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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]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article discusses spinal trauma, highlighting that while it is less common than other musculoskeletal injuries, it results in significant disability and financial costs. Topics include the evolving classification and assessment systems for spinal injuries, advancements in surgical techniques, and ongoing challenges in treatment approaches.

Background: To compare the clinical and radiological outcomes of monoplanar screws (MSs) versus hybrid fixed axial and polyaxial screws (HSs) in percutaneous short-segment intermediate screw fixation (PSISF) for traumatic thoracolumbar burst fractures (TTBFs) in patients without neurologic impairment. Methods: A consecutive series of 100 patients with single-segment TTBFs and no neurologic impairment who underwent PSISF with 6 monoplanar screws (MS group) or correct were retrospectively enrolled. The demographic data, radiologic evaluation indicators, perioperative indicators and clinical assessment indicators were analysed between the MS group and HS group. Results: The demographic data and perioperative indicators were not significantly different in the two groups (P > 0.05). The postoperative anterior vertebral height ratio (AVHR), kyphosis Cobb angle (KCA), vertebral wedge angle (VWA) and spinal canal encroachment rate (SCER) were significantly improved in both groups (*P < 0.05). The MS group obtained better correction than the HS group in terms of improvement in the AVHR, KCA and VWA after surgery (*P < 0.05). At the last follow-up, the MS group had less correction loss of AVHR, KCA and VWA (*P < 0.05). The MS group presented greater improvement in the SCER at the last follow-up (*P < 0.05). The visual analogue scale (VAS) score and Oswestry Disability Index (ODI) score of all patients were significantly better postoperatively than those preoperatively (*P < 0.05), and the scores collected at each follow-up visit did not differ significantly between the two groups (P > 0.05). In the MS group, no internal fixation failure was observed during the follow-up period, but, in the HS group, two cases of internal fixation failure were observed at the last follow-up (one case of rod loosening and one case of screw breakage). Conclusions: Both MSs and HSs fixation are effective treatments for TTBFs and have comparable clinical outcomes. In contrast, MSs fixation can improve the correction effect, better improve the SCER, and further reduce correction loss as well as reduce the incidence of instrumentation failure. Therefore, MSs fixation might be a better option for treating TTBFs in patients without neurological deficits. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Physical Medicine & Rehabilitation Sciences is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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]

Background: The purpose was to evaluate the clinical effect of a custom-made Y-shaped fracture fragment reduction device and to assist in posterior unilateral small fenestration of lamina to reduce the fracture fragments. Methods: In this study, 40 patients were assigned to one of two groups: the traditional reduction device group (TRG) or the Y-shaped reduction device group (YRG). All patients underwent posterior unilateral small fenestration of the lamina and direct decompression through the spinal canal. And the operation time (OT), intraoperative bleeding (IB), preoperative, postoperative, and final follow-up data on the spinal stenosis rate (SSR), Cobb angle, the anterior compression ratio of injured vertebrae (ACRIV), and ASIA neurological function grade were compared between the two groups. Result: There were no complications, including vascular and nerve injury, serious postoperative infection, internal fixation fracture, or loosening, for any of the patients. And the average follow-up time of the two groups was 14.2 months, the average operation time of the TRG was 236.6 min, and the average intraoperative blood loss was 357.20 ml. Moreover, the average operation time of the YRG was 190.6 min, and the average intraoperative blood loss was 241.5 ml. There were significant differences between the two groups in terms of operation duration and intraoperative blood loss. The YRG's was lower than that of the TRG. Besides, there was no difference in SSR, Cobb angle, ACRIV, or neurological recovery between the two groups before or immediately after the operation or at the last follow-up. Conclusion: The Y-shaped fracture reduction device can reduce the fracture fragments and the OT and IB stably; it also has satisfactory postoperative curative effects and clinical utility. [ABSTRACT FROM AUTHOR]

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 < 0.05). Additionally, two cases of pedicle screw breakage and seven cases of pedicle screw wear and cutting in the vertebral body were observed at the last follow-up, resulting in varying degrees of low back pain. However, no instances of rod breakage were reported. Conclusion: The modified TLICS system is a practical tool for the classification and assessment of thoracolumbar fractures. It has guiding significance for clinical treatment, and the operation rate was slightly lower than that of TLICS system. [ABSTRACT FROM AUTHOR]

Introduction: Differentiating an acute from chronic compression fracture of the thoracolumbar (TL) spine can pose a dilemma for radiologists interpreting spinal imaging following trauma. Mild wedging of the vertebrae can be due to spondylosis or osteoporosis, whilst acute simple compression fractures may not always be associated with loss of body height. In this observational study, we hypothesize that the presence of a vertebral body cortical step is a reliable sign of an acute compression fracture on Computed Tomography (CT) scans. Methods: In a retrospective review of thoracolumbar CT scans following trauma, two observers analysed for the presence of a cortical step at the anterior or posterior vertebral body cortex, fracture morphology and associated injuries. A 'cortical step' is defined as a break of hyperdense cortex on CT scans, intervening non-sclerosed trabecular bone, and sharp overlap of the underlying cortex. MRI of the spine was used as gold standard. Results: 187 consecutive CT scans over 2 years were assessed. Sensitivity, specificity and accuracy of cortical step sign were 100%, 90.2% and 97% in diagnosing an acute thoracolumbar compression fracture, respectively. The interobserver reliability was high (kappa = 0.97). False positive cortical step was seen in Kummel's disease and large Schmorl's nodule. Conclusion: Our results demonstrate high sensitivity and specificity of 'cortical step sign' in diagnosing acute vertebral body compression fractures of TL spine on CT scans in patients with trauma. This sign can be useful to radiologists for safe clearance of the thoracolumbar spine following trauma, helping distinguish acute trauma from chronic causes of vertebral body height loss. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective multicenter study. Objective: To evaluate mid- to long-term surgical outcomes of thoracic dumbbell tumors managed by laminectomy and unilateral total facetectomy without instrumented fusion. Methods: A total of 15 patients with thoracic dumbbell tumors who underwent primary resection by laminectomy and unilateral total facetectomy without spinal instrumented fusion between 2000 and 2015 were reviewed. Patient characteristics, surgical outcomes (including spinal alignment and stability), disc degeneration, pain, disability, and health-related quality of life were evaluated. Additionally, to analyze the impact of the affected levels on these outcomes, we divided the patients into 2 groups: a middle thoracic group and a thoracolumbar group. Results: The mean duration of follow-up was 100.5 months (range, 36-190 months). The affected level was T3-T4 or below in all patients. Although the local kyphosis angle (8.1° to 12.7°), thoracic kyphosis angle (25.6° to 33.9°), and coronal Cobb angle (6.6° to 9.5°) significantly increased from preoperative to the final visit (P ≤.02), no patient demonstrated spinal instability. From magnetic resonance imaging, no patient had a worse grade of disc degeneration in the affected level than those in the adjacent levels. The percentage of patients who presented with an Oswestry disability index ≤ 22% was 80%. Moreover, the surgical region did not adversely affect the outcomes. No patient required additional surgery due to spinal instability or deformity. Conclusions: Unilateral total facetectomy without fusion to resect thoracic dumbbell tumors caused neither spinal deformity nor instability requiring additional surgery at the mid- to long-term follow-up. [ABSTRACT FROM AUTHOR]

