Direct medical costs of traumatic thoracolumbar spine fractures

Indian Journal of Physical Medicine and Rehabilitation, 2015

Study design and subjects Cross-sectional descriptive analysis of data of patients with thoracolumbar SCI admitted for rehabilitation at a tertiary care centre from January 2011 to September 2014. Objectives To identify the demographic pattern of TLSCI admitted to this centre. Setting Department of PM&R, King George's Medical University, Lucknow. Methods One hundred and thirty-three consecutive patients of traumatic TLSCI admitted for rehabilitation were included in the study. Detailed demographic, clinical, neurological evaluation as per ASIA scale and radiological assessment done and analyzed. Results Mean age of our sample was 29.62±5 years. There were 21.05% females and 78.95% males. A significant percentage (36.84%) was farmers/labourers, followed by students 26.31%. Majority (67.67%) had fall from height followed by road traffic accidents (21%). Only 3.76% received ambulance for transport and majority (87.22%) of the cases transported by hired four wheelers. Only 18.78% ca...

Neurospine, 2021

World Federation of Neurosurgical Societies (WFNS) Spine Committee is focused on giving a new horizon in light of research and available recent past data. With the increasing advances and day to day variations in surgical approaches, it has become extremely important to develop new guidelines and recommendations. After developing and publishing guidelines about cervical trauma, 1 spinal cord injury, 2 lumbar spinal stenosis, 3 and cervical spondylotic myelopathy, 4 the WFNS Spine Committee has developed recommendations regarding thoracolumbar (TL) spine trauma. This was achieved after a gross literature search between 2010 and 2020 and then holding a consensus meeting. It is an honour for me to be part of this work done during the chairmanship of Prof Zileli, Prof Fornari, and myself. Up-to-date information was reviewed to reach an agreement in the World Federation of Neurosurgical Societies (WFNS) Spine Committee meeting. The first meeting was conducted live in Peshawar in December 2019, and the second meeting was a virtual meeting on June 12, 2020. Both meetings aimed to analyze a preformulated questionnaire through preliminary literature review statements based on the current evidence levels to generate recommendations through a comprehensive voting session. Delphi method was utilized to administer the questionnaire to preserve a high degree of validity. The consensus was achieved when the sum for disagreement or agreement was ≥ 66%. Each consensus point was clearly defined, with evidence strength, recommendation grade, and consensus level provided. The 6 papers you will find in the following pages are guidelines for almost all aspects of the TL fracture. The annual incidence of TL fractures is about 30/100,000 inhabitants, including osteoporotic fractures. There is a trend towards increasing fractures in developed countries, especially due to low velocity falls in the elderly population. The mortality rate after the spinal injury decreases in developed countries due to improvements in motor vehicle safety and traffic regulations. 5 The TL spine is the most frequently injured spinal region in blunt trauma. The potential risk of concomitant injury to the spinal cord, chronic pain, and lifelong disability presents a significant burden on patients and the health service. Due to the range of injury classification systems and varied treatment efficacy, literature on the indications for nonoperative treatment of TL fractures is conflicting. The WFNS Spine Committee was able to formulate numerous key recommendations to guide clinical practice. Although compression-type fractures and stable burst fractures can

The spine journal : official journal of the North American Spine Society, 2014

Adverse events (AEs) in thoracic and lumbar spine fractures are common, but little is known about the type of AEs that are specific to this population. Furthermore, very little is known about the incidence and clinical impact of these AEs on patients in the presence of traumatic spinal cord injury and whether they are treated operatively or nonoperatively. The purpose of this study was to determine primarily the incidence of AEs in patients with thoracic or lumbar spine fractures treated both operatively and nonoperatively and their impact on length of stay (LOS) and secondarily the difference in the incidence of AEs in both neurologically intact and compromised patients. This is an ambispective cohort study at a quaternary referral center. Patients admitted at our institution with thoracic or lumbar fractures from January 2009 to December 2013 were identified. Patients with full Spine Adverse Events Severity System (SAVES) data were included. Number and type of AEs collected from S...

