Mono-segmental percutaneous screw fixation in the management of AoSpine thoracolumbar type B fracture in patients with ankylosing spondylitis: A new treatment

PurposeTo assess the viability and effectiveness of mono-segmental percutaneous screw fixation in the treatment of unstable type B thoracolumbar fracture due to ankylosing spondylitis.MethodsWe report here all 40 patients treated by mono-segmental screw fixation in this indication, between January 2018 and January 2022, with follow-up at 3 and 9 months. Study variables comprised operating time, length of stay, fusion, stabilization quality, and peri-operative morbidity and mortality.ResultsOne patient showed early displacement of rods caused by technical error. None of the others showed secondary displacement of rods or screws. Mean age was 73 years (range 18–93), mean hospital stay 4.8 days (range 2–15), mean operative time 52 minutes (range 26–95 minutes) and mean estimated blood loss 40 ml. There were 2 deaths caused by intensive care unit complications. All patients except those in intensive care were verticalized within 24 hours after surgery. Parker score was unchanged for each patient before and after surgery and during follow-up.ConclusionMono-segmental percutaneous screw fixation in the treatment of unstable type B thoracolumbar fracture due to ankylosing spondylitis was safe and effective. This study showed that this surgery reduced length of hospital stay, operative time, blood loss and complications compared to open or extended percutaneous surgery, and allowed fast rehabilitation in this vulnerable population.     

Percutaneous dorsal instrumentation for thoracolumbar extension-distraction fractures in patients with ankylosing spinal disorders: a case series

Background contextThoracolumbar extension-distraction fractures are rare injuries mainly restricted to patients suffering from ankylosing spinal disorders. The most appropriate surgical treatment of these unstable spinal injuries remains to be clarified.PurposeTo report on a cohort of 10 patients treated with closed reduction and percutaneous dorsal instrumentation.Study designCase series.Patient sampleTen consecutive patients with ankylosing spinal disorders and thoracolumbar extension-distraction fractures (Type B3 according to the AOSpine Thoracolumbar Spine Injury Classification System).Outcome measuresPostoperative reduction, alignment, and implant position were analyzed by computed tomography. Loss of reduction was assessed on lateral radiographs by using the Cobb technique. Ambulation ability and pain were assessed at follow-up.MethodsMinimally invasive dorsal percutaneous instrumentation was performed in 10 consecutive patients (3 men, 7 women) with a mean age of 81.5 (range 72–90) years between May 2010 and December 2012. The mean postoperative follow-up time was 7.9 (range 4–28) months.ResultsAll 10 patients were treated with closed reduction and dorsal instrumentation; in no case was conversion to an open approach required. The mean operation time was 60.2 (range 32–135) minutes. None of the patients presented neurologic deficits. Cement-augmented screws were implanted in two cases. Sufficient radiographic correction was achieved in all patients; no case of loss of reduction was noted at final follow-up. In one case, complete hardware removal was performed 9 months after the index operation because of persistent back pain at the level of the implant. One patient died of postoperative inferior vena cava obstruction. At discharge, all patients were able to ambulate without the need for crutches or opioid analgesics. At final follow-up, all patients ambulated with full weight bearing; four patients reported persistent back pain.ConclusionsIn fragile patients with ankylosing spinal disorders and thoracolumbar extension-distraction fractures, closed reduction and percutaneous dorsal instrumentation provide a satisfying midterm functional outcome while minimizing perioperative risks compared with conventional dorsoventral procedures.     

胸腰段骨折后正中单切口360°椎管减压椎体间植骨内固定术的临床观察

目的：探讨后正中单切口360。椎管减压椎体间植骨后路椎弓根螺钉内固定术治疗严重胸腰段骨折伴脊髓压迫症的安全性及有效性。方法：自2009年1月至2010年3月,从收治的108例胸腰椎骨折病例中选取硬膜前后方均有骨性压迫的胸腰段骨折5例患者,男2例,女3例;年龄23-72岁;损伤部位：T12 2例,L,2例,k1例。采用后正中单切口经椎弓根入路360°椎管减压椎体间植骨后路椎弓根螺钉内固定术治疗。记录手术时间、术中出血量、术后24hVAS评分及吗啡用量、手术前后神经功能Frankel／ASIA分级。结果：所有病例获得随访,时间12～18个月,平均14．6个月。手术时间3．1~6．2h;术中出血量1000～2300ml;术后24hVAS评分为1～4分;术后24h吗啡用量为28．8—30．8mg。Frankel／ASIA等级：术前B级1例,C级2例,D级1例,E级1例;术后E级4例,1例从B级提高到D级。结论：后正中单切口360°椎管减压椎间植骨椎弓根螺钉内固定术治疗胸腰段严重骨折是安全、有效的,术后疼痛较轻、并发症较少。     

