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DOI: 10.1055/s-0042-1756322
Spinal Cord Alignment in Patients with Thoracolumbar Burst Fracture
Article in several languages: português | English Financial Support The authors state that they have not received any financial support from either public, commercial, or not-for-profit sources.
Abstract
Objective To evaluate the spinopelvic alignment in patients with thoracolumbar burst fracture (TBF) without neurological deficit treated nonsurgically and surgically in a tertiary reference trauma hospital.
Method Retrospective cross-sectional study of patients with single level, type A3 and A4 AOSpine TBF only of the thoracolumbar region. Analysis of clinical data, low back pain (visual analogue scale [VAS]), Denis Pain Scale, quality of life (SF-36), sagittal (TC, TLC, LL, SVA) and spinopelvic (IP, PV, SI, PI-LL) radiographic parameters of patients treated surgically and nonsurgically.
Results A total of 50 individuals with an average age of 50 years old with a mean follow-up of 109 months (minimum of 19 and maximum of 306 months) were evaluated. There was a significant difference between treatments for the Denis Work Scale (p = 0.046) in favor of nonsurgical treatment. There was no significant difference between the treatments for lower back pain VAS and Denis Pain Scale (p = 0.468 and p = 0.623). There was no significant difference between treatments in any of the domains evaluated with the SF-36 (p > 0.05). Radiographic parameters were not different between the analyzed groups; however, all radiographic parameters showed significant difference between the population considered asymptomatic, except for pelvic incidence (p < 0.005).
Conclusions The spinopelvic alignment was normal in patients with TBF without neurological deficit treated nonsurgically and surgically after a minimum follow-up of 19 months. However, they presented a higher mean pelvic version and discrepancy between lumbar lordosis and pelvic incidence when compared with the reference values of the Brazilian population.
Publication History
Received: 01 March 2022
Accepted: 26 July 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/)
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Referências
- 1 Atlas SW, Regenbogen V, Rogers LF, Kim KS. The radiographic characterization of burst fractures of the spine. AJR Am J Roentgenol 1986; 147 (03) 575-582
- 2 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
- 3 Fakurnejad S, Scheer JK, Patwardhan AG, Havey RM, Voronov LI, Smith ZA. Biomechanics of thoracolumbar burst fractures: methods of induction and treatments. J Clin Neurosci 2014; 21 (12) 2059-2064
- 4 Vaccaro AR, Kim DH, Brodke DS. et al. Diagnosis and management of thoracolumbar spine fractures. Instr Course Lect 2004; 53: 359-373
- 5 Abudou M, Chen X, Kong X, Wu T. Surgical versus non-surgical treatment for thoracolumbar burst fractures without neurological deficit. Cochrane Database Syst Rev 2013; (06) CD005079
- 6 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
- 7 Gnanenthiran SR, Adie S, Harris IA. Nonoperative versus operative treatment for thoracolumbar burst fractures without neurologic deficit: a meta-analysis. Clin Orthop Relat Res 2012; 470 (02) 567-577
- 8 Vaccaro AR, Silber JS. Post-traumatic spinal deformity. Spine 2001; 26 (24, Suppl) S111-S118
- 9 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
- 10 Ghobrial GM, Maulucci CM, Maltenfort M. et al. Operative and nonoperative adverse events in the management of traumatic fractures of the thoracolumbar spine: a systematic review. Neurosurg Focus 2014; 37 (01) E8
- 11 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
- 12 Koller H, Acosta F, Hempfing A. et al. Long-term investigation of nonsurgical treatment for thoracolumbar and lumbar burst fractures: an outcome analysis in sight of spinopelvic balance. Eur Spine J 2008; 17 (08) 1073-1095
- 13 Joaquim AF, Rodrigues SA, DA Silva FS. et al. Is There an Association With Spino-Pelvic Relationships and Clinical Outcome of Type A Thoracic and Lumbar Fractures Treated Non-Surgically?. Int J Spine Surg 2018; 12 (03) 371-376
- 14 Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine 1983; 8 (08) 817-831
- 15 Pratali RR, Nasreddine MA, Diebo B, Oliveira CEAS, Lafage V. Normal values for sagittal spinal alignment: a study of Brazilian subjects. Clinics (São Paulo) 2018; 73: e647
- 16 Tezer M, Erturer RE, Ozturk C, Ozturk I, Kuzgun U. Conservative treatment of fractures of the thoracolumbar spine. Int Orthop 2005; 29 (02) 78-82
- 17 Marks M, Stanford C, Newton P. Which lateral radiographic positioning technique provides the most reliable and functional representation of a patient's sagittal balance?. Spine 2009; 34 (09) 949-954
- 18 Kuklo TR, Polly DW, Owens BD, Zeidman SM, Chang AS, Klemme WR. Measurement of thoracic and lumbar fracture kyphosis: evaluation of intraobserver, interobserver, and technique variability. Spine 2001; 26 (01) 61-65 , discussion 66
- 19 Pratali RR, Hennemann SA, Amaral R. et al. Standardized terminology of adult spine deformity for Brazilian Portuguese. Coluna/Columna 2015; 14 (04) 281-285
- 20 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
- 21 Laguardia J, Campos MR, Travassos C, Najar AL, Anjos LA, Vasconcellos MM. Brazilian normative data for the Short Form 36 questionnaire, version 2. Rev Bras Epidemiol 2013; 16 (04) 889-897
- 22 Mayer M, Ortmaier R, Koller H. et al. Impact of Sagittal Balance on Clinical Outcomes in Surgically Treated T12 and L1 Burst Fractures: Analysis of Long-Term Outcomes after Posterior-Only and Combined Posteroanterior Treatment. BioMed Res Int 2017; 2017: 1568258
- 23 Meakin JR, Fulford J, Seymour R, Welsman JR, Knapp KM. The relationship between sagittal curvature and extensor muscle volume in the lumbar spine. J Anat 2013; 222 (06) 608-614
- 24 Kang CH, Shin MJ, Kim SM, Lee SH, Lee CS. MRI of paraspinal muscles in lumbar degenerative kyphosis patients and control patients with chronic low back pain. Clin Radiol 2007; 62 (05) 479-486
- 25 Ferrero E, Skalli W, Lafage V. et al. Relationships between radiographic parameters and spinopelvic muscles in adult spinal deformity patients. Eur Spine J 2020; 29 (06) 1328-1339