Journal of Ayub Medical College, Abbottabad : JAMC

The purpose of descriptive case series study was to see the conservative and surgical outcome in respect of neurological improvement, sphincter functions and early ambulation in cases of traumatic thoracolumbar injuries in a tertiary care hospital. This was a hospital based prospective study comprised of 50 thoracolumbar injury cases registered during the period of 1 year from September 2005 to September 2006. All cases were evaluated for their clinical features. During initial phase, level and degree of neurological injury was assessed using Frankle grades. Operative and postoperative record with x-rays and MRI were maintained. The follow-up ranged from 6 to 12 months with clinical and radiological assessment. A total of 50 cases were registered, 43 (86%) were males and 7 (14%) were females. Fall was the most common cause of injury (92%). The most common level involved was L1 (46%). The 2nd common site of injury was T12 (12%). The treatment given was conservative in 42.55%, and sur...

Neurospine

To obtain a list of recommendations about clinical and radiological factors affecting outcome in thoraco-lumbar fractures with the aim of helping spine surgeons in daily practice. A systematic literature search in PubMed and Google Scholar database was done from 2010 to 2020 on the topic “thoracolumbar fracture AND radiology AND surgical outcomes” and “thoracolumbar fracture AND radiology AND surgical outcomes.” A total of 58 papers were analyzed and WFNS (World Federation of Neurosurgical Societies) Spine Committee organized 2 consensus meetings to formulate the specific recommendations the first in Peshawar in December 2019 and in a subsequent virtual meeting in June 2020 to reach an agreement. Both meetings utilized the Delphi method to analyze preliminary literature review statements based on the current evidence levels to generate recommendations through a comprehensive voting session. Eight statements were presented and reached the consensus about this topic. A variety of clin...

Journal of Trauma-injury Infection and Critical Care, 2007

Background: Fractures to the thoracolumbar spine (TLS) commonly occur because of major trauma mechanisms. In one series, 4.4% of all patients arriving at a Level I trauma center were diagnosed as having TLS fracture. Approximately 19% to 50% of these fractures in the TLS region will be associated with neurologic damage to the spinal cord. To date there are no randomized studies and only a few prospective studies specifically addressing the subject. The Eastern Association for the Surgery of Trauma organization Practice Management Guidelines committee set out to develop an EBM guideline for the diagnosis of TLS fractures.

European Journal of Orthopaedic Surgery and Traumatology, 2006

This year’s ARGOS International Symposium, held in Paris, January 26–27, focused on thoracolumbar fractures and their assessment.Indeed this topic is of high interest for spine surgeons around the world as the treatment of thoracolumbar is still a matter of debate. As in every year, over 250 attendees gathered at the Salons d’Iéna eager to exchange their ideas and different points of view in the well-established friendly and collegial atmosphere of ARGOS meetings. Together with the faculty members, who covered most of the issues related to this particularly hot topic, they tried to better understand thoracolumbar fractures mechanisms and define therapeutic patterns.Thursday January 26Session 1Starting the first session on Thursday afternoon, Professor Jean-Paul Steib, MD, Strasbourg, France, and Doctor Mark Weidenbaum, MD, New York, USA, discussed the “Choice of approach—Posterior, anterior, double approach—decision criteria”.The indications for surgery when dealing with thoracolumbar

