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Spinal injuries occur in 3% of all patients with trauma, most commonly in males, and often as a result of high-velocity impact followed by abrupt deceleration. The most affected region after spinal trauma is the thoracolumbar junction because of the anterior center of gravity at the T12-L1 vertebral level and the relatively stiff thoracic spine uniting with the mobile lumbar spine. Many classifications exist to guide the choice of operative versus nonoperative management of traumatic injuries at this site. However, the classifications do not consider the segmental alignment of the spine, an aspect that has been shown to improve quality of life in nontraumatic postoperative spinal patients. Ignoring this aspect of thoracolumbar management often contributes to the development of posttraumatic malalignment and other complications. This review recommends that a new or modified classification system accounts for sagittal segmental alignment factors, including the level of the injured vertebra, the number of affected adjacent levels, imaging techniques with better specificity and sensitivity, and assessment for osteoporosis. Case studies are included to show the importance of segmental sagittal alignment and the vertebral level on patient outcomes. [ABSTRACT FROM AUTHOR]

Objectives: To describe a simplified classification scheme for endplate injury morphology based on 3D CT and to examine possible associations between endplate injury morphology and vertebral space and other variables such as type of fracture and disc degeneration in a group of patients with thoracolumbar fractures. Methods: This study was a retrospective cohort study. We collected patients with thoracolumbar fractures admitted from January 2015 to August 2020 and divided them into three groups based on the morphology of endplate injury (45 cases of mild endplate injury, 54 cases of moderate endplate injury, and 42 cases of severe endplate injury, SEI). Data of vertebral body and intervertebral space height and angle, the Pfirrmann grade, endplate healing morphology were collected during preoperative, postoperative, and long‐term follow‐up of patients in each group. One‐way analysis of variance (ANOVA), chi‐squared test, and repeated measurement ANOVA were used to compare and analyze the influence of endplate injury morphology on patient prognosis. Results: Most moderate injuries to the endplate (fissure‐type injury) and severe injuries (irregular depression‐type injury, Schmorl's node‐type injury) resulted in significant disc degeneration in the long‐term transition. This study also showed significant differences in the height of the anterior margin of the injured spine and the intervertebral space height index during this process. Conclusions: The current study suggests that although the region of injury in endplate fissure‐type injury is small preoperatively, it may be a major factor in leading to severe disc degeneration, loss of intervertebral height, and Cobb angle in the long term. The results of our study therefore may allow surgeons to predict the prognosis of patients with thoracolumbar fractures and guide their treatment. [ABSTRACT FROM AUTHOR]

Objectives: This study discusses the experience at our centre with treating traumatic thoracolumbar fractures using percutaneous pedicle screw fixation. Methods: We reviewed the case notes and imaging retrospectively between January 2013 and June 2019. Results: A total of 257 patients were included, 123 males and 134 females aged between 17 and 70; the mean age was 47.6 years. The majority of injuries were from fall from significant height. The fractures involved the thoracic and lumbar vertebra in 98 and 151 of the cases respectively. Percutaneous pedicle screw fixation was performed either one or two levels above and below the fracture depending on the level of injury. Forty two cases were treated with additional short pedicle screws at the level of fracture. More than 15% (39) of the patients presented with a neurological deficit; more than 80% (32) of those showed post-operative improvement in their neurology as per Frankel Grading system. The mean operative time was 117 min ± 45 min; mean length of hospital stay was 7.2 days ± 3.8 days, with significant improvement in pain. Conclusions: Percutaneous pedicle screw fixation is a safe surgical option with comparable outcomes to open surgery and a potential reduction in perioperative morbidity. [ABSTRACT FROM AUTHOR]

Objective: Exploring the effect of using prefabricated conical absorbable gelatin sponge to fill and remove pedicle screw paths during percutaneous pedicle screw removal and internal fixation surgery on postoperative local bleeding. Methods: From June 2020 to January 2023, our hospital included a total of 68 patients who met the inclusion and exclusion criteria for internal fixation removal after percutaneous pedicle screw surgery. Randomly divided into two groups, the observation group was filled with prefabricated conical absorbable gelatin sponge after removing the pedicle screws, while the control group was only treated with saline irrigation and then left empty. Collect and compare blood laboratory indicators, postoperative incision pain and functional scores, and corresponding imaging examinations of patients before and 3 days after surgery. Results: In the observation group, there was no significant statistical difference in blood routine results between preoperative and postoperative 3 days (P>0.05). The experimental group had significantly better inflammatory factor results than the control group on postoperative 3 days (P<0.05); At the time of dressing change 2 days after surgery, the experimental group was significantly better than the control group in terms of local swelling degree and estimated bleeding volume under ultrasound (P<0.05). There was no statistically significant difference in VAS score and ODI score between the two groups before surgery and 1 day after surgery (P>0.05), but in the comparison 5 days after surgery, the experimental group was significantly better than the control group (P<0.05). All patients did not experience irreparable complications. Conclusion: After percutaneous pedicle screw surgery, the original incision is taken out for internal fixation. Prefabricated conical absorbable gelatin sponge is used to fill the screw path, which can significantly reduce postoperative bleeding, alleviate patient pain, and shorten hospital stay. It is an ideal treatment method and can be promoted for routine application in this type of surgery. [ABSTRACT FROM AUTHOR]

Purpose: The study’s objective was to assess the effect of the screw insertion depth into fractured vertebrae in treating thoracolumbar fractures. Materials and methods: This was a retrospective analysis of 92 patients with thoracolumbar fractures from December 2018 to February 2020. Patients had AO type A2, A3 thoracolumbar fractures. The patients were divided into two groups according to the screw insertion depth. The vertebral wedge angle (VWA), Cobb angle (CA), anterior vertebral body height (AVBH), middle vertebral body height (MVBH), visual analog scale (VAS) score, and Oswestry Disability Index (ODI) were compared preoperatively and at one week and 12 months postoperatively. The correlation between Vertebral height loss and potential risk factors, such as sex, age, BMD and BMI was evaluated. Results: Compared with the preoperative data, the postoperative clinical and radiographic findings were significantly different in both groups, But no significant difference between the two groups at 1 week. At 1 year postoperatively, there was a significant difference in the CA (p < 0.0001), VWA (p = 0.047), AVBH (p < 0.0001), MVBH (p < 0.0001), VAS score (p < 0.0001), and ODI (p < 0.0001) between the two groups, Except for age, bone density and other influencing factors the long screw group had better treatment results than the short screw group. Conclusion: A longer screw provides greater grip on the fractured vertebral body and stronger support to the vertebral plate. The optimal screw placement depth exceeds 60% of the vertebral body length on the lateral view. [ABSTRACT FROM AUTHOR]

Surgical intervention for unstable thoracolumbar spine fractures is common, but delayed management and complications can impact outcomes. This study compares perioperative outcomes between patients directly admitted and those transferred from another facility for thoracolumbar spine surgery, aiming to identify predictors of complications and mortality. A multicenter retrospective cohort study used the American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2021 identified 61,626 patients undergoing fusion surgeries for thoracolumbar spine fractures, excluding spinal cord injury or pathological fractures. Patients were categorized as Direct (admitted from the emergency department) and Transfer (transferred from another facility). Perioperative outcomes, including operative time, length of stay (LOS), 30-day mortality, and complications, were compared. Our patient population (54.3% female, mean age 62.4 ± 12.9 years) comprised 12.2% Transfer and 87.8% Direct patients. Following propensity score matching, Transfer patients had a longer hospital LOS (5.1 ± 5.7 days vs. 4.5 ± 4.6 days, P < 0.001). Transfer exhibited higher rates of superficial incisional surgical site infection (1.7% vs. 1.1%, P = 0.003), sepsis (1.7% vs. 1.3%, P = 0.038), pneumonia (1.7% vs. 1.2%, P = 0.019), postoperative reintubation (0.9% vs. 0.6%, P = 0.036), and failure to wean off ventilator >48 hours postsurgery (0.7% vs. 0.3%, P = 0.005) compared to Direct admissions. Direct group had a higher rate of perioperative transfusion (16.5% vs. 13.4%, P < 0.001). Transfer patients also had a higher 30-day mortality rate compared to Direct admissions (1.1% vs. 0.6%, P = 0.002). Interhospital transfers significantly affect hospital LOS, postoperative morbidity, and mortality in thoracolumbar spine surgery. Enhancing postoperative monitoring for transfer patients is crucial. [ABSTRACT FROM AUTHOR]

