<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:""><span style="font-family:Verdana;"> Thoracolumbar spine fr...<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:""><span style="font-family:Verdana;"> Thoracolumbar spine fracture-dislocations are very unstable and usually secondary to high energy trauma. Due to disruption of the entire vertebrae columns, the absence of neurological deficit is exceptional. </span><b><span style="font-family:Verdana;">Aim: </span></b><span style="font-family:Verdana;">The purpose of this work is to report our experience in the management of this entity in a context of limited resources and to make a review of the literature. </span><b><span style="font-family:Verdana;">Case presentation: </span></b><span style="font-family:Verdana;">A 30-year-old man was admitted with a severe low back pain after a traffic accident. Neurological functions were intact after examination. Radiological assessments revealed a complete L3-L4 fracture-dislocation.</span></span><span style="font-family:""><span style="font-family:Verdana;"> The patient underwent an open posterior reduction and internal long segment fixation. The post-operative was marked by a surgical site infection treated with surgical debridement and targeted antibiotic therapy. The neurological functions were preserved. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Fracture-dislocations of the thoracolumbar spine</span><span style="color:red;"> </span></span><span style="font-family:Verdana;">are</span><span style="font-family:Verdana;"> caused by high energy trauma and are remarkably unstable lesions. When they are associated with intact neurorological functions, reduction and stabilization of these fractures are a challenge.展开更多
Spine fractures account for a large portion of musculoskeletal injuries worldwide. A classification of spine fractures is necessary in order to develop a common language for treatment indications and outcomes. Several...Spine fractures account for a large portion of musculoskeletal injuries worldwide. A classification of spine fractures is necessary in order to develop a common language for treatment indications and outcomes. Several classification systems have been developed based on injury anatomy or mechanisms of action, but they have demonstrated poor reliability, have yielded little prognostic information, and have not been widely used. For this reason, the Arbeitsgemeinschaftfür Osteosynthesefragen(AO) committee has classified thorocolumbar spine injuries based on the pathomorphological criteria into3 types(A: Compression; B: Distraction; C: Axial torque and rotational deformity). Each of these types is further divided into 3 groups and 3 subgroups reflecting progressive scale of morphological damage and the degree of instability. Because of its highly detailed sub classifications, the AO system has shown limited interobserver variability. It is similar to its predecessors in that it does not incorporate the patient's neurologic status.The need for a reliable, reproducible, clinically relevant, prognostic classification system with an optimal balance of ease of use and detail of injury description contributed to the development of a new classification system, the thoracolumbar injury classification and severity score(TLICS). The TLICS defines injury based on three clinical characteristics: injury morphology, integrity of the posterior ligamentous complex, and neurologic status of the patient. The severity score offers prognostic information and is helpful in decision making about surgical vs nonsurgical management.展开更多
This is an expert consensus on the evaluation and treatment of thoracolumbar spinal injury,established from February 2009 to July 2010.The expert consensus consists mainly of six parts with a total of 54 recommendatio...This is an expert consensus on the evaluation and treatment of thoracolumbar spinal injury,established from February 2009 to July 2010.The expert consensus consists mainly of six parts with a total of 54 recommendations including the overview(one item);pre-hospital care(one item);evaluation and diagnosis(13 items);treatment(23 items);prevention and treatment of major complications(12 items);and rehabilitation(four items).This is the first time that Chinese experts have published a consensus on spine and spinal cord injury.The expert consensus was established based on Delphi methods,literature analysis,and clinical experiences.Each recommendation is supported by and was interpreted using multi-level evidences.The level of agreement with the recommendation among the panel members was assessed as either low,moderate,or strong.Each panel member was asked to indicate his or her level of agreement on a 5-point scale,with "1" corresponding to neutrality and "5" representing maximum agreement.Scores were aggregated across the panel members and an arithmetic mean was calculated.This mean score was then translated into low,moderate,or strong.After all of the votes were collected and calculated,the results showed no low-level recommendations,10 moderate-level recommendations,and 44 strong-level recommendations.An expert consensus was reached and was recognized by Chinese spine surgeons.Wide-scale adoption of these recommendations is urgent in the management of acute thoracolumbar spine and spinal cord injury in a broader attempt to create a standard evaluation and treatment strategy for acute thoracolumbar spine and spinal cord injury in China.展开更多