BACKGROUND: Posterior approach pedicle screw fixation without fusion is widely used in the treatment of neurologically intact type A3 thoracolumbar fractures. OBJECTIVE: To analyze the influence of the facet joint (FJ) angle on FJ degeneration following posterior approach pedicle screw fixation without fusion in neurologically intact type A3 thoracolumbar fractures. METHODS: Fifty-eight patients who underwent pedicle screw fixation via the traditional posterior approach (n = 28) or the Wiltse approach (n = 30) were enrolled. A CT scan was performed before fixation and before fixation removal (Within 1.5 to 2 years after fixation) to evaluate the FJs parameters, including FJ inclination (FJI), FJ tropism (FJT), FJ violation, and FJ degeneration grade (FJDG), of three fixed segments and the adjacent segment below the fixed segments. RESULTS: There was no significant difference in FJ violation rate, FJDG deterioration, or FJ angle between the two groups (P > 0.05). FJDG deterioration showed a weak positive correlation with FJI and FJT before fixation, and the angular change in FJI (P < 0.05); and FJT before fixation and the angular change in FJI were risk factors for FJDG deterioration (P < 0.01). CONCLUSION: The Wiltse approach did not increase the rate of FJDG deterioration and FJs angle changes. However, the FJT before fixation and the angular change in FJI were risk factors for FJDG deterioration. [ABSTRACT FROM AUTHOR]

The article focuses on a case report of hepatotoxicity caused by therapeutic doses of acetaminophen in a frail and malnourished elderly patient. It discusses the risk factors for acetaminophen-induced hepatotoxicity in such patients, the challenges of dosing adjustments, and the importance of monitoring liver function tests when taking acetaminophen.

Among the various intraoperative neurophysiologic monitoring (IONM) techniques, transcranial motor-evoked potential (Tc-MEP) has recently become the most widely used method to monitor motor function. However, we often find that Tc-MEP is not sufficiently detected at the start of surgery. Therefore, we aimed to analyze the reasons and risk factors for not detecting sufficient baseline signal of Tc-MEP from the beginning of spinal surgery. We categorized IONM data from 1058 patients who underwent spine surgeries at a single institution from 2014 to 2020 and categorized them into 2 groups: 1) "poor MEP" if Tc-MEP could not be sufficiently obtained and 2) "normal MEP" if Tc-MEP could be sufficiently obtained from the surgery. We analyzed the patient's age, gender, underlying disease, operation type, level numbers, baseline motor function, existence of pathologic reflex, myelopathy, and duration from the onset and clinical diagnosis. The rate of failure to obtain sufficient baseline Tc-MEP signals in spine surgery was 21.8% (231/1058). Multivariate analysis showed significant associations of existence of diabetes mellitus, myelopathy, thoracic spine surgery, baseline motor deficit and tumor, and trauma disease with loss of meaningful and interpretable signals in baseline Tc-MEP (P < 0.05). Only 15 of 231 patients (6.4%) showed a trend of signal recovery after decompression procedures. Various factors (myelopathy, diabetes mellitus, thoracic surgery, baseline motor deficit, tumor, and trauma) were closely related to not obtaining sufficient baseline signals for Tc-MEP. When operating on patients with these considerations, we need to consider the efficacy and usefulness of Tc- MEP. [ABSTRACT FROM AUTHOR]

Background: Traumatic Spinal Injuries (TSI) often follow high velocity injuries and frequently accompanied by polytrauma. While most studies have focussed on outcomes of spinal cord injuries, the incidence and risk factors that predict morbidity and mortality after TSI has not been well-defined. Methods: Data of consecutive patients of TSI (n = 2065) treated over a 5-year-period were evaluated for demographics, injury mechanisms, neurological status, associated injuries, timing of surgery and co-morbidities. The thirty-day incidence and risk factors for complications, length of stay and mortality were analysed. Results: The incidence of spinal trauma was 6.2%. Associated injuries were seen in 49.7% (n = 1028), and 33.5% (n = 692) patients had comorbidities. The 30-day mortality was 0.73% (n = 15). Associated chest injuries (p = 0.0001), cervical spine injury (p = 0.0001), ASIA-A neurology (p < 0.01) and ankylosing spondylitis (p = 0.01) correlated with higher mortality. Peri-operative morbidity was noted in 571 patients (27.7%) and were significantly associated with age > 60 (p = 0.043), ASIA-A neurology (p < 0.05), chest injuries (p = 0.042), cervical and thoracic spine injury (p < 0.0001). The mean length of stay in hospital was 8.87 days. Cervical spine injury (p < 0.0001), delay in surgery > 48 h (p = 0.011), Diabetes mellitus (p = 0.01), Ankylosing spondylitis (p = 0.009), associated injuries of chest, head, pelvis and face (p < 0.05) were independent risk factors for longer hospital stay. Conclusion: Key predictors of mortality after spinal trauma were cervical spine injury, complete neurological deficit, chest injuries and ankylosing spondylitis, while additionally higher age and thoracic injuries contributed to higher morbidity and prolonged hospitalisation. Notably multi-level injuries, higher age, co-morbidities and timing of surgery did not influence the mortality. [ABSTRACT FROM AUTHOR]

Introduction: The majority of musculoskeletal injuries around the globe are spine fractures. The thoracic and lumbar spine account for 75-90% of fractures of the spine. Aim of study: To compare the radiological and clinical results of short segment with index vertebra fixation with those of long segment fixation, in the cases of thoracolumbar fractures. Patients and Methods: This interventional comparative study included 40 patients with traumatic thoracolumbar fractures, of these 20 patients underwent short segment open transpedicular posterior with index vertebral fixation and 20 patients underwent long segment open transpedicular posterior fixation. Results: The operative time in Short Segment with Index Vertebra Fixation (SSIVF) was 149 minutes taking considerably less time than Long Segment Fixation (LSF) (195 minutes). Blood loss was significantly less in SSIVF (290.5 ± 94.88 mL.) than in LSF (495.5 ± 110.76 mL). Regarding postoperative visual analogue scale (PVAS) pain was significantly lower in SSIVF (2.25 ± 1.45) group than in LSF group (4.6 ± 1.79) and Oswestry Disability Index (ODI) was significantly lower in SSIVF group (20.4 ± 12.1) than in LSF group (26.05 ± 13.45) follow-up after 12 weeks postoperatively. Angl of Kyphosis measured by Cobb angle in LSF group (7.7 ± 2.030) correction was significantly best than in SSIVF group (9.3 ± 2.25) Follow-up after 12 weeks postoperatively. Conclusion: In comparison with LSF technique, the SSIVF technique yielded significantly better clinical and functional outcomes for PVAS and ODI. Compared to the SSIVF procedure, the LSF technique greatly outperformed of radiological correction of Cobb's angle at the most recent follow-up. [ABSTRACT FROM AUTHOR]

Background: Most traumatic vertebral fractures occur in the thoracolumbar junction, lumbar spine, less frequently in the middle thoracic and upper thoracic spine. The aim of this study was to evaluate the retrospective multifactorial evaluation of cases who underwent vertebral stabilization after acute traumatic thoracolumbar fractures. Materials and Methods: Between 2020-2022, 60 patients who underwent vertebral stabilization after acute traumatic thoracolumbar fractures were evaluated postoperatively. Each patient Clinical data, type and location of fracture, presence of neurological damage, pre- and postoperative radiological measurements, post-operative complications, reoperation, Arbeitsgemeinschaft für Osteosynthesefragen Spine and American Spinal Injury Association classification data were evaluated. Results: The mean age of the patients was 33.5+16.2. When the trauma etiology of the patients was examined, falling was the most common with 68.3%, car traffic accident and suicide were the second most common with 13.3%, and non-vehicle traffic accident was observed with 3.3%. Considering the localization, trauma L1 fracture was observed in 20 patients. Type B fractures were seen in 28 patients. While no complications were observed in 53 patients, revision surgery was performed in 5 patients. It was observed that the postoperative neurological examination of the patient with preoperative American Spinal Injury Association A did not change. Conclusions: Thoracolonbar fractures usually occur after high-energy trauma. It is frequently seen in the thoracolumbar junction and causes neurological deficits. Neurological recovery is limited in patients with complete deficits. However, neurological improvement can be observed in incomplete fractures. Treatment of patients should be started immediately and they should be allowed to return to their routine life. [ABSTRACT FROM AUTHOR]

