摘要 :
Introduction: Thoracolumbar spine fractures are common injuries that can result in significant disability, deformity and neurological deficit. There are standard classification systems that have been described based on fracture mo...
展开
Introduction: Thoracolumbar spine fractures are common injuries that can result in significant disability, deformity and neurological deficit. There are standard classification systems that have been described based on fracture morphology, injury mechanism, neurological deficit and injury to posterior ligamentous complex. The thoracolumbar junction (T10-L2) is uniquely positioned in between the rigid thoracic spine and the mobile lumbar spine. This transition from the less mobile thoracic spine with its associated ribs and sternum to the more dynamic lumbar spine subjects the thoracolumbar region to significant biomechanical stress. Hence, fractures of the thoracolumbar region are the most common injuries of the vertebral column. Material and Methods: This retrospective study was conducted on 651 cases with thoracolumbar spine fractures admitted in Emergency Clinical Hospital “Prof. Dr. N. Oblu”, Neurosurgery, Iasi, Romania between Ian 2014- Dec 2017. Conclusions: Trauma to the thoraco-lumbar spine and spinal cord is potentially devastating injury an it can be accompanied by significant neurologic damage , including paraplegia . Patients with incomplete neurologic deficits may regain a large amount of useful function with early or rapid surgical treatment.Imaging studies are essential to confirm the exact location of lesion, to assess the stability of the spine.
收起
摘要 :
Disc protrusion is a common cause of back-related pain and lameness in certain breeds of dogs (Simeone and Rothman 1982, Bray and Burbridge 1998a, b). However, it appears to be a rare occurrence in equines, with only six reports i...
展开
Disc protrusion is a common cause of back-related pain and lameness in certain breeds of dogs (Simeone and Rothman 1982, Bray and Burbridge 1998a, b). However, it appears to be a rare occurrence in equines, with only six reports in which lesions consistent with disc protrusion have been described (Taylor and others 1977, Foss and others 1983, Nixon and others 1984, Townsend and others 1986, Stadler and others 1987, Furr and others 1991). Disc degeneration has been mentioned as a possible cause of ataxia in horses (Whitwell 1980, Wheeler and Sharp 1997). This short communication describes the clinical, radiographic and postmortem findings in a donkey with thoracal intervertebral disc protrusion.
收起
摘要 :
The aim of this multicentre study was to determine whether the recently introduced AOSpine Classification and Injury Severity System has better interrater and intrarater reliability than the already existing Thoracolumbar Injury C...
展开
The aim of this multicentre study was to determine whether the recently introduced AOSpine Classification and Injury Severity System has better interrater and intrarater reliability than the already existing Thoracolumbar Injury Classification and Severity Score (TLICS) for thoracolumbar spine injuries.
收起
摘要 :
Useful thoracolumbar injury classifications allow for meaningful and concise communication between surgeons, trainees, and researchers. Although many have been proposed, none have been able to obtain universal acceptance. Historic...
展开
Useful thoracolumbar injury classifications allow for meaningful and concise communication between surgeons, trainees, and researchers. Although many have been proposed, none have been able to obtain universal acceptance. Historically, classifications focused only on the osseous injuries; more recent classifications focused on the injury morphology and other critical determinants of treatment, including the posterior ligamentous complex integrity and the patient's neurologic status. This review details the important historic classifications and reviews more contemporary thoracolumbar injury classifications, such as the Thoracolumbar Injury Classification System and the AOSpine Thoracolumbar Injury Classification System.
收起
摘要 :
The goal of this discussion was to review the most recent literature (2001) in regard to neurologic recovery after thoracolumbar fractures. Even though numerous recent studies have been published on the topic of thoracolumbar frac...
展开
The goal of this discussion was to review the most recent literature (2001) in regard to neurologic recovery after thoracolumbar fractures. Even though numerous recent studies have been published on the topic of thoracolumbar fractures, only a few authors specifically evaluate neurologic recovery after such injury. Three recent studies question the value of decompression altogether, even with neurologic injury. One study looks specifically at recovery of sexual function in relation to injury at the conus medullaris. Another study explores the correlation between native preinjury canal dimensions and the likelihood of neurologic injury after thoracolumbar fractures. Another study assesses the value of magnetic resonance imaging (MRI) in acute evaluation of thoracolumbar trauma in the pediatric population and also investigates the ability of MRI to predict long-term neurologic recovery. Finally, a biomechanical study is included that evaluates the amount of indirect canal and foraminal decompression achieved from posterior instrumentation and reduction. < copyright > 2002 Lippincott Williams & Wilkins, Inc.
收起
摘要 :
Series of cases from our own practice as a means of reviewing the basic principles for the treatment of thoracolumbar fractures are presented in this article. Although there are no widely accepted evidence-based standards to guide...
展开
Series of cases from our own practice as a means of reviewing the basic principles for the treatment of thoracolumbar fractures are presented in this article. Although there are no widely accepted evidence-based standards to guide surgeons in choosing treatment approaches, several basic and logical principles may be applied to each case to first decide whether a patient is best managed nonoperatively or with surgical treatment. If operative management is indicated, the surgeon must decide whether decompression and/or stabilization is indicated, whether surgery should be done from an anterior and/or posterior approach, the timing of surgery, the surgical technique, and how extensive the instrumentation should be. Through a series of case example, the authors emphasize the principles of short fixation for most cases to preserve spinal motion. Successful surgery for thoracolumbar fracture can be achieved for most cases with short anterior or posterior fixation.