Objective: The revision procedure for failure of internal fixation after thoracolumbar fracture is controversial. Combined anterior and posterior surgery is associated with higher risk more intraoperative bleeding and tissue damage. The success rate of simple anterior surgery needs further confirmation, and posterior surgery lacks stability of internal fixation. This study evaluates the feasibility and surgical effect of multi‐rod constructs in the revision of thoracolumbar fractures. Methods: Eleven patients with thoracolumbar fractures who underwent previous construct failure and were treated with revision and internal fixation with the multi‐rod technique from March 2017 to September 2018 were analyzed. The original internal fixation was removed and replaced in the medial insertion of satellite rods and bone graft. The average follow‐up time was 15.97 months. The intraoperation blood loss, the time of the operation, activation and discharge and the rate of rod fracture were calculated. The sagittal Cobb angle before revision, after revision and at the last follow‐up were compared. The clinical effect was evaluated by visual analogue scale (VAS) and Oswestry Disability Index questionnaire (ODI). Results: The average operation time was 107 min, the intraoperative blood loss was 131.81 mL, the active time was 1.59 days, and the discharge time was 10.89 days. No rod fractured again during the follow‐up period. The paired t‐test was used to compare the Cobb angle, VAS score, and ODI before and after surgery. There was significant difference in the sagittal Cobb angle between the pre‐revision and the posterior sagittal position (p = 0.000), and no significant difference was found between post‐revision and last follow‐up (p = 0.551). VAS and ODI were greatly improved at the last follow‐up. Conclusion: The literature on revision of thoracolumbar fractures is insufficient and comprises varying opinions. This paper proposes a new treatment option. The application of the multi‐rod constructs in the revision of thoracolumbar fractures is safe, simple, and effective and might provide guidance for future clinical work. [ABSTRACT FROM AUTHOR]

Fractures of the thoracic and thoracolumbar spine are common both in low- and high-energy injuries. Most of the fractures can be treated conservatively; however surgical intervention may be required in unstable injuries and those with spinal cord involvement. This article describes the biomechanics of the thoracic and thoracolumbar regions of the spine, explains the classification of the fracture and injury patterns and provides guidance on the decision-making for surgical management. Special considerations with regards to the approaches and length of fixation in each fracture pattern are mentioned. Categories such as fractures on the background of osteoporosis or ankylosing spondylitis are also covered. [ABSTRACT FROM AUTHOR]

Objectives To describe a simplified classification scheme for endplate injury morphology based on 3D CT and to examine possible associations between endplate injury morphology and vertebral space and other variables such as type of fracture and disc degeneration in a group of patients with thoracolumbar fractures. Methods This study was a retrospective cohort study. We collected patients with thoracolumbar fractures admitted from January 2015 to August 2020 and divided them into three groups based on the morphology of endplate injury (45 cases of mild endplate injury, 54 cases of moderate endplate injury, and 42 cases of severe endplate injury, SEI). Data of vertebral body and intervertebral space height and angle, the Pfirrmann grade, endplate healing morphology were collected during preoperative, postoperative, and long‐term follow‐up of patients in each group. One‐way analysis of variance (ANOVA), chi‐squared test, and repeated measurement ANOVA were used to compare and analyze the influence of endplate injury morphology on patient prognosis. Results Most moderate injuries to the endplate (fissure‐type injury) and severe injuries (irregular depression‐type injury, Schmorl's node‐type injury) resulted in significant disc degeneration in the long‐term transition. This study also showed significant differences in the height of the anterior margin of the injured spine and the intervertebral space height index during this process. Conclusions The current study suggests that although the region of injury in endplate fissure‐type injury is small preoperatively, it may be a major factor in leading to severe disc degeneration, loss of intervertebral height, and Cobb angle in the long term. The results of our study therefore may allow surgeons to predict the prognosis of patients with thoracolumbar fractures and guide their treatment.

Abstract Purpose The study’s objective was to assess the effect of the screw insertion depth into fractured vertebrae in treating thoracolumbar fractures. Materials and methods This was a retrospective analysis of 92 patients with thoracolumbar fractures from December 2018 to February 2020. Patients had AO type A2, A3 thoracolumbar fractures. The patients were divided into two groups according to the screw insertion depth. The vertebral wedge angle (VWA), Cobb angle (CA), anterior vertebral body height (AVBH), middle vertebral body height (MVBH), visual analog scale (VAS) score, and Oswestry Disability Index (ODI) were compared preoperatively and at one week and 12 months postoperatively. The correlation between Vertebral height loss and potential risk factors, such as sex, age, BMD and BMI was evaluated. Results Compared with the preoperative data, the postoperative clinical and radiographic findings were significantly different in both groups, But no significant difference between the two groups at 1 week. At 1 year postoperatively, there was a significant difference in the CA (p

Objective The revision procedure for failure of internal fixation after thoracolumbar fracture is controversial. Combined anterior and posterior surgery is associated with higher risk more intraoperative bleeding and tissue damage. The success rate of simple anterior surgery needs further confirmation, and posterior surgery lacks stability of internal fixation. This study evaluates the feasibility and surgical effect of multi‐rod constructs in the revision of thoracolumbar fractures. Methods Eleven patients with thoracolumbar fractures who underwent previous construct failure and were treated with revision and internal fixation with the multi‐rod technique from March 2017 to September 2018 were analyzed. The original internal fixation was removed and replaced in the medial insertion of satellite rods and bone graft. The average follow‐up time was 15.97 months. The intraoperation blood loss, the time of the operation, activation and discharge and the rate of rod fracture were calculated. The sagittal Cobb angle before revision, after revision and at the last follow‐up were compared. The clinical effect was evaluated by visual analogue scale (VAS) and Oswestry Disability Index questionnaire (ODI). Results The average operation time was 107 min, the intraoperative blood loss was 131.81 mL, the active time was 1.59 days, and the discharge time was 10.89 days. No rod fractured again during the follow‐up period. The paired t‐test was used to compare the Cobb angle, VAS score, and ODI before and after surgery. There was significant difference in the sagittal Cobb angle between the pre‐revision and the posterior sagittal position (p = 0.000), and no significant difference was found between post‐revision and last follow‐up (p = 0.551). VAS and ODI were greatly improved at the last follow‐up. Conclusion The literature on revision of thoracolumbar fractures is insufficient and comprises varying opinions. This paper proposes a new treatment option. The application of the multi‐rod constructs in the revision of thoracolumbar fractures is safe, simple, and effective and might provide guidance for future clinical work.

The traditional thoracolumbar fracture image-assisted classification method has low accuracy and poor generalization ability. Therefore, based on deep convolutional neural network, this paper proposes an AI classification method for thoracolumbar fracture for auxiliary diagnosis. Firstly, a total of 698 CT images of patients with lumbar spine fractures were collected from Sichuan Integrative Medicine Hospital, and a data set was established, including 279 compression fractures (category A), 295 burst fractures (category B), and 124 normal (category C). Secondly, the convolutional neural network model ResNet-50 was modified and combined with transfer learning to train, verify and test the data set to obtain the AI classification model of thoracolumbar fracture. Then, the Confusion Matrix is used to evaluate the prediction model. The accuracy of the training set and the validation set of the model is 95.75% and 96.36%, respectively, indicating that the model obtained by training has good accuracy and generalization ability. This paper proposes an image-assisted classification method for thoracolumbar fracture, which can improve the efficiency and accuracy of manual diagnosis.

