Research Progress in the Treatment of Thoracolumbar Fractures
Download PDF
$currentUrl="http://$_SERVER[HTTP_HOST]$_SERVER[REQUEST_URI]"

Keywords

Thoracolumbar fracture
Treatment
Surgery
Conservative treatment

DOI

10.26689/jcnr.v6i6.4508

Submitted : 2022-10-26
Accepted : 2022-11-10
Published : 2022-11-25

Abstract

The thoracolumbar junction is the junction of the thoracic and lumbar spine and is subjected to high biomechanical stress. With the rapid development of the society, the morbidity of thoracolumbar spine increases every year. Thoracolumbar fracture may affect the stability of the spine and even result in paralysis via the compression of the spinal cord. As a result of advancements in modern medicine, the theoretical and practical aspects concerning thoracolumbar fracture have made great progress. However, due to the complexity of thoracolumbar fracture, controversy still exists in the treatment strategies and methods for thoracolumbar fractures. In order to provide reference for clinical practice, the research progress in the treatment of thoracolumbar fracture is reviewed in this paper.

References

Reinhold M, Knop C, Beisse R, et al., 2009, Operative Treatment of traumatic Fractures of the Thoracic and Lumbar Spinal Column. Part I: Epidemiology. Unfallchirurg, 112(1): 33–42 + 44–45. http://doi.org/10.1007/s00113-008-1524-7

Hsu JM, Joseph T, Ellis AM, 2003, Thoracolumbar Fracture in Blunt Trauma Patients: Guidelines for Diagnosis and Imaging. Injury, 34(6): 426–33. https://doi.org/10.1016/S0020-1383(02)00368-6

Vaccaro AR, Oner C, Kepler CK, et al., 2013, AOSpine Thoracolumbar Spine Injury Classification System: Fracture Description, Neurological Status, and Key Modifiers. Spine, 38(23): 2028–2037. http://doi.org/10.1097/BRS.0b013e3182a8a381

Wood K, Buttermann G, Mehbod A, et al., 2003, Operative Compared with Nonoperative Treatment of a Thoracolumbar Burst Fracture Without Neurological Deficit. A Prospective, Randomized Study. J Bone Joint Surg Am, 85(5): 773–881. http://doi.org/10.2106/00004623-200305000-00001

Wood KB, Buttermann GR, Phukan R, et al., 2015, Operative Compared with Nonoperative Treatment of a Thoracolumbar Burst Fracture Without Neurological Deficit: A Prospective Randomized Study with Follow-Up at Sixteen to Twenty-Two Years. J Bone Joint Surg Am, 97(1): 3–9. http://doi.org/10.2106/jbjs.N.00226

Siebenga J, Leferink VJ, Segers MJ, et al., 2006, Treatment of Traumatic Thoracolumbar Spine Fractures: A Multicenter Prospective Randomized Study of Operative Versus Nonsurgical Treatment. Spine, 31(25): 2881–2890. htpp://doi.org/10.1097/01.brs.0000247804.91869.1e

Vaccaro AR, Zeiller SC, Hulbert RJ, et al., 2005, The Thoracolumbar Injury Severity Score: A Proposed Treatment Algorithm. J Spinal Disord Tech, 18(3): 209–215.

Kaul R, Chhabra HS, Vaccaro AR, et al., 2017, Reliability Assessment of AOSpine Thoracolumbar Spine Injury Classification System and Thoracolumbar Injury Classification and Severity Score (TLICS) for Thoracolumbar Spine Injuries: Results of a Multicentre Study. Eur Spine J, 26(5): 1470–1476. http://doi.org/10.1007/s00586-016-4663-5

Mattei TA, Hanovnikian J, Dinh DH, 2014, Progressive Kyphotic Deformity in Comminuted Burst Fractures Treated Non-Operatively: The Achilles Tendon of the Thoracolumbar Injury Classification and Severity Score (TLICS). Eur Spine J, 23(11): 2255–2562. http://doi.org/10.1007/s00586-014-3312-0

Schnake KJ, 2014, Expert’s Comment Concerning Grand Rounds Case Entitled “Progressive Kyphotic Deformity In Comminuted Burst Fractures Treated Non-Operatively: The Achilles Tendon of the Thoracolumbar Injury Classification and Severity Score (TLICS)” (T.A. Mattei, J. Hanovnikian, D. Dinh). Eur Spine J, 23(11): 2263–2264. http://doi.org/10.1007/s00586-014-3591-5

Kendler DL, Bauer DC, Davison KS, et al., 2016, Vertebral Fractures: Clinical Importance and Management. Am J Med, 129(2): 221.E1–221.E10. http://doi.org/10.1016/j.amjmed.2015.09.020

Shamji MF, Roffey DM, Young DK, et al., 2014, A Pilot Evaluation of the Role of Bracing in Stable Thoracolumbar Burst Fractures Without Neurological Deficit. J Spinal Disord Tech, 27(7): 370–375. http://doi.org/10.1097/BSD.0b013e31826eacae

Bailey CS, Urquhart JC, Dvorak MF, et al., 2014, Orthosis Versus No Orthosis for the Treatment of Thoracolumbar Burst Fractures Without Neurologic Injury: A Multicenter Prospective Randomized Equivalence Trial. Spine J, 14(11): 2557–2564. http://doi.org/10.1016/j.spinee.2013.10.017

Hitchon PW, Abode-Iyamah K, Dahdaleh NS, et al., 2016, Nonoperative Management in Neurologically Intact Thoracolumbar Burst Fractures: Clinical and Radiographic Outcomes. Spine, 41(6): 483–439. http://doi.org/10.1097/brs.0000000000001253

Panteliadis P, Musbahi O, Muthian S, et al., 2018, A Comparison of Three Different Methods of Fixation in the Management of Thoracolumbar Fractures. Int J Spine Surg, 12(1): 1–7. http://doi.org/10.14444/5001

Ye C, Luo Z, Yu X, et al., 2017, Comparing the Efficacy of Short-Segment Pedicle Screw Instrumentation With and Without Intermediate Screws for Treating Unstable Thoracolumbar Fractures. Medicine, 96(34): e7893. http://doi.org/10.1097/md.0000000000007893

Farrokhi MR, Razmkon A, Maghami Z, et al., 2010, Inclusion of the Fracture Level in Short Segment Fixation of Thoracolumbar Fractures. Eur Spine J, 19(10): 1651–6. http://doi.org/10.1007/s00586-010-1449-z

Dobran M, Nasi D, Brunozzi D, et al., 2016, Treatment of Unstable Thoracolumbar Junction Fractures: Short-Segment Pedicle Fixation with Inclusion of the Fracture Level Versus Long-Segment Instrumentation. Acta Neurochir, 158(10): 1883–1889. http://doi.org/10.1007/s00701-016-2907-0

Guven O, Kocaoglu B, Bezer M, et al., 2009, The Use of Screw at the Fracture Level in the Treatment of Thoracolumbar Burst Fractures. J Spinal Disord Tech, 22(6): 417–421. http://doi.org/10.1097/BSD.0b013e3181870385

Li K, Zhang W, Liu D, et al., 2016, Pedicle Screw Fixation Combined with Intermediate Screw at the Fracture Level for Treatment of Thoracolumbar Fractures: A Meta-Analysis. Medicine, 95(33): e4574. http://doi.org/10.1097/md.0000000000004574

Mahar A, Kim C, Wedemeyer M, et al., 2007, Short-Segment Fixation of Lumbar Burst Fractures Using Pedicle Fixation at the Level of the Fracture. Spine, 32(14): 1503–1507. http://doi.org/10.1097/BRS.0b013e318067dd24

Tong MJ, Tang Q, Wang CG, et al., 2018, Efficacy of Using Intermediate Screws in Short-Segment Fixation for Thoracolumbar Fractures: A Meta-Analysis of Randomized Controlled Trials. World Neurosurg, 110: e271–e280. http://doi.org/10.1016/j.wneu.2017.10.157

Ozbek Z, Ozkara E, Onner H, et al., 2017, Treatment of Unstable Thoracolumbar Fractures: Does Fracture-Level Fixation Accelerate the Bone Healing?. World Neurosurg, 107: 362–370. http://doi.org/10.1016/j.wneu.2017.08.007

Liu L, Gan Y, Zhou Q, et al., 2015, Improved Monosegment Pedicle Instrumentation for Treatment of Thoracolumbar Incomplete Burst Fractures. Biomed Res Int, 2015: 357206. http://doi.org/10.1155/2015/357206

La Maida GA, Luceri F, Ferraro M, et al., 2016, Monosegmental Vs Bisegmental Pedicle Fixation for the Treatment of Thoracolumbar Spine Fractures. Injury, 47: S35–S43. http://doi.org/10.1016/j.injury.2016.07.052

Wei FX, Liu SY, Liang CX, et al., 2010, Transpedicular Fixation in Management of Thoracolumbar Burst Fractures: Monosegmental Fixation Versus Short-Segment Instrumentation. Spine, 35(15): E714–E720. http://doi.org/10.1097/BRS.0b013e3181d7ad1d

