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The management of thoracolumbar burst fractures: a prospective study between conservative management, traditional open spinal surgery and minimally interventional spinal surgery.

Kumar A, Aujla R, Lee C - Springerplus (2015)

Bottom Line: Those patients treated with MIS techniques demonstrated superior outcomes compared to traditional open techniques and conservative methods of treatment, with significantly reduced hospital stay, better return to work & leisure, and the best chance of restoring their spine to near its pre-injury status.We would recommend MIS techniques as the best way of treating single level thoracolumbar spinal fractures.There is a significant improvement in ODI when treated by MIS over open surgical methods.

View Article: PubMed Central - PubMed

Affiliation: Specialist Orthopaedic Registrar, University Hospitals Leicester, Infirmary Square, Leicester, LE1 5WW UK.

ABSTRACT
The objective of this study was to assess which patient group had better outcomes for management of single level thoracolumbar spinal fractures. We prospectively collected data on the outcomes of patients having either conservatively managed, traditional open surgery, or minimally interventional surgery (MIS) for treatment of a single level thoracolumbar fracture. All patients had previously asymptomatic spines prior to their fractures and had a single level thoracolumbar burst fracture of more than 20° kyphosis. Fractures treated operatively, either via open surgery or MIS techniques, were corrected to less than 10° of residual kyphosis using a monoaxial pedicle screw construct 2 levels above & 2 levels below the fracture posteriorly only. The metalwork was removed between 6 months and 1 year post operatively to remobilise the spinal segments. All patients were then evaluated at least 6 months after metal work removal and at 18 months post fracture using radiographs and the Oswestry Disability Index (ODI). Those patients treated with MIS techniques demonstrated superior outcomes compared to traditional open techniques and conservative methods of treatment, with significantly reduced hospital stay, better return to work & leisure, and the best chance of restoring their spine to near its pre-injury status. We would recommend MIS techniques as the best way of treating single level thoracolumbar spinal fractures. There is a significant improvement in ODI when treated by MIS over open surgical methods.

No MeSH data available.


Related in: MedlinePlus

Radiograph of lower thoracic and lumbar vertebrae 12 months after stabilisation and correction a. Lateral b. Anterio-posterior.
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Fig8: Radiograph of lower thoracic and lumbar vertebrae 12 months after stabilisation and correction a. Lateral b. Anterio-posterior.

Mentions: All surgically treated patients were mobilised immediately post-operatively without any secondary bracing, and were monitored regularly post-operatively. After the removal of sutures at 2 weeks, patients were seen at 3 and 6 months post operatively with standing radiographs prior to implant removal. As this was a corrective procedure for sagittal mal-alignment not involving fusion, all implants were removed between 6 months and 1 year after surgery to remobilise the stabilised segments once the fractured vertebra had healed (Kim et al. 2011; Tezeren et al. 2009; Jindal et al. 2012) (Figure 8). Implant removal was achieved via MIS methods. If the patient had undergone open surgery, then although the old scar was opened, the implants were removed by muscle splitting portholes, the rods being slid out from underneath the muscles from the top portholes, to spare the muscles further violation from a midline approach. If the patient had had MIS techniques, then the old incisions were used and the implants were removed via the same muscle sparing techniques as above. This ensured that there was no morbidity or further trauma caused to the paraspinal muscles by implant removal.Figure 8


The management of thoracolumbar burst fractures: a prospective study between conservative management, traditional open spinal surgery and minimally interventional spinal surgery.

Kumar A, Aujla R, Lee C - Springerplus (2015)

Radiograph of lower thoracic and lumbar vertebrae 12 months after stabilisation and correction a. Lateral b. Anterio-posterior.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4418977&req=5

Fig8: Radiograph of lower thoracic and lumbar vertebrae 12 months after stabilisation and correction a. Lateral b. Anterio-posterior.
Mentions: All surgically treated patients were mobilised immediately post-operatively without any secondary bracing, and were monitored regularly post-operatively. After the removal of sutures at 2 weeks, patients were seen at 3 and 6 months post operatively with standing radiographs prior to implant removal. As this was a corrective procedure for sagittal mal-alignment not involving fusion, all implants were removed between 6 months and 1 year after surgery to remobilise the stabilised segments once the fractured vertebra had healed (Kim et al. 2011; Tezeren et al. 2009; Jindal et al. 2012) (Figure 8). Implant removal was achieved via MIS methods. If the patient had undergone open surgery, then although the old scar was opened, the implants were removed by muscle splitting portholes, the rods being slid out from underneath the muscles from the top portholes, to spare the muscles further violation from a midline approach. If the patient had had MIS techniques, then the old incisions were used and the implants were removed via the same muscle sparing techniques as above. This ensured that there was no morbidity or further trauma caused to the paraspinal muscles by implant removal.Figure 8

Bottom Line: Those patients treated with MIS techniques demonstrated superior outcomes compared to traditional open techniques and conservative methods of treatment, with significantly reduced hospital stay, better return to work & leisure, and the best chance of restoring their spine to near its pre-injury status.We would recommend MIS techniques as the best way of treating single level thoracolumbar spinal fractures.There is a significant improvement in ODI when treated by MIS over open surgical methods.

View Article: PubMed Central - PubMed

Affiliation: Specialist Orthopaedic Registrar, University Hospitals Leicester, Infirmary Square, Leicester, LE1 5WW UK.

ABSTRACT
The objective of this study was to assess which patient group had better outcomes for management of single level thoracolumbar spinal fractures. We prospectively collected data on the outcomes of patients having either conservatively managed, traditional open surgery, or minimally interventional surgery (MIS) for treatment of a single level thoracolumbar fracture. All patients had previously asymptomatic spines prior to their fractures and had a single level thoracolumbar burst fracture of more than 20° kyphosis. Fractures treated operatively, either via open surgery or MIS techniques, were corrected to less than 10° of residual kyphosis using a monoaxial pedicle screw construct 2 levels above & 2 levels below the fracture posteriorly only. The metalwork was removed between 6 months and 1 year post operatively to remobilise the spinal segments. All patients were then evaluated at least 6 months after metal work removal and at 18 months post fracture using radiographs and the Oswestry Disability Index (ODI). Those patients treated with MIS techniques demonstrated superior outcomes compared to traditional open techniques and conservative methods of treatment, with significantly reduced hospital stay, better return to work & leisure, and the best chance of restoring their spine to near its pre-injury status. We would recommend MIS techniques as the best way of treating single level thoracolumbar spinal fractures. There is a significant improvement in ODI when treated by MIS over open surgical methods.

No MeSH data available.


Related in: MedlinePlus