Andrei F Joaquim1, Alpesh A Patel2, Gregory D Schroeder3, Alexander R Vaccaro3. 1. a Neurosurgery Division , State University of Campinas , Campinas-SP , Brazil. 2. b Department of Orthopaedic Surgery , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA. 3. c Department of Orthopaedic Surgery and Neurosurgery at Thomas Jefferson University , Philadelphia , Pennsylvania , USA.
Abstract
CONTEXT: Current treatment of TLST should consider injury morphology, neurological status, clinical status (pain and disability) and also multimodal radiological evaluation (MMRE) with CT, MRI and dynamic/ standing plain radiographs. METHODS: A narrative literature review was performed to propose a treatment algorithm to guide the management of thoracolumbar spinal trauma (TLST). In order to classify injuries and surgical indications, we utilized the two most recent classification systems (TLICS and new AO spine classification) and related recent literature. RESULTS: Injuries were categorized into three groups according to stability: 1) Stable injuries, 2) Potentially unstable injuries/ delayed instability or 3) Clearly unstable injuries. Stable injuries included most of AO type A fractures without neurological deficit, mild clinical symptoms and without risk factors for late deformity. Potentially unstable injuries generally included patients without neurological deficits but with some risk factors for late deformity or with severe clinical symptoms. Surgery may be recommended in this group. Finally, clearly unstable injuries are those with spinal dislocations and/ or with neurological deficits, especially in the setting of persistent neural tissue compression, requiring early surgical treatment. CONCLUSIONS: The proposed treatment algorithm is intended to help surgeons select the best treatment modality for their patients, categorizing injuries according to their main characteristics into one of these three groups. Further studies addressing the reliability and safety of this algorithm are necessary.
CONTEXT: Current treatment of TLST should consider injury morphology, neurological status, clinical status (pain and disability) and also multimodal radiological evaluation (MMRE) with CT, MRI and dynamic/ standing plain radiographs. METHODS: A narrative literature review was performed to propose a treatment algorithm to guide the management of thoracolumbar spinal trauma (TLST). In order to classify injuries and surgical indications, we utilized the two most recent classification systems (TLICS and new AO spine classification) and related recent literature. RESULTS: Injuries were categorized into three groups according to stability: 1) Stable injuries, 2) Potentially unstable injuries/ delayed instability or 3) Clearly unstable injuries. Stable injuries included most of AO type A fractures without neurological deficit, mild clinical symptoms and without risk factors for late deformity. Potentially unstable injuries generally included patients without neurological deficits but with some risk factors for late deformity or with severe clinical symptoms. Surgery may be recommended in this group. Finally, clearly unstable injuries are those with spinal dislocations and/ or with neurological deficits, especially in the setting of persistent neural tissue compression, requiring early surgical treatment. CONCLUSIONS: The proposed treatment algorithm is intended to help surgeons select the best treatment modality for their patients, categorizing injuries according to their main characteristics into one of these three groups. Further studies addressing the reliability and safety of this algorithm are necessary.
Authors: Alexander R Vaccaro; Steven C Zeiller; R John Hulbert; Paul A Anderson; Mitchel Harris; Rune Hedlund; James Harrop; Marcel Dvorak; Kirkham Wood; Michael G Fehlings; Charles Fisher; Ronald A Lehman; D Greg Anderson; Christopher M Bono; Timothy Kuklo; F C Oner Journal: J Spinal Disord Tech Date: 2005-06
Authors: Andrei F Joaquim; Brandon Lawrence; Michael Daubs; Darrel Brodke; Helder Tedeschi; Alexander R Vaccaro; Alpesh A Patel Journal: J Spinal Cord Med Date: 2013-11-26 Impact factor: 1.985
Authors: Alexander R Vaccaro; Cumhur Oner; Christopher K Kepler; Marcel Dvorak; Klaus Schnake; Carlo Bellabarba; Max Reinhold; Bizhan Aarabi; Frank Kandziora; Jens Chapman; Rajasekaran Shanmuganathan; Michael Fehlings; Luiz Vialle Journal: Spine (Phila Pa 1976) Date: 2013-11-01 Impact factor: 3.468