Objective Thoracolumbar fractures are one of the most common fractures in clinical practice. Surgical intervention is recommended to restore spinal alignment or decompress the nerves when there are unstable fractures or neurological injuries. However, after excessive forward thrust force restoration, facet joint dislocation often occurs between the upper vertebra and the fractured vertebra, which usually leads to unsatisfactory reduction outcomes. Herein, we propose a novel spinal facet joint toothed plate to assist in fracture reduction. The purpose of this study is to evaluate the effectiveness of the new spinal facet joint toothed plate in preventing facet joint dislocation, and its advantages compared to traditional pedicle screw‐rod decompression. Methods A total of 26 patients in the toothed plate group and 93 patients in the traditional group who experienced thoracolumbar fracture with reduction were retrospectively included. Relevant patients' information and clinical parameters were collected. Furthermore, visual analogue scores (VAS) scores and Oswestry disability index (ODI) scores were also collected. Moreover, imaging parameters were calculated based on radiographs. Correlated data were analyzed by χ2 test and t test. Results All patients in this study had no postoperative complications. Postoperative VAS scores and ODI scores (p

Objective: To evaluate the efficacy of open and percutaneous pedicle screw fixation in the treatment of thoracolumbar fractures. Methods: Online databases MEDLINE (PubMed), SCOPUS, and Cochrane were searched for English language articles published between January 2001 and December 2023, limited to articles that included the clinical and radiological outcomes of adult patients. The main outcome measures of the study were the Oswestry Disability Index (ODI), the Numeric Rating Scale (NRS) score, and the Cobb angle. Results: A total of 7 studies involving 909 patients were included; 374 (41.1%) procedures were performed with open surgery (OS), while 535 (58.9%) procedures were conducted with minimally invasive surgery (MIS). The mean value of ODI in the MIS group was 8.29% [CI 95% 4.82–11.76], compared to the other group, which was 14.22% (p-value 0.87). Patients receiving a MIS had an average NRS of 1.54 [CI95% 0.98–2.10] whilst OS had 2.31 [CI95% 1.50–3.12] (p-value 0.12). Conclusions: The percutaneous technique is equally safe and effective in resolving the deformity, but the clear advantages are represented by the reduction in blood loss, shorter operative times, a lower incidence of infection, shorter hospitalization, shorter postoperative rehabilitation, and therefore good results in terms of quality of life. [ABSTRACT FROM AUTHOR]

This study aimed to establish a predictive nomogram model for recollapse of fractured vertebra after posterior pedicle screw fixation in thoracolumbar fractures (TLFs). Patients undergoing posterior pedicle screw fixation for TLFs at our hospital between January 2016 and December 2021 were retrospectively reviewed. Patients were divided into 2 groups according to the presence or absence of recollapse of the fractured vertebra at the final follow-up. The predictors for fractured vertebra recollapse were identified by univariate and multivariable logistic regression analysis, and a nomogram model was developed. The prediction performance and internal validation were established. A total of 224 patients were included in this study. Of these, 46 (20.5%) patients developed recollapse of fractured vertebra. Age, thoracic and lumbar injury severity score, screw distribution in the fractured vertebra, and anterior vertebral height compression ratio were associated with vertebral recollapse. These predictors were used to construct a predictive nomogram. The area under the receiver operating characteristic curve of the nomogram model was 0.891. The concordance index was 0.891, and it was 0.877 with bootstrapping validation. The calibration curves and decision curve analysis also suggested that the nomogram model had excellent predictive performances for fractured vertebra recollapse. A clinical nomogram incorporating 4 variables was constructed to predict fractured vertebra recollapse after posterior pedicle screw fixation for TLFs. The nomogram demonstrated good calibration and discriminative abilities, which may help clinicians to make better treatment decisions. [ABSTRACT FROM AUTHOR]

Six-screw short-segment posterior fixation for thoracolumbar fractures, which involves intermediate screws at the fractured vertebrae has been proposed to reduce the rates of kyphosis recurrence and implant failure. Yet, little is known about the mechanisms and biomechanical responses by which intermediate screws at the fracture vertebrae enhance fixation strength. The objective of this study was to investigate the biomechanical properties that are associated with the augmentation of intermediate screws in relation to the severity of type A thoracolumbar fracture using finite element analysis. Short-segment stabilization models with or without augmentation screws at fractured vertebrae were established based on finite element model of moderate compressive fractures, severe compressive fractures and burst fractures. The spinal stiffness, stresses at the implanted hardware, and axial displacement of the bony defect were measured and compared under mechanical loading conditions. All six-screw stabilization showed a decreased range of motion in extension, lateral bending, and axial rotation compared to the traditional four-screw fixation models. Burst thoracolumbar fracture benefited more from augmentation of intermediate screws at the fracture vertebrae. The stress of the rod in six-screw models increased while decreased that of pedicle screws. Our results suggested that patients with more unstable fractures might achieve greater benefits from augmentation of intermediate screws at the fracture vertebrae. Augmentation of intermediate screws at the fracture vertebrae is recommended for patients with higher wedge-shaped or burst fractures to reduce the risk of hardware failure and postoperative re-collapse of injured vertebrae. [ABSTRACT FROM AUTHOR]

Showing results of open and percutaneous surgical management of traumatic AO type A3, A4 and B2 thoracic and lumbar fractures. Retrospective comparative analysis of traditional open fusion versus percutaneous navigated fixation of thoracic and lumbar spinal fractures. Minimum 24 months follow-up to collect ODI and VAS outcome scores for comparative analysis was required. Fifty-seven patients with a mean age of 39 years met the inclusion criteria. Twenty-six patients were in the open group (Group O) and 31 in the percutaneous group (Group P). The majority of fractures were either type A3 or A4; there were three type B chance fractures in Group O and one in Group P. VAS and ODI scores followed comparable trends in the two groups until the final follow-up. The main statistically significant result between the two groups was blood loss, which was lower in Group P (110 versus 270 ml in Group O on average), although this did not reflect into different clinical outcomes. Similar peri-operative measures of operating time and length of stay were found between the two groups. A significantly higher degree of loss of reduction was noted at follow-up in Group P (8° versus 5° in Group O on average). Open and percutaneous posterior fixation techniques of thoracic and lumbar fractures in this cohort were associated with different perioperative blood losses as well as radiological measurements, but not with clinically meaningful differences in patient reported outcome measures at 24 months' follow-up. [ABSTRACT FROM AUTHOR]

Thoracolumbar (TL) fractures are among the most common vertebral fractures. These patients have high morbidity and mortality due to injury mechanisms and associated injuries. Spinal cord injury (SCI) is a prevalent complication of spinal fractures of the thoracolumbar region. Aim: To determine the pooled rate of thoracolumbar fractures and SCI in blunt trauma patients. Methods: A systematic review and meta-analysis of observational studies were performed. The search was conducted in the PubMed, Scopus, Web of Science, and Embase databases. The authors screened and selected studies based on predefined inclusion and exclusion criteria. Studies were then evaluated for risk of bias using the JBI checklist. The pooled event rate and 95% confidence intervals (CI) were calculated using random effects models. Subgroup and meta-regression analyses were performed to explore sources of heterogeneity. Results: Twenty-one studies fulfilled the selection criteria. The pooled rate of TL fractures was 8.08% (CI = 6.18–10.50%), with high heterogeneity (I2 = 99.98%, P < 0.001). Thoracic and lumbar fractures accounted for 45.23% and 59.01% of the TL fractures, respectively. Meta-regression revealed that the midpoint of the study period was a significant moderator. The pooled event rate of SCI among TL fracture patients was 15.81% (CI = 11.11 to 22.01%) with high heterogeneity (I2 = 98.31%, P < 0.001). The country of study was identified as a source of heterogeneity through subgroup analysis, and studies from the United States reported higher rates of SCI. Meta-regression revealed that the critical appraisal score was negatively associated with event rate. Conclusion: Our study evaluated the rate of TL fractures in multiple countries at different time points. We observed an increase in the rate of TL fractures over time. SCI results also seemed to vary based on the country of the original study. [ABSTRACT FROM AUTHOR]