Between 1990 and 1996, 15 patients with thoracolumbar spine fracture complicated by simple conusmedullaris injury were admitted. All patients were Injured by falling from height (mean, o meters). Clinical symp-toms in...Between 1990 and 1996, 15 patients with thoracolumbar spine fracture complicated by simple conusmedullaris injury were admitted. All patients were Injured by falling from height (mean, o meters). Clinical symp-toms indicated hypoesthesia or anesthesia of S3-5 sensory region,dysporia and urinary dysfunction. but normal sensation and motion of the bilateral lower extremities. Waston-Jones classified the spinal cord and nerve root injury following thoracolumbar spine fracture into three types. According to our observations, it should be classfied into five types: 1) concussion of the conus medullaris; 2) simple incomplete injury of the conus medullaris; 3) simplecomplete injury of the conus medullaris; 4) spinal cord transection and partial nerve root injury; 5) spinal cordtransection and entire nerve root injury.展开更多
Background: Long segment transpedicular screw fixation in thoracolumbar spine injury has gained popularity in the last decades as it provides immediate stability, prevents further risk of complications and allows earl...Background: Long segment transpedicular screw fixation in thoracolumbar spine injury has gained popularity in the last decades as it provides immediate stability, prevents further risk of complications and allows early mobilization of patient. Objectives: Evaluation of clinical and functional outcome after long segment transpedicular screw fixation in unstable thoracolumbar spine injury with incomplete neurological deficit patients. Methods: This quasi experimental study was conducted at Dhaka Medical College and Hospital (DMCH), Dhaka, Bangladesh from January 2016 to December 2017. A total of twenty four (24) patients with traumatic unstable fracture of the thoracolumbar spine with incomplete neurological deficit underwent long segment transpedicular screw fixation were included in this study. Clinical and radiologic outcomes were assessed pre-operatively and post-operatively. Results: A total of 24 patients aged between 20 - 60 years of both sexes (Male-21, Female-03) were included in this study. Their mean (±SD) age was 33.12 (±8.57) years. Most of them were farmer [09 (37.5%)] and day labour [08 (33.33%)]. Motor vehicle accidents were the most common [16 (66.67%)] cause of injury and then fall from height [08 (33.33%)]. The most common level of injury involved was L1-10 (41.67%) patients, followed by L2-07 (29.17%), T12-05 (20.83%) and T11-02 (8.33%) of the study patients. Burst fracture was the commonest [22 (91.67%)] type of fracture followed by Chance fracture [02 (8.33%)]. Pre-operative mean (±SD) Cobb angle, Kyphotic deformation of vertebral body, Beck index and vertebral compression deformity were 21.83 ± 4.5 degrees, 22.09 ± 4.40 degrees, 0.78 ± 2.65 and 0.18 ± 0.93 mm respectively, after procedure which were significantly (p Conclusions: Long segment transpedicular screw fixation is an effective method of treatment in patients having thoracolumbar spine injury with incomplete neurological deficit.展开更多
Paraplegic gait orthosis has been shown to help paraplegic patients stand and walk, although this method cannot be individualized for patients with different spinal cord injuries and functional recovery of the lower e...Paraplegic gait orthosis has been shown to help paraplegic patients stand and walk, although this method cannot be individualized for patients with different spinal cord injuries and functional recovery of the lower extremities. There is, however, a great need to develop individualized paraplegic orthosis to improve overall quality of life for paraplegic patients. In the present study, 36 spinal cord(below T4) injury patients were equally and randomly divided into control and observation groups. The control group received systematic rehabilitation training, including maintenance of joint range of motion, residual muscle strength training, standing training, balance training, and functional electrical stimulation. The observation group received an individualized paraplegic locomotion brace and functional training according to the various spinal cord injury levels and muscle strength based on comprehensive systematic rehabilitation training. After 3 months of rehabilitation training, the observation group achieved therapeutic locomotion in 8 cases, family-based locomotion in 7 cases, and community-based locomotion in 3 cases. However, locomotion was not achieved in any of the control group patients. These findings suggest that individualized paraplegic braces significantly improve activity of daily living and locomotion in patients with thoracolumbar spinal cord injury.展开更多
Objective:To evaluate the clinical effect of posterior internal fixation and fusion in the treatment of thoracolumbar fractures.Methods:36 patients with thoracolumbar fractures from January 2018 to December 2020 were ...Objective:To evaluate the clinical effect of posterior internal fixation and fusion in the treatment of thoracolumbar fractures.Methods:36 patients with thoracolumbar fractures from January 2018 to December 2020 were selected and divided into study group and control group according to the random number table model.The control group was treated with anterior internal fixation,while the study group was treated with posterior internal fixation and fusion.The indexes of the two groups were compared and analyzed.Results:Compared with the operation related indexes of the two groups,the study group had more advantages(P<0.05);The postoperative kyphosis Cobb angle,height of anterior and posterior vertebral body,wedge index of the two groups were better than those before operation(P<0.05),and there was no significant difference between the two groups(P>0.05);There was no significant difference between the two groups(P>0.05).Conclusion:The clinical effect of posterior internal fixation and fusion in the treatment of thoracolumbar fractures is significant,and the body damage is slight,which is worthy of comprehensive promotion.展开更多