Mccormack T, Karaikovic E, Gaines RW, 1994, The Load Sharing Classification of Spine Fractures. Spine, 19(15): 1741–1744. http://doi.org/10.1097/00007632-199408000-00014

Wang H, Jiang J, 2015, How to Use the Load-Sharing Classification of Spine Fractures?. Eur Spine J, 24(2): 406–407. http://doi.org/10.1007/s00586-014-3711-2

Elzinga M, Segers M, Siebenga J, et al., 2012, Inter- and Intraobserver Agreement on the Load Sharing Classification of Thoracolumbar Spine Fractures. Injury, 43(4): 416–422. http://doi.org/10.1016/j.injury.2011.05.013

Dai LY, Jin WJ, 2005, Interobserver and Intraobserver Reliability in the Load Sharing Classification of the Assessment of Thoracolumbar Burst Fractures. Spine, 30(3): 354–358. http://doi.org/10.1097/01.brs.0000152095.85927.24

Sodhi HBS, Savardekar AR, Chauhan RB, et al., 2017, Factors Predicting Long-Term Outcome After Short-Segment Posterior Fixation for Traumatic Thoracolumbar Fractures. Surg Neurol Int, 8: 233.

Liao JC, Fan KF, 2017, Posterior Short-Segment Fixation in Thoracolumbar Unstable Burst Fractures – Transpedicular Grafting or Six-Screw Construct?. Clin Neurol Neurosurg, 153: 56–63. http://doi.org/10.1016/j.clineuro.2016.12.011

Vu TT, Morishita Y, Yugue I, et al., 2015, Radiological Outcome of Short Segment Posterior Instrumentation and Fusion for Thoracolumbar Burst Fractures. Asian Spine J, 9(3): 427–432. http://doi.org/10.4184/asj.2015.9.3.427

Pellise F, Barastegui D, Hernandez-Fernandez A, et al., 2015, Viability and Long-Term Survival of Short-Segment Posterior Fixation in Thoracolumbar Burst Fractures. Spine J, 15(8): 1796–1803. http://doi.org/10.1016/j.spinee.2014.03.012

Avanzi O, Landim E, Meves R, et al., 2010, Thoracolumbar Burst Fracture: Load Sharing Classification and Posterior Instrumentation Failure. Rev Bras Ortop, 45(3): 236–240. http:doi.org/10.1016/s2255-4971(15)30363-3

Aono H, Ishii K, Tobimatsu H, et al., 2017, Temporary Short-Segment Pedicle Screw Fixation for Thoracolumbar Burst Fractures: Comparative Study With or Without Vertebroplasty. Spine J, 17(8): 1113–1119. http://doi.org/10.1016/j.spinee.2017.03.022

Kanna RM, Shetty AP, Rajasekaran S, 2015, Posterior Fixation Including the Fractured Vertebra for Severe Unstable Thoracolumbar Fractures. Spine J, 15(2): 256–264. http://doi.org/10.1016/j.spinee.2014.09.004

Kose KC, Inanmaz ME, Isik C, et al., 2014, Short Segment Pedicle Screw Instrumentation with an Index Level Screw and Cantilevered Hyperlordotic Reduction in the Treatment of Type-A Fractures of the Thoracolumbar Spine. Bone Joint J, 96-B(4): 541–547. http://doi.org/10.1302/0301-620x.96b4.33249

Park SR, Na HY, Kim JM, et al., 2016, More than 5-Year Follow-up Results of Two-Level and Three-Level Posterior Fixations of Thoracolumbar Burst Fractures with Load-Sharing Scores of Seven and Eight Points. Clin Orthop Surg, 8(1): 71–77. http://doi.org/10.4055/cios.2016.8.1.71

De Iure F, Lofrese G, De Bonis P, et al., 2107, Vertebral Body Spread in Thoracolumbar Burst Fractures Can Predict Posterior Construct Failure. Spine J, 18(6): 1005–1013. http://doi.org/10.1016/j.spinee.2017.10.064

Wang ST, Ma HL, Liu CL, et al., 2006, Is Fusion Necessary for Surgically Treated Burst Fractures of the Thoracolumbar and Lumbar Spine?: A Prospective, Randomized Study. Spine, 31(23): 2646–2652; discussion 2653. http://doi.org/10.1097/01.brs.0000244555.28310.40

Chou PH, Ma HL, Wang ST, et al., 2014, Fusion May Not Be a Necessary Procedure for Surgically Treated Burst Fractures of the Thoracolumbar and Lumbar Spines: A Follow-Up of at Least Ten Years. J Bone Joint Surg Am, 96(20): 1724–1731. http://doi.org/10.2106/jbjs.M.01486

