Classification? Classification system should be: Comprehensive Usable Accurate Predictable Able to guide intervention
|
|
- Evelyn Lyons
- 5 years ago
- Views:
Transcription
1 Moderator: Dr. P.S. Chandra Dr. Dr Deepak Gupta
2
3
4
5 Classification? Classification system should be: Comprehensive Usable Accurate Predictable Able to guide intervention
6 A precise, comprehensive, ideal and informative classification system has eluded spine surgeons since Boehler first proposed his injury categories in 1929.
7 classification? Holdsworth ods ot (JBJS, JS, 1970) Denis (Spine, 1983) McAfee Classification(JBJS J 65 A; 1983) Load sharing Classification(McCormack et.al. Spine 19; 1994) Comprehensive Classification(Magerl Eur J Spine 3; 199Gertzbein Spine 19; 1994) Thoracolumbar Injury Severity Score (TLISS)(Spine 2007 Feb 1;32(3).)
8 Denis (Spine, 1983) 1 st classification after introduction of CT Modified the column concept of Holdsworth Spinal stability is based on 3 column Middle column: important of structural stability. Degree of instability: included the neurological status of patient. t
9
10 McCormack and Gaines (Spine 19; 1994) Load sharing classification Degree of vertebral body comminution, apposition of fracture fragments, and the amount of sagittal plane deformity. Sought to predict the risk of implant failure.
11
12 AO(Arbeitsgemeinschaft fur Osteosynthesenfragen)/ Magerl (Eur J Spine 3; 1994) Based on Pathomorphological criteria. And review of 1445 consecutive TL cases. Advantage Comprehensive Disadvantage Complex Does not define stability Moderate reliability. Eur Spine J Jun;11(3): Epub 2002 Jan 29 Does not include neurological deficit
13
14 Type A : vertebral body compression A1: impaction fracture A2: split fracture A3: burst fracture Type B : distraction ( all 3 columns) B1: posterior injury ligamentous B2: posterior injury osseous B3: anterior injury through disc Type c : rotational (all 3 columns) C1: type A with rotation C2: type B with rotation C3: rotational shear
15 TLISS (Spine 2007 Feb 1;32(3).) To assist in clinical decision making for operative versus non operative care Mechanism of injury, integrity of the PLC, and neurologic status. <3 : non operative, > 5 : operative, stabilization with or without decompression. Advantage Comprehensive Define stability Moderate reliability J Spinal Disord Tech Aug;22(6): Disadvantage Validity and ability to prove outcome remain unproven Validation studies performed by spine trauma study group. Spine J Sep;9(9):780 8.
16 Injury morphology Compression 1 Burst +1 Translational/rotational 3 Distraction 4 Neurological status PLC Intact 1 Nerve root 2 Cord, Conus medullaris Incomplete 3 Complete 2 Cauda Equina 3 Intact 0 Injury Suspected/indeterminate 2 Injured 3
17
18
19
20
21 Imaging X ray Inexpensive and quick Demonstrate loss of vertebral height. Kyphotic angle Interspinous distance in AP and Lateral view with alignment of spinous process for rotation of vertebra. Assess posterior vertebral body on lateral l view.
22
23 CT scan Excellent visualization of bony anatomy, particularly middle spinal column, spinal canal shape and patency. Reverse cortical sign contraindication for ligamentotaxis in posterior approach.
24
25 MRI scan Excellent visualization of soft tissue i.e. ligament (post ligament), disc, spinal cord. Poor prognostic factor : edema extending two vertebral level and presence of hematoma within spinal cord.
26
27 Defining instability Why is it important to look for instability? Instability is the key to therapeutic indications because it equates, in many cases, with a need for internal stabilization. Francis Denis, M.D. Spinal stability as defined by the three column spine concept in acute spinal trauma. CORR. 189: 65 76
28 Definition of stability as formulated by Whitesides,Magrel and Denis A stable spine is one which can withstand axial forces anteriorly, tensile forces posteriorly and rotational forces, so as to hold the body erect, protecting the contents of the canal and preventing progressive kyphosis Whitesides TE Jr (1977) Traumatic kyphosis of the thoracolumbar spine. Clin Orthoped 128: Francis Denis. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine Vol 8; No 8:
29 If neurology is intact whether h to operate or not No superiority of conservative therapy over operative therapy Surg Neurol Mar;67(3):221 31; discussion 231. A review of the management of thoracolumbar burst fractures. Dai LY J Bone Joint Surg Am May;85 A(5): Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit. A prospective, randomized study. Wood K, Cochrane Database Syst Rev Oct 18;(4):CD Operative versus non operative treatment for thoracolumbar burst fractures without neurological ldeficit. Yi L
30 Stable thoracolumbar burst without neurology (vertebral compression or canal encroachment < 40% or kyphosis <15 degrees with a stable posterior column) Medically unfit J Neurosurg Jan;86(1):48 55
31 Whether cast bracing can be used in stable/unstable burst fracture J Neurosurg Spine 2009 Christopher S. Bailey A thoracolumbar burst fracture, in exclusion of an associated posterior ligamentous complex injury, is inherently a very stable injury and may not require a brace.
32 Spine Sep 1996 Chow, Gregory H. Functional Outcome of Thoracolumbar Burst Fractures Managed With Hyperextension Casting or Bracing and Early Mobilization Non operative management of thoracolumbar burst fractures with hyperextension casting or bracing was proven to be a safe and effective method of treatment in selected patients. Clinical results were favorable. No neurologic deterioration was observed. Hospitalization i times were minimized. i i Patient satisfaction was high. The authors do not believe that ligamentous injury of the posterior column is a contraindication to nonoperative management of thoracolumbar burst fractures.