Objective: Thoracolumbar fractures are one of the most common fractures in clinical practice. Surgical intervention is recommended to restore spinal alignment or decompress the nerves when there are unstable fractures or neurological injuries. However, after excessive forward thrust force restoration, facet joint dislocation often occurs between the upper vertebra and the fractured vertebra, which usually leads to unsatisfactory reduction outcomes. Herein, we propose a novel spinal facet joint toothed plate to assist in fracture reduction. The purpose of this study is to evaluate the effectiveness of the new spinal facet joint toothed plate in preventing facet joint dislocation, and its advantages compared to traditional pedicle screw‐rod decompression. Methods: A total of 26 patients in the toothed plate group and 93 patients in the traditional group who experienced thoracolumbar fracture with reduction were retrospectively included. Relevant patients' information and clinical parameters were collected. Furthermore, visual analogue scores (VAS) scores and Oswestry disability index (ODI) scores were also collected. Moreover, imaging parameters were calculated based on radiographs. Correlated data were analyzed by χ2 test and t test. Results: All patients in this study had no postoperative complications. Postoperative VAS scores and ODI scores (p < 0.001) were statistically significant (p < 0.001) in both groups compared with preoperative scores and further decreased (p < 0.001) at final follow‐up. In addition, the postoperative vertebral margin ratio (VMR) (p < 0.001) and vertebral angle of the injured vertebrae (p < 0.001) were significantly improved compared with the preoperative period. There were no significant differences in postoperative VAS scores and ODI scores between the two groups. However, toothed plate reduction significantly improved the VMR (p < 0.05) and vertebral angle (p < 0.05) compared with conventional reduction. Ultimately, the total screw accuracy was 98.72% (sum of levels 0 and I), with 100% screw accuracy in the segment related to the tooth plate in the tooth plate group. The dislocation rate was higher in the conventional group (6.45%) than in the new serrated plate repositioning group (0.00%). Conclusion: The facet toothed plate assisted reduction method prevents facet joint dislocation and improves fracture reduction compared to traditional reduction technique, hence it could be considered as a novel surgical strategy for thoracolumbar fracture reduction. [ABSTRACT FROM AUTHOR]

Introduction: Post operative pain control in thoracolumbar spinal fixation following fracture is important for early rehabilitation. Erector Spinae Plane block (ESB) is an effective method. Study Design: A prospective comparative longitudinal observational study. Objective: The objective is to study the efficacy of erector spinae plane block (ESB) with general anesthesia (GA) in postoperative analgesia in comparison to GA only in thoracolumbar spinal fracture surgery. Materials and Methods: A total of 40 patients enrolled for the study were randomly allocated into two groups, 20 patients received GA without ESB and 20 patients with GA and ESB. Numerical rating scale (NRS) pain score was noted in postoperative period at 1, 2, 4, 6, 9, and 24 hours, respectively. Results: There was a statistically significant difference in NRS score for 1, 2, 4, 6, and 9 h and the ESB group had better pain control but at 24 h, there was no statistically significant difference was noted. Conclusion: Postoperative pain control directly affects the recovery of a patient in any surgical condition. Thoracolumbar spine fracture fixation is a major surgery and postoperative pain control plays a major role during the early recovery period. ESB has been shown a very effective, cost-effective method of pain control in thoracolumbar spine surgery for fractures.

Abstract Background This study aimed to assess the outcomes of conservative management in patients with thoracolumbar fractures classified with a Thoracolumbar Injury Classification and Severity (TLICS) score of 4 or 5, and to analyze initial imaging findings and clinical risk factors associated with treatment failure. Methods In this retrospective analysis, patients with thoracolumbar fractures and a TLICS score of 4 or 5, determined through MRI from January 2017 to December 2020, were included. Patients undergoing conservative treatment were categorized into two groups: Group 1 (treatment success) and Group 2 (treatment failure), based on initial and 6-month follow-up outcomes. Clinical data were compared between the two groups. Initial radiological assessments included three kyphosis measurements (Cobb angle, Gardner angle, and sagittal index [SI]), anterior and posterior wall height, and central canal compromise (CC). Additionally, risk factors contributing to treatment failure were analyzed. Results The conservative treatment group comprised 84 patients (mean age, 60.25 ± 15.53; range 22–85; 42 men), with 57 in Group 1 and 27 in Group 2. Group 2 exhibited a higher proportion of women, older age, and lower bone mass density (p = 0.001–0.005). Initial imaging findings in Group 2 revealed significantly greater values for Cobb angle, SI, and CC (p = 0.001–0.045 or

Abstract Purpose To explore whether it is necessary to put drain tubes after posterior pedicle screw fixation of thoracolumbar fractures. Methods From April 2020 to January 2023, a total of 291 patients with recent thoracolumbar fractures (AO type-A or type-B) who received the pedicle screw fixation operation were enrolled retrospectively. In 77 patients, drain tubes were used in the pedicle screw fixation surgery, while no drain tubes were placed in the other group. After gleaning demographic information and results of lab examination and imageology examination, all data were put into a database. Independent-sample t-tests, Pearson Chi-Square tests, Linear regression analysis, and correlation analysis were then performed. Results Compared to the control group, the drainage group had significantly lower postoperative CRP levels (P = 0.047), less use of antipyretics (P = 0.035), higher ADL scores (P = 0.001), and lower NRS scores (P

Objective To explore the efficacy and prognosis of robot-assisted percutaneous pedicle screw (PPS) in the treatment of thoracic and lumbar spine fracture. Methods A total of 84 patients with thoracolumbar fracture were selected from Xuzhou Renci Hospital from November 2018 to November 2022, and divided into study group (42 cases with robot-assisted PPS) and control group (42 cases with free-hand PPS) according to random number rank method. Perioperative indexes, nail placement accuracy, prognostic indexes (VAS score, Cobb Angle, relative height of anterior vertebra) and incidence of postoperative complications were compared between the two groups. Results Less intraoperative blood loss, shorter fluoroscopy time, fluoroscopy times, operative time, single nail placement time and radiation exposure time, and higher nail placement accuracy were observed in the study group (P < 0.05). VAS score and Cobb Angle of the injured vertebrae were lower in the postoperative 3 d and the last follow-up, and the relative height of the injured vertebrae was higher than that before surgery in the two groups (P < 0.05). Conclusion Robot-assisted PPS in the treatment of thoracolumbar fracture has a good application effect, which can shorten the operation time, reduce the intraoperative fluoroscopy times, improve the accuracy of nail placement, and have good safety. [ABSTRACT FROM AUTHOR]

Background: This study aimed to assess the outcomes of conservative management in patients with thoracolumbar fractures classified with a Thoracolumbar Injury Classification and Severity (TLICS) score of 4 or 5, and to analyze initial imaging findings and clinical risk factors associated with treatment failure. Methods: In this retrospective analysis, patients with thoracolumbar fractures and a TLICS score of 4 or 5, determined through MRI from January 2017 to December 2020, were included. Patients undergoing conservative treatment were categorized into two groups: Group 1 (treatment success) and Group 2 (treatment failure), based on initial and 6-month follow-up outcomes. Clinical data were compared between the two groups. Initial radiological assessments included three kyphosis measurements (Cobb angle, Gardner angle, and sagittal index [SI]), anterior and posterior wall height, and central canal compromise (CC). Additionally, risk factors contributing to treatment failure were analyzed. Results: The conservative treatment group comprised 84 patients (mean age, 60.25 ± 15.53; range 22–85; 42 men), with 57 in Group 1 and 27 in Group 2. Group 2 exhibited a higher proportion of women, older age, and lower bone mass density (p = 0.001–0.005). Initial imaging findings in Group 2 revealed significantly greater values for Cobb angle, SI, and CC (p = 0.001–0.045 or < 0.001; with cutoff values of 18.2, 12.8, and 7.8%, respectively), and lower anterior wall height (p = 0.001), demonstrating good to excellent interobserver agreement (0.72–0.99, p < 0.001). Furthermore, osteoporosis was identified as a significant risk factor (odds ratio = 5.64, p = 0.008). Conclusion: Among patients with TLICS scores of 4 or 5, those experiencing conservative treatment failure exhibited unfavorable initial radiological findings, a higher proportion of women, advanced age, and osteoporosis. Additionally, osteoporosis emerged as a significant risk factor for treatment failure. [ABSTRACT FROM AUTHOR]

Purpose: To explore whether it is necessary to put drain tubes after posterior pedicle screw fixation of thoracolumbar fractures. Methods: From April 2020 to January 2023, a total of 291 patients with recent thoracolumbar fractures (AO type-A or type-B) who received the pedicle screw fixation operation were enrolled retrospectively. In 77 patients, drain tubes were used in the pedicle screw fixation surgery, while no drain tubes were placed in the other group. After gleaning demographic information and results of lab examination and imageology examination, all data were put into a database. Independent-sample t-tests, Pearson Chi-Square tests, Linear regression analysis, and correlation analysis were then performed. Results: Compared to the control group, the drainage group had significantly lower postoperative CRP levels (P = 0.047), less use of antipyretics (P = 0.035), higher ADL scores (P = 0.001), and lower NRS scores (P < 0.001) on the 6th day after surgery. Other investigation items, such as demographic information, operation time, intraoperative blood loss, body temperature, and other preoperative and postoperative lab results, showed no significant differences. Conclusions: The use of a drain tube in the pedicle screw fixation of thoracolumbar fractures is correlated with the improvement of patients' living and activity ability and the reduction of inflammation, postoperative fever and pain. [ABSTRACT FROM AUTHOR]