收起
摘要 :
An unstable thoracolumbar fracture with incomplete neurologic deficit requires decompression and stabilization. The choice of surgical approach and the extent of fusion are dependent upon numerous factors, including the pattern an...
展开
An unstable thoracolumbar fracture with incomplete neurologic deficit requires decompression and stabilization. The choice of surgical approach and the extent of fusion are dependent upon numerous factors, including the pattern and level of the fracture, the comorbidities of the patient, and the experience of the surgeon. In a patient with an unstable fracture of L1with dorsal retropulsion of fragments into the spinal canal, we would consider a two-stage surgical procedure. In the first stage, T12 to L2 is exposed via a thoracoabdominal approach. A corpectomy of L1 allows access for ventral decompression of the thecal sac. A titanium cage filled with autograft can be used for replacement of L1 with supplementation by a ventral rod construct from T12 to L2. Some patients may require supplemental dorsal tension band reconstruction. In the second stage, a dorsal pedicle screw and rod construct from T11 to L3 can enhance stability and spread the stresses of the reconstruction over subsequent levels. Adequate decompression of the spinal canal with subsequent reconstruction and stabilization of L1 optimizes the environment for functional rehabilitation and recovery.
收起
摘要 :
Abstract Background The skeletal manifestations of lysosomal storage diseases (LSDs) are largely refractory to available therapeutic modalities. Consequently, there is an increasing need to manage their spinal deformities. The aim...
展开
Abstract Background The skeletal manifestations of lysosomal storage diseases (LSDs) are largely refractory to available therapeutic modalities. Consequently, there is an increasing need to manage their spinal deformities. The aim was to perform a systematic review to answer the questions, “What are the reported indications for surgery for spinal deformity in patients with LSDs?” and “what are the published surgical management strategies?”. Methods Articles that made reference to at least one LSD, a spinal abnormality and surgical management were included. Extracted study data included: study type, sample size, methodology and year of publication. The following clinical information was collected: demographics, spinal abnormalities, and surgical indications, details and outcomes. Results Thirty‐seven articles were included, with 23 describing surgical management of craniocervical manifestations seen in mucopolysaccharidosis. Radiological evidence of myelopathy at the craniocervical junction and/or progressive clinical neurological compromise were accepted as surgical indications. Prophylactic surgery was proposed by some authors. The recommended surgical technique and whether to stabilise and/or decompress varied between articles and LSD types. Twenty‐one articles discussed thoracolumbar pathology, including thoracolumbar kyphosis and scoliosis. Radiological severity, progression of deformity, and presence of neurological deterioration were discussed as surgical indications. Most papers recommended circumferential arthrodesis via combined anterior and posterior approaches. Conclusion The surgical management of spinal disorders in LSDs remains controversial. Centres managing these patients should be encouraged to have a standardised system of reporting outcomes, to facilitate recommendations for management of the spinal manifestations.
收起
摘要 :
Background The purpose of this study was to evaluate the effectiveness between percutaneous and open pedicle screw fixation without fusion for treating type A3 and A4 thoracolumbar fractures. Traumatic thoracolumbar burst fracture...
展开
Background The purpose of this study was to evaluate the effectiveness between percutaneous and open pedicle screw fixation without fusion for treating type A3 and A4 thoracolumbar fractures. Traumatic thoracolumbar burst fracture is a common pathology without a consensus on the best treatment approach. Percutaneous pedicle screw fixation (PPSF) systems have been recently introduced in the treatment of spinal fractures to reduce the adverse effects associated with the conventional open approaches, such as iatrogenic muscle denervation and pain. Methods A prospective analysis was made to evaluate consecutive 46 patients with type A3 and A4 thoracolumbar fractures. Patients were divided into a percutaneous pedicle screw fixation group (PPSF) and an open pedicle screw fixation group (OPSF). The mean age of patients in PPSF group (12 men, 11 woman) was 49.9 years and in OPSF group (10 men, 13 women) 52.2 years. For the purpose of evaluation, the radiological assessment of the bisegmental Cobb angle, the loss of correction, the volume of blood loss, operation time, cumulative radiation time and dose were recorded and compared. Results All patients were followed up for 12 months. There were no significant differences between OPSF and PPSF in the Cobb angle preoperative and postoperative angle and the loss of bisegmental correction. In PPSF group, the mean preoperative Cobb angle was 10.9 degrees and improved by 4.5 degrees postoperatively, and in OPSF group the preoperative angle was 12.1 degrees and postoperatively improved by 3.8 degrees. Significant differences between OPSF and PPSF were found in the mean cumulative radiation time, radiation dose and operation time. PPSF group also had a significantly lower perioperative blood loss. Conclusions Both open and percutaneous short-segment pedicle fixation were safe and effective methods to treat thoracolumbar burst fractures. Percutaneous fixation without fusion seems to be suitable for type A3 and A4 fractures.
收起
原文获取