First intention vertebroplasty in fractures within an ankylosed thoracolumbar spinal segment

PurposeTo evaluate the outcome of percutaneous vertebral cementoplasty (PVC) as the first-line treatment for traumatic thoracolumbar fractures within an ankylosed spinal segment.Materials and methodsThirty-one patients (15 men, 16 women; mean age: 79.2 ± 11 [SD] years; age range: 66–95 years) with thoracolumbar fractures within an ankylosed spine segment without neurological impairment treated with PVC were retrospectively evaluated. All patients were controlled at six weeks and one year after PVC. Ankylosing conditions, fractures sites and types, radiological consolidation, spinal complications were assessed. Anterior/posterior vertebral height ratios were measured before and after PVC. Postoperative pain relief and treatment success (radiological fracture consolidation) rates were considered.ResultsThe 31 patients had a total of 39 fractures (19 stable [49%], 20 unstable [51%]) treated with PVC. Primary success rate of PVC (initial fracture consolidation without complication) was 61% (19/31). Seven patients (7/31; 23%) exhibited new fractures, and the secondary success rate of PVC (global fracture consolidation one year after repeat PVC) was 87% (34/39). Global consolidation rates of unstable fractures were 85% (17/20) of treated levels. Pain score was null in 84% patients (26/31) one year after PVC. There were no significant differences between pre-PVC (0.62 ± 0.18 [SD]; range: 0.22–0.88) and post-PVC (0.60 ± 0.18 [SD]; range: 0.35–0.88) vertebral height ratios (P = 0.94).ConclusionPVC conveys a high overall success rate and effectively controls pain in patients with vertebral fractures within ankylosed spine segments.     

Retrospective, propensity score-matched cohort study examining timing of fracture fixation for traumatic thoracolumbar fractures

Abstract The timing of surgery in patients with traumatic thoracic/thoracolumbar fractures, with or without spinal cord injury, remains controversial. The objective of this study was to determine the importance of the timing of surgery for complications and resource utilization following fixation of traumatic thoracic/thoracolumbar fractures. In this retrospective cohort study, the 2003-2008 California Inpatient Databases were searched for patients receiving traumatic thoracic/thoracolumbar fracture fixation. Patients were classified as having early (<72?h) or late (>72?h) surgery. Propensity score modeling produced a matched cohort balanced on age, comorbidity, trauma severity, and other factors. Complications, mortality, length of stay, and hospital charges were assessed. Multivariate logistic regression was used to determine the impact of delayed surgery on in-hospital complications after balancing and controlling for other important factors. Early surgery (<72?h) for traumatic thoracic/thoracolumbar fractures was associated with a significantly lower overall complication rate (including cardiac, thromboembolic, and respiratory complications), and decreased hospital stay. In-hospital charges were significantly lower ($38,120 difference) in the early surgery group. Multivariate analysis identified time to surgery as the strongest predictor of in-hospital complications, although age, medical comorbidities, and injury severity score were also independently associated with increased complications. We reinforce the beneficial impact of early spinal surgery (prior to 72?h) in traumatic thoracic/thoracolumbar fractures to reduce in-hospital complications, hospital stay, and resource utilization. These results provide further support to the emerging literature and professional consensus regarding the importance of early thoracic/thoracolumbar spine stabilization of traumatic fractures to improve patient outcomes and limit hospitalization costs.     

强直性脊柱炎脊柱骨折的治疗

目的 了解强且性脊柱炎(AS)脊柱骨折治疗的特点及注意事项。方法对19例AS脊柱骨折病例进行回顾性分析硬随访,19例中颈椎骨折11例,9例发生在C5-7间;胸腰椎骨折8例,7例为应力骨折,均发生存T10-L2间。二柱骨折16例。9例并发脊髓损伤,其中8例为颈椎骨折。所有19例患者均接受了手术治疗。颈椎骨折或脱位采用了4种手术方式,其中9例做了前路间盘切除或椎体次全切除、椎间值骨加钢板内固定术。胸腰椎骨折也做了4种术式,其中5例的术式为后路长节段固定加前、后联合融合,结果术岳18例患者获得了平均46．4个月的随访。并发脊髓损伤的9例患者,术后8例的神经功能有恢复。18例患者的骨折部位均已骨性愈合一术中并发脊髓损伤2例,因脑血管意外死亡1例,并发肺炎2例。结论 AS脊柱骨折好发于下颈椎及胸腰段,大多为三柱骨折,颈椎骨折并发脊髓损伤的发生率较高。胸腰椎多为应力骨折一手术治疗可使大多数患者的骨折愈合良好,神经功能有不同程度的恢复。对颈椎骨折患者,可采用前路椎体问植骨、钢板内固定的术式;而对于胸腰椎骨折,主张后路长节段固定,前、后联合植骨融合,术中及术后均可能出现并发症,应注意预防或避免。     

Spinal fractures in patients with ankylosing spondylitis

Thirty-one consecutive patients with ankylosing spondylitis and spinal fractures were reviewed. There were 6 women and 25 men with a mean age of 60±11 years; 19 had cervical and 12 had thoracolumbar injuries. Of the patients with cervical fracture, two had an additional cervical fracture and one had an additional thoracic fracture. Three trauma mechanisms were identified: high-energy trauma in 13 patients, low-energy trauma in 13 and insufficiency fracture in 5. One-third of the patients suffered immediate neurological impairment, a further one-third developed neurological impairment before coming for treatment and only one-third remained intact. Two patients with thoracolumbar fractures had deteriorated neurologically due to displacements during surgery at other hospitals. All patients were treated operatively except the two patients with two-level cervical fractures, who were managed in halo vests. In the cervical spine both anterior and posterior approaches were employed. In the thoracolumbar spine the majority of the patients were initially treated using a posterior approach only. Complications were common. Of the 27 patients with neurological compromise, 10 had remained unchanged; 12 had improved one Frankel grade; 4 had improved by two Frankel grades; 1 had improved by four Frankel grades. We conclude that even minor trauma can cause fracture in an ankylosed spine. A high proportion of patients with spinal fractures and ankylosing spondylitis have neurological damage. The risk of late neurological deterioration is substantial. As the condition is very rare and the treatment is demanding and associated with a very high risk of complications, the treatment of these patients should be centralised in special spinal trauma units. A combined approach that stabilises the spine from both sides is probably beneficial.     

Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications

The ankylosed spine is prone to fracture after minor trauma due to its changed biomechanical properties. Although many case reports and small series have been published on patients with ankylosing spondylitis (AS) suffering spine fractures, solid data on clinical outcome are rare. In advanced diffuse idiopathic skeletal hyperostosis (DISH), ossification of spinal ligaments also leads to ankylosis. The prevalence of AS is stable, but since DISH may become more widespread due to its association with age, obesity and type 2 diabetes mellitus, a systematic review of the literature was conducted to increase the current knowledge on treatment, neurological status and complications of patients with preexisting ankylosed spines sustaining spinal trauma. A literature search was performed to obtain all relevant articles concerning the outcome of patients with AS or DISH admitted with spinal fractures. Predefined parameters were extracted from the papers and pooled to study the effect of treatment on neurological status and complications. Ninety-three articles were included, representing 345 AS patients and 55 DISH patients. Most fractures were localized in the cervical spine and resulted from low energy impact. Delayed diagnosis often occurred due to patient and doctor related factors. On admission 67.2% of the AS patients and 40.0% of the DISH patients demonstrated neurologic deficits, while secondary neurological deterioration occurred frequently. Surgical or nonoperative treatment did not alter the neurological prospective for most patients. The complication rate was 51.1% in AS patients and 32.7% in DISH patients. The overall mortality within 3 months after injury was 17.7% in AS and 20.0% in DISH. This review suggests that the clinical outcome of patients with fractures in previously ankylosed spines, due to AS or DISH, is considerably worse compared to the general trauma population. Considering the potential increase in prevalence of DISH cases, this condition may render a new challenge for physicians treating spinal injuries.     

Iatrogenic fractures in ankylosing spondylitis—a report of two cases

Study design: Two cases of intraoperative, iatrogenic cervical spine fractures in patients with ankylosing spondylitis are reported. Objective: To describe the uncommon complication of iatrogenic cervical spine fractures occurring during spine surgery in patients with ankylosing spondylitis. Summary of background data: To our knowledge, this is the first report on this rare complication. Methods: A 39-year-old patient (1) with ankylosing spondylitis was operated on for cervical stenosis due to C1/2 anterolisthesis. Fifteen hours postoperatively, he developed acute quadriplegia. MRI revealed a fracture/dislocation of C6 on C7 and compression of the spinal cord at this level. Revision was performed with decompression and instrumentation from the occiput to T3. A 55-year-old patient (2) with ankylosing spondylitis and thoracic hyperkyphosis underwent a correction procedure consisting of costotransversectomy, anterior cage implantation at T8/9, and posterior instrumentation from T4 to L1. Halo traction was temporarily applied for correction. At the end of the operation, with the patient still under anesthesia, increased mobility of the cervical spine was noticed. Emergent MRI revealed a fracture of the anterior structures of C6/7. Posterior instrumentation from C5 to T1 was then performed. Results: Quadriplegia persisted in patient 1 until his death secondary to further complications. Patient 2 was mobilized without any neurologic deficits. The fracture healed in good alignment. Conclusions: Iatrogenic fractures of the cervical spine during surgery in ankylosing spondylitis patients are a rare but potentially severe complication. Early diagnosis and therapy are necessary before dislocation, cord compression, and subsequent neurologic impairment occur.     

陈旧性胸腰椎骨质疏松性骨折伴后凸畸形手术截骨方式的选择

目的：探讨单节段或双节段经椎弓根椎体截骨（pedicle subtraction osteotomy,PSO）治疗陈旧性胸腰椎骨质疏松性骨折伴后凸畸形的临床疗效。方法：对2015年1月至2017年6月收治的26例陈旧性胸腰椎骨质疏松性骨折伴后凸畸形患者进行回顾性分析,其中男12例,女14例,年龄58~72岁,平均65.6岁。骨折至手术时间（8.2±1.5）年。根据手术方式不同分为单节段PSO组（A组）和双节段PSO组（B组）。记录两组患者围术期资料,通过比较术前及术后1个月影像学数据及术后并发症分析两种术式矫形效果,术前及末次随访采用Oswestry功能障碍指数（Oswestry Disability Index,ODI）和疼痛视觉模拟评分（visual analogue scale,VAS）分析临床疗效。结果：26例患者均获随访,时间6~24个月,平均14.5个月。两组患者手术时间、术中失血量比较差异有统计学意义（P<0.05）,术后总引流量、住院时间比较差异无统计学意义（P>0.05）。单节段PSO组术后矫正角度为（33.3±9.4）°,矫正率为85.3%;双节段PSO组术后矫正角度为（41.0±13.5）°,矫正率为92.7%;两组比较差异有统计学意义（P<0.05）。两组患者术后腰椎前凸角（lumbar lordosis,LL）、矢状面垂直轴（sagittal vertical axis,SVA）及ODI、VAS比较差异无统计学意义（P>0.05）。单节段PSO组出现圆锥损伤1例,经治疗后恢复;双节段PSO组无脊髓损伤并发症。单节段PSO组3例患者术中螺钉松动,双节段PSO组为1例,两组差异有统计学意义（P<0.05）,4例患者均使用骨水泥强化钉道后再次置入螺钉,随访未发现螺钉松动。两组患者均无脊柱前方血管及神经损伤、截骨未融合等并发症。结论：单节段PSO与双节段PSO治疗陈旧性胸腰椎骨质疏松骨折伴后凸畸形均可取得较好的矫形效果和临床疗效。对于矫正角度>40°的患者,双节段PSO可提供更好的矫正角度,且安全性更好,但双节段PSO手术时间更长,术中出血更多。     

多节段非相邻型胸腰椎骨折的手术治疗及分型

目的：探讨多节段非相邻型胸腰椎骨折的手术治疗方式和分型。方法：2005年12月至2008年12月共治疗24例多节段非相邻型胸腰椎骨折患者,其中男16例,女8例;年龄18～63岁,平均36岁。根据ASIA脊髓神经功能损伤分级：A级1例,B级2例,C级2例,D级8例,E级11例。按改进的MNSF分类方法将骨折分为：A型15例,B型9例。骨折范围T6～L4,共累及48个椎体。按ASIA分级评分及影像学资料进行回顾性分析。结果：24例患者均接受手术治疗,无漏诊或延迟诊断。患者术后均获随访,随访时间3～36个月,平均18.3个月。骨折全部获得骨性愈合,骨折椎体高度无明显丢失,无钉棒弯曲、松动或断裂。术前13例脊髓神经损伤患者,术后除1例A级和1例B级无恢复外,其余11例均有1级以上脊髓神经功能恢复,共计A级1例,B级1例,C级1例,D级2例,E级19例。结论：对传统分类方法进行改进以便指导临床治疗,多节段非相邻型胸腰椎骨折的治疗方式应该根据神经损伤情况、骨折稳定性及骨折类型决定。     

