Hitchon Patrick W, Abode-Iyamah Kingsley, Dahdaleh Nader S, Shaffrey Christopher, Noeller Jennifer, He Wenzhuan, Moritani Toshio
*Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA†Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL‡Department of Neurosurgery, University of Virginia School of Medicine, Charlottesville, VA§Department of Neurology & Neurosciences, Rutgers-New Jersey Medical School, Newark, NJ¶Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA.
Spine (Phila Pa 1976). 2016 Mar;41(6):483-9. doi: 10.1097/BRS.0000000000001253.
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The identification of factors that lead to the failure of nonoperative management in neurologically intact thoracolumbar burst fractures. SUMMARY OF BACKGROUND DATA: The treatment of thoracolumbar burst fractures (TLBF) can be controversial, particularly in the neurologically intact. Surgery for intact burst fractures has been advocated for early mobilization and a shorter hospital stay. These goals, however, have not always been achieved, rejuvenating an interest in nonoperative treatment. METHODS: Sixty-eight neurologically intact patients with burst fractures of the thoracolumbar junction (T11-L2), and a thoracolumbar injury classification and severity score (TLICS) of 2, were treated at our institution. Based on CT scans, patients were scored based on the load-sharing classification (LSC) scale. Initial treatment consisted of bracing in clamshell thoracolumbar orthosis and gradual mobilization. RESULTS: Owing to pain limiting mobilization, 18 patients failed nonoperative management and required instrumentation. Those who failed nonsurgical management were significantly more kyphotic (8° ± 10) and stenotic (52% ± 14%) than those successfully treated nonoperatively (3° ± 7 and 63 ± 12%, respectively). The LSC score of those undergoing surgery (6.9 ± 1.1) was also greater than those successfully treated nonoperatively (5.8 ± 1.3, P = 0.006). Length of hospitalization was longer, and hospital charges higher in those requiring surgery compared to the nonoperative group. At follow-up there was no difference between groups in the visual analog score for pain (VAS) or the Oswestry disability index. CONCLUSION: Owing to pain limiting mobilization, a quarter of neurologically intact patients with thoracolumbar burst fractures and a TLICS score of 2 failed nonsurgical management. The greater the kyphosis, stenosis, and fragmentation of the fracture, the more likely patients required surgery. In addition to the TLICS classification, other radiographic and clinical parameters should be included in selecting appropriate treatment strategy. The cost savings with nonoperative treatment of intact burst fractures, when appropriate, are significant.
研究设计：回顾性队列研究。 目的：确定导致神经功能完整的胸腰椎爆裂骨折非手术治疗失败的因素。 背景数据总结：胸腰椎爆裂骨折（TLBF）的治疗可能存在争议，尤其是在神经功能完整的患者中。对于完整的爆裂骨折，手术治疗一直被提倡用于早期活动和缩短住院时间。然而，这些目标并非总能实现，这使得人们对非手术治疗重新产生了兴趣。 方法：在我们机构治疗了68例神经功能完整的胸腰段交界处（T11-L2）爆裂骨折患者，胸腰椎损伤分类和严重程度评分（TLICS）为2分。根据CT扫描，患者根据载荷分担分类（LSC）量表进行评分。初始治疗包括使用蛤壳式胸腰椎矫形器进行支具固定和逐步活动。 结果：由于疼痛限制了活动，18例患者非手术治疗失败，需要进行内固定。非手术治疗失败的患者比成功接受非手术治疗的患者后凸畸形（8°±10）和椎管狭窄（52%±14%）明显更严重（分别为3°±7和63±12%）。接受手术治疗的患者的LSC评分（6.9±1.1）也高于成功接受非手术治疗的患者（5.8±1.3，P=0.006）。与非手术组相比，需要手术治疗的患者住院时间更长，住院费用更高。在随访时，两组在疼痛视觉模拟评分（VAS）或奥斯威斯利功能障碍指数方面没有差异。 结论：由于疼痛限制了活动，四分之一神经功能完整、胸腰椎爆裂骨折且TLICS评分为2分的患者非手术治疗失败。骨折的后凸畸形、狭窄和碎裂越严重，患者需要手术的可能性就越大。除了TLICS分类外，在选择合适的治疗策略时还应包括其他影像学和临床参数。在适当情况下，完整爆裂骨折的非手术治疗节省的费用是可观的。
Spine (Phila Pa 1976). 2016-3
Spine (Phila Pa 1976). 1996-9-15
J Spinal Disord Tech. 2014-10
Spine (Phila Pa 1976). 1999-2-15
Spine (Phila Pa 1976). 1993-6-15
BMC Musculoskelet Disord. 2024-11-18
Eur J Trauma Emerg Surg. 2024-10
Zotero 插件