CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2018; 37(04): 304-308
DOI: 10.1055/s-0038-1675223
Artigo Original | Original Article
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Outcome Evaluation of Patients with Burst Thoracolumbar Fractures: A Case Series

Avaliação de resultados de pacientes com fraturas toracolombares do tipo explosão: Uma série de casos
Mohammad Jamali
1   Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
,
Yashar Goorakani
2   Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
,
Niloofar Solat
2   Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
,
Reza Taheri
1   Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
,
Sulmaz Ghahramani
3   Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz Iran
› Author Affiliations
Funding None.
Further Information

Publication History

22 May 2018

31 August 2018

Publication Date:
06 November 2018 (online)

Abstract

Objective The aim of the present study was to evaluate the outcome of short segment instrumentation in patients affected by burst thoracolumbar fractures.

Methods A total of 19 patients with unstable burst fractures of the thoracolumbar spine were eligible for short segment instrumentation. Their functional outcome (by using the Oswestry and Denis scales) and back pain (using the visual analog scale) were evaluated after 12 months.

Results The mean age of the patients was 30.7 years old, and most of them were male (n = 15). The mean hospital stay was 4.6 days. The mean ± standard deviation (SD) of the pain score according to the visual analog scale was 1.63 ± 1.25 after 12 months of surgery, and there were no patients classified with grades 4 or 5 on the Denis work scale. The average Oswestry disability index (ODI) was 17% during the follow-ups.

Conclusions The outcome of the studied patients, including the clinical pain and the functional outcome of postsurgical patients, suggested that the short-segment instrumentation could be an appropriate method for patients with unstable thoracolumbar junction fractures. However, a long-term follow-up is recommended.

Resumo

Objetivo O presente estudo visa avaliar o resultado de instrumentação segmentar curta em pacientes afetados por fraturas toracolombares do tipo explosão.

Métodos Um total de 19 pacientes com fraturas do tipo explosão instáveis na espinha toracolombar foram elegíveis para instrumentação segmentar curta. O resultado funcional (usando as escalas de Oswestry e Denis) e dor nas costas (usando a escala visual analógica da dor) foi avaliado após 12 meses.

Resultados A idade média dos pacientes era de 30,7 anos, sendo a maioria homens (n = 15). A média de internação hospitalar foi de 4,6 dias. O desvio padrão (σ) da pontuação de dor, de acordo com a escala visual analógica foi de 1,63 a 1,25 após 12 meses de cirurgia, não havendo pacientes classificados com graus quatro ou cinco na escala de trabalho de Denis. A média da pontuação de incapacidade de Oswestry foi de 17% durante o acompanhamento.

Conclusões Os resultados dos pacientes estudados, incluindo a dor clínica e o resultado funcional de pacientes pós-cirúrgicos, sugeriu que a instrumentação segmentar curta pode ser um método apropriado para pacientes com fraturas instáveis nas junções toracolombares. No entanto, um acompanhamento de longo prazo é recomendado.