33 What is the ideal time for surgery Spine (Phila Pa 1976) Apr 20;35(9 Suppl):S Does early fracture fixation of thoracolumbar spine fractures decrease morbidity or mortality? Bellabarba C These studies demonstrated that early stabilization of fractures reduced the mean number of days on a ventilator, the number of days in intensive care unit and in hospital Ideally, patients with unstable thoracic fractures y,p should undergo early (<72 hours) stabilization of their injury to reduce morbidity and, possibly, mortality.
34 J Spinal Cord Med. 2005;28(1):11 9. Timing of surgery following spinal cord injury. Kishan S Early surgical treatment ( within 24 hrs ) is beneficial in terms of reducing complications length of stay, and hospital costs. Further studies are needed d to clearly l demonstrate t the impact of operative timing on neurological outcome. Those patients in whom operations were performed within first 24 hour had a lower rate of complications. Willberger JE (1991)
35 Early surgery ( <5 days) : Ligamentotaxis /Annulotaxis useful in burst fractures. Anterior approach : Wait 3 4 days for hyperemeia to subside, less bleeding. Severely injured : early surgery: Few c/c, shorter hospital stay, reduced ventilatory requirement. A retrospective analysis of treatment outcomes. Olumide A Danisa. Spine surgery, Virginia, JNS 1995.
36 Approach? Journal of Spinal Disorders & Techniques. February 2006 Surgical Decision Making for Unstable Thoracolumbar Spine Injuries: Results of a Consensus Panel Review by the Spine Trauma Study Group. Vaccaro, Alexander R Decision making for the surgical treatment of thoracolumbar injuries is largely dependent on three patient characteristics: Injury morphology Neurologic status Posterior ligament integrity. A logical and practical decision making process based on these characteristics may guide treatment even for the most complicated fracture patterns.
37 Suggested Surgical Approach
38 Anterior approach Advantage: Predictable canal decompression, improvement neurology, no increased morbidity Posterior approach Advantage : Spinal stability, deformity correction, low morbidity Disadvantage Disadvantage Stiffness : 15% + than normal spine Stiffness of normal spine : 76% Instrument failure :4 11% Instrument failure rate : 9 54% Loss of correction : 1 4 degrees Loss of correction 3 12 degrees Less time, Less blood loss, less expensive ( JNS 1995,Virginia)
39 Is decompression indicated for complete spinal cord injury Journal Bone Joint Surg Br Jul;82(5): () Does 'canal clearance' affect neurological outcome after thoracolumbar burst fractures? Boerger TO The paralysis occurs at the moment of injury and is not related to the position of the fragments of the fracture on subsequent imaging. Alteration of the canal by 'surgical clearance' does not affect the neurological outcome. There is no established advantage of surgical over non surgical treatment as regards neurological improvement. Surgical treatment for burst fracture in the belief that neurological improvement can be achieved is not justified, although surgery may still occasionally be indicated for structural reasons.
40 Length of fusion : short versus long segment Short segment fusion : fracture without translation (LSC 6 or <6). Long segment fusion : fracture with translation ( LSC 7,8,9). Better but loses spinal mobility.
41 Surgical approaches: anterior, posterior or anteroposterior Posterior fixation i : LSC 6 or <6. Anterior fixation : LSC >7 LSC >7 with translational l injury : anterior followed by posterior fixation.
42 Can anterior reconstruction be avoided by long segment posterior fixation in unstable Thoraco Lumbar burst fracture? J Spinal Disord Tech Dec;18(6): Posterior fixation of thoracolumbar burst fracture: short segment segment pedicle fixation versus long segment instrumentation. Tezeren G LS instrumentation is a more effective management of thoracolumbar burst fractures. Anterior column support would negate the need for LS fixation Nevertheless, clinical outcome is same between the two groups.
43 Compression fracture in osteoporotic bones Balloon kyphoplasty versus vertebroplasty for treatment of osteoporotic vertebral compression fracture: a prospective, comparative, and randomized clinical study Higher cost of the kyphotic balloon procedure, we recommend vertebroplasty over kyphoplasty for the treatment of osteoporotic VCFs. Osteoporos Int Feb;21(2): Epub 2009 Jun 10.
44 Vertebral body stenting VBS is an innovative technique which allows for the possibly complete reduction of vertebral compression fractures and helps maintain the restored height by means of a stent. The height loss after balloon deflation is significantly decreased by using VBS compared to kyphoplasty, thus offering a new promising i option for vertebral augmentation. Eur Spine J (2010) 19:
45
46 Comparison of anterolateral and posterior approaches in the management of thoracolumbar burst fractures. Angular deformity is more successfully corrected and maintained i when the anterior approach is used. Retrospective study, T12 L2 fracture, 63 patient. J Neurosurg Spine 5: , 2006
47 Unstable Thoracolumbar Burst Fractures Anterior Only Versus Short Segment Posterior Fixation This study compares anterior only fixation utilizing a corpectomy strut graft and a modern thoracolumbar plating system with a posterior only construct using pedicle screws and load sharing hooks for the treatment of unstable burst fractures. Anterior only group continued to demonstrate statistically significant ifi improvement in sagittal alignment at follow up compared to preoperative measurements. J Spinal Disord Tech 2006;19:
48 PLIF in thoracolumbar trauma: technique and radiological results This technique can be an alternative procedure to combined operations regarding the presented radiological i l results of successful fusion and loss of correction. Eur Spine J (2010) 19:
49 Is Methylprednisolone really useful. Uncertain Various studies have shown contradicting results Three multi Centre NASCIS studies in US inconclusive
50 Recommendations within 3 hrs : for 24 hrs 3 8 hrs : for 48 hrs However it should be mentioned that there is no dfii definite conclusive evidence of a beneficial fiil effect and that there could be some complications related to its use. Dose Bolus IV 30 mg/kg body weight over 15 minutes Constant infusion 5.4 mg/kg/hour for 23 hours
51 Take Home Message Classification? No ideal system TLICS, AO, Denis suitable available options Defining instability A stable spine is one which can withstand axial forces anteriorly, tensile forces posteriorly and rotational forces, so as to hold the body erect, protecting the contents of the canal and preventing progressive kyphosis. Injury to PLC is a main indicator of instability. Role of cast bracing in stable/unstable burst fracture Proven to be a safe and effective method of treatment in selected patients.