Surgical outcomes of open anterior and open posterior approaches, for thoracolumbar A3 to C3/AO type fractures, are compared. A PubMed search was conducted from 1990 to 2024 related to anterior, posterior, and combined approaches. Inclusion criteria: Fresh traumatic T10 to L2 fractures, age ≥13 years, ≥10 cases, minimum follow-up 6 months. Exclusion criteria: Cadaveric studies, pathological fractures, reviews, thoracoscopy-assisted, mini-open lateral (MOLA) and minimal invasive anterior or posterior approaches. Coleman Methodology Scores (CMS) (modified for spinal trauma) indicated potential selection bias in the selected studies. PRISMA guidelines were adapted. Nineteen studies with 847 participants were selected. The average CMS quality score was fair. The anterior approach, although it better decompresses the compromised spinal canal, it is also associated with increased surgical complications compared to the posterior approach. The neurological outcome, the loss of correction and the reoperation rate, were similar to both approaches. This systematic review favors posterior approach. The anterior approach is demanding and is associated with a higher rate of surgical complications compared to the posterior approach. The limitations of the selected studies included inconsistence in the: 1) approaches selection, 2) classifications of the fracture types and the neurological status and 3) variety of instrumentations used. CRD42023484222 [ABSTRACT FROM AUTHOR]

INTRODUCTION: The indications for operative treatment and type of stabilization procedures for the treatment of thoracolumbar fracture remains controversial. Long-segment pedicle screw fixation permits correction of kyphotic deformity while short -segment pedicle screw fixation preserves motion segments, reduces costs and time of surgery. Our aim is to study the correlation and comparison between clinical and radiological outcome of both fixations and identify factors that might contribute to the outcome. MATERIALS AND METHODS: 60 patients with thoracolumbar spine fracture from 2017 to 2022 were identified. Age, gender, mechanism of injury, classification of fracture, duration of hospital stays and one-year post-operative outcome of Visual Analogue (VAS) pain score, and Oswestry Disability Index (ODI) score were documented. Pre- and post-operative AP/Lateral radiographs measurements of local kyphotic angle, Cobb angle were measured. Signs of fixation failure were examined at follow-up. RESULTS: Subjects mean age is 42.4, male predominance (85%) and workrelated. The highest incidence was at level of L1 (56.7 %) in the long-segment and 46.7 % in short-segment. Most common injury was burst fracture (AO classification A3 A4 group) due to fall from height. There is shorter hospital stay documented in the short-segment fixation. Radiological outcome measured in both groups were comparable with no signs of fixation failure. Short-segment fixation group also resulted in better clinical and functional outcome at one-year follow-up. CONCLUSION: There is no significant difference in radiologic outcome of Cobb and kyphotic angle in both fixation groups. Short-segment fixation has significantly better clinical and functional outcome post-operative and at 1-year follow up. [ABSTRACT FROM AUTHOR]

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.

Abstract Study design A retrospective study. Purpose The study objectives were as follows: 1) to analyze the factors influencing the occurrence of the intravertebral shell phenomenon (ISP) after thoracolumbar spinal fracture surgery and the evolutionary outcome of this phenomenon; and 2) to make recommendations for the clinical prevention and treatment of ISP. Methods We retrospectively analyzed 331 patients with single-segment fractures of the thoracolumbar spine treated with internal fixation via a pedicle screw-rod system. Univariate and multivariate logistic regression were used to analyze factors influencing ISP. Results A total of 260 patients (78.5%) developed ISP after surgery. Reduced bone mineral density, screw insertion depth, degree of vertebral body injury, and excessive vertebral body spreading were significantly associated with the occurrence of ISP (P

Background. Thoracolumbar fractures are among the most common and unstable traumatic injuries to the spine. They require a rigid fixation. However, there are controversies in the choice of fixation types. This study aimed to compare longsegment posterior fixation (LSPF) bridging the injured vertebra and short-segment fixation with screws in the fractured vertebra (SSFFV). Methods. This was an analytical study of 22 patients admitted to the Kinshasa University Teaching Hospital from 2020 to 2023 with thoraco-lumbar fractures. Variables of interest included: sex, age, occupation, cause of fracture, ASIA score, injured vertebra, Magerl fracture types, Sagittal Cobb angle (SCA), and level of fixation. Data were analysed using SPSS 26 software. Results. Ten patients (45.4%) had SSFFV and 12 (54.6%) had LSPF. Overall, the sex ratio was 4.5 and, the mean age was 35.27±9.88 years. Road accidents accounted for 72.7% of causes, fracture of L1 (50%), ASIA A (41%) and Magerl B (54,5%). Preoperative features did not show a difference between the two fixations. No difference was observed in function values before surgery (p=0.863) and at one year postoperatively (p=0.914). The mean SCA was 15.57 ± 5.90° before surgery, and 12.60±5.94° one year after surgery showing a significant correction of local kyphosis of 3° (P <0.001). There was no significant difference in the degrees of correction of local kyphosis immediately postoperatively (p=0.591) and at one year postoperative (p=0.819) and also in the degrees of loss of local kyphosis (p=0.870) between SSFFV and LSPF. Conclusion. This study did not show a significant difference in functional recovery, reduction and loss of correction of traumatic kyphosis between the two fixations. The SSFFV therefore appears to be an effective alternative to LSPF. [ABSTRACT FROM AUTHOR]

An active straight leg raise (SLR) is a weight bearing test which assesses pain upon movement and a patient's ability to load their pelvis, lumbar, and thoracic spine. Since many stable patients undergo computed tomography (CT) scanning solely for spinal tenderness, our hypothesis is that performing active straight leg raising could effectively rule out lumbar and thoracic vertebral fractures. Blunt trauma patients ≥18 years of age with Glasgow Coma Scale 15 presenting in hemodynamically stable condition were screened. Patients remaining in the supine position were asked to perform SLR at 12, 18, and 24 inches above the bed. The patient's ability to raise the leg, baseline pain, and pain at each level were assessed. Patients also underwent standard CT scanning of the chest, abdomen and pelvis. The clinical examination results were then matched post hoc with the official radiology reports. 99 patients were screened, 65 males and 34 females. Spinal fractures were present in 15/99 patients (16%). Mechanisms of injury included motor vehicle collision 51%, pedestrian struck 25%, fall1 9%, and other 4%. The median pain score of patients with and without significant spinal fractures at 12, 18, 24 inches was 7.5, 7, 6 and 5, 5, 4, respectively. At 24 inches, active SLR had sensitivity of 0.47, a specificity of 0.59, a positive predictive value of 0.17, and an negative predictive value of 0.86. Although SLR has been discussed as a useful adjunct to secondary survey and physical exam following blunt trauma, its positive and more importantly negative predictive value are insufficient to rule out spinal column fractures. Liberal indications for CT based upon mechanism and especially pain and tenderness are necessary to identify all thoraco-lumbar spine fractures. • Blunt trauma patients were asked to perform active straight leg raise (SLR). • Active SLR did not produce significant sensitivity or specificity for fracture. • Active SLR did not produce significant positive predictive value or NPV for fracture. • Spinal tenderness was elicited in 42% of nonfracture patients. • In thoracolumbar fracture computed tomography imaging remains the standard test for ruling out injury. [ABSTRACT FROM AUTHOR]

ObjectiveThis study aimed to investigate the biomechanical characteristics of the tandem spinal external fixation (TSEF) for treating multilevel noncontiguous spinal fracture (MNSF) using finite element analysis and provide a theoretical basis for clinical application.MethodsWe constructed two models of L2 and L4 vertebral fractures that were fixed with the TSEF and the long-segment spinal inner fixation (LSIF). The range of motion (ROM), maximum stresses at L2 and L4 vertebrae, the screws and rods, and the intervertebral discs of the two models were recorded under load control. Subsequently, the required torque, the maximum stress at L2 and L4 vertebrae, the screws and rods, and the intervertebral discs were analyzed under displacement control.ResultsUnder load control, the TSEF model reserved more ROM than the LSIF model. The maximum stresses of screws in the TSEF model were increased, while the maximum stresses of rods were reduced compared to the LSIF model. Moreover, the maximum stresses of L2 and L4 vertebrae and discs in the TSEF model were increased compared to the LSIF model. Under displacement control, the TSEF model required fewer moments (N·mm) than the LSIF model. Compared to the LSIF model, the maximum stresses of screws and rods in the TSEF model have decreased; the maximum stresses at L2 and L4 in the TSEF model were increased. In the flexion condition, the maximum stresses of discs in the TSEF model were less than the LSIF model, while the maximum stresses of discs in the TSEF model were higher in the extension condition.ConclusionCompared to LSIF, the TSEF has a better stress distribution with higher overall mobility. Theoretically, it reduces the stress concentration of the connecting rods and the stress shielding of the fractured vertebral bodies.

