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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery
DOI: 10.1055/s-0043-1776276
Case Report

The Importance of Orthostatic Radiography in the Management of Thoracolumbar Fractures: Case Report

A importância do raio-X em ortostase no manejo das fraturas toracolombares: relato de caso
Pedro Neves Fortunato 
1   Department of Neurosurgery, Hospital Municipal Mario Gatti, Campinas, SP, Brazil
,
Yvens Barbosa Fernandes
1   Department of Neurosurgery, Hospital Municipal Mario Gatti, Campinas, SP, Brazil
,
Andrei Fernandes Joaquim
2   Department of Neurology, Universidade de Campinas (UNICAMP), Campinas, SP, Brazil
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Abstract

Patients who are victims of traumatic injuries in the spine are evaluated by radiological protocols, as recommended by Advanced Trauma Life Support (ATLS), including a computed tomography (CT) scan with the patient in the decubitus position. Spine fractures considered stable with initial nonoperative management should be further evaluated with a standard simple plain radiograph in orthostasis and/or a magnetic resonance image (MRI), to exclude any associated ligament injury and avoid neurological damage caused by occult instabilities. We present an illustrative case with an injury diagnosed through orthostasis X-ray to discuss its importance in the management of thoracolumbar fractures.

Keywords

thoracolumbar fracture - orthostatic X-ray - conservative management - instrumented fusion