52 Ideal time for surgery As soon as the general condition is stable. Role of Surgery in neurologically intact pts There is no superiority of conservative therapy over operative therapy except in poly trauma patients t in whom the surgery has better results. Approach? Determined by incompleteness and PLC involvement.
53 Is decompression indicated for complete SCI. Surgical decompression is not vital to the neurological recovery but may obviate later complications of syrinx and may provide a patent canal for any future successful regenerative therapy. Role of pedicle screws in the fracture vertebra? Helps to provide better kyphosis correction and biomechanical stability. Does anterior reconstruction avoid long segment posterior fixation in unstable thoraco Lumbar burst fracture?r Particularly useful in preserving rotation in SCI.
54 Role of augumentation of the fractured vertebrae with kyphoplasty Provides excellent immediate reduction of post traumatic segmental kyphosis. Is methylprednisolone really useful Uncertain For all patients reporting within 8 hours of injury the option of using methylprednisolone could be given to the patients.
55 Thank You
Classification of Thoracolumbar Spine Injuries
Classification of Thoracolumbar Spine Injuries Guillem Saló Bru 1 IMAS. Hospitals del Mar i de l Esperança. ICATME. Institut Universitari Dexeus USP. UNIVERSITAT AUTÒNOMA DE BARCELONA Objectives of classification
More informationSUBAXIAL CERVICAL SPINE TRAUMA- DIAGNOSIS AND MANAGEMENT
SUBAXIAL CERVICAL SPINE TRAUMA- DIAGNOSIS AND MANAGEMENT 1 Anatomy 3 columns- Anterior, middle and Posterior Anterior- ALL, Anterior 2/3 rd body & disc. Middle- Posterior 1/3 rd of body & disc, PLL Posterior-
More informationfactor for identifying unstable thoracolumbar fractures. There are clinical and radiological criteria
NMJ-Vol :2/ Issue:1/ Jan June 2013 Case Report Medical Sciences Progressive subluxation of thoracic wedge compression fracture with unidentified PLC injury Dr.Thalluri.Gopala krishnaiah* Dr.Voleti.Surya
More informationDepartement of Neurosurgery A.O.R.N A. Cardarelli- Naples.
Percutaneous posterior pedicle screw fixation in the treatment of thoracic, lumbar and thoraco-lumbar junction (T12-L1) traumatic and pathological spine fractures. Report of 45 cases. G. Vitale, A. Punzo,
More informationFractures of the thoracic and lumbar spine and thoracolumbar transition
Most spinal column injuries occur in the thoracolumbar transition, the area between the lower thoracic spine and the upper lumbar spine; over half of all vertebral fractures involve the 12 th thoracic
More informationVAriation. Orthotics and Me (?surgeons) Greg Etherington Spine Surgeon. Orthopaedic & Neurosurgery backgrounds. Subspeciality training
Orthotics and Me (?surgeons) Greg Etherington Spine Surgeon Orthopaedic & Neurosurgery backgrounds Subspeciality training spine, upper limb, trauma, pelvis. What do you do in spine? Lumbar Cervical Trauma
More informationAO CLASSIFICATIONS THORACO-LUMBAR SPINAL INJURIES
AO CLASSIFICATIONS THORACO-LUMBAR SPINAL INJURIES T H E A O / A S I F ( A R B E I T S G E M E I N S C H A F T F Ü R O S T E O S Y N T H E S E F R A G E N / A S S O C I A T I O N F O R T H E S T U D Y O
More informationThoracolumbar spine trauma classifications: evolution or more confusion
Thoracolumbar spine trauma classifications: evolution or more confusion Poster No.: C-1713 Congress: ECR 2012 Type: Educational Exhibit Authors: J. P. Salazar, J. Halaburda Berni, C. Torrents, L. Casas;
More informationTreatment of thoracolumbar burst fractures by vertebral shortening
Eur Spine J (2002) 11 :8 12 DOI 10.1007/s005860000214 TECHNICAL INNOVATION Alejandro Reyes-Sanchez Luis M. Rosales Victor P. Miramontes Dario E. Garin Treatment of thoracolumbar burst fractures by vertebral
More informationAdvantages of MISS. Disclosures. Thoracolumbar Trauma: Minimally Invasive Techniques. Minimal Invasive Spine Surgery 11/8/2013.
3 rd Annual UCSF Techniques in Complex Spine Surgery Program Thoracolumbar Trauma: Minimally Invasive Techniques Research Support: Stryker Disclosures Murat Pekmezci, MD Assistant Clinical Professor UCSF/SFGH
More informationThoracolumbar fractures. Treatment options. A long trip.