两种不同入路治疗无神经症状胸腰椎骨折的病例对照研究

目的:探讨两种不同手术入路治疗无神经症状胸腰椎骨折的临床疗效。方法:自2008年1月至2009年12月,对采用经后正中入路(A组,20例)和椎旁肌间隙入路(B组,20例)治疗的无神经损伤的胸腰椎骨折40例进行回顾性分析,男13例,女27例,年龄26～61岁,平均46岁。所有患者均接受相同的脊柱后路内固定系统(Basis TM)。40例患者平均随访16个月(10～27个月)。分析内容包括手术时间、术中出血量、术后引流量、术后卧床时间、术后24 h及72 h疼痛视觉模拟评分(VAS)、术后Cobb角纠正率、椎体塌陷纠正率。结果:术后患者均无明显并发症,两组患者术后Cobb角纠正率,椎体塌陷纠正率比较无统计学差异;经椎旁肌间隙入路组在手术时间、术中出血量、术后引流量、术后卧床时间、术后24 h及72 h的VAS等方面均优于后正中入路组。结论:经椎旁肌间隙入路治疗无神经症状胸腰椎骨折具有创伤小、出血少、术后恢复快等优点,但有神经症状或椎管内占位超过1/3者慎用此入路。     

Moss Miami内固定及椎管减压治疗胸腰椎骨折的探讨

目的: 探讨MossMiami内固定及椎管减压治疗胸腰椎骨折的临床疗效。方法:对 18例胸腰椎骨折患者应用MossMiami内固定系统进行复位内固定。结果: 18例患者术中均获得良好复位, 平均随访 14个月 (9~20个月), 骨折全部愈合, 无断钉、断棒、内固定松动等情况。结论: MossMiami内固定操作简便,复位满意, 固定牢靠, 是治疗胸腰椎骨折有效治疗方法之一。     

Thoracolumbar spinal fractures associated with ground level falls in the elderly: An analysis of 254,486 emergency department visits

Study designretrospective.ObjectivesTo investigate the epidemiology of elderly (age ≥65 years) patients who presented to the emergency department (ED) in the United States with thoracolumbar (TL) fractures after ground level falls.MethodsUsing the National Emergency Department Sample database, we queried all ED visits in the United States from 2009 through 2012 of elderly patients who presented after ground level falls. We identified patients who sustained TL fractures with and without neurological injury. Resulting data was used to analyze the fracture prevalence, ED and patient characteristics, associated injuries, treatment patterns, inpatient mortality, and hospital charges.ResultsOf the 6,654,526 ED visits in the elderly for ground level falls, 254,486 (3.8%) were associated with a diagnosis of TL fracture. 39% patients had multiple injuries, and upper extremity fractures were the most common associated injuries. Overall, 55.6% were admitted to the hospital. Of those, 77.7% were treated non-operatively, 20.4% were treated with cement augmentation alone, 1.5% were treated with spinal fusion surgery, and 0.4% were treated with spinal decompression alone. The overall rate of inpatient mortality was 2.14%.ConclusionsThis investigation evaluated the epidemiology of elderly patients who presented to the ED in the United States with TL fractures after ground level falls. The study demonstrated a rather high incidence of TL fractures in this patient cohort. As a result, it is important for ED physicians and orthopaedic surgeons to be highly suspicious of TL fractures in elderly patients who sustain low energy trauma. With the continued aging of the population and rising health care costs, future effort ought to focus on fall prevention and increased surveillance for TL injuries in the elderly.     

强直性脊柱炎脊柱骨折的特点及诊断

目的：探讨强直性脊柱炎脊柱骨折的特点，为其临床诊断与治疗提供参考。方法：回顾性分析1994年1月～2001年10月收治的19例强直性脊柱炎脊柱骨折病例。结果：所有19例患者均符合强直性脊柱炎的诊断标准，其中17例骨折前有平均20．6年的强直性脊柱炎病史，另2例方确诊有强直性脊柱炎。19例中15例有外伤史，其中9例为平地跌倒或扭伤，另4例无外伤史。损伤机制：过伸伤7例，垂直挤压伤2例，侧屈损伤l例，屈曲伤1例，4例不详。颈椎骨折11例，9例发生在C5～C7；包括剪力骨折lO例，应力骨折1例。胸腰椎骨折8例，7例为应力骨折，均发生在T10～L2，1例为L3剪力骨折。19例中经椎间隙骨折12例，经椎体骨折7例。三柱骨折16例，骨折伴脱位5例。9例并发脊髓损伤，其中8例为颈椎骨折。外伤至诊断为骨折的间隔时间为10h～7个月，平均29．6d。2例曾被误诊为脊柱结核。结论：导致强直性脊柱炎患者发生脊柱骨折的外力往往较轻。损伤机制多为过伸伤。骨折好发于下颈椎及胸腰段。剪力骨折多发生在颈椎，大多为三柱骨折，容易伴发脱位，脊髓损伤的发生率较高；应力骨折多发生在胸腰段，脊髓损伤不多见。此类骨折多为经椎间隙骨折，易发生诊断延误。     

Management of cervical spinal fractures in ankylosing spondylitis with posterior fixation

STUDY DESIGN: Introduction of a posterior approach for internal fixation of fractures of the ankylosed cervical spine. OBJECTIVES: To evaluate the clinical outcome of patients with ankylosing spondylitis and cervical spinal fractures treated with posterior instrumentation and a collar orthosis. SUMMARY OF BACKGROUND DATA: Cervical spinal fractures in patients with ankylosing spondylitis almost always extend completely across the vertebral segment to include both anterior and posterior elements. Treatment with immobilization alone is often inadequate. Generalized spinal rigidity and exaggerated thoracic kyphosis may hinder anterior exposure. Posterior approaches have been described but generally require postoperative halo immobilization. In the authors' technique for patients whose spinal alignment is relatively well preserved, a posterior exposure is used that achieves three-point internal fixation along multiple segments. The complications associated with halo immobilization are avoided. METHODS: Seven patients with ankylosing spondylitis and fractures of the cervical spine were stabilized with posterior instrumentation. Patients were immobilized after surgery with either a cervical collar or a sternal occipital mandibular immobilizing brace and observed for neurologic outcome, radiographic evidence of bony fusion, and complications. RESULTS: No patient experienced neurologic deterioration with surgery. Two patients died at acute rehabilitative facilities after discharge. Radiographic evidence of fusion was observed in the five patients available for follow-up. CONCLUSIONS: Patients with ankylosing spondylitis and cervical spinal fractures can be adequately treated with lateral mass plating and interspinous wiring of autologous rib graft. Adequate postoperative immobilization can be attained with a cervical collar and does not require a halo vest.     

Fractures of the spine in ankylosing spondylitis. Diagnosis, treatment, and complications

Spinal injuries in patients with previous ankylosing spondylitis were reviewed retrospectively. Fractures frequently occurred as a result of minimal trauma and were associated with severe neurologic deficits in 75% of cases. A characteristic fracture pattern was seen radiographically, and appeared to result from the altered biomechanics of the ankylosed spine. Although the fractures were markedly unstable, nonoperative treatment was uniformly successful in achieving union. The incidence of complications and mortality in this group was significantly lower than that reported in other studies, and the authors attribute this to conservative management within a spinal cord injury unit.     

经皮间接减压内固定术治疗伴有神经损伤的胸腰椎爆裂性骨折

目的探讨后路经皮间接减压内固定术治疗伴有神经损伤的胸腰椎爆裂性骨折的有效性及安全性。方法 2015年6月—2017年6月,共25例伴神经损伤的胸腰椎爆裂性骨折患者接受后路经皮间接减压内固定术治疗。采用Frankel分级评估神经功能等级,采用疼痛视觉模拟量表(VAS)评分评估腰背部疼痛程度。测量并记录术前、术后及末次随访时矢状位Cobb角、伤椎椎体前缘高度百分比、伤椎楔形角、椎管占位率等影像学指标。结果所有患者手术均顺利完成,随访6～24(12.6±5.6)个月,末次随访时所有患者腰背部疼痛症状均明显改善,椎管得到有效减压,神经功能均明显改善,椎体骨折复位愈合,随访无明显丢失,无内固定相关并发症发生。结论后路经皮间接减压内固定术可避免椎管内直接减压,保护脊柱后方结构,减少手术创伤,临床疗效满意,对于伴有不完全神经损伤的胸腰椎爆裂性骨折的治疗是一种微创、安全、有效的选择。     