Publication History

Received: 18 December 2022

Accepted: 21 June 2023

Article published online:
27 October 2023

© 2023. Sociedade Brasileira de Neurocirurgia. 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 commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Wood KB, Li W, Lebl DR, Ploumis A. Management of thoracolumbar spine fractures. Spine J 2014; 14 (01) 145-164 DOI: 10.1016/j.spinee.2012.10.041. Erratum in: Spine J. 2014 Aug 1;14(8): A18. Lebl, Darren S [corrected to Lebl, Darren R]. PMID: 24332321
    CrossrefPubMedGoogle Scholar
  • 2 Hauser CJ, Visvikis G, Hinrichs C. et al. Prospective validation of computed tomographic screening of the thoracolumbar spine in trauma. J Trauma 2003; 55 (02) 228-234 , discussion 234–235
    CrossrefPubMedGoogle Scholar
  • 3 Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J 1994; 3 (04) 184-201
    CrossrefPubMedGoogle Scholar
  • 4 Joaquim AF, Patel AA. Thoracolumbar spine trauma: Evaluation and surgical decision-making. J Craniovertebr Junction Spine 2013; 4 (01) 3-9
    CrossrefPubMedGoogle Scholar
  • 5 Ferguson RL, Allen Jr BL. A mechanistic classification of thoracolumbar spine fractures. Clin Orthop Relat Res 1984; (189) 77-88
    PubMedGoogle 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
    CrossrefPubMedGoogle Scholar
  • 7 Keene JS. Radiographic evaluation of thoracolumbar fractures. Clin Orthop Relat Res 1984; (189) 58-64
    PubMedGoogle Scholar
  • 8 Dalinka MK, Kessler H, Weiss M. The radiographic evaluation of spinal trauma. Emerg Med Clin North Am 1985; 3 (03) 475-490
    CrossrefPubMedGoogle Scholar
  • 9 Alcalá-Cerra G, Paternina-Caicedo AJ, Díaz-Becerra C, Moscote-Salazar LR, Fernandes-Joaquim A. Orthosis for thoracolumbar burst fractures without neurologic deficit: A systematic review of prospective randomized controlled trials. J Craniovertebr Junction Spine 2014; 5 (01) 25-32
    CrossrefPubMedGoogle Scholar
  • 10 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
  • 11 Benedetti PF, Fahr LM, Kuhns LR, Hayman LA. MR imaging findings in spinal ligamentous injury. AJR Am J Roentgenol 2000; 175 (03) 661-665
    CrossrefPubMedGoogle Scholar
  • 12 Bizdikian A, El Rachkidi R. Posterior Ligamentous Complex Injuries of the Thoracolumbar Spine: Importance and Surgical Implications. 2021
    PubMedGoogle Scholar
  • 13 Schmidt OI, Gahr RH, Gosse A, Heyde CE. ATLS(R) and damage control in spine trauma. World J Emerg Surg 2009; 4: 9
    CrossrefPubMedGoogle Scholar
  • 14 Borba VC. et al. IMPORTANCE OF RADIOGRAPHY IN ORTHOSTATISM IN THE CONDUCT OF THORACOLOMBAR TRANSITION FRACTURES. Coluna/Columna 2021; 20 (01) 60-63 [online]
    CrossrefPubMedGoogle Scholar
  • 15 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 DOI: 10.1097/00007632-199306150-00004.
    CrossrefPubMedGoogle Scholar
  • 16 Vaccaro AR, Lee JY, Schweitzer Jr KM. et al; Spine Trauma Study Group. Assessment of injury to the posterior ligamentous complex in thoracolumbar spine trauma. Spine J 2006; 6 (05) 524-528
    CrossrefPubMedGoogle Scholar
  • 17 Barcelos ACES, Joaquim AF, Botelho RV. Reliability of the evaluation of posterior ligamentous complex injury in thoracolumbar spine trauma with the use of computed tomography scan. Eur Spine J 2016; 25 (04) 1135-1143
    CrossrefPubMedGoogle Scholar
  • 18 Haba H, Taneichi H, Kotani Y. et al. Diagnostic accuracy of magnetic resonance imaging for detecting posterior ligamentous complex injury associated with thoracic and lumbar fractures. J Neurosurg 2003; 99 (01) 20-26
    PubMedGoogle Scholar
  • 19 Wilmink JT. MR imaging of the spine: trauma and degenerative disease. Eur Radiol 1999; 9 (07) 1259-1266
    CrossrefPubMedGoogle Scholar
  • 20 Parizel PM, Gielen JL, Vanhoenacker FM. 2007. The spine in sports injuries: the cervical spine. In: Vanhoenacker FM, Maes M, Gielen JL. (eds) Imaging of orthopedic sports injuries. Springer; Berlin: , pp 377-390
    Google Scholar
  • 21 Adams JM, Cockburn MI, Difazio LT, Garcia FA, Siegel BK, Bilaniuk JW. Spinal clearance in the difficult trauma patient: a role for screening MRI of the spine. Am Surg 2006; 72 (01) 101-105
    CrossrefPubMedGoogle Scholar
  • 22 Linn M, Kim CW, Valente M. Compression fractures of the thoracic and lumbar spine. In: Zigler JE, Eismont FJ, Garfin SR, Vaccaro AR. Spine Trauma. Rosemont: American Academy of Orthopaedic Surgeons; 2011. . p. 499-514.
    Google Scholar
  • 23 Geck MJ, Yoo S, Wang JC. Assessment of cervical ligamentous injury in trauma patients using MRI. J Spinal Disord 2001; 14 (05) 371-377
    CrossrefPubMedGoogle Scholar
  • 24 Pizones J, Zúñiga L, Sánchez-Mariscal F, Alvarez P, Gómez-Rice A, Izquierdo E. MRI study of post-traumatic incompetence of posterior ligamentous complex: importance of the supraspinous ligament. Prospective study of 74 traumatic fractures. Eur Spine J 2012; 21 (11) 2222-2231
    CrossrefPubMedGoogle Scholar
  • 25 Selden NR, Quint DJ, Patel N, d'Arcy HS, Papadopoulos SM. Emergency magnetic resonance imaging of cervical spinal cord injuries: clinical correlation and prognosis. Neurosurgery 1999; 44 (04) 785-792 , discussion 792–793
    CrossrefPubMedGoogle Scholar
  • 26 Defino HLA, Fuentes AER, Remondi PH, Vallim EC. Tratamento conservador das fraturas da coluna toracolombar. Rev Bras Ortop 2000; 35 (08) 301-308
    PubMedGoogle Scholar
  • 27 Keynan O, Fisher CG, Vaccaro A. et al. Radiographic measurement parameters in thoracolumbar fractures: a systematic review and consensus statement of the spine trauma study group. Spine 2006; 31 (05) E156-E165
    CrossrefPubMedGoogle Scholar
  • 28 Keene JS, Lash EG, Kling Jr TF. Undetected posttraumatic instability of “stable” thoracolumbar fractures. J Orthop Trauma 1988; 2 (03) 202-211
    CrossrefPubMedGoogle Scholar
  • 29 Tsou PM, Wang J, Khoo L, Shamie AN, Holly L. A thoracic and lumbar spine injury severity classification based on neurologic function grade, spinal canal deformity, and spinal biomechanical stability. Spine J 2006; 6 (06) 636-647
    CrossrefPubMedGoogle Scholar
  • 30 Garcia EB, Silva AL, Pimenta LG. et al. Fratura da coluna toracolombar do tipo explosão em T12/L1/L2. Rev Bras Ortop 2002; 37 (10) 445-453
    PubMedGoogle Scholar
  • 31 Petersilge CA, Pathria MN, Emery SE, Masaryk TJ. Thoracolumbar burst fractures: evaluation with MR imaging. Radiology 1995; 194 (01) 49-54
    CrossrefPubMedGoogle Scholar