Objective Conventional open internal fixation surgery for thoracolumbar fractures has many complications and long recovery time. There are few clinical studies on the minimally invasive percutaneous injured vertebrae screw internal fixation. The purpose of this paper is to evaluate the application value of minimally invasive percutaneous injured vertebrae screw internal fixation in the treatment of thoracolumbar fractures (TF). Methods A total of 98 patients with TF admitted to our hospital from January 2019 to December 2021 were retrospectively enrolled. According to the surgical method, the patients were divided into the study group (n = 49, treated with minimally invasive percutaneous injured vertebrae screw internal fixation) and the control group (n = 49, treated with traditional open internal fixation surgery). The two groups were compared in the perioperative period, the degree of pain at different periods, the percentage of the height of the anterior edge of the injured vertebra, the Cobb angle of the injured vertebra body and the wedge angle of the injured vertebra body at the first week and the last follow‐up, and the postoperative complications and the occurrence of the cone shell after the operation were recorded. Then, statistical analysis such as Student's t test or Chi‐Square test was performed. Results The operation time (p = 0.002), intraoperative blood loss (p

Abstract Background Previous studies on thoracolumbar fractures with neurological symptoms have focused on how to achieve satisfactory fracture reduction, adequate nerve decompression, and stable spinal alignment. With the development of the minimally invasive spine surgery technique, achieving satisfactory treatment results and reducing iatrogenic trauma at the same time has become a new goal of spinal surgery. This research used percutaneous transpedicular screw distraction to partially reduce the fractured vertebrae, followed by completing nerve decompression and reducing residual displacement bone fragments with the assistance of the unilateral biportal endoscopic (UBE) technique to achieve full protection of bone-ligament tissue and obtain good clinical efficacy. Methods Guide wires were safely inserted into the fractured vertebra and adjacent upper and lower vertebra under the surveillance of anteroposterior and lateral X-ray fluoroscopy. Transpedicular screws were implanted via guide wires on the side with mild neurological deficits or bone fragment compression (the opposite side of the endoscopic operation). A titanium rod was installed and moderately distracted to reduce the fractured vertebra. Then, under the guidance of the endoscopic view, the laminectomy and ligamentum flavum resection were completed according to the position of the protruding bone fragment into the spinal canal, and the compressed dural sac or nerve root was fully exposed and decompressed. An L-shaped replacer was used to reduce residual bone fragments. The ipsilateral transpedicular screws and rod were installed and adjusted to match the contralateral side. The drainage tube was indwelled, and the incision was closed. The preoperative and postoperative images of the patients were evaluated, and the recovery of neurological symptoms was observed. Results Surgery was successfully completed on all six patients, and no intraoperative conversion to open surgery was performed. Postoperative images showed good reduction of the protruding bone fragment and good placement of all screws. At the last follow-up, the neurological symptoms of all patients returned to normal. Conclusion The UBE technique combined with percutaneous transpedicular screw fixation in the treatment of thoracolumbar fractures with neurological symptoms can effectively achieve the reduction of displaced bone fragments, improve damaged nerve function, stabilize spinal alignment, and protect the integrity of bone-ligament tissue.

Abstract Objective This study aimed to evaluate the feasibility of the modified thoracolumbar injury classification and severity score system in guiding clinical treatment. Methods A retrospective study was conducted on a cohort of 120 patients with thoracolumbar fractures who were admitted to the Department of Spinal Surgery at Ningbo Sixth Hospital between December 2019 and June 2021. The study population consisted of 68 males and 52 females, with an average age of 36.7 ± 5.7 years. The severity of the fractures was assessed based on comprehensive scores incorporating fracture morphology, neurological function, posterior ligament complex integrity, and disc injury status. The evaluation was performed using the total score T, which guided the formulation of the clinical treatment strategy. Furthermore, the study compared the treatment options, imaging data, and clinical efficacy between two classification systems. Results The analysis of 120 patients revealed no statistically significant difference in the total score or treatment method between the TLICS system and the modified TLICS system. However, the operation rate for the modified TLICS system (73.3%) was slightly lower compared to the TLICS system (79.2%). All patients were followed up for a mean duration of 19.2 ± 4.6 months, ranging from 11 to 27 months. At the last follow-up, the visual analogue scale score was 1.94 ± 0.52, and the modified Japanese Orthopaedic Association score was 28.8 ± 4.5, indicating a significant improvement compared to the scores obtained prior to treatment. The neurological status exhibited varying degrees of improvement. Notably, the anterior vertebral height ratio was 87.10 ± 7.17%, the sagittal index was 90.35 ± 7.72%, and the Cobb angle was 3.05 ± 0.97 degrees at the last follow-up. All these measurements demonstrated statistically significant differences compared to the values observed prior to treatment (P

Background. Thoracolumbar fractures are among the most common and unstable traumatic injuries to the spine. They require a rigid fixation. However, there are controversies in the choice of fixation types. This study aimed to compare long-segment posterior fixation (LSPF) bridging the injured vertebra and short-segment fixation with screws in the fractured vertebra (SSFFV). Methods. This was an analytical study of 22 patients admitted to the Kinshasa University Teaching Hospital from 2020 to 2023 with thoraco-lumbar fractures. Variables of interest included: sex, age, occupation, cause of fracture, ASIA score, injured vertebra, Magerl fracture types, Sagittal Cobb angle (SCA), and level of fixation. Data were analysed using SPSS 26 software. Results. Ten patients (45.4%) had SSFFV and 12 (54.6%) had LSPF. Overall, the sex ratio was 4.5 and, the mean age was 35.27±9.88 years. Road accidents accounted for 72.7% of causes, fracture of L1 (50%), ASIA A (41%) and Magerl B (54,5%). Pre-operative features did not show a difference between the two fixations. No difference was observed in function values before surgery (p=0.863) and at one year postoperatively (p=0.914). The mean SCA was 15.57 ± 5.90° before surgery, and 12.60±5.94° one year after surgery showing a significant correction of local kyphosis of 3° (P

Introduction: Percutaneous techniques for the surgical treatment of vertebral fractures are constantly progressing. There are different biomechanics involved. Research question: Two percutaneous, monoaxial fixation systems with different reduction tools were analyzed in relation to their reduction capacity. Additionally, the impact of anterior fusion, fracture severity and bone quality on reduction and loss of reduction were examined. Material and methods: 117 cases were retrospectively included in the monocentric study. The subsample (N = 53) with complete data at follow-up times was used to analyze the influence of anterior fusion. The dependencies on fracture severity and bone quality were determined using Spearman and Pearson correlation. Results: Both systems achieved equally good reduction (9° mean, 95%-CI: 8°–11°, p