Objectives: Percutaneous pedicle screw fixation (PPSF) has been a common surgery for treating thoracolumbar and lumbar fractures. Many studies have reported PPSF is associated with poor reduction. We present a reliable method by using short-segment monoaxial percutaneous screws and instrumentational maneuvers to reduce the spine. This study aimed to evaluate radiological and clinical results of this method of reduction compared to traditional polyaxial screws method in treating thoracolumbar and lumbar fractures.Methods: From February 2015 to February 2021, 64 patients with thoracolumbar and lumbar fractures in our department were retrospectively reviewed and divided into experimental group and control group according to different treatment methods. The experimental group was treated with short-segment monoaxial percutaneous screws (which were inserted at the adjacent vertebrae one level above, one level below the fracture, and the fractured vertebra) and instrumentational maneuvers method, while the control group was treated with traditional polyaxial screws method. The operation time was recorded. Visual analogue scale (VAS) and Oswestry disability index (ODI) were assessed as the clinical outcomes. The anterior height of the injured vertebra (AVH), the kyphosis cobb angle and the vertebral wedge angle were used to evaluate the fracture radiological reduction.Results: A total of 64 patients were enrolled including 31 in the experimental group and 33 in the control group. There were no significant difference in operation time, AVH, the kyphosis cobb angle,the wedge angle of injured vertebra,VAS and ODI score between the two groups in preoperation. In each group, there were significant differences in the AVH, the kyphosis cobb angle and wedge angle of injured vertebra between preoperation and immediate postoperation. In each group, there were significant differences in VAS and ODI score between the preoperation and last follow-up. The total correction rates of AVH,the kyphosis cobb angle and the wedge angle of injured vertebra were significantly higher in the experimental group than those in the control group, while the loss of correction was significantly lower than the control.Conclusions: The reduction technique using monoaxial percutaneous screws and instrumentational maneuvers for thoracolumbar and lumbar fractures exhibited better radiological results and satisfying functional outcomes when compared to traditional polyaxial screws. [ABSTRACT FROM AUTHOR]

Background: Many surgeons have encountered patients who could not immediately undergo surgery to treat spinal fractures because they had associated injuries and/or because a complete diagnosis was delayed. For such patients, practitioners might assume that delays could mean that the eventual reduction would be insufficient. However, no report covered risk factors for insufficient reduction of fractured vertebra including duration from injury onset to surgery. The purpose of this study is to investigate the risk factors for insufficient reduction after short-segment fixation of thoracolumbar burst fractures. Methods: Our multicenter study included 253 patients who sustained a single thoracolumbar burst fracture and underwent short-segment fixation. We measured the local vertebral body angle (VBA) on roentgenograms, before and after surgery, and then calculated the reduction angle and reduction rate of the fractured vertebra by using the following formula: Preoperative VBA - Postoperative VBA / Preoperative VBA × 100. A multiple logistical regression analysis was performed to identify risk factors for insufficient reduction. The factors that we evaluated were age, gender, affected spine level, time elapsed from injury to surgery, inclusion of vertebroplasty with surgery, load-sharing score (LSS), AO classification (type A or B), preoperative VBA, and the ratio of canal compromise before surgery. Results: There were 140 male and 113 female patients, with an average age of 43 years, and the mean time elapsed between injury and surgery was 3.8 days. The mean reduction angle was 12°, and the mean reduction rate was 76%. The mean LSS was 6.4 points. Multiple linear regression analysis revealed that a higher LSS, a larger preoperative VBA, a younger age, and being female disposed patients to having a larger reduction angle and reduction rate. The time elapsed from injury to surgery had no relation to the quality of fracture reduction in the acute period. Conclusions: Our findings indicate that if there is no neurologic deficit, we might not need to hurry surgical reduction of fractured vertebrae in the acute phase. [ABSTRACT FROM AUTHOR]

BACKGROUND: Spinal cord injury (SCI) results in neurological dysfunction of the spinal cord below the injury. OBJECTIVE: To explore the immediate and long-term effects of robotic-assisted gait training (RAGT) on the recovery of motor function and walking ability in children with thoracolumbar incomplete SCI. METHODS: Twenty-one children with thoracolumbar incomplete SCI were randomly divided into the experimental (n = 11) and control groups (n = 10). The control group received 60 min of conventional physical therapy, and the experimental group received 30 min of RAGT based on 30 minutes of conventional physical therapy. Changes in walking speed and distance, physiological cost index (PCI), lower extremity motor score (LEMS), SCI walking index and centre-of-pressure (COP) envelope area score were observed in both groups of children before and after eight weeks of training. The primary outcome measures were the 10-metre walk test (10MWT) and six-minute walk distance (6MWD) at preferred and maximal speeds. In addition, several other measures were assessed, such as postural control and balance, lower limb strength and energy expenditure. RESULTS: Compared with control group, the self-selected walk speed (SWS), maximum walking speed (MWS), 6MWD, PCI, LEMS, COP, and Walking Index for Spinal Cord injury II (WISCI II) of experimental group were improved after treatment. The 6MWD, PCI, COP, and WISCI II after eight weeks of treatment were improved in experimental group. All indicators were not identical at three different time points when compared between two groups. Pairwise comparisons in experimental group suggested that the SWS, MWS, 6MWD, PCI, LEMS, COP, and WISCI II after treatment were higher than those before treatment. The 6MWD, LEMS, COP, and WISCI II after treatment were higher than at the one-month follow-up appointment. The SWS, PCI, LEMS, COP, and WISCI II at the eight-week follow-up appointment were improved. CONCLUSION: Robotic-assisted gait training may significantly improve the immediate motor function and walking ability of children with thoracolumbar incomplete SCI. [ABSTRACT FROM AUTHOR]

Background: Surgical treatment of severe thoracolumbar kyphosis (TLK) secondary to late osteoporotic vertebral compression fracture (OVCF) presents several challenges to spine surgeons. Proper selection of distal fusion level is an important issue in surgical planning to decrease the likelihood of distal mechanical complications. This study was designed to compare the clinical and radiographic outcomes in elderly patients suffering from severe TLK related with late OVCF between different distal fusion strategies and to recommend a superior distal fusion level for these patients.Methods: A total of 57 consecutive subjects with a minimum follow-up of two years were retrospectively reviewed. TLK was defined as the hyperkyphosis with an apex below T10. Severe TLK was defined as the Cobb angle of kyphosis ≥60°. Patients fused to sagittal stable vertebra (SSV) were assigned to Group SSV, while those fused to the vertebra above and below SSV were assigned to Groups SSV- and SSV+, respectively. Bone cement was used to enhance pedicle screw fixation. Clinical and radiographic results were collected and compared between different groups.Results: Deformity corrections and living quality improvements at the latest follow-up were superior in Group SSV than Group SSV- with shorter fusion levels, while to the equal extent with Group SSV+ with longer fusion levels. 7 cases of distal complications were observed in Group SSV-. Negatively balanced lowest instrumented vertebra was revealed to be the independent factor predicting distal complications. Patients' satisfaction of their surgical management was greater in Group SSV than Group SSV- (83.2 ± 4.4% vs. 70.5 ± 10.9%, P = 0.024), while comparable with Groups SSV + SSV+ (84.8 ± 5.7%).Conclusions: Fusion to SSV with cement-augmented pedicle screws could limit the development of distal junctional mechanical complications after surgical treatment for severe TLK secondary to late OVCF in elderly patients, while achieves satisfactory deformity correction with the preservation of necessary lumbar motility. [ABSTRACT FROM AUTHOR]

