Schnake Klaus J, Dvorak Marcel F, Öner Cumhur F, Dandurand Charlotte, Muijs Sander, Bigdon Sebastian F
Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus St. Marien Erlangen, Erlangen, Germany.
Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany.
Global Spine J. 2024 Feb;14(1_suppl):62S-65S. doi: 10.1177/21925682231211286.
Cross-sectional survey study.
To investigate factors affecting decision-making in thoracolumbar burst-fractures without neurologic deficit.
A 40-question survey addressing expert-related, economic, and radiological factors was distributed to 30 international trauma experts. Descriptive statistics were used to assess the impact of these factors on operative or non-operative management preferences.
Out of 30 experts, 27 completed the survey. The majority of respondents worked at level 1 trauma centers (81.5%) within university settings (77.8%). They were primarily orthopedic surgeons (66.7%) and had over 10 years of experience (70.4%). About 81% found distinguishing between A3 and A4 fractures relevant for decision-making. Most experts (59%) treated A3 fractures non-surgically, while only 30% treated A4 fractures conservatively. Compensation systems did not influence treatment recommendations, and hospital measures promoting surgeries did not significantly affect distribution. Radiological factors, such as local kyphosis (25/27), fracture comminution (23/27), overall sagittal balance (21/27), and spinal canal narrowing (20/27), influenced decisions.
Incomplete burst fractures (A3) are predominantly treated non-surgically, while complete burst fractures (A4) are primarily treated surgically. Compensation, third-party incentives, and outpatient care did not significantly impact decision-making. Radiological factors beyond the AO Spine thoracolumbar classification system seem to be essential and warrant further evaluation.
横断面调查研究。
探讨影响无神经功能缺损的胸腰椎爆裂骨折决策的因素。
向30位国际创伤专家发放了一份包含40个问题的调查问卷，内容涉及专家相关因素、经济因素和放射学因素。采用描述性统计方法评估这些因素对手术或非手术治疗偏好的影响。
30位专家中，27位完成了调查。大多数受访者在大学附属医院的一级创伤中心工作（81.5%），且工作环境为大学附属医院（77.8%）。他们主要是骨科医生（66.7%），且有超过10年的工作经验（70.4%）。约81%的人认为区分A3和A4骨折对决策有意义。大多数专家（59%）对A3骨折采取非手术治疗，而只有30%的人对A4骨折采取保守治疗。赔偿制度不影响治疗建议，医院促进手术的措施也未显著影响治疗分布。放射学因素，如局部后凸（25/27）、骨折粉碎程度（23/27）、整体矢状面平衡（21/27）和椎管狭窄（20/27），会影响决策。
不完全爆裂骨折（A3）主要采用非手术治疗，而完全爆裂骨折（A4）主要采用手术治疗。赔偿、第三方激励措施和门诊治疗对决策没有显著影响。AO脊柱胸腰椎分类系统以外的放射学因素似乎至关重要，值得进一步评估。