Thoracolumbar fractures. Treatment options. A long trip. MIS SURGERY. WHY NOT? Murcia. October 5, 2012. Dr. Pedro Cortés García. Spinal Unit. Orthopaedic department. Canary Islands University Hospital
More informationDelayed surgery in neurologically intact patients affected by thoraco-lumbar junction burst fractures: to reduce pain and improve quality of life
Original Study Delayed surgery in neurologically intact patients affected by thoraco-lumbar junction burst fractures: to reduce pain and improve quality of life Lorenzo Nigro 1, Roberto Tarantino 1, Pasquale
More informationCommon fracture & dislocation of the cervical spine. Theerachai Apivatthakakul Department of Orthopaedic Chiangmai University
Common fracture & dislocation of the cervical spine Theerachai Apivatthakakul Department of Orthopaedic Chiangmai University Objective Anatomy Mechanism and type of injury PE.and radiographic evaluation
More informationMISS in Thoracolumbar Fractures
MISS in Thoracolumbar Fractures Guillem Saló Bru, MD, Phd Spine Unit. Orthopaedic Department. Hospital del Mar. Barcelona. Associated Professor. Universitat Autónoma de Barcelona. Introduction. The application
More informationTHORACO-LUMBAR SPINE TRAUMA NORDIC TRAUMA COURSE 2016, AARHUS
THORACO-LUMBAR SPINE TRAUMA NORDIC TRAUMA COURSE 2016, AARHUS Ken F. Linnau, MD, MS Emergency Radiology Harborview Medical Center University of Washington Seattle, WA Thanks to Quynh T. Nguyen, MHS, PA-C
More informationSubaxial Cervical Spine Trauma
Subaxial Cervical Spine Trauma Pooria Salari, MD Assistant Professor Of Orthopaedics Department of Orthopaedic Surgery St. Louis University School of Medicine St. Louis, Missouri, USA Initial Evaluation
More informationThoracic and Lumbar Spine Fractures and Dislocations: Assessment and Classification
Thoracic and Lumbar Spine Fractures and Dislocations: Assessment and Classification Mark L Prasarn MD University of Texas Dept of Orthopaedic Surgery Houston, Texas Updated 7/2016 Anatomy of the Spine
More informationDorsal Cervical Surgeries and Techniques
Dorsal Cervical Approaches Dorsal Cervical Surgeries and Techniques Gregory R. Trost, MD Professor and Vice Chair of Neurological Surgery University of Wisconsin-Madison Advantages Straightforward Easily
More informationTreatment Algorithm For Unstable Burst Fracture
Symposium International Journal of Spine 2016 Sep-Dec;1(2):27-32 Treatment Algorithm For Unstable Burst Fracture 1 1 1 Ketan Khurjekar, Himanshu Kulkarni, Mayur Kardile Introduction Burst fractures comprise
More informationOriginal Article Clinics in Orthopedic Surgery 2016;8:
Original Article Clinics in Orthopedic Surgery 2016;8:71-77 http://dx.doi.org/10.4055/cios.2016.8.1.71 More than 5-Year Follow-up Results of Two- Level and Three-Level Posterior Fixations of Thoracolumbar
More informationStage Operation for Unstable Lumbar Spine Fracture- Dislocation with Incomplete Paraplegia: A Case Series
C a s e R e p o r t J. of Advanced Spine Surgery Volume 2, Number 2, pp 60~65 Journal of Advanced Spine Surgery JASS Stage Operation for Unstable Lumbar Spine Fracture- Dislocation with Incomplete Paraplegia:
More informationSubaxial Cervical Spine Trauma Dr Hesarikia BUMS
Subaxial Cervical Spine Trauma Dr. Hesarikia BUMS Subaxial Cervical Spine From C3-C7 ROM Majority of cervical flexion Lateral bending Approximately 50% rotation Ligamentous Anatomy Anterior ALL, PLL, intervertebral
More informationDiagnostic accuracy of MRI in detecting posterior ligamentous complex injury in thoracolumbar vertebral fractures
Diagnostic accuracy of MRI in detecting posterior ligamentous complex injury in thoracolumbar vertebral fractures Poster No.: C-1726 Congress: ECR 2011 Type: Scientific Exhibit Authors: E. Aguirre, P.
More informationREFERENCE DOCTOR Thoracolumbar Trauma MIS Options. Hyeun Sung Kim, MD, PhD,
Thoracolumbar Trauma MIS Options Medical College of Chosun University, Gwangju, South Korea (1994) / Board of Neurosurgery (1999) MEMBERSHIPS & PROFESSIONAL SOCIETIES Korean Neurosurgical Society / Korean
More informationFUNCTIONAL OUTCOMES OF TRAUMATIC PARAPLEGIA PATIENTS: DOES SURGERY IMPROVE THE QUALITY OF LIFE?
FUNCTIONAL OUTCOMES OF TRAUMATIC PARAPLEGIA PATIENTS: DOES SURGERY IMPROVE THE QUALITY OF LIFE? Original Article Orthopaedics R S Bajoria 1, Mahendra Panwar 2, Anand Rao 3, Sameer Gupta 4 1 - Associate
More informationSubaxial Cervical Spine Trauma. Introduction. Anatomic Considerations 7/23/2018
Subaxial Cervical Spine Trauma Sheyan J. Armaghani, MD Florida Orthopedic Institute Assistant Professor USF Dept of Orthopedics Introduction Trauma to the cervical spine accounts for 5 of all spine injuries
More informationPostero-lateral approach with open view vertebroplasty - eggshell technique
Romanian Neurosurgery (2013) XX 4: 357-368 357 Postero-lateral approach with open view vertebroplasty - eggshell technique E.Fl. Exergian 1, I.Fl. Luca-Husti 2, D. Şerban 1 1 Spine Surgery Department,
More informationThoracolumbar Spine Trauma: II. Principles of Management
Thoracolumbar Spine Trauma: II. Principles of Management Jeffrey M. Spivak, MD, Alexander R. Vaccaro, MD, and Jerome M. Cotler, MD Abstract The care of patients with thoracolumbar spine trauma with or
More informationThoracolumbar Spine Fractures
Thoracolumbar Spine Fractures C. Craig Blackmore, MD, MPH Professor of Radiology Adjunct Professor of Health Services Harborview Injury Prevention and Research Center University of Washington Outline Who
More informationVertebral Augmentation for Compression Fractures. Scott Magnuson, MD Pain Management of North Idaho, PLLC
Vertebral Augmentation for Compression Fractures Scott Magnuson, MD Pain Management of North Idaho, PLLC OVCFs are most common type of fragility fracture 20-25% Caucasian women and men over 50 yrs have
More informationSynex System TECHNIQUE GUIDE. An expandable vertebral body replacement device
Synex System TECHNIQUE GUIDE An expandable vertebral body replacement device Original Instruments and Implants of the Association for the Study of Internal Fixation AO ASIF Synex System Overview The Synex
More informationINTRODUCTION.