Background: Complete subluxation of >100% of one vertebral body with respect to the adjacent vertebra is defined as spondyloptosis. It is the severest form of injury caused by high-energy trauma. Pediatric patients with a traumatic spine injury, particularly spondyloptosis are surgically demanding as reduction and achieving realignment of the spinal column requires diligent planning and execution.Objective: To enlighten readers about this rare but severest form of thoracolumbar spine injury and its management.Methods: Retrospective analysis of patients treated here with spondyloptosis between 2008 and 2016 was done.Results: Seven children, ranging from 9 to 18 years (mean years) age were included in the study. Five patients had spondyloptosis at thoracolumbar junction and one each in the lumbar and thoracic spine. All patients underwent single-stage posterior surgical reduction and fixation except one patient who refused surgery. Intraoperatively, cord transection was seen in five patients while dura was intact in one patient. The mean follow-up period was 17 months (1-36 months) during which one patient expired due to complications arising from bedsores. All patients remained American Spinal Injury Association (ASIA) A neurologically.Conclusions: Traumatic spondyloptosis is a challenging proposition to treat and the aim of surgery is to stabilize the spine. Rehabilitation remains the most crucial but the neglected part and dearth of proper rehabilitation centers inflict high mortality and morbidity in developing countries. [ABSTRACT FROM AUTHOR]

Copyright of Ege Journal of Medicine is the property of Ege University, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The management of patients with thoracolumbar burst fractures remains a topic of debate, with conservative treatment being successful in most cases but not all. This study aimed to assess the utility of machine learning models (MLMs) in predicting the need for surgery in patients with these fractures who do not respond to conservative management., Methods: A retrospective analysis of 357 patients with traumatic thoracolumbar burst fractures treated conservatively between January 2017 and October 2023 was conducted. Various potential risk factors for treatment failure were evaluated, including age, gender, BMI, smoking, diabetes, vertebral body compression rate, anterior height compression, Cobb angle, interpedicular distance, canal compromise, and pain intensity. Three MLMs-random forest (RF), support vector machine (SVM), and k-nearest neighborhood (k-NN)-were used to predict treatment failure, with the RF model also identifying factors associated with treatment failure., Results: Among the patients studied, most (85.2%) completed conservative treatment, while 14.8% required surgery during follow-up. Smoking (OR: 2.01; 95% CI: 1.54-2.86; p = 0.011) and interpedicular distance (OR: 2.31; 95% CI: 1.22-2.73; p = 0.003) were found to be independent risk factors for treatment failure. The MLMs demonstrated good performance, with SVM achieving the highest accuracy (0.931), followed by RF (0.911) and k-NN (0.896). SVM also exhibited superior sensitivity and specificity compared to the other models, with AUC values of 0.897, 0.854, and 0.815 for SVM, RF, and k-NN, respectively., Conclusion: This study underscores the effectiveness of MLMs in predicting conservative treatment failure in patients with thoracolumbar burst fractures. These models offer valuable prognostic insights that can aid in optimizing patient management and clinical outcomes in this specific patient population., Competing Interests: Declarations Ethics approval and consent to participate The study received ethics approval by the Kermanshah University of Medical Science Ethics Committee. Written informed consent to participate was obtained from all patients. All methods were carried out in accordance with relevant guidelines and regulations. The patient’s data included in this manuscript has not been previously reported. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Thoracolumbar burst fracture treatment in neurologically intact patients is controversial with many classification systems to help guide management. Thoracolumbar Injury Classification and Severity score (TLICS) provides a framework, but evidence is limited, and recommendations are primarily based on expert opinion. In this retrospective cohort study, data was reviewed for patients with thoracolumbar burst fractures at a Level-1 Trauma Center in New England from 2013 to 2018. Neurologically intact patients without subluxation/dislocation on supine computed tomography were included. Multimodal pain control and early mobilization were encouraged. Patients that failed to mobilize due to pain were treated with operative stabilization. Outcome measures include degree of kyphosis, visual analog scale pain scores, and neurological function. Thirty-one patients with thoracolumbar burst fractures with TLICS scores of 4 or 5 were identified, of which 21 were treated nonoperatively. Kyphosis at final follow-up was 26.4 degrees for the nonoperative cohort versus 13.5 degrees for the operative group (P < .001). Nonoperative patients tended towards shorter hospital lengths-of-stay (3.0 vs 7.1 days, P = .085) and lower final pain scores (2.0 vs 4.0, P = .147) compared to the operative group. Two patients (6%) developed radicular pain with mobilization, which resolved after surgical intervention. No patients experienced decline in neurologic function. A trial of mobilization for neurologically intact TLICS grade 4 and 5 thoracolumbar burst fractures is a safe and reasonable treatment option that resulted in successful nonoperative management of 21 out of 31 (68%) patients., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

This study reviews the long-term efficacy of short-segment posterior instrumentation and fusion (SSPIF) in treating thoracolumbar burst fractures. Authors retrospectively reviewed the radiographic results of single-level thoracolumbar burst fractures treated by SSPIF. Vertebral body height and wedge angles were measured on the preoperative, postoperative, and follow-up radiographic images. The degree of pain and work ability was measured using the Denis scale. The analysis consisted of 12 patients with a mean age of 39.7 years (range 21-60) and a mean follow-up of 225.6 ± 20.3 months. There were significant differences among the wedge angles at preoperative and other periods of time, but there was no significant difference between the early postoperative and all other time periods afterwards (P < .001, P = .567, P = .937, P = .879). SSPIF effectively restored the anterior and middle vertebral body height and wedge angle deformities, and the improvement was maintained for almost 20 years after the surgery. Therefore, SSPIF is a safe and effective modality of treatment for thoracolumbar burst fractures., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Some patients suffering from thoracolumbar complete burst fracture causing neurological deficit may be eligible for single-stage posterior-only three column reconstruction with spine jack expansion kyphoplasty., Method: Short segment monoaxial pedicle screws are placed. Spine jack working channels are positioned in the comminuted vertebral body. Then, the surgeon can perform jack expansion kyphoplasty and short-segment fixation and distraction in the order best suited, considering whether the collapsed vertebral body has been expanded thanks to hyperlordosis positioning. This strategy allows to regain both native vertebral body height and proper regional sagittal balance. Wide decompression with laminectomy and arthrectomy is necessary at the level of posterior wall recession., Conclusion: Combination of short segment pedicle screw fixation with distraction and open spine jack kyphoplasty is technically feasible and avoids the need for corpectomy in complete burst fractures with neurological deficit., Competing Interests: Declarations Ethical approval The patients or their relatives were able to read this manuscript and its associated illustrations, and they have given their consent for publication. This work was conducted according to the declaration of Helsinki of 1964 and any of its further amendments. Competing interests The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)

