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Injuries of the thoracolumbar spine

Kunal C Shah, Akshay Gadia, Premik Nagad, Shekhar Bhojraj, Abhay Nene
Buckling collapse is the term typically used to describe severe kyphosis more than 100 degrees, characteristically seen in thoracolumbar tuberculosis. Neurofibromatosis is rarely associated with severe cervical kyphosis. Dystrophic changes in vertebra make surgical correction and fusion challenging. Single stage cervical osteotomies (pedicle subtraction osteotomy, vertebral column resection etc) are commonly done in cervico-thoracic junction. However it is technically challenging and associated with high risk of vertebral artery injury, neural injury etc when performed in higher cervical spine...
March 14, 2018: World Neurosurgery
Michelle H Chua, Raksmey Hong, Tytim Rydeth, Iv Vycheth, Sam Nang, Din Vuthy, Kee B Park
INTRODUCTION: In recent years, delivery of cost-effective "essential neurosurgery" in resource-limited communities has been recognized as an indispensable part of health care and a global health priority. The purpose of this study was to review outcomes from operative management of spine trauma at a resource limited government hospital in Phnom Penh, Cambodia, and to provide an epidemiologic report to guide prevention programs. METHODS: A retrospective review of a prospective neurosurgical database was performed to identify risk factors for spine trauma and severe spinal cord injury (ASIA A or ASIA B) and to evaluate the cost-effectiveness of surgery for patients treated at Preah Kossamak Hospital for subaxial and thoracolumbar spine trauma from 2013 to 2016...
March 14, 2018: World Neurosurgery
Kivanc Atesok, Nobuhiro Tanaka, Andrew O'Brien, Yohan Robinson, Dachling Pang, Donald Deinlein, Sakthivel Rajaram Manoharan, Jason Pittman, Steven Theiss
"Spinal Cord Injury without Radiographic Abnormality" (SCIWORA) is a term that denotes objective clinical signs of posttraumatic spinal cord injury without evidence of fracture or malalignment on plain radiographs and computed tomography (CT) of the spine. SCIWORA is most commonly seen in children with a predilection for the cervical spinal cord due to the increased mobility of the cervical spine, the inherent ligamentous laxity, and the large head-to-body ratio during childhood. However, SCIWORA can also be seen in adults and, in rare cases, the thoracolumbar spinal cord can be affected too...
2018: Advances in Orthopedics
Miguel Pishnamaz, Ulrike Schemmann, Christian Herren, Klemens Horst, Philipp Lichte, Frank Hildebrand, Hans-Christoph Pape, Philipp Kobbe
PURPOSE: This review addressed the question of whether minimally invasive surgery after traumatic thoracolumbar spine fractures can reduce paraspinal muscle injury, limit changes in muscular structure and function, and lead to better functional outcome. Special emphasis was given to studies using imaging techniques or electromyography to evaluate the lumbar multifidus muscle structure and function. METHODS: The authors searched the literature in the PubMed/Medline, EMBASE, by cross-referencing and additional hand search...
March 1, 2018: Journal of Musculoskeletal & Neuronal Interactions
Junfeng Zeng, Quan Gong, Hao Liu, Xin Rong, Chen Ding
RATIONALE: Traumatic fracture of the thoracolumbar junction (T10-L2) is the most common fracture of the spinal column. Due to the disruption of the entire vertebrae column, the fracture-dislocation of the thoracolumbar spine is almost invariably associated with neurological injury. A complete fracture-dislocation of the thoracolumbar spine without neurological deficit is a rare entity. PATIENT CONCERNS: A 38-year-old man presented with severe low back pain after an accident when he was building a house...
March 2018: Medicine (Baltimore)
Peta Skeers, Camila R Battistuzzo, Jillian M Clark, Stephen Bernard, Brian J C Freeman, Peter E Batchelor
BACKGROUND: Spinal cord injury in the cervical spine is commonly accompanied by cord compression and urgent surgical decompression may improve neurological recovery. However, the extent of spinal cord compression and its relationship to neurological recovery following traumatic thoracolumbar spinal cord injury is unclear. The purpose of this study was to quantify maximum cord compression following thoracolumbar spinal cord injury and to assess the relationship among cord compression, cord swelling, and eventual clinical outcome...