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BACKGROUND: Percutaneous long-arm single-axis pedicle screw fixation and minimally invasive percutaneous single-plane pedicle screw internal fixation are both classical minimally invasive surgical options commonly used in clinical practice, but the two surgical methods in the treatment of thoracolumbar fractures are still controversial. OBJECTIVE: To compare the advantages and limitations of two procedures, long-arm single-axis pedicle screw percutaneous approach and minimally invasive percutaneous single-plane pedicle screw internal fixation, in the treatment of thoracolumbar fractures. METHODS: Ninety patients with thoracolumbar fractures admitted to Shenzhen Hospital of Guangzhou University of Chinese Medicine from March 2017 to June 2021 were included and assigned to the control group (n=45) and the trial group (n=45). The control group received minimally invasive percutaneous single-plane pedicle screw internal fixation. The trial group received long-arm single-axis pedicle screw percutaneous approach. The indexes related to perioperative general condition, pain level, and recovery were compared between the two groups. RESULTS AND CONCLUSION: (1) Compared with the control group, the trial group had less intraoperative blood loss, shorter operative time and hospital stay (P < 0.05). (2) At 2 weeks and 1 month after operation, Oswestry dysfunction index score and Cobb angle in the trial group were lower than those in the control group (P < 0.05). The anterior and posterior heights of the injured vertebra were higher in the trial group than those of the control group (P < 0.05). At 2 months after operation, the Oswestry dysfunction index score and Cobb angle in the trial group were lower than those in the control group (P < 0.05). There was no significant difference in the anterior and posterior heights of the injured vertebra between the two groups (P > 0.05). At 2 weeks after operation, the visual analog scale score was lower in the trial group than that in the control group (P < 0.05). (3) Among the 45 cases in the control group, there were 2 cases of incision infection, 2 cases of dyskinesia, and 1 case of implant-related adverse reactions, with a total incidence rate of 11%. Among the 45 cases in the trial group, there were 2 cases of dyskinesia, and the total incidence was 4%. There was no significant difference in the total incidence of complications between the two groups (P > 0.05). (4) Both long-arm single-axis pedicle screw percutaneous approach and minimally invasive percutaneous single-plane pedicle screw internal fixation can achieve better results in the treatment of thoracolumbar fractures. However, the former has shorter operative time and less intraoperative blood loss, so the former is the ideal surgical option for obtaining the same benefit. [ABSTRACT FROM AUTHOR]

Objective: Conventional open internal fixation surgery for thoracolumbar fractures has many complications and long recovery time. There are few clinical studies on the minimally invasive percutaneous injured vertebrae screw internal fixation. The purpose of this paper is to evaluate the application value of minimally invasive percutaneous injured vertebrae screw internal fixation in the treatment of thoracolumbar fractures (TF). Methods: A total of 98 patients with TF admitted to our hospital from January 2019 to December 2021 were retrospectively enrolled. According to the surgical method, the patients were divided into the study group (n = 49, treated with minimally invasive percutaneous injured vertebrae screw internal fixation) and the control group (n = 49, treated with traditional open internal fixation surgery). The two groups were compared in the perioperative period, the degree of pain at different periods, the percentage of the height of the anterior edge of the injured vertebra, the Cobb angle of the injured vertebra body and the wedge angle of the injured vertebra body at the first week and the last follow‐up, and the postoperative complications and the occurrence of the cone shell after the operation were recorded. Then, statistical analysis such as Student's t test or Chi‐Square test was performed. Results: The operation time (p = 0.002), intraoperative blood loss (p < 0.001), postoperative drainage volume (p = 0.011), and length of hospital stay (p = 0.003) in the study group were significantly lower than that in the control group. The VAS in the study group (3.38 ± 1.02) was significantly lower than that in the control group (4.56 ± 1.04) on the 7th day after the operation, with a significant difference (p < 0.001). The correction values of the percentage of leading edge height (LEH), Cobb angle, wedge angle in the study group were significantly lower than that in the control group at 1 week after surgery (all ps < 0.001). The incidence of postoperative complications in the study group (one case, 2.04%) was significantly lower than that in the control group (seven cases, 14.29%) (p = 0.031). At 1 month, 6 months, 10 months, and the last follow‐up, the incidence of "empty shell" on CT scan in the study group were lower than that in the control group with a significant difference (all ps < 0.05). Conclusion: Applying minimally invasive percutaneous injured vertebrae screw internal fixation is more beneficial to shorten the operation time and hospital stay, with fewer postoperative complications. [ABSTRACT FROM AUTHOR]

Disc degeneration after trauma has been the focus of several investigations, although vertebral endplate changes have received comparatively less attention. The main aim of the present study is to radiologically evaluate the prevalence of the degree of degeneration of the adjacent discs and endplates after AO type A thoracolumbar fractures. We retrospectively reviewed 25 patients with an AO type A injury (50 discs and 150 endplates). The type of disc lesion adjacent to the fractured vertebra was classified using the Pfirrmann and Oner classifications immediately after trauma and at the 1-year follow-up. The endplate defects were assessed using the endplate scoring system (total endplate score 1–6) in T1-weighted images. The kyphosis angle and vertebral body height were also measured. The study population consisted of 18 men (72%) and 7 women (28%), with a mean age of 38.9 ± 11.3 years. Overall, 28% of the fractures were type A1, 4% were type A2, 24% were type A3, and 44% were type A4. On statistical analysis, a significant change was found in the degree of degeneration in the cranial adjacent disc using both the Oner (P = 0.004) and Pfirrmann (P = 0.001) classifications at the end of 1 year. The morphological changes at the cranial adjacent discs at 1 year of follow-up showed a strong positive correlation with superior endplate degeneration. The results from the present study indicate that endplate fractures of vertebrae in patients with thoracolumbar burst fractures can cause disc degeneration, especially at the cranial endplate. [ABSTRACT FROM AUTHOR]

Abstract Background This retrospective cohort study aimed to compare the clinical and radiological outcomes between two treatment strategies focusing on non-osteoporotic AOSpine-type A3 fractures of the thoracolumbar spine with neurological deficits at levels T11 to L2. Methods In total, 67 patients between 18 and 60 years of age who were treated operatively with either of the two treatment strategies were included. One treatment strategy included open posterior stabilization and decompression, whereas the other was based on percutaneous posterior stabilization and decompression via a tubular retraction system. Demographic data, surgical variables, and further parameters were assessed. Patient-reported outcomes (PROs), including the Visual Analog Scale (VAS), the Oswestry Disability Index (ODI), and the American Spinal Injury Association (ASIA) impairment score, were measured to assess functional outcomes. The regional Cobb angle (CA), the anterior height ratio of the fractured vertebrae (AHRV), and the degree of canal encroachment (DCE) were assessed. The ASIA score was used to assess neurological function recovery. The follow-up period was at least 12 months. Results Surgical time and postoperative hospital stay were significantly shorter in the minimally invasive surgery (MIS) group. Intraoperative blood loss was significantly less in the MIS group. Regarding radiological outcome, CA and AHRV at the time of follow-up did not show a significant difference. DCE at the time of follow-up was significantly improved in the MIS group. Lower VAS scores and better ODIs were observed in the MIS group at the 6-month follow-up, but similar outcomes were observed at the 12-month follow-up. The ASIA score was similar between both groups at the 12-month follow-up. Conclusions Both treatment strategies are safe and effective; however, MIS could provide earlier pain relief and better functional outcomes compared with OS.

Objective To investigate the influencing factors for postoperative pain after percutaneous vertebroplasty （PVP） in patients with osteoporotic thoracolumbar fracture, and to build a nomogram prediction model. Methods A total of 136 patients with osteoporotic thoracolumbar spine fracture admitted to our hospital from July 2019 to June 2022 were selected and divided into pain group （n = 58） and control group （n = 78）. The patients' clinical data were analyzed by one-way analysis; MedCalc software was used to analyze the ROC curve; logistic regression was used to analyze the risk factors affecting postoperative pain; R language software 4.0" rms" package was used to construct the columnar graphical prediction model of postoperative pain in osteoporotic thoracolumbar spine fracture patients, and the calibration and decision curves were used to analyze the postoperative pain. Calibration and decision curves were used for internal validation and evaluation of clinical predictive efficacy. Results Differences between the two groups were statistically significant in terms of age, literacy, psychological disorders, smoking, history of previous fracture, BMD, ASA grading, operative time, volume of cement injected, and cement leakage. The AUCs for age, operative time, and bone cement injection volume were 0.785, 0.815, and 0.846, and the optimal cutoff values were 64 years, 47 min, and 4.7 mL. age, literacy, mental illness, smoking, BMD, ASA classification, bone cement injection volume, and bone cement leakage were risk factors for postoperative pain. The C-index of the column-line graph prediction model was 0.826（ 95% CI: 0.714 ~ 0.902）, which was a good fit; the threshold of the column-line graph prediction model was > 0.19, which provided a net clinical benefit. Conclusion Age, education, mental illness, smoking, BMD, ASA classification, cement injection volume, and cement leakage were risk factors for postoperative pain in patients with osteoporotic thoracolumbar spine fracture, and the construction of a columnar graphical prediction model for this purpose could help to improve the prognosis of clinical interventions. [ABSTRACT FROM AUTHOR]