Background: Preoperative adjacent disc height (DH) was found as an independent risk factor for adjacent segment degeneration (ASD) after percutaneous kyphoplasty (PKP), indicating the preoperative status of the adjacent intervertebral discs may be closely related to adjacent segment complications. To establish the reference intervals (RIs) for adjacent DH of fresh osteoporotic vertebral compression fracture (OVCF) in Chinese postmenopausal women, and investigate the association with adjacent segment complications after PKP., Methods: Consecutive inpatients diagnosed with fresh OVCF between November 2015 and August 2023 were reviewed. The enrolled patients were divided into subgroups based on injured vertebral level; then, the cranial and caudal DH were measured. The characteristics of DH among subgroups were identified, and specific RIs were established using the indirect Hoffmann method. The associations between DH and adjacent segment complications were assessed using multivariate analysis., Results: The DH of the cranial disc was significantly lower than the corresponding caudal disc in all vertebral levels, which showed an increasing trend from T11 to L4. The RIs of DH were as follows: T11 (cranial), 2.14-5.14 mm; T11 (caudal), 2.64-5.89 mm; T12 (cranial), 2.69-5.77 mm; T12 (caudal), 3.18-6.57 mm; L1 (cranial), 3.05-6.59 mm; L1 (caudal), 3.40-8.29 mm; L2 (cranial), 3.68-8.36 mm; L2 (caudal), 4.57-9.78 mm; L3 (cranial), 4.53-8.92 mm; L3 (caudal), 5.26-10.07 mm; L4 (cranial), 4.70-11.42 mm; and L4 (caudal), 5.52-12.12 mm. Increased risks of adjacent segment complications after PKP were observed in patients with decreased adjacent DH., Conclusion: The estimated vertebral level and disc level-specific RIs for adjacent DH of fresh OVCF were established in the Chinese postmenopausal women population. A decrease in adjacent DH posed high risks of adjacent segment complications after PKP for treating OVCF., Competing Interests: Declarations Ethics approval and consent to participate The research conducted has been performed in accordance with the Declaration of Helsinki. Approval for the study was obtained from the ethics committees of the Beijing Chaoyang Hospital (2023-KE-242). Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Introduction: In trauma, we can perform a lateral radiography of the lumbosacral hinge taking the femoral heads if we include it in the initial lesion assessment. Thus, the pelvic incidence informs about the type of back as described by Roussouly., Aim: To describe the clinical and radiological results of these types of back which are operated on for a thoracolumbar fracture., Methods: We recorded the clinical, radiological data and the characteristics of the fracture of 120 patient operated on for a thoracolumbar spine fracture over a period of 14 years between February 2005 and July 2019. We studied the deformation according to Regional traumatic angulation (ART), Sagittal Farcy Index (SIF), Gardner Segment Kyphotic Deformity (GSKD). Functional evaluation was carried out according to the Denis Pain Scale. Radiological evaluation was based on relative gain and loss., Results: In individuals with low pelvic incidence, a prevalence of 72% was observed for type A fracture, whereas types B and C accounted for 45.9% (P<0.05) for backs with high pelvic incidence. The Denis Pain Scale score indicated that 90% of individuals with low incidence backs had scores below 3, whereas only 65.6% of those with high incidences had scores below 3 (P<0.05). The loss of correction for backs with low incidences was measured at 1.2°, while for backs with high incidences, it was 3° (p<0.05)., Conclusion: Fractures on backs with low pelvic incidence considered as stiff backs are more frequently of type A, with better functional results and less losses.

Vertebral compression fractures (VCFs) are the most common osteoporotic fractures. Only 1/3 of patients with VCFs are clinically diagnosed. In our institution, the Fracture Liaison Service (FLS) was launched in 2017 to improve osteoporosis management for hospitalized patients. (1) To assess osteoporosis awareness among medical providers for emergency department (ED)/hospitalized patients aged 50 or greater; (2) To estimate the rate of FLS consults or referrals to primary care providers (FLS/PCP) by primary teams. A centralized radiology system was used to examine all thoracic and lumbar computed tomography (CT) scans conducted between June 1, 2017 and June 1, 2022. 449 studies were identified with the radiologic impression "compression fracture". 182 studies were excluded after manual chart review. 267 hospitalizations/ED visits with lumbar and/or thoracic spine CT scans were included. Referrals to FLS (26) or PCP (27) were made in 53 cases (~ 20% of the total). In the ED subgroup (131 hospitalizations), only 17 patients had FLS/PCP referrals. The "compression fracture" was mentioned in 227 (85%) discharge notes (any part), while "osteoporosis" was mentioned in only 74 (28%) hospitalizations. A statistically significant difference was found between the two groups when "osteoporosis" was mentioned in the "assessment and plan" section (p = 0.02). Our data show that the overall osteoporosis care for affected patients is suboptimal. Medical providers often overlook the presence of osteoporosis, leading to a lack of consultation with the FLS of referral to PCPs for further evaluation and treatment., (© 2024. The Author(s).)

Background: The alternation of brain white matter (WM) network has been studied in adult spinal cord injury (SCI) patients. However, the WM network alterations in pediatric SCI patients remain unclear., Purpose: To evaluate WM network changes and their functional impact in children with thoracolumbar SCI (TSCI)., Study Type: Prospective., Subjects: Thirty-five pediatric patients with TSCI (8.94 ± 1.86 years, 8/27 males/females) and 34 age- and gender-matched healthy controls (HCs) participated in this study., Field Strength/sequence: 3.0 T/DTI imaging using spin-echo echo-planar and T1-weighted imaging using 3D T1-weighted magnetization-prepared rapid gradient-echo sequence., Assessment: Pediatric SCI patients were evaluated for motor and sensory scores, injury level, time since injury, and age at injury. The WM network was constructed using a continuous tracing method, resulting in a 90 × 90 matrix. The global and regional metrics were obtained to investigate the alterations of the WM structural network. topology., Statistical Tests: Two-sample independent t-tests, chi-squared test, Mann-Whitney U-test, and Spearman correlation. Statistical significance was set at P < 0.05., Results: Compared with HCs, pediatric TSCI patients displayed decreased shortest path length (L p  = 1.080 ± 0.130) and normalized L p (λ = 5.020 ± 0.363), and increased global efficiency (E g  = 0.200 ± 0.015). Notably, these patients also demonstrated heightened regional properties in the orbitofrontal cortex, limbic system, default mode network, and several audio-visual-related regions. Moreover, the λ and L p values negatively correlated with sensory scores. Conversely, nodal efficiency values in the right calcarine fissure and surrounding cortex positively correlated with sensory scores. The age at injury positively correlated with node degree in the left parahippocampal gyrus and nodal efficiency in the right posterior cingulate gyrus., Data Conclusion: Reorganization of the WM networks in pediatric SCI patients is indicated by increased global and nodal efficiency, which may provide promising neuroimaging biomarkers for functional assessment of pediatric SCI., Evidence Level: 2 TECHNICAL EFFICACY: Stage 5., (© 2024 International Society for Magnetic Resonance in Medicine.)

Objective: To conduct a systematic review of studies on various posterior pedicle screw fixation (PSF) methods used for treating neurologically intact thoracolumbar burst fractures and to identify the most effective and safe approaches., Methods: We conducted a systematic review adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with the study registered in PROSPERO (CRD42024531093). The inclusion criteria were: (1) publication dates from January 1, 2004, to December 31, 2023; (2) availability of full-text articles in English; (3) thoracolumbar burst fractures without neurological deficits; (4) patients aged over 18; (5) reports on treatment outcomes or complications; (6) a mean follow-up period of at least 12 months., Results: A total of 69 articles covering 116 patient groups were included. Our analysis highlighted the advantages of short-segment fixation without fusion over monosegmental, short-segment and long-segment fusion in terms of shorter operation times and reduced intraoperative blood loss (p = 0.001 and p < 0.001, respectively). Extensive fusion was associated with a significantly higher frequency of deep surgical site infections compared to other PSF methods (p = 0.043). Percutaneous pedicle screw fixation, applied to patients with lower body compression rates and kyphotic deformities, led to less potential for correction (p = 0.004), yet significantly decreased blood loss (p = 0.011), operation duration (p < 0.0001), and hospitalization duration (p < 0.0001). No significant benefits were observed with the use of additional intermediate screws in short-segment PSF., Conclusions: Short-segment pedicle screw fixation could be the optimal surgical treatment method for neurologically intact thoracolumbar burst fractures. The use of posterior lateral fusion in this context may increase the deep surgical site infection rate without reducing the frequency of implant-related complications or improving long-term treatment outcomes. The percutaneous approach remains the preferred technique; however, its limited reduction capabilities should be carefully considered during surgical planning for patients with severe kyphotic deformities. The application of intermediate screws in such patients has not demonstrated significant advantages. Removing the fixation system has not led to a significant decrease in implant-related complications or improvement in quality of life. The data obtained from the systematic review may assist surgeons in selecting the most appropriate surgical treatment method for patients with neurologically intact thoracolumbar burst fractures, thereby avoiding ineffective procedures and improving both short-term and long-term outcomes., (Copyright © 2024 Sociedad Española de Neurocirugía. Published by Elsevier España, S.L.U. All rights reserved.)