文摘<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:""><span style="font-family:Verdana;"> Thoracolumbar spine fracture-dislocations are very unstable and usually secondary to high energy trauma. Due to disruption of the entire vertebrae columns, the absence of neurological deficit is exceptional. </span><b><span style="font-family:Verdana;">Aim: </span></b><span style="font-family:Verdana;">The purpose of this work is to report our experience in the management of this entity in a context of limited resources and to make a review of the literature. </span><b><span style="font-family:Verdana;">Case presentation: </span></b><span style="font-family:Verdana;">A 30-year-old man was admitted with a severe low back pain after a traffic accident. Neurological functions were intact after examination. Radiological assessments revealed a complete L3-L4 fracture-dislocation.</span></span><span style="font-family:""><span style="font-family:Verdana;"> The patient underwent an open posterior reduction and internal long segment fixation. The post-operative was marked by a surgical site infection treated with surgical debridement and targeted antibiotic therapy. The neurological functions were preserved. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Fracture-dislocations of the thoracolumbar spine</span><span style="color:red;"> </span></span><span style="font-family:Verdana;">are</span><span style="font-family:Verdana;"> caused by high energy trauma and are remarkably unstable lesions. When they are associated with intact neurorological functions, reduction and stabilization of these fractures are a challenge.
文摘Spine fractures account for a large portion of musculoskeletal injuries worldwide. A classification of spine fractures is necessary in order to develop a common language for treatment indications and outcomes. Several classification systems have been developed based on injury anatomy or mechanisms of action, but they have demonstrated poor reliability, have yielded little prognostic information, and have not been widely used. For this reason, the Arbeitsgemeinschaftfür Osteosynthesefragen(AO) committee has classified thorocolumbar spine injuries based on the pathomorphological criteria into3 types(A: Compression; B: Distraction; C: Axial torque and rotational deformity). Each of these types is further divided into 3 groups and 3 subgroups reflecting progressive scale of morphological damage and the degree of instability. Because of its highly detailed sub classifications, the AO system has shown limited interobserver variability. It is similar to its predecessors in that it does not incorporate the patient's neurologic status.The need for a reliable, reproducible, clinically relevant, prognostic classification system with an optimal balance of ease of use and detail of injury description contributed to the development of a new classification system, the thoracolumbar injury classification and severity score(TLICS). The TLICS defines injury based on three clinical characteristics: injury morphology, integrity of the posterior ligamentous complex, and neurologic status of the patient. The severity score offers prognostic information and is helpful in decision making about surgical vs nonsurgical management.
基金supported by the Capital Medical Development Foundation of Beijing,No.2005-2016the Scientific and Technique Fund of the Chinese PLA during the Eleventh Five-Year Plan Period,No.06G028
文摘This is an expert consensus on the evaluation and treatment of thoracolumbar spinal injury,established from February 2009 to July 2010.The expert consensus consists mainly of six parts with a total of 54 recommendations including the overview(one item);pre-hospital care(one item);evaluation and diagnosis(13 items);treatment(23 items);prevention and treatment of major complications(12 items);and rehabilitation(four items).This is the first time that Chinese experts have published a consensus on spine and spinal cord injury.The expert consensus was established based on Delphi methods,literature analysis,and clinical experiences.Each recommendation is supported by and was interpreted using multi-level evidences.The level of agreement with the recommendation among the panel members was assessed as either low,moderate,or strong.Each panel member was asked to indicate his or her level of agreement on a 5-point scale,with "1" corresponding to neutrality and "5" representing maximum agreement.Scores were aggregated across the panel members and an arithmetic mean was calculated.This mean score was then translated into low,moderate,or strong.After all of the votes were collected and calculated,the results showed no low-level recommendations,10 moderate-level recommendations,and 44 strong-level recommendations.An expert consensus was reached and was recognized by Chinese spine surgeons.Wide-scale adoption of these recommendations is urgent in the management of acute thoracolumbar spine and spinal cord injury in a broader attempt to create a standard evaluation and treatment strategy for acute thoracolumbar spine and spinal cord injury in China.
