Download PDF
CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2023; 58(01): 042-047
DOI: 10.1055/s-0042-1749622
Original Article
Coluna

Comparação entre tratamento cirúrgico e conservador para fraturas toracolombares AOSpine tipo A3 e A4 sem déficit neurológico: Estudo de coorte prospectivo observacional

Article in several languages: português | English
Emiliano Neves Vialle 
1   Grupo de Cirurgia da Coluna, Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, PR, Brasil
,
Asdrubal Falavigna 
2   Serviço de Ortopedia e Traumatologia, Universidade de Caxias do Sul (UCS), Caxias do Sul, RS, Brasil
,
André de Oliveira Arruda 
1   Grupo de Cirurgia da Coluna, Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, PR, Brasil
,
Joana Bretas Cabral Rondon Guasque 
1   Grupo de Cirurgia da Coluna, Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, PR, Brasil
,
Bárbara Miroski de Oliveira Pinto 
1   Grupo de Cirurgia da Coluna, Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, PR, Brasil
,
Guilherme Finger 
3   Departamento de Neurocirurgia, Hospital Cristo Redentor, Porto Alegre, Brasil
,
Ericson Sfreddo 
3   Departamento de Neurocirurgia, Hospital Cristo Redentor, Porto Alegre, Brasil
,
André Martins de Lima Cecchini 
3   Departamento de Neurocirurgia, Hospital Cristo Redentor, Porto Alegre, Brasil
› Author Affiliations
› Further Information
   Permissions and Reprints

Resumo

Objetivo Comparar os resultados clínicos entre os tratamentos conservador (CS) e cirúrgico (CXS) das fraturas A3 e A4 sem déficit neurológico.

Métodos Estudo prospectivo observacional de paciente com fraturas toracolombares tipo A3 e A4. Esses pacientes foram separados entre os grupos cirúrgico e conservador e avaliados sequencialmente através da escala numérica de dor (NRS), do questionário de incapacidade de Roland-Morris (RMDQ), do EuroQol-5D (EQ-5D) e da escala de trabalho de Denis (DWS) até 2,5 anos de acompanhamento.

Resultados Ambos os grupos apresentaram melhora significante, sem diferença estatística nos questionários de dor (NRS: CXS 2,4 ± 2,6; CS 3,5 ± 2,6; p > 0,05), funcionalidade (RMDQ: CS 7 ± 6,4; CXS 5,5 ± 5,2; p > 0,05), qualidade de vida (EQ-5D) e retorno ao trabalho (DWS).

Conclusão Ambos os tratamentos são opções viáveis e com resultados clínicos equivalentes. Há uma tendência a melhores resultados no tratamento cirúrgico das fraturas A4.

Palavras-chave

fixação interna de fraturas - fraturas da coluna vertebral - resultado do tratamento - tratamento conservador

Suporte Financeiro

Este estudo teve suporte financeiro e logístico da AOSpine Latin America.


Trabalho multicêntrico desenvolvido no Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, PR e no Hospital Cristo Redentor, Porto Alegre, RS, Brasil.