www.jkns.or.kr http://dx.doi.org/1.334/jkns.212.51.4.23 J Korean Neurosurg Soc 51 : 23-27, 212 Print ISSN 25-3711 On-line ISSN 1598-7876 Copyright 212 The Korean Neurosurgical Society Clinical Article
More informationMd Quamar Azam, Mir Sadat-Ali
Asian Spine Journal 984 Md Quamar Review Azam Article et al. http://dx.doi.org/10.4184/asj.2015.9.6.984 The Concept of Evolution of Thoracolumbar Fracture Classifications Helps in Surgical Decisions Md
More information102 Results RESULTS. Age Mean=S.D Range 42= years -84 years Number % <30 years years >50 years
102 Results RESULTS A total of 50 cases were studied 39 males and 11females.Their age ranged between 16 years and 84 years (mean 42years). T1 and T2WI were acquired for all cases in sagittal and axial
More informationLong Posterior Fixation with Short Fusion for the Treatment of TB Spondylitis of the Thoracic and Lumbar Spine with or without Neurologic Deficit
Long Posterior Fixation with Short Fusion for the Treatment of TB Spondylitis of the Thoracic and Lumbar Spine with or without Neurologic Deficit Shih-Tien Wang MD, Chien-Lin Liu MD 王世典劉建麟 School of Medicine,
More informationCombined Anterior-Posterior Surgery Versus Posterior Surgery for Thoracolumbar Burst Fractures: A Systematic Review of the Literature
The Open Orthopaedics Journal, 2010, 4, 93-100 93 Open Access Combined Anterior-Posterior Surgery Versus Posterior Surgery for Thoracolumbar Burst Fractures: A Systematic Review of the Literature Pim P.
More informationComprehension of the common spine disorder.
Objectives Comprehension of the common spine disorder. Disc degeneration/hernia. Spinal stenosis. Common spinal deformity (Spondylolisthesis, Scoliosis). Osteoporotic fracture. Anatomy Anatomy Anatomy
More informationIt consist of two components: the outer, laminar fibrous container (or annulus), and the inner, semifluid mass (the nucleus pulposus).
Lumbar Spine The lumbar vertebrae are the last five vertebrae of the vertebral column. They are particularly large and heavy when compared with the vertebrae of the cervical or thoracicc spine. Their bodies
More informationThorasic and lumbar spinal injury. Dr.Abrisham
Thorasic and lumbar spinal injury Dr.Abrisham Goal : alignment Stability Preserve neuologic function early mobilization Incidence: most site is thoraco lumbar 50% T 11 to L 1 30% L 2 to L 5 Motor vehicle
More informationAlthough unstable thoracolumbar injuries are a common
ORIGINAL ARTICLE Anterior-Only Stabilization of Three-Column Thoracolumbar Injuries Rick C. Sasso, MD, Natalie M. Best, BS, Thomas M. Reilly, MD, and Robert A. McGuire, Jr., MD Objective: The optimal treatment
More informationSpinal Cord Injuries: The Basics. Kadre Sneddon POS Rounds October 1, 2003
Spinal Cord Injuries: The Basics Kadre Sneddon POS Rounds October 1, 2003 Anatomy Dorsal columntouch, vibration Corticospinal tract- UMN Anterior horn-lmn Spinothalamic tractpain, temperature (contralateral)
More informationSHORT SEGMENT FIXATION THORACOLUMBAR UNSTABLE BURST FRACTURES USING DC PLATES & PEDICLE SCREWS
STUDY SHORT SEGMENT FIXATION THORACOLUMBAR UNSTABLE BURST FRACTURES USING DC PLATES & PEDICLE SCREWS *Hashem, N.; **A Subai, N. *Faculty of Medicine, Ains Shams University, Egypt ^Department of Orthopedics,
More informationTraumatic thoracic spinal fracture dislocation with minimal or no cord injury
J Neurosurg (Spine 3) 96:333 337, 2002 Traumatic thoracic spinal fracture dislocation with minimal or no cord injury Report of four cases and review of the literature SCOTT SHAPIRO M.D., TODD ABEL, M.D.,
More informationELY ASHKENAZI Israel Spine Center at Assuta Hospital Tel Aviv, Israel
nterior cervical decompression using the Hybrid Decompression Fixation technique, a combination of corpectomies and or discectomies, in the management of multilevel cervical myelopathy J ORTHOP TRUM SURG
More informationPatient Information MIS LLIF. Lateral Lumbar Interbody Fusion Using Minimally Invasive Surgical Techniques
Patient Information MIS LLIF Lateral Lumbar Interbody Fusion Using Minimally Invasive Surgical Techniques Table of Contents Anatomy of Spine...2 General Conditions of the Spine....4 What is Spondylolisthesis....5
More informationFractures of the Thoracic and Lumbar Spine
A spinal fracture is a serious injury. Nader M. Hebela, MD Fellow of the American Academy of Orthopaedic Surgeons http://orthodoc.aaos.org/hebela Cleveland Clinic Abu Dhabi Cleveland Clinic Abu Dhabi Neurological
More informationPercutaneous Posterior Fixation: A Unique Entity to minimize Further Damage to Patient with Traumatic Spine
Kaushal R Patel et al RESEARCH ARTICLE 10.5005/jp-journals-10039-1129 Percutaneous Posterior Fixation: A Unique Entity to minimize Further Damage to Patient with Traumatic Spine 1 Kaushal R Patel, 2 Jayprakash
More information5. Department of Neurological Surgery, University of California, San Francisco, San Francisco,
CONGRESS OF NEUROLOGICAL SURGEONS SYSTEMATIC REVIEW AND EVIDENCE-BASED GUIDELINES ON THE EVALUATION AND TREATMENT OF PATIENTS WITH THORACOLUMBAR SPINE TRAUMA: CLASSIFICATION OF INJURY Sponsored by: Congress
More informationSir William Asher ANATOMY
SPINAL CORD INJURY BASICS RELATED TO LIFE CARE PLANNING Lesson 1 Sir William Asher Picture the pathetic patient lying long abed, the urine leaking from his distended bladder, the lime draining from his
More information3D titanium interbody fusion cages sharx. White Paper
3D titanium interbody fusion cages sharx (SLM selective laser melted) Goal of the study: Does the sharx intervertebral cage due to innovative material, new design, and lordotic shape solve some problems
More informationASJ. A Rare Hyperextension Injury in Thoracic Spine Presenting with Delayed Paraplegia. Asian Spine Journal. Introduction
sian Spine Journal 126 Dong-Eun Case Shin Report et al. http://dx.doi.org/10.4184/asj.2013.7.2.126 Rare Hyperextension Injury in Thoracic Spine Presenting with Delayed Paraplegia Dong-Eun Shin, Ki-Sik
More information5/19/2017. Interspinous Process Fixation with the Minuteman G3. What is the Minuteman G3. How Does it Work?