February 21, 2018: Journal of Bone and Joint Surgery. American Volume
Brian M Clemency, Christopher T Tanski, Jennifer Gibson Chambers, Michael O'Brien, Andrew S Knapp, Alexander J Clark, Patrick McGoff, Johanna Innes, Heather A Lindstrom, David Hostler
BACKGROUND: Backboards have been shown to cause pain in uninjured patients. This may alter physical exam findings, leading emergency department (ED) providers to suspect a spinal injury when none exists resulting in additional imaging of the thoracolumbar spine. New York had previously employed a "Spinal Immobilization" protocol that included compulsory backboard application for all patients with suspected spinal injuries. In 2015, New York instituted a new "Spinal Motion Restriction" protocol that made backboard use optional for these patients...
February 15, 2018: Prehospital Emergency Care
Ashley P Marek, Jean Dominique Morancy, Jeffrey G Chipman, Rachel M Nygaard, Robert M Roach, Michele M Loor
The incidence of thoracolumbar spine fractures in blunt trauma is 4 to 5 per cent. These fractures may lead to neurologic injury, chronic back pain, and disability. Most studies from United States trauma centers focus on neurologic sequelae and/or compare treatment modalities. However, most patients with spine fractures do not have a neurologic deficit. Our primary objective was to determine the long-term outcome of traumatic thoracolumbar spine fractures, specifically addressing quality of life, chronic pain, and employment using a validated patient outcome survey...
January 1, 2018: American Surgeon
Taylor E Purvis, Rafael De la Garza Ramos, Eric W Sankey, Isaac O Karikari, C Rory Goodwin, Daniel M Sciubba
Management of spine fractures among the elderly is complicated by preexisting comorbidities and increased risk of osseous nonunion. Whether operative treatment is superior for the management of thoracolumbar fractures in the aged is unknown. The purpose of this study was to investigate the rates of in-hospital medical complications after non-operative and operative treatment of thoracolumbar fractures in elderly patients. The Nationwide Inpatient Sample database from 2002 to 2011 was used to identify patients over 75 years of age with a principal discharge diagnosis of thoracolumbar fracture without spinal cord injury...
February 5, 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Dimitrios Ntourantonis, Vasileios Tsekouras, Panagiotis Korovessis
STUDY DESIGN: A case report. OBJECTIVE: To outline the potential risks of late bleeding from the segmental vessels following less invasively dorsolateral approaches to the thoracolumbar spine. SUMMARY OF BACKGROUND DATA: A low risk of major intraoperative bleeding, associated traditional dorsolateral approach to the lumbar spine is reported , but segmental arteries and great vessels may be rarely damaged. Spine surgeons who are involved with these approaches should be aware of these rare but potential dangerous vascular complication because they could be life threatening, particularly in elderly patients with increased morbidity, and/or metastatic disease to the spine...
February 6, 2018: Spine
Andrei F Joaquim, Alpesh A Patel, Gregory D Schroeder, Alexander R Vaccaro
Context Current treatment of TLST should consider injury morphology, neurological status, clinical status (pain and disability) and also multimodal radiological evaluation (MMRE) with CT, MRI and dynamic/ standing plain radiographs. Methods A narrative literature review was performed to propose a treatment algorithm to guide the management of thoracolumbar spinal trauma (TLST). In order to classify injuries and surgical indications, we utilized the two most recent classification systems (TLICS and new AO spine classification) and related recent literature...
February 7, 2018: Journal of Spinal Cord Medicine
S Krinner, S Schmitt, S Grupp, F F Hennig, A Langenbach, S Schulz-Drost
BACKGROUND: Combinations of sternal and spinal fractures often occur due to high velocity accidents and are associated with a high incidence of concomitant injuries. The anterior thoracic wall is described as the fourth column of torso stability, which is why sternovertebral injuries (SVI) present a high risk of sagittal deformation of the trunk, in particular injuries of the thoracic spine. To date, no studies have been published on the frequency distribution of the involved vertebral bodies in large patient groups...
February 5, 2018: Der Unfallchirurg
Rajdeep Singh Bagga, Arvind B Goregaonkar, Aditya Anand Dahapute, Saurabh R Muni, Sandeep Gokhale, Jitesh Manghwani
Aim: To study the functional and radiological outcomes in cases managed conservatively for single-level traumatic thoracolumbar spine fractures without neurological deficit. Materials and Methods: In this prospective study design, thirty patients who presented to tertiary care hospital and diagnosed with posttraumatic thoracolumbar vertebral fracture without any neurodeficit were recruited. All the patients were managed conservatively as per the protocol which included bed rest, spinal braces, and physiotherapy...