Purpose: Surgical stabilization of the spine by vertebral body replacement (VBR) is used for spinal disorders such as traumatic fractures to provide an anatomical re-adjustment of the spine to prevent late detrimental effects and pain [1-4]. This study addresses the clinical outcome after a ventral intervention with VBR and bisegmental fusion., Methods: The study includes 76 patients (mean age: 59.34 ± 15.97; 34 females and 42 males) with fractures in the lower thoracic and lumbar spine. They were selected from patients of our hospital who received an anterolateral VBR surgery on the corresponding lower spine region over a nine-year period. Only patients were examined with X-rays and complete follow-up records. Exclusion criteria were changes due to degeneration and pathological fractures. Patients were divided into two groups, the thoracotomy group (Th10-L1) and the lumbotomy group (L2-5), respectively. Minimum one year after surgery, patients were asked about their well-being using a precasted questionnaire., Results: No significant differences with respect to the subjective impression of the patients concerning their back pain, spinal functional impairment, their general functional status and their quality of life impairment. Unfortunately, however, only a rather modest but significant increase of the post-surgical life quality was reported., Conclusions: Patients who underwent VBR in the lower thoracic or lumbar spine show modest long-term well-being. The results suggest that injuries to the lower thoracic or lumbar spine requiring vertebral body replacement should be classified as severe injuries since they adversely affect the patients' long-term well-being., Trial Registration: Study of clinical outcome of patients after vertebral body replacement of the ventral thoracal and lumbal spine, DRKS00031452. Registered 10th March 2023 - Prospectively registered. Trial registration number DRKS00031452., (© 2024. The Author(s).)

Objective: To design and apply a novel puncture method, named P TO P technique, and to evaluate its efficacy and safety., Method: The data of patients treated with PVA in medical institution from January 2020 to December 2022 were reviewed and analyzed. The degree of pain relief and recovery from daily activities were evaluated using VAS and LAS scores, and radiological parameters were evaluated using local kyphosis angle and excellent cement distribution. Complications such as cement leakage and recurrent vertebral fractures were also recorded., Results: 157 patients with thoracolumbar OVCF were successfully treated with novel puncture techniques. All postoperative clinical and radiological parameters significantly decreased in all patients, except for an increase in local kyphosis angle at the last follow-up compared to postoperative. All other above indicators remained statistically significant at the last follow-up compared to postoperative improvement. Except for 2 patients with poor cement distribution, the remaining 155 patients successfully achieved satisfactory results in unilateral puncture and bilateral cement distribution, achieving an excellent rate of 98.73%. In addition, 18 cases (11.46%) of cement leakage occurred during the operation, fortunately none of them were uncomfortable. During the postoperative follow-up period, 4 cases (2.55%) of recurrent fractures occurred. No other serious complications such as neurologic or named vascular injuries occurred., Conclusion: The application of P TO P technology in thoracolumbar OVCF patients is safe and effective. It can not only reduce pain and quickly recover daily activities, but also achieve the perfect effect of unilateral puncture and bilateral cement filling., (© 2024. The Author(s).)

There is a paucity of data available on the context preceding anterior fusion failure or the need for a posterior fusion, the timing of the second operation, or any correlation between the different instrumentation and failure rates. A retrospective chart review was performed of 131 identified patients who underwent anterolateral corpectomy and fusion for a thoracolumbar burst fracture from 2000 to 2012 in a single institution. 96 patients had clinical and radiographic follow up of greater than two months. Mean kyphosis correction from preoperative (14.1°) to postoperative kyphosis (6.3°) was 7.7° and 37% had loss of kyphotic correction at follow-up. In a univariate analysis, use of a bone strut graft (OR 3.2, p = 0.01), point-loaded graft position (OR 4.9, p = 0.005), end plate damage/subsidence (OR 6.7, p < 0.0001), and graft to endplate width ratio of ≤ 45% on AP x-ray (OR 3.0, p = 0.02) were associated with loss of kyphotic correction. 41% demonstrated scoliosis of ≥ 5° at follow-up. Graft location towards the left of midline (OR 8.6, p < 0.0001), point-loaded graft position (OR 3.8, p = 0.01), and end plate damage/subsidence (OR 5.5, p = 0.0001) were also associated with scoliosis at the time of final follow-up. Five patients required posterior fusion and fifteen patients continued to have daily pain, only one of which was determined to be related to kyphosis. Use of a bone strut graft versus expandable cage, graft location, graft position, presence of early or late subsidence and width of the graft may be associated with loss of kyphotic correction and scoliosis., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: This study aims to assess the diagnostic utility of vertebral CT value and CT value difference in distinguishing between fresh and old osteoporotic vertebral compression fractures (OVCF)., Methods: A retrospective analysis was conducted on 118 patients with OVCF who underwent both MRI and CT examinations at our hospital. The nature of the fractured vertebra was determined according to MRI. The CT value of the fractured vertebrae and the mean CT value of the adjacent normal vertebrae were measured separately, and the differences between these values were calculated. Independent samples t-tests were used to compare CT value and CT value difference among all groups. The receiver operating characteristic (ROC) curve was employed to determine the optimal cut-off value for both CT value and CT value difference in differentiating fresh and old fractures., Results: The study included a total of 163 fractured vertebrae from 118 patients. The CT value of fresh fractured vertebrae was significantly higher than those of adjacent normal vertebrae, which was statistically different (P < 0.001). In contrast, the difference between CT value of old fractured vertebrae and those of adjacent normal vertebrae was not statistically significant (P > 0.05). There were significant differences in CT value and CT value difference between fresh fractured vertebrae and old fractured vertebrae (P < 0.001). The ROC curve analysis showed that the optimal cut-off value of CT value for fresh fractures and old fractures was 103.40 HU. The optimal cut-off value of CT value difference was 39.81 HU., Conclusion: Vertebral CT value and CT value difference offer a certain reference value for distinguishing between fresh and old OVCF. These parameters can serve as a rapid diagnostic tool when MRI is unavailable or impractical, aiding in the timely assessment of OVCF., (© 2024. The Author(s).)

Purpose: To investigate the value and age- and gender-specific threshold values of bone mineral density (BMD) by quantitative computed tomography (QCT) for the prediction of spontaneous thoracolumbar vertebral fractures and thoracolumbar junction fractures accompanying distant vertebral fractures., Methods: Among the 556 patients included, 68 patients had thoracolumbar vertebral fractures (12 patients with distant vertebral fractures, 56 patients without distant vertebral fractures) and 488 patients had no vertebral fractures. All patients were grouped by gender and age. According to the principle of Youden index, the threshold values were calculated from receiver operating characteristic (ROC) curves., Results: The threshold values for predicting thoracolumbar vertebral fractures were 89.8 mg/cm 3 for all subjects, 90.1 mg/cm 3 for men, and 88.6 mg/cm 3 for women. The threshold values for men aged < 60 years old and ≥ 60 years old were 117.4 mg/cm 3 and 87.5 mg/cm 3 , respectively. The threshold values for women aged < 60 years old and ≥ 60 years old were 88.6 and 68.4 mg/cm 3 , respectively. The threshold value for predicting spontaneous thoracolumbar junction fractures with distant vertebral fractures was 62.7 mg/cm 3 ., Conclusions: QCT provides a good ability to predict age- and gender-specific spontaneous thoracolumbar vertebral fractures, and to further predict spontaneous thoracolumbar junction fractures with distant vertebral fractures., (© 2024. The Author(s).)

