B Bouyer1, M Vassal2, F Zairi3, A Dhenin4, M Grelat5, A Dubory6, H Giorgi7, A Walter8, G Lonjon9, C Dauzac10, N Lonjon11. 1. Département de chirurgie orthopédique et de traumatologie du sport, hôpital Pitié-Salpêtrière, AP-HP Paris, 47-83, boulevard de l'Hôpital, 75013 Paris, France. 2. Département de neurochirurgie, hôpital Gui-de-Chauliac, 80, avenue Augustin-Fliche, 34090 Montpellier, France. 3. Département de neurochirurgie, hôpital universitaire de Lille, hôpital Roger-Salengro, rue Emile-Laine, 59037 Lille, France. 4. Unité rachidienne, département de chirurgie orthopédique, hôpital universitaire de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France. 5. Département de neurochirurgie, hôpital universitaire de Dijon, 7, rue Isabelle-de-Portugal, 21000 Dijon, France. 6. Unité rachidienne et tumorale, département de chirurgie orthopédique, hôpital universitaire Bicêtre, AP-HP Paris, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France. 7. Unité rachidienne, département de chirurgie orthopédique, hôpital La Conception, AP-HM Marseille, université Aix-Marseille, 147, boulevard Baille, 13005 Marseille, France. 8. Service de chirurgie du Rachis Pavillon chirurgical B, hôpitaux universitaires de Strasbourg, BP 426, 67091 Strasbourg, France. 9. Département de chirurgie orthopédique, hôpital Raymond-Poincaré, université Versailles Saint-Quentin, AP-HP Paris, 104, boulevard Raymond-Poincaré, 92380 Garches, France. 10. Département de chirurgie orthopédique, hôpital Beaujon, université Paris Diderot, AP-HP Paris, 100, boulevard Général-Leclerc, 92110 Clichy, France. 11. Département de neurochirurgie, hôpital Gui-de-Chauliac, 80, avenue Augustin-Fliche, 34090 Montpellier, France. Electronic address: nlonjon@gmail.com.
Abstract
INTRODUCTION: Recent epidemiological data for spinal trauma in France are sparse. However, increased knowledge of sagittal balance and the development of minimally invasive techniques have greatly improved surgical management. OBJECTIVES: To describe the epidemiology and management of traumatic vertebral fracture, and to analyze evolution and risk factors for poor functional outcome at 1 year's follow-up. MATERIALS AND METHODS: A prospective multicenter French cohort study was performed over a 6-month period in 2011, including all cases of vertebral fracture surgery. Data were collected by online questionnaire over the Internet. Demographic characteristics, lesion type and surgical procedures were collected. Clinical, functional and radiological assessment was carried out at 1 year. RESULTS: Five hundred and eighteen patients, with a mean age of 47 years, were included. Sixty-seven percent of fractures involved the thoracic or lumbar segment. Thirty percent of patients had multiple fractures and 28% neurological impairment. A minimally invasive technique was performed in 20% of cases and neurological decompression in 25%. Dural tear was observed in 42 patients (8%). Seventy percent of patients were followed up at 1 year. Functionally, SF-36 scores decreased on all dimensions, significantly associated with age, persistent neurological deficit and previous spine imbalance. Thirty-eight percent of working patients had returned to work. Radiologically, sagittal balance was good in 74% of cases, with fracture consolidation in 70%. DISCUSSION: Despite progress in management, spinal trauma was still a source of significant morbidity in 2011, with pronounced decrease in quality of life. Conserved sagittal balance appeared to be associated with better functional outcome.
INTRODUCTION: Recent epidemiological data for spinal trauma in France are sparse. However, increased knowledge of sagittal balance and the development of minimally invasive techniques have greatly improved surgical management. OBJECTIVES: To describe the epidemiology and management of traumatic vertebral fracture, and to analyze evolution and risk factors for poor functional outcome at 1 year's follow-up. MATERIALS AND METHODS: A prospective multicenter French cohort study was performed over a 6-month period in 2011, including all cases of vertebral fracture surgery. Data were collected by online questionnaire over the Internet. Demographic characteristics, lesion type and surgical procedures were collected. Clinical, functional and radiological assessment was carried out at 1 year. RESULTS: Five hundred and eighteen patients, with a mean age of 47 years, were included. Sixty-seven percent of fractures involved the thoracic or lumbar segment. Thirty percent of patients had multiple fractures and 28% neurological impairment. A minimally invasive technique was performed in 20% of cases and neurological decompression in 25%. Dural tear was observed in 42 patients (8%). Seventy percent of patients were followed up at 1 year. Functionally, SF-36 scores decreased on all dimensions, significantly associated with age, persistent neurological deficit and previous spine imbalance. Thirty-eight percent of working patients had returned to work. Radiologically, sagittal balance was good in 74% of cases, with fracture consolidation in 70%. DISCUSSION: Despite progress in management, spinal trauma was still a source of significant morbidity in 2011, with pronounced decrease in quality of life. Conserved sagittal balance appeared to be associated with better functional outcome.