Objective: To study the relationship between serum osteocalcin (OC), 25-hydroxyvitamin D [25 (OH)D] and parathyroid hormone (PTH) levels and thoracolumbar fracture in elderly patients with osteoporosis and its predictive value. A total of 171 elderly patients with osteoporosis admitted to Western Theater General Hospital from June 2019 to June 2022 were selected. They were divided into fracture group (n=80) and non-fracture group (n= 91) according to whether there was thoracolumbar fracture or not. The serum levels of OC, 25(OH)D and PTH were compared between the two groups. Univariate and multivariate Logistic regression analysis was used to identify the related influencing factors of thoracolumbar fracture in elderly patients with osteoporosis. The receiver operating characteristic (ROC) curve was used to determine the efficacy of serum OC, 25 (OH)D and PTH levels in predicting thoracolumbar fractures in elderly patients with osteoporosis. Results: The serum OC and 25 (OH)D levels in the fracture group were lower than those in the non-fracture group, while the PTH level was higher than that in the non-fracture group (all P<0.05). Univariate analysis showed that age, course of osteoporosis and grade of osteoporosis were associated with thoracolumbar fracture in elderly patients with osteoporosis (all P<0.05). Multivariate Logistic regression analysis showed that age≥ 70 years, duration of osteoporosis≥ 6 months, osteoporosis grade Ⅲ, and high PTH level were risk factors for thoracolumbar fracture in elderly patients with osteoporosis, while high OC and 25(OH)D levels were protective factors for thoracolumbar fracture in elderly patients with osteoporosis(all P<0.05). ROC curve analysis showed that the combination of serum OC, 25 (OH)D and PTH levels in predicting thoracolumbar fracture in elderly patients with osteoporosis was better than the above three indicators alone. Conclusion: Elevated serum PTH level is a risk factor for thoracolumbar fracture in elderly patients with osteoporosis, while high OC and 25 (OH)D levels are protective factors. Combined detection of the three indexes has a better efficacy in predicting thoracolumbar fracture in elderly patients with osteoporosis. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to explore the safety and effectiveness of percutaneous lordoplasty (PLP) in the treatment of severe osteoporotic vertebral compression fracture (OVCF). Methods: Included in this prospective study were patients with single-segment acute severe OVCF who were treated with PLP in our institution from July 2016 to October 2019. Patients' back pain and quality of life were assessed using the visual analog scale (VAS) and SF-36 scores. Lateral X-ray radiography of the spine was performed to measure the vertebral height, vertebral kyphotic angle, and segmental kyphotic angle, and to evaluate the outcome of fracture reduction and kyphotic correction. Intra-and postoperative complications were recorded. Results: Of the 51 included patients, 47 patients were followed up for 12 months. The VAS score decreased from preoperative 7.33 ± 1.92 to postoperative 1.76 ± 0.85 at the 12thmonth (p<0.05), and the SF-36 score increased frompreoperative 79.50 ± 9.22 to postoperative 136.94 ± 6.39 at the 12th month (p < 0.05). During the 1-year follow-up period, the anterior height of the vertebral body increased significantly frompreoperative 10.49±1.93mmto 19.33±1.86mm(p<0.05); the posterior height of the vertebral body increased insignificantly from preoperative 22.23 ± 2.36mm to 23.05 ± 1.86mm (p > 0.05); the vertebral kyphotic angle decreased significantly from preoperative 18.33° ± 11.49° to 8.73° ± 1.21° (p < 0.05); and the segmental kyphotic angle decreased significantly frompreoperative 24.48° ± 4.64° to 11.70° ± 1.34° (p < 0.05). During the 1-year follow-up period, there was no significant difference in the radiologic parameters, VAS scores, and SF-36 scores, between the 1st day and the 12th month of post-operation (P > 0.05). No nerve damage occurred in any of the cases. Intraoperative cement leakage occurred in six cases, and the fracture of the adjacent vertebral body occurred in one case. Conclusion: PLP can well reduce the risk of fracture and achieve good kyphotic correction and may prove to be a safe, cost-effective and minimally invasive alternative option for the treatment of severe OVCF with kyphotic deformity. [ABSTRACT FROM AUTHOR]

Background: Previous studies on thoracolumbar fractures with neurological symptoms have focused on how to achieve satisfactory fracture reduction, adequate nerve decompression, and stable spinal alignment. With the development of the minimally invasive spine surgery technique, achieving satisfactory treatment results and reducing iatrogenic trauma at the same time has become a new goal of spinal surgery. This research used percutaneous transpedicular screw distraction to partially reduce the fractured vertebrae, followed by completing nerve decompression and reducing residual displacement bone fragments with the assistance of the unilateral biportal endoscopic (UBE) technique to achieve full protection of bone-ligament tissue and obtain good clinical efficacy. Methods: Guide wires were safely inserted into the fractured vertebra and adjacent upper and lower vertebra under the surveillance of anteroposterior and lateral X-ray fluoroscopy. Transpedicular screws were implanted via guide wires on the side with mild neurological deficits or bone fragment compression (the opposite side of the endoscopic operation). A titanium rod was installed and moderately distracted to reduce the fractured vertebra. Then, under the guidance of the endoscopic view, the laminectomy and ligamentum flavum resection were completed according to the position of the protruding bone fragment into the spinal canal, and the compressed dural sac or nerve root was fully exposed and decompressed. An L-shaped replacer was used to reduce residual bone fragments. The ipsilateral transpedicular screws and rod were installed and adjusted to match the contralateral side. The drainage tube was indwelled, and the incision was closed. The preoperative and postoperative images of the patients were evaluated, and the recovery of neurological symptoms was observed. Results: Surgery was successfully completed on all six patients, and no intraoperative conversion to open surgery was performed. Postoperative images showed good reduction of the protruding bone fragment and good placement of all screws. At the last follow-up, the neurological symptoms of all patients returned to normal. Conclusion: The UBE technique combined with percutaneous transpedicular screw fixation in the treatment of thoracolumbar fractures with neurological symptoms can effectively achieve the reduction of displaced bone fragments, improve damaged nerve function, stabilize spinal alignment, and protect the integrity of bone-ligament tissue. [ABSTRACT FROM AUTHOR]

Study design: Retrospective study. Introduction: Spinal fractures are common trauma that can be treated by a range of techniques, from functional to surgical. Spine surgery has been around for many years. The first procedures were done open but have been plagued by numerous complications—sometimes severe—and substantial intraoperative blood loss. Percutaneous surgery was developed to help reduce the complications while providing similar clinical and radiological outcomes to open surgery. We conducted a study to compare open and percutaneous surgery and to evaluate other complications as well as short- and medium-term clinical and radiological results. Material and methods: Retrospective, single-center study comparing two cohorts of patients suffering from an isolated vertebral fracture who were operated using either an open or percutaneous technique. Included were patients who had an isolated vertebral fracture between T10 and L3 and were operated between 01/01/2016 and 31/12/2018 at the Reims university hospital. These patients were reviewed in person after a minimum of 18 months postoperative for clinical and radiological assessments. The Mercuriali and Brecher formula was used to calculate intraoperative blood loss based on pre- and postoperative hematocrit; the total blood volume was determined with the Nadler formula. Results: The study cohort consisted of 79 patients operated by percutaneous surgery and 55 patients operated by open surgery. The blood loss in the percutaneous surgery group was 176 mL versus 220 mL in the open surgery group (p = 0.02). The length of hospital stay was shorter after percutaneous surgery (mean of 3.6 days) than after open surgery (mean of 5.5 days) (p < 0.001). Also, the pedicle screw placement was optimal in 88% of percutaneous procedures versus 67% of open procedures (p < 0.001). Conclusion: Percutaneous surgery for thoracolumbar fractures causes less blood loss than conventional open surgery. The clinical and radiological results are on par with conventional open surgery. The mean length of hospital stay is shorter and the accuracy of pedicular screw placement is higher with percutaneous surgery. Thus, we can conclude that percutaneous surgery is the preferred treatment for thoracolumbar fractures when no neurological deficit is present. Level of evidence: IV. [ABSTRACT FROM AUTHOR]