文摘Between 1990 and 1996, 15 patients with thoracolumbar spine fracture complicated by simple conusmedullaris injury were admitted. All patients were Injured by falling from height (mean, o meters). Clinical symp-toms indicated hypoesthesia or anesthesia of S3-5 sensory region,dysporia and urinary dysfunction. but normal sensation and motion of the bilateral lower extremities. Waston-Jones classified the spinal cord and nerve root injury following thoracolumbar spine fracture into three types. According to our observations, it should be classfied into five types: 1) concussion of the conus medullaris; 2) simple incomplete injury of the conus medullaris; 3) simplecomplete injury of the conus medullaris; 4) spinal cord transection and partial nerve root injury; 5) spinal cordtransection and entire nerve root injury.
文摘Background: Long segment transpedicular screw fixation in thoracolumbar spine injury has gained popularity in the last decades as it provides immediate stability, prevents further risk of complications and allows early mobilization of patient. Objectives: Evaluation of clinical and functional outcome after long segment transpedicular screw fixation in unstable thoracolumbar spine injury with incomplete neurological deficit patients. Methods: This quasi experimental study was conducted at Dhaka Medical College and Hospital (DMCH), Dhaka, Bangladesh from January 2016 to December 2017. A total of twenty four (24) patients with traumatic unstable fracture of the thoracolumbar spine with incomplete neurological deficit underwent long segment transpedicular screw fixation were included in this study. Clinical and radiologic outcomes were assessed pre-operatively and post-operatively. Results: A total of 24 patients aged between 20 - 60 years of both sexes (Male-21, Female-03) were included in this study. Their mean (±SD) age was 33.12 (±8.57) years. Most of them were farmer [09 (37.5%)] and day labour [08 (33.33%)]. Motor vehicle accidents were the most common [16 (66.67%)] cause of injury and then fall from height [08 (33.33%)]. The most common level of injury involved was L1-10 (41.67%) patients, followed by L2-07 (29.17%), T12-05 (20.83%) and T11-02 (8.33%) of the study patients. Burst fracture was the commonest [22 (91.67%)] type of fracture followed by Chance fracture [02 (8.33%)]. Pre-operative mean (±SD) Cobb angle, Kyphotic deformation of vertebral body, Beck index and vertebral compression deformity were 21.83 ± 4.5 degrees, 22.09 ± 4.40 degrees, 0.78 ± 2.65 and 0.18 ± 0.93 mm respectively, after procedure which were significantly (p Conclusions: Long segment transpedicular screw fixation is an effective method of treatment in patients having thoracolumbar spine injury with incomplete neurological deficit.
文摘Paraplegic gait orthosis has been shown to help paraplegic patients stand and walk, although this method cannot be individualized for patients with different spinal cord injuries and functional recovery of the lower extremities. There is, however, a great need to develop individualized paraplegic orthosis to improve overall quality of life for paraplegic patients. In the present study, 36 spinal cord(below T4) injury patients were equally and randomly divided into control and observation groups. The control group received systematic rehabilitation training, including maintenance of joint range of motion, residual muscle strength training, standing training, balance training, and functional electrical stimulation. The observation group received an individualized paraplegic locomotion brace and functional training according to the various spinal cord injury levels and muscle strength based on comprehensive systematic rehabilitation training. After 3 months of rehabilitation training, the observation group achieved therapeutic locomotion in 8 cases, family-based locomotion in 7 cases, and community-based locomotion in 3 cases. However, locomotion was not achieved in any of the control group patients. These findings suggest that individualized paraplegic braces significantly improve activity of daily living and locomotion in patients with thoracolumbar spinal cord injury.
文摘Objective:To evaluate the clinical effect of posterior internal fixation and fusion in the treatment of thoracolumbar fractures.Methods:36 patients with thoracolumbar fractures from January 2018 to December 2020 were selected and divided into study group and control group according to the random number table model.The control group was treated with anterior internal fixation,while the study group was treated with posterior internal fixation and fusion.The indexes of the two groups were compared and analyzed.Results:Compared with the operation related indexes of the two groups,the study group had more advantages(P<0.05);The postoperative kyphosis Cobb angle,height of anterior and posterior vertebral body,wedge index of the two groups were better than those before operation(P<0.05),and there was no significant difference between the two groups(P>0.05);There was no significant difference between the two groups(P>0.05).Conclusion:The clinical effect of posterior internal fixation and fusion in the treatment of thoracolumbar fractures is significant,and the body damage is slight,which is worthy of comprehensive promotion.