Publication History

Received: 23 October 2021

Accepted: 28 April 2022

Article published online:
24 March 2023

© 2023. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • Referências

  • 1 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 (05) 773-781
    CrossrefPubMedGoogle Scholar
  • 2 Jansson KA, Blomqvist P, Svedmark P. et al. Thoracolumbar vertebral fractures in Sweden: an analysis of 13,496 patients admitted to hospital. Eur J Epidemiol 2010; 25 (06) 431-437
    CrossrefPubMedGoogle Scholar
  • 3 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 2013; 38 (23) 2028-2037
    CrossrefPubMedGoogle Scholar
  • 4 Siebenga J, Leferink VJ, Segers MJ. et al. Treatment of traumatic thoracolumbar spine fractures: a multicenter prospective randomized study of operative versus nonsurgical treatment. Spine 2006; 31 (25) 2881-2890
    CrossrefPubMedGoogle Scholar
  • 5 Post RB, van der Sluis CK, Leferink VJ, Dijkstra PU, ten Duis HJ. Nonoperatively treated type A spinal fractures: mid-term versus long-term functional outcome. Int Orthop 2009; 33 (04) 1055-1060
    CrossrefPubMedGoogle Scholar
  • 6 Vorlat P, Leirs G, Tajdar F, Hulsmans H, De Boeck H, Vaes P. Predictors of Recovery After Conservative Treatment of AO-Type A Thoracolumbar Spine Fractures Without Neurological Deficit. Spine 2018; 43 (02) 141-147
    CrossrefPubMedGoogle Scholar
  • 7 Pehlivanoglu T, Akgul T, Bayram S. et al. Conservative Versus Operative Treatment of Stable Thoracolumbar Burst Fractures in Neurologically Intact Patients: Is There Any Difference Regarding the Clinical and Radiographic Outcomes?. Spine 2020; 45 (07) 452-458
    CrossrefPubMedGoogle Scholar
  • 8 Wood KB, Buttermann GR, Phukan R. et al. Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit: a prospective randomized study with follow-up at sixteen to twenty-two years. J Bone Joint Surg Am 2015; 97 (01) 3-9
    CrossrefPubMedGoogle Scholar
  • 9 Yi L, Jingping B, Gele J, Baoleri X, Taixiang W. Operative versus non-operative treatment for thoracolumbar burst fractures without neurological deficit. Cochrane Database Syst Rev 2006; (04) CD005079
    PubMedGoogle Scholar
  • 10 Rometsch E, Spruit M, Härtl R. et al. Does Operative or Nonoperative Treatment Achieve Better Results in A3 and A4 Spinal Fractures Without Neurological Deficit?: Systematic Literature Review With Meta-Analysis. Global Spine J 2017; 7 (04) 350-372
    CrossrefPubMedGoogle Scholar
  • 11 Butler JS, Walsh A, O'Byrne J. Functional outcome of burst fractures of the first lumbar vertebra managed surgically and conservatively. Int Orthop 2005; 29 (01) 51-54
    CrossrefPubMedGoogle Scholar
  • 12 Rajasekaran S. Thoracolumbar burst fractures without neurological deficit: the role for conservative treatment. Eur Spine J 2010; 19 (Suppl. 01) S40-S47
    CrossrefPubMedGoogle Scholar
  • 13 Aebi M. Classification of thoracolumbar fractures and dislocations. Eur Spine J 2010; 19 (Suppl. 01) S2-S7
    CrossrefPubMedGoogle Scholar
  • 14 Shen WJ, Liu TJ, Shen YS. Nonoperative treatment versus posterior fixation for thoracolumbar junction burst fractures without neurologic deficit. Spine 2001; 26 (09) 1038-1045
    CrossrefPubMedGoogle Scholar
  • 15 Rabb CH, Hoh DJ, Anderson PA. et al. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Evaluation and Treatment of Patients with Thoracolumbar Spine Trauma: Operative Versus Nonoperative Treatment. Neurosurgery 2019; 84 (01) E50-E52
    CrossrefPubMedGoogle Scholar
  • 16 Cantor JB, Lebwohl NH, Garvey T, Eismont FJ. Nonoperative management of stable thoracolumbar burst fractures with early ambulation and bracing. Spine 1993; 18 (08) 971-976
    CrossrefPubMedGoogle Scholar
  • 17 Bailey CS, Dvorak MF, Thomas KC. et al. Comparison of thoracolumbosacral orthosis and no orthosis for the treatment of thoracolumbar burst fractures: interim analysis of a multicenter randomized clinical equivalence trial. J Neurosurg Spine 2009; 11 (03) 295-303
    CrossrefPubMedGoogle Scholar
  • 18 Bailey CS, Urquhart JC, Dvorak MF. et al. Orthosis versus no orthosis for the treatment of thoracolumbar burst fractures without neurologic injury: a multicenter prospective randomized equivalence trial. Spine J 2014; 14 (11) 2557-2564
    CrossrefPubMedGoogle Scholar
  • 19 Breivik H, Borchgrevink PC, Allen SM. et al. Assessment of pain. Br J Anaesth 2008; 101 (01) 17-24
    CrossrefPubMedGoogle Scholar
  • 20 Roland M, Morris R. A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain. Spine 1983; 8 (02) 141-144
    CrossrefPubMedGoogle Scholar
  • 21 EuroQol Group. EuroQol–a new facility for the measurement of health-related quality of life. Health Policy 1990; 16 (03) 199-208
    Google Scholar
  • 22 Haywood KL, Garratt AM, Fitzpatrick R. Quality of life in older people: a structured review of generic self-assessed health instruments. Qual Life Res 2005; 14 (07) 1651-1668
    CrossrefPubMedGoogle Scholar
  • 23 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
    PubMedGoogle Scholar
  • 24 Sadatsune DA, Costa PP, Caffaro MF, Umeta RS, Meves R, Avanzi O. Thoracolumbar burst fracture: correlation between kyphosis and function after surgical treatment. Rev Bras Ortop 2015; 47 (04) 474-478
    Google Scholar