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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2023; 58(01): 058-066
DOI: 10.1055/s-0042-1756322
Artigo Original
Coluna

Alinhamento espinopélvico em pacientes com fratura toracolombar explosão

Article in several languages: português | English
Lucas Miotto José 
1   Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil
,
Pedro Coury 
1   Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil
,
Robert Meves 
2   Grupo de Coluna, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil
› Author Affiliations Suporte Financeiro O presente estudo não recebeu nenhum apoio financeiro de fontes públicas, comerciais ou sem fins lucrativos.
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Resumo

Objetivo Avaliar o alinhamento espinopélvico em pacientes com fratura toracolombar do tipo explosão (FTE) sem déficit neurológico tratados de forma não operatória e operatória em um hospital terciário de referência em trauma.

Método Estudo transversal retrospectivo de pacientes com FTE apenas da região toracolombar, de nível único, do tipo A3 e A4 AOSpine. Análise de dados clínicos, dor lombar (escala visual analógica [EVA]), Escala de Denis, qualidade de vida (SF-36), parâmetros radiográficos sagitais (cifose torácica [CT], cifose toracolombar [CTL], lordose lombar [LL] e eixo vertical sagital [EVS]) e espinopélvicos (incidência pélvica [IP], versão pélvica [VP], inclinação sacral [IS] e a discrepância entre incidência pélvica e lordose lombar [IP-LL]) de pacientes tratados de forma operatória e não operatória.

Resultados O presente estudo avaliou um total de 50 indivíduos com uma média de 50 anos de idade com acompanhamento médio de 109 meses (mínimo de 19 e máximo de 306 meses). Houve diferença significativa entre os tratamentos para Denis trabalho (p = 0,046) a favor do tratamento não operatório. Não houve diferença significativa entre os tratamentos para EVA dor lombar e Denis dor (p = 0,468 e p = 0,623). Não houve diferença significante entre os tratamentos em nenhum dos domínios avaliados do SF-36 (p > 0,05). Parâmetros radiográficos não se mostraram diferentes entre os grupos analisados; contudo, todos os parâmetros radiográficos mostraram diferença significante entre a população considerada assintomática, com exceção da incidência pélvica (p < 0,005).

Conclusões O alinhamento espinopélvico foi normal em pacientes com FTE sem déficit neurológico tratados de forma não operatória e operatória, após acompanhamento mínimo de 19 meses. Entretanto, estes pacientes apresentaram maior média de versão pélvica e de discrepância entre lordose lombar e incidência pélvica quando comparados com os valores de referência da população brasileira.

Palavras-chave

curvaturas da coluna vertebral - fraturas da coluna vertebral - traumatismos da coluna vertebral


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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 4 Vaccaro AR, Kim DH, Brodke DS. et al. Diagnosis and management of thoracolumbar spine fractures. Instr Course Lect 2004; 53: 359-373
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 8 Vaccaro AR, Silber JS. Post-traumatic spinal deformity. Spine 2001; 26 (24, Suppl) S111-S118
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 14 Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine 1983; 8 (08) 817-831
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar