Seminars in Spine Surgery
Volume 22, Issue 1 , Pages 20-32 , March 2010

Surgical Management of Thoracolumbar Fractures: Rationale for Short Fixation

  • Justin S. Smith, MD, PhD

      Affiliations

    • Department of Neurosurgery, University of Virginia, Charlottesville, VA
    • ,
  • Vincent Arlet, MD

      Affiliations

    • Department of Neurosurgery, University of Virginia, Charlottesville, VA
    • Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
    • Corresponding Author InformationAddress reprint requests to Vincent Arlet, MD, Division of Scoliosis and Spine Surgery, Department of Orthopedic Surgery, University of Virginia, 400 Ray C. Hunt Drive, Suite 330, Charlottesville, VA 22903

References 

  1. Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine. 1983;8:817–831
  2. Magerl F, Aebi M, Gertzbein SD, et al. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J. 1994;3:184–201
  3. Vaccaro AR, Zeiller SC, Hulbert RJ, et al. The thoracolumbar injury severity score: a proposed treatment algorithm. J Spinal Disord Tech. 2005;18:209–215
  4. Vaccaro AR, Lim MR, Hurlbert RJ, et al. Surgical decision making for unstable thoracolumbar spine injuries: results of a consensus panel review by the Spine Trauma Study Group. J Spinal Disord Tech. 2006;19:1–10
  5. Alanay A, Yazici M, Acaroglu E, et al. Course of nonsurgical management of burst fractures with intact posterior ligamentous complex: an MRI study. Spine. 2004;29:2425–2431
  6. van der Roer N, de Lange ES, Bakker FC, et al. Management of traumatic thoracolumbar fractures: a systematic review of the literature. Eur Spine J. 2005;14:527–534
  7. Cantor JB, Lebwohl NH, Garvey T, et al. Nonoperative management of stable thoracolumbar burst fractures with early ambulation and bracing. Spine. 1993;18:971–976
  8. Chow GH, Nelson BJ, Gebhard JS, et al. Functional outcome of thoracolumbar burst fractures managed with hyperextension casting or bracing and early mobilization. Spine. 1996;21:2170–2175
  9. Mumford J, Weinstein JN, Spratt KF, et al. Thoracolumbar burst fractures (The clinical efficacy and outcome of nonoperative management). Spine. 1993;18:955–970
  10. Shen WJ, Shen YS. Nonsurgical treatment of three-column thoracolumbar junction burst fractures without neurologic deficit. Spine. 1999;24:412–415
  11. Tropiano P, Huang RC, Louis CA, et al. Functional and radiographic outcome of thoracolumbar and lumbar burst fractures managed by closed orthopaedic reduction and casting. Spine. 2003;28:2459–2465
  12. Reid DC, Hu R, Davis LA, et al. The nonoperative treatment of burst fractures of the thoracolumbar junction. J Trauma. 1988;28:1188–1194
  13. Shen WJ, Liu TJ, Shen YS. Nonoperative treatment versus posterior fixation for thoracolumbar junction burst fractures without neurologic deficit. Spine. 2001;26:1038–1045
  14. Denis F, Armstrong GW, Searls K, et al. Acute thoracolumbar burst fractures in the absence of neurologic deficit: a comparison between operative and nonoperative treatment. Clin Orthop Relat Res. 1984;189:142–149
  15. Hartman MB, Chrin AM, Rechtine GR. Non-operative treatment of thoracolumbar fractures. Paraplegia. 1995;33:73–76
  16. Hitchon PW, Torner JC, Haddad SF, et al. Management options in thoracolumbar burst fractures. Surg Neurol. 1998;49:619–626discussion 626-617
  17. Knight RQ, Stornelli DP, Chan DP, et al. Comparison of operative versus nonoperative treatment of lumbar burst fractures. Clin Orthop Relat Res. 1993;293:112–121
  18. Seybold EA, Sweeney CA, Fredrickson BE, et al. Functional outcome of low lumbar burst fractures (A multicenter review of operative and nonoperative treatment of L3-L5). Spine. 1999;24:2154–2161
  19. Weinstein JN, Collalto P, Lehmann TR. Thoracolumbar “burst” fractures treated conservatively: a long-term follow-up. Spine. 1988;13:33–38
  20. Willen J, Lindahl S, Nordwall A. Unstable thoracolumbar fractures (A comparative clinical study of conservative treatment and Harrington instrumentation). Spine. 1985;10:111–122
  21. Wood K, Buttermann G, Mehbod A, et al. Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit: a prospective, randomized study. J Bone Joint Surg Am. 2003;85-A:773–781
  22. Siebenga J, Leferink VJ, Segers MJ, et al. Treatment of traumatic thoracolumbar spine fractures: a multicenter prospective randomized study of operative versus nonsurgical treatment. Spine. 2006;31:2881–2890
  23. Kramer DL, Rodgers WB, Mansfield FL. Transpedicular instrumentation and short-segment fusion of thoracolumbar fractures: a prospective study using a single instrumentation system. J Orthop Trauma. 1995;9:499–506
  24. McNamara MJ, Stephens GC, Spengler DM. Transpedicular short-segment fusions for treatment of lumbar burst fractures. J Spinal Disord. 1992;5:183–187