October 2017: Journal of Craniovertebral Junction and Spine
Jeffrey P Mullin, Alvin Y Chan, Emily Bennett, Michael P Steinmetz
BACKGROUND: Bilateral extracavitary approach (BECA) is an option for decompression cases that require a more extended ventral approach. The clear advantage is increased accessibility to the most ventral aspects of the spine from a bilateral perspective. OBJECTIVE: To assess the safety and efficacy of thoracic and thoracolumbar decompression and/or reconstruction from BECA. METHODS: A retrospective chart review was performed reviewing all patients who underwent BECA for thoracolumbar decompression from 2003 to 2012 at our institution...
February 1, 2018: Operative Neurosurgery (Hagerstown, Md.)
Rohit Singh, Amit Bhalla, Matthew Ockendon, Stuart Hay
Background: Motocross is a form of motorcycle racing held on established off-road circuits and has been a recreational and competitive sport across the world for >100 years. In the United Kingdom alone, motocross has grown into a phenomenally ambitious and popular franchise. There are >200 motocross clubs across the country, permitting >900 events annually. Purpose: To assess the current trend of spine-related motocross injuries over the past 5 years. Study Design: Descriptive epidemiology study...
January 2018: Orthopaedic Journal of Sports Medicine
Ross L Dawkins, Joseph H Miller, Omar I Ramadan, Michael C Lysek, Elizabeth N Kuhn, Brandon G Rocque, Michael J Conklin, R Shane Tubbs, Beverly C Walters, Bonita S Agee, Curtis J Rozzelle
OBJECTIVE There are many classification systems for injuries of the thoracolumbar spine. The recent Thoracolumbar Injury Classification and Severity Score (TLICS) has been shown to be a reliable tool for adult patients. The aim of this study was to assess the reliability of the TLICS system in pediatric patients. The validity of the TLICS system is assessed in a companion paper. METHODS The medical records of pediatric patients with acute, traumatic thoracolumbar fractures at a single Level 1 trauma center were retrospectively reviewed...
January 12, 2018: Journal of Neurosurgery. Pediatrics
Kimberly Hamilton, Brandon Rocque, Nathaniel Brooks
BACKGROUND: Deer hunting is popular in much of the United States. In Wisconsin, use of tree stands for hunting is common. Spine surgeons at a Level 1 Trauma Center observed a high incidence of spine and spinal cord injury due to falls from tree stands while hunting. This study's purpose is to systematically characterize and classify those injuries. METHODS: We reviewed the University of Wisconsin Hospital and Clinics' trauma database for tree stand-related injuries from 1999 to 2013...
November 2017: WMJ: Official Publication of the State Medical Society of Wisconsin
Cong-Cong Wu, Hai-Ming Jin, Ying-Zhao Yan, Jian Chen, Ke Wang, Jian-Le Wang, Zeng-Jie Zhang, Ai-Min Wu, Xiang-Yang Wang
OBJECTIVES: To investigate the effect of sequential ligament failure on the range of motion (ROM) and location of the instantaneous axes of rotation (IAR) of the thoracolumbar spine (T12-L1) finite element (FE) model, and to verify the role of the supraspinous ligament (SSL) in maintaining the stability of the injured thoracolumbar spine. METHODS: A FE model of the fracture thoracolumbar spine was developed and validated against published data. The posterior ligamentous complex (PLC) in the fractured T12-L1 segment was then reduced in a sequential manner from the facet capsular ligament (FCL), part of the interspinous ligament (ISL), supraspinous ligament, and entire ISL, to the ligamentum flavum (LF)...
January 6, 2018: World Neurosurgery
Alan M Chen, Jeffrey B Neustadt, Jennifer Neville Kucera
A 10-year-old female with neurofibromatosis type 1 and severe dystrophic scoliosis presented with a two-month history of difficulty ambulating due to low back pain. The patient did not have any neurological symptoms. MRI of the thoracolumbar spine demonstrated subluxation of the right posterior tenth and eleventh ribs through their respective neural foramina, with mild mass effect on the thecal sac without abnormal cord signal or cord compression. Groups of neurofibromas were present along the right ribs and paravertebral soft tissues around these levels...
August 2017: Journal of Radiology Case Reports
Sachin Kumar, Satish Kumar, Rajender Kumar Arya, Avinash Kumar
Study Design: Prospective clinical study. Purpose: The purpose of this study was to evaluate the effect of interlaminar fusion and short segment pedicle screw fixation on thoracolumbar vertebral injuries for preventing pain and post-traumatic kyphosis. Overview of Literature: The treatment of thoracolumbar injuries continues to be one of the most controversial areas in spine care. The main aim of surgical treatment is to decompress the spinal cord or nerve roots, realign the spine, and correct or prevent post-traumatic kyphosis...
December 2017: Asian Spine Journal
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