• The thoracolumbar junction is a flexible transition region in the spine, susceptible to injury due to the transfer of kinetic energy. • Clinicians should maintain a high suspicion of injury with thoracolumbar trauma because the incidence of a second vertebral fracture is 10% to 15%, and soft tissue injury may be as high as 50%. • The most common mechanism of abdominal injuries is distraction or seat-belt injuries. Blunt abdominal aortic dissections are associated with distraction-rotational injuries of the thoracolumbar region. • The three-column model of spine injury suggests that when all three columns are injured, surgery may be necessary. Goals of surgery should be restoration of stability, balancing of opposing biomechanical forces, and decompression of the spinal canal with the aim to improve neurologic outcome. • Dorsal decompression via multilevel laminectomy alone after thoracic and thoracolumbar injuries has been shown to be ineffective and should not be performed as an isolated treatment strategy. Pedicle screw fixation provides for instrumentation of vertebrae with fractured or absent laminae, with purchase through all three columns. Increased rigidity by pedicle screw fixation permits fewer segments of fixation. 1-5 A pproximately 160,000 patients a year in the United States suffer traumatic spinal column injuries, with 10% to 30% of them having a concurrent spinal cord injury. 6-9 Although most of these injuries involve cervical (C1-C2) and lumbar (L3-L5) spine fractures, 15% to 20% of traumatic fractures occur at the thoracolumbar junction (T11-L2), whereas 9% to 16% occur in the thoracic spine (T1-T10). 10-13 Paraplegia secondary to thoracic fractures have a first-year mortality rate of 7%, 6,14 illustrating the devastating effects of thoracolumbar trauma. The thoracic spine and thoracolumbar junction presents a unique regional anatomy, with resulting biomechanical characteristics that predispose this area to traumatic injury. Primary goals in thoracolumbar trauma patients are prompt recognition and treatment of associated injuries and expeditious stabilization of the spine and protection of the neural elements. Biomechanics Forces along the long, rigid kyphotic thoracic spine catalyze an abrupt switch into the shorter, mobile lordotic lumbar spine at the thoracolumbar junction (Fig. 30.1). Biomechanically, this transition zone is susceptible to injury and is the most commonly injured portion of the spine. High-energy trauma (motor vehicle accidents) is the leading cause of injury over this region, followed by falls and sports-related injuries. 2-5 Owing to the higher energy mechanisms of injury, additional organ systems are often injured in up to 50% of thoracolumbar trauma patients. 14 The vertebral body is the primary load-bearing structure of the spine, with the intervertebral disk transferring all forces applied to the adjacent vertebral bodies. 15-17 The annulus fibro-sus of the intervertebral disk supports a significant portion of all applied axial and lateral loads and resists tension and shearing. 18 The spinal ligamentous structures are essential in maintaining overall sagittal balance. The posterior longitudinal ligament (PLL) is a relatively weak ligament that provides some restriction to hyperflexion, along with the ligamentum flavum. The thick anterior longitudinal ligament (ALL) functions to resist spinal hyperextension and distraction. 19 The thoracic spine differs from the remainder of the spinal column because it is supported by and maintains articulations with the ribs. The intact rib cage increases the axial load-resisting capacity of the thoracic spine by a magnitude of four. The rib cage and facet articulations limit rotation, and therefore most thoracic spine fractures occur from a flexion or axial compression force vector. 20 Most of stability in flexion is provided by the costovertebral articulations. 21 A significant factor in the degree and extent of fracture character is the rate of force impact loading. 22 The thoracolumbar vertebrae are at an increased risk for developing compression fractures after trauma as a þÿ D o w n l o a d e d f o r A h m e d G ü l (a h m a d _ w a r d 1 5 @ e r d o g a n. e d u. t r) a t R e c e p T a y y i p E r d o a n U n i v e r s i t y f r o m C l i n i c a l K e y. c o m b y E l s e v i e r o n M a r c h 0 6 , 2 0 2 0. For personal use only. No other uses without permission.

International Journal of Orthopaedics Sciences, 2016

Introduction: Approximately 90% of all spinal fractures occur in the thoracic and lumbar spines. In fact, the majority of thoracic and lumbar injuries occur within the region between T11 and L1, commonly referred to as the thoracolumbar junction Methodology: A general physical examination which included nourishment status, height, weight, body mass index, pallor, icterus, cyanosis and clubbing were done. Blood pressure and pulse of the patient was measured and recorded. Local examination of spine were inspected for swelling, any scar, sinus and palpated for tenderness. Results: Commonly fractured vertebra is L1(30%) and then L2 and L3 jointly (23.33%). Least fractured vertebra is L4 Conclusion: The most common mode of injury in these patients with thoracolumbar vertebral fractures was fall from height (80%) followed by road traffic accidents (RTA)

European Journal of Orthopaedic Surgery & Traumatology

Thoracolumbar spine injuries are commonly seen in trauma settings and have a high risk of causing serious morbidity. There can be controversy when it comes to classifying thoracolumbar injuries within the spinal community, but there remains a need to classify, evaluate and manage thoracolumbar fractures. This article aims to provide a guide on classification of thoracolumbar spine injuries using the AO Spine Thoracolumbar Injury Classification System (AO TLICS).