Interspinous Process Fixation with the Minuteman G3 LLOYDINE J. JACOBS, MD CASTELLVI SPINE MEETING MAY 13, 2017 What is the Minuteman G3 The world s first spinous process plating system that is: Minimally
More informationEfficiency of Ligamentotaxis Using PLL for Thoracic and Lumbar Burst Fractures in the Load-sharing Classification
Efficiency of Ligamentotaxis Using PLL for Thoracic and Lumbar Burst Fractures in the Load-sharing Classification Won-Ju Jeong, MD; Joon-Woo Kim, MD; Dong-Kyo Seo, MD; Hyun-Joo Lee, MD; Jun-Young Kim,
More informationThoracolumbar Injury Classification and Injury Severity Score System: A Literature Review of Its Safety
80 Review Article GLOBAL SPINE JOURNAL THIEME Thoracolumbar Injury Classification and Injury Severity Score System: A Literature Review of Its Safety Andrei Fernandes Joaquim 1 Dhiego Chaves de Almeida
More informationAdolescent Idiopathic Scoliosis
Adolescent Idiopathic Scoliosis Surgical Treatment Comparisons By: Dr. Alex Rabinovich and Dr. Devin Peterson Options 1. Pedicle Screws versus Hooks 2. Posterior versus Anterior Instrumentation 3. Open
More informationUniversity of Groningen. Thoracolumbar spinal fractures Leferink, Vincentius Johannes Maria
University of Groningen Thoracolumbar spinal fractures Leferink, Vincentius Johannes Maria IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from
More informationA New Classification of Thoracolumbar Injuries
A New Classification of Thoracolumbar Injuries The Importance of Injury Morphology, the Integrity of the Posterior Ligamentous Complex, and Neurologic Status Alexander R. Vaccaro, MD,* Ronald A. Lehman,
More informationShort Segment Screw Fixation without Fusion for Low Lumbar Burst Fracture: Severe Canal Compromise but Neurologically Intact Cases
CLINICAL ARTICLE Korean J Neurotrauma 2013;9:101-105 pissn 2234-8999 / eissn 2288-2243 http://dx.doi.org/10.13004/kjnt.2013.9.2.101 Short Segment Screw Fixation without Fusion for Low Lumbar Burst Fracture:
More informationObjectives. Comprehension of the common spine disorder
Objectives Comprehension of the common spine disorder Disc degeneration/hernia Spinal stenosis Common spinal deformity (Spondylolisthesis, Scoliosis) Osteoporotic fracture Destructive spinal lesions Anatomy
More informationCLINICAL SCIENCE. Yueju Liu, I,II,# Guangbin Li, III,# Tianhua Dong, I,II Yingze Zhang, I,II Heng Li I,II * & INTRODUCTION
CLINICAL SCIENCE One-stage partial vertebrectomy, titanium mesh implantation and pedicle screw fixation in the treatment of thoracolumbar burst fractures through a posterior approach Yueju Liu, I,II,#
More informationInterspinous Fusion Devices. Midterm results. ROME SPINE 2012, 7th International Meeting Rome, 6-7 December 2012
Interspinous Fusion Devices. Midterm results. ROME SPINE 2012, 7th International Meeting Rome, 6-7 December 2012 Posterior distraction and decompression Secure Fixation and Stabilization Integrated Bone
More informationImaging of Cervical Spine Trauma Tudor H Hughes, M.D.
Imaging of Cervical Spine Trauma Tudor H Hughes, M.D. General Considerations Most spinal fractures are due to a single episode of major trauma. Fatigue fractures of the spine are unusual except in the
More informationModule 1: Basic Comprehensive Course
The Hellenic Spine Society organize 5 modules according to the following program, which is based on the Eurospine program Module 1: Basic Comprehensive Course SESSION1: SPINE THE BIGGER PICTURE Evidence
More informationClinical Analysis of Minimally Invasive Single-segment Reduction and Internal Fixation in Patients with Thoracolumbar Fractures
Journal of Clinical and Nursing Research 2018, 2(1): 23-27 Journal of Clinical and Nursing Research Clinical Analysis of Minimally Invasive Single-segment Reduction and Internal Fixation in Patients with
More informationThoracolumbar Spinal Injuries
31 Thoracolumbar Spinal Injuries Michael Heinzelmann, Guido A. Wanner Fractures Section 883 Core Messages Spinal fractures are frequently located at the thoracolumbar junction for biomechanical reasons
More informationTraumatic Thoracolumbar Spine Injuries: What the Spine Surgeon Wants to Know 1
Note: This copy is for your personal non-commercial use only. To order presentation-ready copies for distribution to your colleagues or clients, contact us at www.rsna.org/rsnarights. TRAUMA/EMERGENCY
More informationKumaFix fixation for thoracolumbar burst fractures: a prospective study on selective consecutive patients
Xi an Hong Hui Hospital Xi an, Shaanxi, China KumaFix fixation for thoracolumbar burst fractures: a prospective study on selective consecutive patients Dingjun Hao, Baorong He, Liang Yan Hong Hui Hospital,
More informationCh ng Hwei Choo, Mun Keong Kwan, Yin Wei Chris Chan. Case presentation. Introduction
Case Report Page 1 of 5 Surgical reduction technique (transpedicle) for unstable thoracolumbar burst fractures with retropulsion resulting in severe spinal canal stenosis: a preliminary case report Ch
More informationTechnique Guide. ARCH Laminoplasty System. Dedicated System for Open-door Laminoplasty.