Dai LY, Jiang LS, Jiang SD, 2009, Posterior Short-Segment Fixation With or Without Fusion for Thoracolumbar Burst Fractures. A Five to Seven-Year Prospective Randomized Study. J Bone Joint Surg Am, 91(5): 1033–1041. http://doi.org/10.2106/jbjs.H.00510

Jindal N, Sankhala SS, Bachhal V, 2012, The Role of Fusion in the Management of Burst Fractures of the Thoracolumbar Spine Treated by Short Segment Pedicle Screw Fixation: A Prospective Randomised Trial. J Bone Joint Surg Br, 94-B(8): 1101–1106. http://doi.org/10.1302/0301-620x.94b8.28311

Ko SB, Lee SW, 2014, Result of Posterior Instrumentation Without Fusion in the Management of Thoracolumbar and Lumbar Unstable Burst Fracture. J Spinal Disord Tech, 27(4): 189–195. http://doi.org/10.1097/BSD.0b013e31825bfc8e

Tezeren G, Bulut O, Tukenmez M, et al., 2009, Long Segment Instrumentation of Thoracolumbar Burst Fracture: Fusion Versus Nonfusion. J Back Musculoskelet Rehabil, 22(2): 107–112. http://doi.org/10.3233/bmr-2009-0224

Mayer TG, Vanharanta H, Gatchel RJ, et al., 1989, Comparison of CT Scan Muscle Measurements and Isokinetic Trunk Strength in Postoperative Patients. Spine, 14(1): 33–36. http://doi.org/10.1097/00007632-198901000-00006

Zhou Y, 2016, Research Progress of Minimally Invasive Percutaneous Pedicle Screw Fixation in the Treatment of Thoracolumbar Fracture. Chinese Journal of Trauma, 32(5): 464–468. http://doi.org/10.3760/cma.j.issn.1001-8050.2016.05.018

Kirkpatrick JS, 2003, Thoracolumbar Fracture Management: Anterior Approach. J Am Acad Orthop Surg, 11(5): 355–363. http://doi.org/10.5435/00124635-200309000-00008

Esses SI, Botsford DJ, Kostuik JP, 1990, Evaluation of Surgical Treatment for Burst Fractures. Spine, 15(7): 667–673. http://doi.org/10.1097/00007632-199007000-00010

Wood KB, Bohn D, Mehbod A, 2005, Anterior Versus Posterior Treatment of Stable Thoracolumbar Burst Fractures Without Neurologic Deficit: A Prospective, Randomized Study. J Spinal Disord Tech, 18: S15–S23. http://doi.org/10.1097/01.bsd.0000132287.65702.8a

Danisa OA, Shaffrey CI, Jane JA, et al., 1995, Surgical Approaches for the Correction of Unstable Thoracolumbar Burst Fractures: A Retrospective Analysis of Treatment Outcomes. J Neurosurg, 83(6): 977–983. http://doi.org/10.3171/jns.1995.83.6.0977

Hitchon PW, Torner J, Eichholz KM, et al., 2006, Comparison of Anterolateral and Posterior Approaches in the Management of Thoracolumbar Burst Fractures. J Neurosurg Spine, 5(2): 117–125. http://doi.org/10.3171/spi.2006.5.2.117

Sasso RC, Renkens K, Hanson D, et al., 2006, Unstable Thoracolumbar Burst Fractures: Anterior-Only Versus Short-Segment Posterior Fixation. J Spinal Disord Tech, 19(4): 242–248. http://doi.org/10.1097/01.bsd.0000211298.59884.24

Zhu Q, Shi F, Cai W, et al., 2015, Comparison of Anterior Versus Posterior Approach in the Treatment of Thoracolumbar Fractures: A Systematic Review. Int Surg, 100(6): 1124–1133. http://doi.org/10.9738/intsurg-d-14-00135.1

Xu GJ, Li ZJ, Ma JX, et al., 2013, Anterior Versus Posterior Approach for Treatment of Thoracolumbar Burst Fractures: A Meta-Analysis. Eur Spine J, 22(10): 2176–2183. http://doi.org/10.1007/s00586-013-2987-y

Shi R, Liu H, Zhao X, et al., 2011, Anterior Single Segmental Decompression and Fixation for Denis B Type Thoracolumbar Burst Fracture with Neurological Deficiency: Thirty-Four Cases with Average Twenty-Six Month Follow-Up. Spine, 36(9): E598–E605. http://doi.org/10.1097/BRS.0b013e3181e04b8f