Spinal cord injury in the setting of traumatic thoracolumbar fracture is not reliably associated with increased risk of associated intra-abdominal injury following blunt trauma: An analysis of a National Trauma Registry database

Purpose: There is a common opinion that spinal fractures usually reflect the substantial impact of injuries and therefore may be used as a marker of significant associated injuries, specifically for intraabdominal injury (IAI). The impact of concomitant spinal cord injury (SCI) with the risk of associated IAI has not been well clarified. The aim of this study was to evaluate the incidence and severity of IAIs in patients suffering from spinal fractures with or without SCI. Methods: A retrospective cohort study using the Israeli National Trauma Registry was conducted. Patients with thoracic, lumbar and thoracolumbar fractures resulting from blunt mechanisms of injury from January 1, 1997 to December 31, 2018 were examined, comparing the incidence, severity and mortality of IAIs in patients with or without SCI. The collected variables included age, gender, mechanism of injury, incidence and severity of the concomitant IAIs and pelvic fractures, abbreviated injury scale, injury severity score, and mortality. Statistical analysis was performed using GraphPad InStat ® Version 3.10, with Chi-square test for independence and two sided Fisher’s exact probability test. Results: Review of the Israeli National Trauma Database revealed a total of 16,878 patients with spinal fractures. Combined thoracic and lumbar fractures were observed in 1272 patients (7.5%), isolated thoracic fractures in 4967 patients (29.4%) and isolated lumbar fractures in 10,639 patients (63.0%). The incidence of concomitant SCI was found in 4.95% (63/1272), 7.65% (380/4967) and 2.50% (266/10639) of these patients, respectively. The overall mortality was 2.5%, proving higher among isolated thoracic fracture patient than among isolated lumbar fracture counterparts (11.3% vs. 4.6%, p < 0.001). Isolated thoracic fractures with SCI were significantly more likely to die than non-SCI counterparts (8.2% vs. 3.1%, p < 0.001). There were no differences in the incidence of IAIs between patients with or without SCI following thoracolumbar fractures overall or in isolated thoracic fractures; although isolated lumbar fractures patients with SCI were more likely to have renal (3.4% vs. 1.6%, p = 0.02) or bowel injuries (2.3% vs. 1.0%, p = 0.04) than the non-SCI counterparts. Conclusion: SCI in the setting of thoracolumbar fracture does not appear to be a marker for associated IAI. However, in a subset of isolated lumbar fractures, SCI patient is associated with increased risks for renal and bowel injury.     

Spinal fractures in patients with Diffuse idiopathic skeletal hyperostosis:A nationwide multi-institution survey

BackgroundDiffuse idiopathic skeletal hyperostosis (DISH) increases the spine's susceptibility to unstable fractures that can cause neurological deterioration. However, the detail of injury is still unclear. A nationwide multicenter retrospective study was conducted to assess the clinical characteristics and radiographic features of spinal fractures in patients with DISH.MethodsPatients were eligible for this study if they 1) had DISH, defined as flowing ossification along the anterolateral aspect of at least four contiguous vertebral bodies, and 2) had an injury in the ankylosing spine. This study included 285 patients with DISH (221 males, 64 females; mean age 75.2 ± 9.5 years).ResultsThe major cause of injury was falling from a standing or sitting position; this affected 146 patients (51.2%). Diagnosis of the fracture was delayed in 115 patients (40.4%). Later neurological deterioration by one or more Frankel grade was seen in 87 patients (30.5%). The following factors were significantly associated with neurological deficits: delayed diagnosis (p = 0.033), injury of the posterior column (p = 0.021), and the presence of ossification of the posterior longitudinal ligament (OPLL) (p < 0.001). The majority of patients (n = 241, 84.6%) were treated surgically, most commonly by conventional open posterior fixation (n = 199, 69.8%). Neurological improvement was seen in 20.0% of the conservatively treated patients, and in 47.0% of the patients treated surgically.ConclusionsMinor trauma could cause spinal fractures in DISH patients. Delayed diagnosis, injury of the posterior column, and the presence of OPLL were significantly associated with neurological deterioration. Patients with neurological deficits or unstable fractures should be treated by fixation surgery.