Recommendations for treatment of thoracolumbar spine fractures by the Slovenian spine society
DOI:
https://doi.org/10.6016/ZdravVestn.3140Keywords:
thoraco-lumbar spinal fracture, recommendations, diagnostics, classification, treatmentAbstract
Fractures of the thoracolumbar spine (TLF) represent a wide variety of injuries. Treatment depends on the severity of spinal injury, the general condition of the patient and preexisting spinal pathologies. This complex reasoning is additionally complicated by the unclear and sometimes even conflicting evidence in the literature. Nevertheless, in severe injuries only a fast and well-coordinated chain of interventions from the first care in the field to the final rehabilitation can lead to a satisfactory outcome. Therefore, the recommendations for treatment of TLF of the Slovenian Spine Society include recommendations from care in the field and emergency room, as well as diagnostic procedures and injury classification to surgical treatment, and finally, rehabilitation and post-injury follow-up strategies. A special emphasis is dedicated to the treatment of TLF with spinal cord injury and, due to the growing number of geriatric patients, to the treatment of osteoporotic fractures and fractures of the ankylosed spine. The aim of these recommendations is to set minimum standards for treatment of TLF in Slovenia, grounded in evidence-based medicine and respecting the regional specifics of the healthcare system.
Downloads
References
1. Wood KB, Li W, Lebl DR, Ploumis A. Management of thoracolumbar spine fractures. Spine J. 2014;14(1):145-64.
DOI: 10.1016/j.spinee.2012.10.041
PMID: 24332321
2. Wood KB, Khanna G, Vaccaro AR, Arnold PM, Harris MB, Mehbod AA. Assessment of two thoracolumbar fracture classification systems as used by multiple surgeons. J Bone Joint Surg Am. 2005;87(7):1423-9.
PMID: 15995107
3. Siebenga J, Leferink VJ, Segers MJ, Elzinga MJ, Bakker FC, Haarman HJ, et al. Treatment of traumatic thoracolumbar spine fractures: a multicenter prospective randomized study of operative versus nonsurgical treatment. Spine. 2006;31(25):2881-90.
DOI: 10.1097/01.brs.0000247804.91869.1e
PMID: 17139218
4. Geršak K, Šoštarič M, Komadina R, Strle F, Fras Z. An approach to adopting professional recommendations and clinical guidelines. Zdrav Vestn. 2018;87(7-8):307-10.
DOI: 10.6016/ZdravVestn.2860
5. ATLS Advanced Trauma Life Support: Student Course Manual. Chicago: American College of Surgeon; 2018. pp. 128-46. [cited 2020 Feb 02]. Available from: https://viaaerearcp.files.wordpress.com/2018/02/atls-2018.pdf.
6. Spinal injury: assessment and initial management: NICE Guideline NG41 Methods, evidence and recommendations February 2016. 10th ed. London: National Clinical Guideline Centre; 2016 [cited 2020 Feb 02]. Available from: https://www.nice.org.uk/guidance/ng41/evidence/full-guideline-2358425776.
7. Verheyden AP, Spiegl UJ, Ekkerlein H, Gercek E, Hauck S, Josten C, et al. Treatment of Fractures of the Thoracolumbar Spine: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU). Global Spine J. 2018;8(2):34S-45S.
DOI: 10.1177/2192568218771668
PMID: 30210959
8. Arnold PM, Anderson PA, Chi JH, Dailey AT, Dhall SS, Eichholz KM, et al. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Evaluation and Treatment of Patients With Thoracolumbar Spine Trauma: pharmacological Treatment. Neurosurgery. 2019;84(1):E36-8.
DOI: 10.1093/neuros/nyy371
PMID: 30202962
9. Poonnoose PM, Ravichandran G, McClelland MR. Missed and mismanaged injuries of the spinal cord. J Trauma. 2002;53(2):314-20.
DOI: 10.1097/00005373-200208000-00021
PMID: 12169940
10. Meldon SW, Moettus LN. Thoracolumbar spine fractures: clinical presentation and the effect of altered sensorium and major injury. J Trauma. 1995;39(6):1110-4.