Been HD, Poolman RW, Ubags LH, 2004, Clinical Outcome and Radiographic Results After Surgical Treatment of Post-Traumatic Thoracolumbar Kyphosis Following Simple Type A Fractures. Eur Spine J, 13(2): 101–107. http://doi.org/10.1007/s00586-003-0576-1

Antoni M, Charles YP, Walter A, et al., 2015, Fusion Rates of Different Anterior Grafts in Thoracolumbar Fractures. J Spinal Disord Tech, 28(9): E528–E533. http://doi.org/10.1097/BSD.0b013e3182aab2bf

Spiegl U, Hauck S, Merkel P, et al., 2012, 6-Year Follow-Up of Ventral Monosegmental Spondylodesis of Incomplete Burst Fractures of the Thoracolumbar Spine Using Three Cortical Iliac Crest Bone Grafts. Arch Orthop Trauma Surg, 132(10): 1473–1480. http://doi.org/10.1007/s00402-012-1576-6

Geiger F, Kafchitsas K, Rauschmann M, 2011, Anterior Vertebroplasty of Adjacent Levels After Vertebral Body Replacement. Eur Spine J, 20(8): 1385–1392. http://doi.org/10.1007/s00586-011-1766-x

Xu BS, Tang TS, Yang HL, 2009, Long-Term Results of Thoracolumbar and Lumbar Burst Fractures After Short-Segment Pedicle Instrumentation, with Special Reference to Implant Failure and Correction Loss. Orthop Surg, 1(2): 85–93. http://doi.org/10.1111/j.1757-7861.2009.00022.x

Kallemeier PM, Beaubien BP, Buttermann GR, et al., 2008, In Vitro Analysis of Anterior and Posterior Fixation in an Experimental Unstable Burst Fracture Model. J Spinal Disord Tech, 21(3): 216–224. http://doi.org/10.1097/BSD.0b013e31807a2f61

Ould-Slimane M, Damade C, Lonjon G, et al., 2017, Instrumented Circumferential Fusion in Two Stages for Instable Lumbar Fracture: Long-Term Results of a Series of 74 Patients on Sagittal Balance and Functional Outcomes. World Neurosurg, 103: 303–309. http://doi.org/10.1016/j.wneu.2017.04.074

Graillon T, Rakotozanany P, Blondel B, et al., 2014, Circumferential Management of Unstable Thoracolumbar Fractures Using an Anterior Expandable Cage, as an Alternative to an Iliac Crest Graft, Combined with a Posterior Screw Fixation: Results of a Series of 85 Patients. Neurosurg Focus, 37(1): E10. http://doi.org/10.3171/2014.5.FOCUS1452

Briem D, Lehmann W, Ruecker AH, et al., 2004, Factors Influencing the Quality of Life After Burst Fractures of the Thoracolumbar Transition. Arch Orthop Trauma Surg, 124(7): 461–468. http://doi.org/10.1007/s00402-004-0710-5

Schnee CL, Ansell LV, 1997, Selection Criteria and Outcome of Operative Approaches for Thoracolumbar Burst Fractures With and Without Neurological Deficit. J Neurosurg, 86(1): 48–55. http://doi.org/10.3171/jns.1997.86.1.0048

Oprel PP, Tuinebreijer WE, Patka P, et al., 2010, Combined Anterior-Posterior Surgery Versus Posterior Surgery for Thoracolumbar Burst Fractures: A Systematic Review of the Literature. Open Orthop J, 4: 93–100. http://doi.org/10.2174/1874325001004010093

Scholz M, Kandziora F, Tschauder T, et al., 2018, Prospective Randomized Controlled Comparison of Posterior Vs. Posterior-Anterior Stabilization of Thoracolumbar Incomplete Cranial Burst Fractures in Neurological Intact Patients: The RASPUTHINE Pilot Study. European Spine Journal, 27(12): 3016–3024. http://doi.org/10.1007/s00586-017-5356-4

Schmid R, Krappinger D, Seykora P, et al., 2010, PLIF in Thoracolumbar Trauma: Technique and Radiological Results. Eur Spine J, 19(7): 1079–1086. http://doi.org/10.1007/s00586-010-1362-5

Kwon WK, Park WB, Lee GY, et al., 2018, Decompression with Lateral Pediculectomy and Circumferential Reconstruction for Unstable Thoracolumbar Burst Fractures: Surgical Techniques and Results in 18 Patients. World Neurosurg, 120: e53–e62. http://doi.org/10.1016/j.wneu.2018.07.137