 
  • References

  • 1 Vu TT, Morishita Y, Yugue I, Hayashi T, Maeda T, Shiba K. Radiological outcome of short segment posterior instrumentation and fusion for thoracolumbar burst fractures. Asian Spine J 2015; 9 (03) 427-432
  • 2 Wood K, Buttermann G, Mehbod A, Garvey T, Jhanjee R, Sechriest V. Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit. A prospective, randomized study. J Bone Joint Surg Am 2003; 85-A (05) 773-781
  • 3 Inamasu J, Guiot BH, Nakatsukasa M. Posterior instrumentation surgery for thoracolumbar junction injury causing neurologic deficit. Neurol Med Chir (Tokyo) 2008; 48 (01) 15-21 , discussion 21
  • 4 Farrokhi MR, Razmkon A, Maghami Z, Nikoo Z. Inclusion of the fracture level in short segment fixation of thoracolumbar fractures. Eur Spine J 2010; 19 (10) 1651-1656
  • 5 Gajjar SH, Menon HJ, Chaudhari N, Chaudhari V. Outcomes of Short Segment Posterior Instrumentation in Unstable Thoracolumbar Fractures. J Clin Diagn Res 2016; 10 (11) RC04-RC08
  • 6 Khare S, Sharma V. Surgical outcome of posterior short segment trans-pedicle screw fixation for thoracolumbar fractures. J Orthop 2013; 10 (04) 162-167
  • 7 Petersilge CA, Emery SE. , Eds. Thoracolumbar burst fracture: evaluating stability. Elsevier: Seminars in Ultrasound, CT and MRI; 1996
  • 8 Tang J, Liu Y, Cao Z, Hu Y, Lu X, Lin B. Short segment screw fixation without fusion in treatment for unstable thoracolumbar burst fracture. Int J Clin Exp Med 2014; 7 (12) 5681-5685
  • 9 Jonathan-James TE, Chen JL, Mitsunaga MM. Short same-segment fixation of thoracolumbar burst fractures. Hawaii J Med Public Health. 2010; 10 (09) S109
  • 10 Shin TS, Kim HW, Park KS, Kim JM, Jung CK. Short-segment pedicle instrumentation of thoracolumbar burst-compression fractures; short term follow-up results. J Korean Neurosurg Soc 2007; 42 (04) 265-270
  • 11 Chen C, Lv G, Xu B, Zhang X, Ma X. Posterior short-segment instrumentation and limited segmental decompression supplemented with vertebroplasty with calcium sulphate and intermediate screws for thoracolumbar burst fractures. Eur Spine J 2014; 23 (07) 1548-1557
  • 12 Yung AW, Thng PL. Radiological outcome of short segment posterior stabilisation and fusion in thoracolumbar spine acute fracture. Ann Acad Med Singapore 2011; 40 (03) 140-144
  • 13 Roy-Camille R, Roy-Camille M, Demeulenaere C. [Osteosynthesis of dorsal, lumbar, and lumbosacral spine with metallic plates screwed into vertebral pedicles and articular apophyses]. Presse Med 1970; 78 (32) 1447-1448
  • 14 Sargın S, Uccedil BY, Necmioğlu S, Bulut M, Gem M. Clinical and radiological results of posterior instrumentation without fusion for thoracolumbar fractures. Afr J Pharm Pharmacol 2011; 5 (07) 819-822
  • 15 Lee YS, Sung JK. Long-term follow-up results of short-segment posterior screw fixation for thoracolumbar burst fractures. J Korean Neurosurg Soc 2005; 37: 416-421
  • 16 McLain RF, Sparling E, Benson DR. Early failure of short-segment pedicle instrumentation for thoracolumbar fractures. A preliminary report. J Bone Joint Surg Am 1993; 75 (02) 162-167
  • 17 Kramer DL, Rodgers WB, Mansfield FL. Transpedicular instrumentation and short-segment fusion of thoracolumbar fractures: a prospective study using a single instrumentation system. J Orthop Trauma 1995; 9 (06) 499-506
  • 18 Huskisson EC. Measurement of pain. Lancet 1974; 2 (7889): 1127-1131
  • 19 Walsh TL, Hanscom B, Lurie JD, Weinstein JN. Is a condition-specific instrument for patients with low back pain/leg symptoms really necessary? The responsiveness of the Oswestry Disability Index, MODEMS, and the SF-36. Spine 2003; 28 (06) 607-615
  • 20 Denis F, Armstrong GW, Searls K, Matta L. Acute thoracolumbar burst fractures in the absence of neurologic deficit. A comparison between operative and nonoperative treatment. Clin Orthop Relat Res 1984; (189) 142-149
  • 21 An HS, Vaccaro A, Cotler JM, Lin S. Low lumbar burst fractures. Comparison among body cast, Harrington rod, Luque rod, and Steffee plate. Spine 1991; 16 (8, Suppl) S440-S444
  • 22 Roy-Camille R, Saillant G, Berteaux D, Salgado V. Osteosynthesis of thoraco-lumbar spine fractures with metal plates screwed through the vertebral pedicles. Reconstr Surg Traumatol 1976; 15: 2-16
  • 23 Pellisé F, Barastegui D, Hernandez-Fernandez A. , et al. Viability and long-term survival of short-segment posterior fixation in thoracolumbar burst fractures. Spine J 2015; 15 (08) 1796-1803
  • 24 McLain RF, Burkus JK, Benson DR. Segmental instrumentation for thoracic and thoracolumbar fractures: prospective analysis of construct survival and five-year follow-up. Spine J 2001; 1 (05) 310-323
  • 25 McCormack T, Karaikovic E, Gaines RW. The load sharing classification of spine fractures. Spine 1994; 19 (15) 1741-1744
  • 26 Uzumcugil O, Dogan A, Yetis M, Yalcinkaya M, Caniklioglu M. Results of ‘two above- one below approach’ with intermediate screws at the fracture site in the surgical treatment of thoracolumbar burst fractures. Kobe J Med Sci 2010; 56 (02) E67-E78