Technique Guide ARCH Laminoplasty System. Dedicated System for Open-door Laminoplasty. Table of Contents Introduction Overview 2 AO ASIF Principles 4 Indications and Contraindications 5 Product Information
More informationPatient Information MIS LLIF. Lateral Lumbar Interbody Fusion Using Minimally Invasive Surgical Techniques
Patient Information MIS LLIF Lateral Lumbar Interbody Fusion Using Minimally Invasive Surgical Techniques Table of Contents Anatomy of Spine....2 General Conditions of the Spine....4 What is Spondylolisthesis....5
More informationAnterior Corpectomy with Expandable Titanium Cages for Thoraco Lumbar Fractures Audrey Paulzak, MD Pat O'Brien, BS W. George Rusyniak, MD Anthony
Anterior Corpectomy with Expandable Titanium Cages for Thoraco Lumbar Fractures Audrey Paulzak, MD Pat O'Brien, BS W. George Rusyniak, MD Anthony Martino, MD University of South Alabama, Department of
More informationNo greater tragedy can befall on a young adult in this most
SUPPLEMENT TO JAPI may 2012 VOL. 60 19 Operative Management of Spinal Injuries Sajan Hegde * Introduction No greater tragedy can befall on a young adult in this most active period of life than a spinal
More informationAOSpine Severity. This. Disclaimer:
AOSpine Classification and Injury Severity System for Traumatic Fractures of the Thoracolumbarr Spine This is the present form of the classification and injury severity system the AOSpine Knowledge Forum
More informationSpontaneous Resolution of Spinal Canal Deformity After Burst Dispersion Fracture
779 Spontaneous Resolution of Spinal Canal Deformity After Burst Dispersion Fracture T. M. H. Chakera 1 George Bedbrook C. M. Bradley3 We reviewed the records of 8 patients with 30 burst-dispersion spinal
More informationC LINICAL A RTICLE. Abstract. The goals of spinal fracture management. Page 34 / SA ORTHOPAEDIC JOURNAL Spring 2006
Page 34 / SA ORTHOPAEDIC JOURNAL Spring 2006 C LINICAL A RTICLE Thoracolumbar trauma: indications and results of surgical management RN Dunn MBChB (UCT) FCS(SA) Orth, MMed (Orth) Head of Spinal Services,
More informationDr Ajit Singh Moderator Dr P S Chandra Dr Rajender Kumar
BIOMECHANICS OF SPINE Dr Ajit Singh Moderator Dr P S Chandra Dr Rajender Kumar What is biomechanics? Biomechanics is the study of the consequences of application of external force on the spine Primary
More informationThe Role of Surgery in the Treatment of Low Back Pain and Radiculopathy. Christian Etter, MD, Spine Surgeon Zürich, Switzerland
The Role of Surgery in the Treatment of Low Back Pain and Radiculopathy Christian Etter, MD, Spine Surgeon Zürich, Switzerland WW Fusion Volume by Disorder 2004E % Tumor/Trauma 11% Deformity 15% Degeneration
More informationThe Thoracolumbar Injury Classification and Severity
J Neurosurg Spine 20:562 567, 2014 AANS, 2014 Clinical results of patients with thoracolumbar spine trauma treated according to the Thoracolumbar Injury Classification and Severity Score Clinical article
More informationPedicle Subtraction Osteotomy. Case JB. Antonio Castellvi 5/19/2017
Pedicle Subtraction Osteotomy John M. Small MD Florida Orthopedic Institute University South Florida Department Orthopedic Surgery Castellvi Spine May 11, 2017 Case JB 66 y/o male 74 235 lbs Retired police
More informationRiver North Pain Management Consultants, S.C., Axel Vargas, M.D., Regional Anesthesiology and Interventional Pain Management.
River North Pain Management Consultants, S.C., Axel Vargas, M.D., Regional Anesthesiology and Interventional Pain Management. Chicago, Illinois, 60611 Phone: (888) 951-6471 Fax: (888) 961-6471 Clinical
More informationTechnique Guide. ECD Expandable Corpectomy Device. Continuously Expandable Vertebral Body Replacement for Tumour Cases.
