules is thought to contribute significantly to the stability of thoracolumbar spine. Currently, no consensus exists on radiographic imaging parameters that may indicate injury to the posterior ligamentous complex.To identify imaging parameters that may (...) suggest a disruption of the PLC of the thoracolumbar spine.A survey analysis of members of the Spine Trauma Study Group.None.Compilation of survey results.An extensive review of the literature from 1949 to the present was performed to identify key radiographic elements that have been suggested as indicators of PLC injury. Twelve items identified as such were placed on a survey and sent to the members of the Spine Trauma Study Group. They were asked to rank the items from most important to least

2006 The Spine Journal

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