  25. Muller U, Berlemann U, Sledge J, et al. Treatment of thoracolumbar burst fractures without neurologic deficit by indirect reduction and posterior instrumentation: bisegmental stabilization with monosegmental fusion. Eur Spine J. 1999;8:284–289
  26. Sasso RC, Renkens K, Hanson D, et al. Unstable thoracolumbar burst fractures: anterior-only versus short-segment posterior fixation. J Spinal Disord Tech. 2006;19:242–248
  27. van der Roer N, de Bruyne MC, Bakker FC, et al. Direct medical costs of traumatic thoracolumbar spine fractures. Acta Orthop. 2005;76:662–666
  28. Yi L, Jingping B, Gele J, et al. Operative versus non-operative treatment for thoracolumbar burst fractures without neurological deficit. Cochrane Database Syst Rev. 2006;18:CD005079
  29. Knop C, Bastian L, Lange U, et al. Complications in surgical treatment of thoracolumbar injuries. Eur Spine J. 2002;11:214–226
  30. Beisse R. Endoscopic surgery on the thoracolumbar junction of the spine. Eur Spine J. 2006;15:687–704
  31. Khoo LT, Beisse R, Potulski M. Thoracoscopic-assisted treatment of thoracic and lumbar fractures: a series of 371 consecutive cases. Neurosurgery. 2002;51:S104–S117
  32. Kim DH, Jahng TA, Balabhadra RS, et al. Thoracoscopic transdiaphragmatic approach to thoracolumbar junction fractures. Spine J. 2004;4:317–328
  33. Schultheiss M, Hartwig E, Kinzl L, et al. Thoracolumbar fracture stabilization: comparative biomechanical evaluation of a new video-assisted implantable system. Eur Spine J. 2004;13:93–100
  34. Schultheiss M, Kinzl L, Claes L, et al. Minimally invasive ventral spondylodesis for thoracolumbar fracture treatment: surgical technique and first clinical outcome. Eur Spine J. 2003;12:618–624
  35. Benson DR, Burkus JK, Montesano PX, et al. Unstable thoracolumbar and lumbar burst fractures treated with the AO fixateur interne. J Spinal Disord. 1992;5:335–343
  36. Esses SI, Botsford DJ, Wright T, et al. Operative treatment of spinal fractures with the AO internal fixator. Spine. 1991;16:S146–S150
  37. McLain RF, Sparling E, Benson DR. Early failure of short-segment pedicle instrumentation for thoracolumbar fractures: a preliminary report. J Bone Joint Surg. 1993;75:162–167
  38. Mahar A, Kim C, Wedemeyer M, et al. Short-segment fixation of lumbar burst fractures using pedicle fixation at the level of the fracture. Spine. 2007;32:1503–1507
  39. Wang ST, Ma HL, Liu CL, et al. Is fusion necessary for surgically treated burst fractures of the thoracolumbar and lumbar spine?: a prospective, randomized study. Spine. 2006;31:2646–2652discussion 2653
  40. Bracken MB, Collins WF, Freeman DF, et al. Efficacy of methylprednisolone in acute spinal cord injury. JAMA. 1984;251:45–52
  41. Bracken MB, Shepard MJ, Collins WF, et al. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal cord injury (Results of the Second National Acute Spinal Cord Injury Study). N Engl J Med. 1990;322:1405–1411
  42. Bracken MB, Shepard MJ, Holford TR, et al. Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury (Results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. National Acute Spinal Cord Injury Study). JAMA. 1997;277:1597–1604
  43. Hurlbert RJ. Strategies of medical intervention in the management of acute spinal cord injury. Spine. 2006;31:S16–S21discussion S36
  44. Nesathurai S. Steroids and spinal cord injury: revisiting the NASCIS 2 and NASCIS 3 trials. J Trauma. 1998;45:1088–1093
  45. Pollard ME, Apple DF. Factors associated with improved neurologic outcomes in patients with incomplete tetraplegia. Spine. 2003;28:33–39
  46. Shapiro SA. Methylprednisolone for spinal cord injury. J Neurosurg. 1992;77:324;author reply 325-327
  47. Molano Mdel R, Broton JG, Bean JA, et al. Complications associated with the prophylactic use of methylprednisolone during surgical stabilization after spinal cord injury. J Neurosurg. 2002;96:267–272
  48. Beringer W, Potts E, Khairi S, et al. Percutaneous pedicle screw instrumentation for temporary internal bracing of nondisplaced bony Chance fractures. J Spinal Disord Tech. 2007;20:242–247
  49. Kreichati GE, Kassab FN, Kharrat KE. Herniated intervertebral disc associated with a lumbar spine dislocation as a cause of Cauda Equina syndrome: a case report. Eur Spine J. 2006;15:1015–1018
  50. Rizzolo SJ, Piazza MR, Cotler JM, et al. Intervertebral disc injury complicating cervical spine trauma. Spine. 1991;16:S187–S189
  51. McCormack T, Karaikovic E, Gaines RW. The load sharing classification of spine fractures. Spine. 1994;19:1741–1744
  52. Alobaid A, Arlet V, Ouellet J, et al. Surgical technique (Technical notes on reduction of thoracic spine fracture dislocation). Can J Surg. 2006;49:131–134

PII: S1040-7383(09)00081-1

doi: 10.1053/j.semss.2009.10.004

Seminars in Spine Surgery
Volume 22, Issue 1 , Pages 20-32 , March 2010

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