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., (© 2024. The Author(s).)

Trabecular bone score (TBS) is a BMD-independent risk factor for fracture. During BMD reporting, it is standard practice to exclude lumbar vertebral levels affected by structural artifact. It is uncertain whether TBS is affected by lumbar spine fractures. The current study examined the effect of lumbar spine compression fractures on TBS measurements. We identified 656 individuals with vertebral fractures (mean age 75.8 ± 7.9 years, 90.9% female) who had lumbar spine DXA, TBS measurements from L1-L4 and vertebral fracture assessment (VFA) for identifying vertebral fractures. There were 272 cases with lumbar spine fractures and 384 controls with only thoracic spine fractures. L1 TBS and BMD were significantly greater in those with than without lumbar fractures (p< 0.001) but did not significantly differ for other vertebral levels or for L1-L4 combined. TBS and BMD measurements were then renormalized to remove level-specific differences (denoted rTBS and rBMD). The mean difference (all fractured minus all non-fractured vertebrae) was +0.040 (+3.3%) for rTBS and +0.088 g/cm 2 (+9.5%) for rBMD (both p <0.001). The largest effect was for L1 with mean difference +0.058 (+4.9%) for rTBS and +0.098 g/cm 2 (+10.6%) for rBMD (both p <0.001). The mean difference between fractured and non-fractured levels for rTBS was +0.028 (+2.4%) for grade 1, +0.036 (+3.0%) for grade 2 and +0.059 (+5.0%) for grade 3 fractures; for rBMD +0.051 (+5.5%), +0.076 (+8.2%) and +0.151 (+16.4%) g/cm 2 , respectively. The impact of excluding lumbar vertebral levels with fracture from the L1-L4 TBS measurement overall was small (-0.011 [-1.0%]; p<0.001) and was also small for grade 3 fractures (-0.020 [-1.7%]; p<0.001). In summary, TBS is mildly increased by VFA-confirmed lumbar vertebral fractures, but the percentage effect is much smaller (less than half) than seen for BMD and minimally affects TBS measured from L1-L4. This would support the use of L1-L4 without exclusions in individuals with lumbar vertebral fractures., Competing Interests: Declaration of competing interest William Leslie declares no conflict of interest. Neil Binkley: Nothing to declare for the context of this paper; research funding from Radius; consultant Amgen. Didier Hans: Co-ownership in the TBS patent. Stock options or royalties: Medimaps Group. Research grants: Amgen, Agnovos, GE Healthcare., (Copyright © 2024 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.)

Background: This study aimed to describe our clinical experience with surgical approaches and patient management for traumatic multiple-level continuous and noncontinuous thoracolumbar spinal fractures., Methods: We retrospectively evaluated patients with continuous and noncontinuous multiple-level thoracolumbar fractures who were operated on by the same surgical team from 2019 to 2021. These patients were divided into two groups: Group 1 (n=12, continuous fractures) and Group 2 (n=14, noncontinuous fractures). We assessed the patients' age, gender, fracture levels, fracture type, classification according to the AO (Arbeitsgemeinschaft für Osteosynthesefragen) Spine Thoracolumbar Fracture Classification, status of posterior ligament damage, presence of additional traumatic pathology, status of decompression via laminectomy, levels of stabilization and fusion, preoperative and postoperative neurological status, presence of cervical trauma, duration of operation, amount of blood loss, duration of hospitalization, and lordosis and kyphosis angles in terms of fusion status and postoperative follow-up over two years. The study excluded patients over the age of 65, those with single-level fractures, and pathological fractures caused by osteoporosis, infection, or spinal tumors., Results: Gender, age, neurological status, application of laminectomy, surgical complications, status of cervical fracture, duration of operation, amount of blood loss, duration of hospitalization, lordosis, and kyphosis angles were uniformly distributed between the groups. All patients underwent fusions, ranging from three to eight, with a median of two (range 2-4) fracture levels, and a median of five instrumented vertebrae, ranging from four to seven. Significant differences between the two groups were observed in terms of operation duration (p=0.001), blood loss (p=0.010), duration of hospitalization (p=0.003), number of fusions (p<0.001), and instrumented vertebral segments (p=0.011)., Conclusion: Thus, a surgical approach involving decompression, vertebral fusion screws, allografts, and bone substitutes can enhance surgical outcomes for patients with continuous and noncontinuous vertebral fractures.

Our study investigates vertebral fractures in individuals with distal radius fractures. Among 512 patients, 41.21% had vertebral fractures, predominantly in the lumbar spine. These findings highlight the importance of screening for vertebral fractures in this population, informing early intervention strategies to mitigate risks associated with osteoporosis., Purpose: This study's main goal was to look into the frequency, location, kind, and severity of asymptomatic vertebral fragility fractures (VFF) in people who had fractures of the fragility of the distal radius. Although VFF is frequently misdiagnosed, it is linked to higher mortality, morbidity, and hip fracture risk. The study also attempted to investigate the relationship between VFF and certain demographic and lifestyle factors, as well as FRAX data, in this patient population., Methods: Between January, 2021, and January, 2022, individuals with low-energy distal radial fractures who presented to the emergency room of tertiary care hospital of Karachi, Pakistan, were the subject of a cross-sectional study and were 45 years of age or older except those who fitted the exclusion criteria (n = 208). The thoracic and/or lumbar spine was imaged using radiology, and information on demographics, way of life, and FRAX (Fracture Risk Assessment Tool) was gathered. Using the Genant semiquantitative approach, an impartial and blinded orthopaedist identified VF in the images and determined their severity. SPSS version 20 was used to analyse the data., Results: Two hundred eleven (41.21%) of them were found to have radiographic VFF and only 12 (2.34%) of the 512 patients who were tested were getting osteoporotic therapy. The thoracic spine (32.7%), followed by the lumbar spine (43.12%), was the area most frequently afflicted. In 24.17% of the patients, multiple fractures of the thoracolumbar spine were found. The wedge form (54.5%), followed by biconcave (30.81%) and crush (14.7%), was the most prevalent VFF type. The majority of detected VFF were rated as having a 25-40% height loss (64.9%) then severe (> 40%) fractures (35.1%), according to the Genant grading method. Notably, there were no variations in smoking, drinking, BMI, or FRAX score between patients with and without VFF that were statistically significant., Conclusion: Based on our study's findings, it is clear that osteoporotic vertebral fragility fractures occur in almost half of individuals with distal radius fractures. The lumbar spine is notably the most affected region, predominantly with wedge fractures. Given the high prevalence of asymptomatic vertebral fragility fractures (VFF), proactive measures are necessary to mitigate associated risks. Prioritising comprehensive fall risk assessments for these patients and interventions to enhance bone mineral density and strength are crucial. Early identification of asymptomatic VFF enables timely intervention, optimising patient care and minimising the risk of complications in this vulnerable population., (© 2024. International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation.)

