Andrei F Joaquim1, Alpesh A Patel2, Gregory D Schroeder3, Alexander R Vaccaro3. 1. 1Neurosurgery Division, State University of Campinas, Campinas, SP Brazil. 2. 2Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL USA. 3. 3Department of Orthopaedic Surgery and Neurosurgery, Thomas Jefferson University, Philadelphia, PA USA.
Abstract
STUDY DESIGN: Review of illustrative cases of a new algorithm to help in the treatment decision of thoracolumbar spine trauma. OBJECTIVES: To illustrate the use of the new algorithm for managing thoracic and lumbar spine trauma. SETTINGS: Recently, a new algorithm for helping in the decision of the best treatment modality for thoracolumbar spine trauma (TLST) was published. The algorithm considers injury morphology, neurological status, clinical status (pain and disability), and also multimodal radiological evaluation (MMRE) in the decision for non-operative versus operative treatment for TLST. Injuries were classified in three groups: (1) stable injuries, (2) potentially unstable injuries/ delayed instability, or (3) clearly unstable injuries. METHODS: Cases examples of the algorithm application were presented and discussed. RESULTS: Stable injuries (minor fractures without instability) are non-surgically treated; potentially unstable injuries or associated with delayed instability may be initially managed non-surgically and operative treatment is an option, especially in the setting of important pain, deformity or a new neurological deficit. Clearly unstable injuries are treated surgically as soon as possible to avoid neurological worsening, severe pain, and/ or progressive spinal deformity. CONCLUSIONS: Clinical examples of TLST were presented, discussed and classified as stable, potentially unstable and clearly unstable injuries. Further studies addressing the reliability and safety of this algorithm are necessary.
STUDY DESIGN: Review of illustrative cases of a new algorithm to help in the treatment decision of thoracolumbar spine trauma. OBJECTIVES: To illustrate the use of the new algorithm for managing thoracic and lumbar spine trauma. SETTINGS: Recently, a new algorithm for helping in the decision of the best treatment modality for thoracolumbar spine trauma (TLST) was published. The algorithm considers injury morphology, neurological status, clinical status (pain and disability), and also multimodal radiological evaluation (MMRE) in the decision for non-operative versus operative treatment for TLST. Injuries were classified in three groups: (1) stable injuries, (2) potentially unstable injuries/ delayed instability, or (3) clearly unstable injuries. METHODS: Cases examples of the algorithm application were presented and discussed. RESULTS: Stable injuries (minor fractures without instability) are non-surgically treated; potentially unstable injuries or associated with delayed instability may be initially managed non-surgically and operative treatment is an option, especially in the setting of important pain, deformity or a new neurological deficit. Clearly unstable injuries are treated surgically as soon as possible to avoid neurological worsening, severe pain, and/ or progressive spinal deformity. CONCLUSIONS: Clinical examples of TLST were presented, discussed and classified as stable, potentially unstable and clearly unstable injuries. 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: Salman Abbasi Fard; Jesse Skoch; Mauricio J Avila; Apar S Patel; Kamran V Sattarov; Christina M Walter; Ali A Baaj Journal: Clin Spine Surg Date: 2017-10 Impact factor: 1.876
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