Technique Guide ECD Expandable Corpectomy Device. Continuously Expandable Vertebral Body Replacement for Tumour Cases. Table of Contents Introduction Overview 2 AO ASIF Principles 4 Indications and Contraindications
More informationRETROLISTHESIS. Retrolisthesis. is found mainly in the cervical spine and lumbar region but can also be often seen in the thoracic spine
RETROLISTHESIS A retrolisthesis is a posterior displacement of one vertebral body with respect to adjacent vertebrae Typically a vertebra is to be in retrolisthesis position when it translates backward
More informationSaudi Journal of Medicine (SJM)
Saudi Journal of Medicine (SJM) Scholars Middle East Publishers Dubai, United Arab Emirates Website: http://scholarsmepub.com/ ISSN 2518-3389 (Print) ISSN 2518-3397 (Online) A Comparative Study of Thoracolumbar
More informationPRELIMINARY PROGRAMME
MODULE 4 TRAUMA 18-19 June 2018 PRELIMINARY PROGRAMME QUICK FACTS WHEN: 18 & 19 June 2018 WHERE: Strasbourg, France IRCAD/EITS 1 Place de l Hôpital 67091 Strasbourg, France MAXIMUM ATTENDEES: 40 delegates
More informationTreatment Options for Thoracolumbar Spine Fractures
& Treatment Options for Thoracolumbar Spine Fractures Eldin E. Karaiković¹*, Hector O. Pacheco² 1. Assistant Professor, Northwestern University, and Director of the Spine Center and Lead Physician, Orthopaedic
More informationSpinal Cord (2011) 49, & 2011 International Spinal Cord Society All rights reserved /11 $
(2011) 49, 573 579 & 2011 International Society All rights reserved 1362-4393/11 $32.00 www.nature.com/sc ORIGINAL ARTICLE Posterior/anterior combined surgery for thoracolumbar burst fracturesfposterior
More informationThoracolumbar Anterior Compression (TAC) System. Allows distraction, compression, and lateral fixation of the lower thoracic and lumbar spine.
Thoracolumbar Anterior Compression (TAC) System. Allows distraction, compression, and lateral fixation of the lower thoracic and lumbar spine. Technique Guide Instruments and implants approved by the AO
More informationFlexion Distraction Injuries in the Thoracolumbar Spine: An In Vitro Study of the Relation Between Flexion Angle and the Motion Axis of Fracture
Journal of Spinal Disorders & Techniques Vol. 15, No. 2, pp. 139 143 2002 Lippincott Williams & Wilkins, Inc., Philadelphia Flexion Distraction Injuries in the Thoracolumbar Spine: An In Vitro Study of
More informationARCH Laminoplasty System. Dedicated System for Open-door Laminoplasty.
ARCH Laminoplasty System. Dedicated System for Open-door Laminoplasty. Surgical Technique This publication is not intended for distribution in the USA. Instruments and implants approved by the AO Foundation.
More informationECD EXPANDABLE CORPECTOMY DEVICE Continuously Expandable Vertebral Body Replacement for Tumour Cases
ECD EXPANDABLE CORPECTOMY DEVICE Continuously Expandable Vertebral Body Replacement for Tumour Cases Instruments and implants approved by the AO Foundation. This publication is not intended for distribution
More informationProDisc-L Total Disc Replacement. IDE Clinical Study.
ProDisc-L Total Disc Replacement. IDE Clinical Study. A multi-center, prospective, randomized clinical trial. Instruments and implants approved by the AO Foundation Table of Contents Indications, Contraindications
More informationLUMBAR SPINAL STENOSIS
LUMBAR SPINAL STENOSIS Always occurs in the mobile segment. Factors play role in Stenosis Pre existing congenital or developmental narrowing of the lumbar spinal canal Translation of one anatomic segment
More informationVertebroplasty with Calcium Composite Bone Graft Combined with Pedicle Screws Fixation in Thoracolumbar Fractures
Med. J. Cairo Univ., Vol. 84, No. 2, March: 145-151, 2016 www.medicaljournalofcairouniversity.net Vertebroplasty with Calcium Composite Bone Graft Combined with Pedicle Screws Fixation in Thoracolumbar
More informationAdult Spinal Deformity Robert Hart. Dept. Orthopaedics and Rehab OHSU
Adult Spinal Deformity 2010 Robert Hart Dept. Orthopaedics and Rehab OHSU What is Adult Spinal Deformity? Untreated Idiopathic Scoliosis Flat Back Syndrome Adjacent Segment Stenosis Non-Union Degenerative
More informationAn Empirical Study of Osteoporotic Vertebral Fracture Review
An Empirical Study of Osteoporotic Vertebral Fracture Review C-H Li 1, M-C Chang 2, Z-P Ho 3, H-Y Chiu 4 ABSTRACT Osteoporotic vertebral fractures (OVF) are most common injuries seen in elder people. The
More informationThoracic Fracture-Dislocations Without Spinal Cord Injury - Two Cases Reports -
Thoracic Fracture-Dislocations Without Spinal Cord Injury - Two Cases Reports - Dong Eun Shin, MD, Seung Yong Rhee, MD, Hak Sun Kim, MD # Department of Orthopaedic Surgery, Bundang CHA Hospital, College
More informationThe Neurologic Outcome Of Posterior Fixation Of Thoraco- Lumbar Spine Fractures In A Rural Tertiary Care Centre Without Help Of Image Intensifier
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861. Volume 4, Issue 6 (Jan.- Feb. 2013), PP 36-40 The Neurologic Outcome Of Posterior Fixation Of Thoraco- Lumbar
More informationInduction and Maintenance of Lordosis in MultiLevel ACDF Using Allograft. Saad Khairi, MD Jennifer Murphy Robert S. Pashman, MD
Induction and Maintenance of Lordosis in MultiLevel ACDF Using Allograft Saad Khairi, MD Jennifer Murphy Robert S. Pashman, MD Purpose Is lordosis induced by multilevel cortical allograft ACDF placed on
More informationJ of Evolution of Med and Dent Sci/ eissn , pissn / Vol. 4/ Issue 34/ Apr 27, 2015 Page 5797
THE CORRELATION OF RADIOLOGICAL EXAMINATION AND VOLITIONAL VOIDING IN THORACO-LUMBAR FRACTURES AND SPINAL INJURY Mathangi Santhosh Kumar 1, Aastha 2, David Mohan 3, Suranjan Bhattacharji 4 HOW TO CITE
More informationDaniele Vanni 1, Andrea Pantalone 1, Vincenzo Magliani 2, Vincenzo Salini 1, Pedro Berjano 3. Introduction
Original Study Corpectomy and expandable cage replacement versus third generation percutaneous augmentation system in case of vertebra plana: rationale and recommendations Daniele Vanni 1, Andrea Pantalone
More information