DOI: 10.1097/00005373-199512000-00017
PMID: 7500403
11. Holmes JF, Panacek EA, Miller PQ, Lapidis AD, Mower WR. Prospective evaluation of criteria for obtaining thoracolumbar radiographs in trauma patients. J Emerg Med. 2003;24(1):1-7.
DOI: 10.1016/S0736-4679(02)00659-5
PMID: 12554032
12. Kepler CK, Vaccaro AR, Schroeder GD, Koerner JD, Vialle LR, Aarabi B, et al. The Thoracolumbar AOSpine Injury Score. Global Spine J. 2016;6(4):329-34.
DOI: 10.1055/s-0035-1563610
PMID: 27190734
13. Vaccaro AR, Lehman RA, Hurlbert RJ, Anderson PA, Harris M, Hedlund R, et al. A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine. 2005;30(20):2325-33.
DOI: 10.1097/01.brs.0000182986.43345.cb
PMID: 16227897
14. Spiegl UJ, Fischer K, Schmidt J, Schnoor J, Delank S, Josten C, et al. The Conservative Treatment of Traumatic Thoracolumbar Vertebral Fractures. Dtsch Arztebl Int. 2018;115(42):697-704.
DOI: 10.3238/arztebl.2018.0697
PMID: 30479250
15. Spiegl UJ, Jarvers JS, Glasmacher S, Heyde CE, Josten C. Release of moveable segments after dorsal stabilization : impact on affected discs. Unfallchirurg. 2016;119(9):747-54.
DOI: 10.1007/s00113-014-2675-3
PMID: 25348505
16. AO Spine Injury Classification Systems. Davos: AO Foundation; 2020 [cited 2020 Feb 02]. Available from: https://aospine.aofoundation.org/clinical-library-and-tools/ao-spine-classification-systems.
17. Verlaan JJ, Diekerhof CH, Buskens E, van der Tweel I, Verbout AJ, Dhert WJ, et al. Surgical treatment of traumatic fractures of the thoracic and lumbar spine: a systematic review of the literature on techniques, complications, and outcome. Spine. 2004;29(7):803-14.
DOI: 10.1097/01.BRS.0000116990.31984.A9
PMID: 15087804
18. Waqar M, Van-Popta D, Barone DG, Bhojak M, Pillay R, Sarsam Z. Short versus long-segment posterior fixation in the treatment of thoracolumbar junction fractures: a comparison of outcomes. Br J Neurosurg. 2017;31(1):54-7.
DOI: 10.1080/02688697.2016.1206185
PMID: 27387358
19. Grossbach AJ, Dahdaleh NS, Abel TJ, Woods GD, Dlouhy BJ, Hitchon PW. Flexion-distraction injuries of the thoracolumbar spine: open fusion versus percutaneous pedicle screw fixation. Neurosurg Focus. 2013;35(2):E2.
DOI: 10.3171/2013.6.FOCUS13176
PMID: 23905953
20. Pizones J, Zúñiga L, Sánchez-Mariscal F, Alvarez P, Gómez-Rice A, Izquierdo E. MRI study of post-traumatic incompetence of posterior ligamentous complex: importance of the supraspinous ligament. Prospective study of 74 traumatic fractures. Eur Spine J. 2012;21(11):2222-31.
DOI: 10.1007/s00586-012-2403-z
PMID: 22722921
21. El Tecle NE, Abode-Iyamah KO, Hitchon PW, Dahdaleh NS. Management of spinal fractures in patients with ankylosing spondylitis. Clin Neurol Neurosurg. 2015;139:177-82.
DOI: 10.1016/j.clineuro.2015.10.014
PMID: 26513429
22. Özbek Z, Özkara E, Önner H, BaŞ G, Erman İC, Özen H, et al. Treatment of Unstable Thoracolumbar Fractures: Does Fracture-Level Fixation Accelerate the Bone Healing? World Neurosurg. 2017;107:362-70.
DOI: 10.1016/j.wneu.2017.08.007
PMID: 28803178
23. Kulkarni AG, Dhruv AN, Bassi AJ. Should we cross the cross-links? Spine. 2013;38(18):E1128-34.
DOI: 10.1097/BRS.0b013e31829af99f
PMID: 23680838
24. Alizadeh M, Kadir MR, Fadhli MM, Fallahiarezoodar A, Azmi B, Murali MR, et al. The use of X-shaped cross-link in posterior spinal constructs improves stability in thoracolumbar burst fracture: a finite element analysis. J Orthop Res. 2013;31(9):1447-54.
DOI: 10.1002/jor.22376
PMID: 23640802
25. Ahuja CS, Wilson JR, Nori S, Kotter MR, Druschel C, Curt A, et al. Traumatic spinal cord injury. Nat Rev Dis Primers. 2017;3(1):17018.
DOI: 10.1038/nrdp.2017.18
PMID: 28447605
26. Fehlings MG, Tetreault LA, Wilson JR, Aarabi B, Anderson P, Arnold PM, et al. A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury and Central Cord Syndrome: Recommendations on the Timing (≤24 Hours Versus >24 Hours) of Decompressive Surgery. Global Spine J. 2017;7(3):195S-202S.
DOI: 10.1177/2192568217706367
PMID: 29164024
27. Jug M, Kejžar N, Cimerman M, Bajrović FF. Window of opportunity for surgical decompression in patients with acute traumatic cervical spinal cord injury. J Neurosurg Spine. 2019:1-9.
DOI: 10.3171/2019.10.SPINE19888
PMID: 31881537
28. Wutte C, Klein B, Becker J, Mach O, Panzer S, Strowitzki M, et al. Earlier Decompression (< 8 Hours) Results in Better Neurological and Functional Outcome after Traumatic Thoracolumbar Spinal Cord Injury. J Neurotrauma. 2019;36(12):2020-7.
DOI: 10.1089/neu.2018.6146
PMID: 30489193
29. Wutte C, Becker J, Klein B, Mach O, Panzer S, Stuby FM, et al. Early Decompression (<8 Hours) Improves Functional Bladder Outcome and Mobility After Traumatic Thoracic Spinal Cord Injury. World Neurosurg. 2020;134:e847-54.
DOI: 10.1016/j.wneu.2019.11.015
PMID: 31715410
30. Westerveld LA, Verlaan JJ, Oner FC. Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications. Eur Spine J. 2009;18(2):145-56.
DOI: 10.1007/s00586-008-0764-0
PMID: 18791749
31. Teunissen FR, Verbeek BM, Cha TD, Schwab JH. Spinal cord injury after traumatic spine fracture in patients with ankylosing spinal disorders. J Neurosurg Spine. 2017;27(6):709-16.
DOI: 10.3171/2017.5.SPINE1722
PMID: 28984512
32. Josten C, Schmidt C, Spiegl U. Osteoporotic vertebral body fractures of the thoracolumbar spine. Diagnostics and therapeutic strategies. Chirurg. 2012;83(10):866-74.
DOI: 10.1007/s00104-012-2338-2
PMID: 23051984
33. Kocjan T. Osteoporoza. In: Komadina R, Tomaževič M. Geriatrična travmatologija. 1st ed. Ljubljana: Slovensko zdravniško društvo; 2018. pp. 210-9.
34. Schnake KJ, Blattert TR, Hahn P, Franck A, Hartmann F, Ullrich B, et al.; Spine Section of the German Society for Orthopaedics and Trauma. Classification of Osteoporotic Thoracolumbar Spine Fractures: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU). Global Spine J. 2018;8(2):46S-9S.
DOI: 10.1177/2192568217717972
PMID: 30210960
35. Genant HK, Wu CY, van Kuijk C, Nevitt MC. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. 1993;8(9):1137-48.
DOI: 10.1002/jbmr.5650080915
PMID: 8237484
36. Blattert TR, Schnake KJ, Gonschorek O, Gercek E, Hartmann F, Katscher S, et al.; Spine Section of the German Society for Orthopaedics and Trauma. Nonsurgical and Surgical Management of Osteoporotic Vertebral Body Fractures: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU). Global Spine J. 2018;8(2):50S-5S.
DOI: 10.1177/2192568217745823
PMID: 30210962
37. Alpantaki K, Dohm M, Korovessis P, Hadjipavlou AG. Surgical options for osteoporotic vertebral compression fractures complicated with spinal deformity and neurologic deficit. Injury. 2018;49(2):261-71.
DOI: 10.1016/j.injury.2017.11.008
PMID: 29150315
38. Movrin I. Osteoporotični zlomi vretenc. In: Geriatrična travmatologija. 1st ed. Ljubljana: Slovensko zdravniško društvo; 2018. pp. 66-77.
39. Goldstein CL, Chutkan NB, Choma TJ, Orr RD. Management of the elderly with vertebral compression fractures. Neurosurgery. 2015;77(4):S33-45.
DOI: 10.1227/NEU.0000000000000947
PMID: 26378356
40. Savage JW, Schroeder GD, Anderson PA. Vertebroplasty and kyphoplasty for the treatment of osteoporotic vertebral compression fractures. J Am Acad Orthop Surg. 2014;22(10):653-64.
DOI: 10.5435/JAAOS-22-10-653
PMID: 25281260
41. Burns AS, Marino RJ, Kalsi-Ryan S, Middleton JW, Tetreault LA, Dettori JR, et al. Type and Timing of Rehabilitation Following Acute and Subacute Spinal Cord Injury: A Systematic Review. Global Spine J. 2017;7(3):175S-94S.
DOI: 10.1177/2192568217703084
PMID: 29164023
42. Axelsson P, Strömqvist B. Can implant removal restore mobility after fracture of the thoracolumbar segment? Acta Orthop. 2016;87(5):511-5.
DOI: 10.1080/17453674.2016.1197531
PMID: 27339484
43. Smits AJ, den Ouden L, Jonkergouw A, Deunk J, Bloemers FW. Posterior implant removal in patients with thoracolumbar spine fractures: long-term results. Eur Spine J. 2017;26(5):1525-34.
DOI: 10.1007/s00586-016-4883-8
PMID: 27864682
44. Reith G, Schmitz-Greven V, Hensel KO, Schneider MM, Tinschmann T, Bouillon B, et al. Metal implant removal: benefits and drawbacks—a patient survey. BMC Surg. 2015;15(1):96.
DOI: 10.1186/s12893-015-0081-6
PMID: 26250649
45. Shah LM, Ross JS. Imaging of spine trauma. Neurosurgery. 2016;79(5):626-42.
DOI: 10.1227/NEU.0000000000001336
PMID: 27404215
46. Aimetti AA, Kirshblum S, Curt A, Mobley J, Grossman RG, Guest JD. Natural history of neurological improvement following complete (AIS A) thoracic spinal cord injury across three registries to guide acute clinical trial design and interpretation. Spinal Cord. 2019;57(9):753-62.
DOI: 10.1038/s41393-019-0299-8
PMID: 31182786
47. Bliemel C, Lefering R, Buecking B, Frink M, Struewer J, Krueger A, et al. Early or delayed stabilization in severely injured patients with spinal fractures? Current surgical objectivity according to the Trauma Registry of DGU: treatment of spine injuries in polytrauma patients. J Trauma Acute Care Surg. 2014;76(2):366-73.
DOI: 10.1097/TA.0b013e3182aafd7a
PMID: 24458043
48. Rustagi T, Drazin D, Oner C, York J, Schroeder GD, Vaccaro AR, et al. Fractures in Spinal Ankylosing Disorders: A Narrative Review of Disease and Injury Types, Treatment Techniques, and Outcomes. J Orthop Trauma. 2017;31:S57-74.
DOI: 10.1097/BOT.0000000000000953
PMID: 28816877
Downloads
Published
Issue
Section
License
The Author transfers to the Publisher (Slovenian Medical Association) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Slovenian Medical Association) has the right to transfer the rights of acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