Purpose: To determine the impact of magnetic resonance imaging (MRI) on fracture classification for thoracic spine fractures (TSFs) compared to computed tomography (CT) alone., Methods: This study was a retrospective review of 63 consecutive patients with TSFs who underwent CT and MRI within ten days of injury. Three reviewers classified all fractures according to the AOSpine Classification and the Thoracolumbar AOSpine Injury severity score (TLAOSIS). Posterior ligamentous complex (PLC) injury on MRI was defined by "black stripe discontinuity" and on CT by the presence of vertebral body translation, facet joint malalignment, horizontal laminar or spinous process fracture, and interspinous widening. The proportion of patients with AO type A/B/C and with TLAOSIS ≤ 5 and ≥ 6 was compared between CT and MRI. Classification and regression trees were used to create a series of predictive models for the probability of PLC injury in AO type A fractures., Results: AO classification using CT was as follows: type A in 35 patients (55%), type B in 18 patients (29%), and type C in 10 patients (16%). Thirty-three patients (52%) had a TLAOSIS ≤5, while the remaining 30 (48%) had TLAOSI ≥6. The addition of MRI after CT upgraded type A to type B fractures in 10 patients (16%) and changed TL AOSIS from ≤5 to ≥6 in 8 cases (12.8%). Type A fractures with load sharing score (LSC) ≥6 had a 60% chance of upgrading to type B, while LSC <6 had a 12.5% chance of upgrading to type B., Conclusions: CT yielded (89%) accuracy in diagnosing PLC injury in TSFs. The addition of MRI after CT substantially changed the AO classification or TLAOISS, compared to CT alone, thus suggesting an added value of MRI for PLC assessment for TSFs classification., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: 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., Methods: 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., Results: 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)., Conclusions: Interhospital transfers significantly affect hospital LOS, postoperative morbidity, and mortality in thoracolumbar spine surgery. Enhancing postoperative monitoring for transfer patients is crucial., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Competing Interests: Declaration of competing interest None of the authors have any conflicts of interest.

Purpose: The AOSpine classification divides thoracolumbar burst fractures into A3 and A4 fractures; nevertheless, past research has found inconsistent interobserver reliability in detecting those two fracture patterns. This systematic analysis aims to synthesize data on the reliability of discriminating between A3 and A4 fractures., Methods: We searched PubMed, Scopus, and the Web of Science for studies reporting the inter- and intra-observer reliability of detecting thoracolumbar AO A3 and A4 fractures using computed tomography (CT). The search spanned 2013 to 2023 and included both primarily reliability and observational comparative studies. We followed the PRISMA guidelines and used the modified COSMIN checklist to assess the studies' quality. Kappa coefficient (k) values were categorized according to Landis and Koch, from slight to excellent., Results: Of the 396 identified studies, nine met the eligibility criteria; all were primarily reliability studies except one observational study. Interobserver k values for A3/A4 fractures varied widely among studies (0.19-86). The interobserver reliability was poor in two studies, fair in one study, moderate in four studies, and excellent in two studies. Only two studies reported intra-observer reliability, showing fair and excellent agreement. The included studies revealed significant heterogeneity in study design, sample size, and interpretation methods., Conclusion: Considerable variability exists in interobserver reliability for distinguishing A3 and A4 fractures from slight to excellent agreement. This variability might be attributed to methodological heterogeneity among studies, limitations of reliability analysis, or diagnostic pitfalls in differentiating between A3 and A4. Most observational studies comparing the outcome of A3 and A4 fractures do not report interobserver agreement, and this should be considered when interpreting their results., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

A 74-year-old male patient was referred with signs of sepsis 5 days after having been diagnosed with a rib fracture following a fall out of bed. Novel hypodensities were visible on thoracic X‑rays and laboratory tests revealed elevated inflammatory parameters. Subsequently performed thoracic computed tomography (CT) scan showed burst fracture of the 3rd thoracic vertebra, posttraumatic esophageal rupture at the same level and mediastinitis. Furthermore, marked degenerative changes of the spinal column (diffuse idiopathic skeletal hyperostosis) were present. The patient underwent emergency thoracotomy and esophagectomy. Gastric pull-up with esophagogastrostomy was postponed for 3 days. After 14 days on the intensive care unit (ICU) and 12 days of i.v. antibiotics, the patient was transferred to the general ward and 7 weeks after trauma the patient was infection-free without difficulties in swallowing. Up to the latest follow-up 41 months following injury, several endoscopic dilations with a bougie due to constrictions at the anastomosis have been performed. Similar to previous cases in the literature, esophageal injury was diagnosed delayed, with the patient already having developed severe complications. This extremely seldom injury should be suspected in young patients following high-energy trauma, but also in older patients after low-energy trauma but known degenerative changes of the vertebral column., (© 2024. The Author(s).)

Background: Long segment fixation has been frequently used to treat thoracolumbar burst fractures. In our study we want to compare the long and short segment with intermediate screw fixation of thoracolumbar junction burst fractures in relation to radiological and clinical outcomes., Methods: We collected the data of 115 patients, with thoracolumbar junction (T11-L2) burst fracture A3 or A4, according to AO Classification. Patients were divided into two groups. Group A was treated by long segment fixation. Group B was treated by short segment fixation. At admission, after surgery, and at 12-month follow-up the patients were radiographically assessed for local kyphotic angle using the Cobb method. Patients were clinically evaluated with the Visual Analogue Scale (VAS) for back pain., Results: The mean difference of the preoperative, immediate postoperative, and 12-month follow-up Cobb angle was significant in both groups (P=0.018). The mean difference of the preoperative and immediate postoperative Cobb angle, Δ1, was significantly greater in group A than in group B (P=0.038), indicating that the Cobb angle correction immediately postoperative was better in patients with double level fixation. The mean difference of the immediate postoperative and 12-month follow-up Cobb angle, Δ2, was significantly greater in group A than in group B (P=0.007), indicating that the maintenance of local Cobb angle correction was better in patients with double level, long fixation. There was no difference in VAS values between group B (single) and group A (double) segment fixation immediately postoperatively (P=0.356) or after 12 months (P=0.147)., Conclusions: In A3 and A4 thoracolumbar junction fractures, long segment fixation can correct the local kyphosis Cobb angle and maintain the correction at 12-month follow-up better than short segment fixation with intermediate screws in the fractured vertebra. However, the radiological difference was not predictive of clinical results.

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., (© 2024 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.)

Chiropractic spinal manipulation therapy (CSMT) of the cervical spine has been reported to cause mechanical dural injuries that result in cerebrospinal fluid (CSF) leaks. We present a case of symptomatic intracranial hypotension after isolated thoracic CSMT. Initial imaging was unable to definitively localize the CSF leak, but dynamic imaging was able to better identify the defect. Multiple epidural blood patches were attempted, including image-guided approaches and with fibrin sealant, but surgical repair was ultimately required. Our case illustrates the risk of dural tear in the setting of recent CSMT and the challenges of managing such an injury., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 International Anesthesia Research Society.)

Background: The Wiltse approach has been extensively employed in thoracolumbar surgeries due to its minimal muscle damage. However, in the middle and lower thoracic spine, the conventional Wiltse approach necessitates the severance of the latissimus dorsi and trapezius muscles, potentially leading to muscular injury. Consequently, we propose a modified Wiltse approach for the middle and lower thoracic vertebrae, which may further mitigate muscular damage., Methods: From May 2018 to April 2022, 60 patients with spinal fractures in the middle and lower thoracic vertebrae (T5-12) were enrolled in this study. Thirty patients underwent surgery using the modified Wiltse approach (Group A), while the remaining 30 patients received traditional posterior surgery (Group B). The observation indices included operation time, intraoperative blood loss, incision length, number of C-arm exposures, postoperative drainage, postoperative ambulation time, discharge time, as well as preoperative and postoperative Cobb's angle, percentage of anterior vertebral body height (PAVBH), visual analog scale (VAS) Score, and Oswestry disability index (ODI)., Results: Compared to the traditional posterior approach, the modified Wiltse approach demonstrated significant advantages in operation time, intraoperative blood loss, length of incision, postoperative ambulation time, postoperative drainage, and discharge time, as well as postoperative VAS and ODI scores. No significant differences were observed between the two groups in terms of number of C-arm exposures, postoperative Cobb's angle, or postoperative PAVBH., Conclusion: We propose a modification of the Wiltse approach for the middle and lower thoracic vertebral regions, which may further minimize muscular damage and facilitate the recovery of patients who have undergone surgery in the middle and lower thoracic vertebrae., (© 2024. The Author(s).)