흉 ·요추 분쇄골절 진단을 위한 일반 방사선촬영인자 비교

김인병,황태식,장석준,이한식 대한응급의학회 1997 대한응급의학회지 Vol.8 No.2

As regard to the treatment modality and its prognosis following the treatment, there are some differences between the thoracolumbar compression fracture and bursting fracture. If bursting fracture is accompanied by nerve injury, especially if the fracture fragment is compressing the spinal cord, it reported that decompression with early surgical intervention would achieve a much better prognosis. Therefore, the authors tried to suggest an overall statistics on the patient`s age, mechanism of injury and injured site and to compare the sensitivity of tools used in diagnosing bursting fracture radiologically, as well as the sensitivity of posterior vertebral body angle, which is used in diagnosing subtle bursting fracture. Three hundred forty three patients admitted to emergency center of Yongdong Severance Hospital with a thoracolumbar fracture from 1992. Jan. to 1994. Dec. Of the 343 patients, minor fracture and those with insufficient X-ray films and clinical notes were excluded from the study. The study was done with 199 patients in retrospective method. All the 199 patients had plain X-ray and computed tomography taken. the results were as follows: 1. The male to female ratio was 114 to 85 with average age being 47.1 years old(14-93 years old). 2. The mechanisms of injury were falling down, traffic accident, slipped down, sprain and contusional injury in the order written. 3. There were 67 cases of compression fracture and 132 cases of bursting fracture. 157 cases had 1 level injury in the order of L1, T12, and L2,33 cases had 2 level injury, and 8 cases were injured in 3 level of the spine. 4. Of the factors determining the radiological diagnosis of bursting fracture, the disruption of posterior cortical line had the highest sensitivity. 5. Of the 45 cases of 1 level injured subtle bursting fracture, those with posterior vertebral body angle of more than 100 degree radiographically had a sensitivity of 82%. Of the thoracolumbar fractured patient admitted to the emergency room, searching for disruption of posterior cortical Tine??> in plain film helped in diagnosing bursting fracture, and calculating the posterior vertebral body angle helped in determining whether further computed tomography was needed in subtle bursting fracture.

흉·요추 골절 환자 40례에 대한 임상적 고찰

오희홍,김일두,변재영,안수기,Oh, Hei-hong,Kim, Il-du,Byun, Jae-yung,Ahn, Soo-gi 대한침구의학회 2001 대한침구의학회지 Vol.18 No.2

Objectives : This study was performed to evaluate the clinical results of the thoracolumbar fracture patients treated with oriental medical methods. Methods : We reviewed 40 patients of thoracolumbar fracture, who were hospitalized at WonKwang University KwangJu Oriental Medical Hospital and treated by oriental medical methods. We classified thoracolumbar fracture according to three column theory and then analyzed the cause of injury, sex-age distribution, treatment, and etc.. Results : 1. The distribution showed female predominance(72.5%) in sex and 70age-bracket predominance in age. 2. In the distribution of causes, the largest group was "lifting heavy objects"(40%) and the next was "slip down"(37.5%). 3. In the duration of symptoms, the largest group was the group of "acutest" (40%). 4. The distribution of injured level was L1 body the most(20%). 5. In classification of fracture, "compression fracture" was the most(57.5%) and the next was "burst fracture", "unstable fracture" in order. 7. Therapeutic effects above "fair" were 37 cases(92.5%). 8. The higher grade of clinical symptoms is, the lower therapeutic effect is. 9. In the distribution of treatment results according to classification of fracture, both the compression fracture and the burst fracture were almost same high and the unstable fracture is relatively lower than them. Conclusions : The result to treating thoracolumbar fracture by oriental medical methods is satisfactory.

축상 및 시상면 재건 전산화 단층촬영 영상을 이용한 흉요추부 방출성 골절의 척추강내 골편 감입 측정

김진호,전창훈,정남수,임오경,노형래 대한척추외과학회 2011 대한척추외과학회지 Vol.18 No.3

Study Design: A retrospective study. Objectives: The aim of this study was to examine the usefulness of axial and sagittal-reconstructed CT images in the evaluation of spinal canal encroachment by thoracolumbar burst fractures. Summary of Literature Review: The dimensions of spinal canal encroachment by burst fractures have been described using axial CT images in the thoracolumbar region and sagittal-reconstructed images in the lower cervical region. However, the validity and reliability,depending on the measuring method, have not been fully evaluated. Materials and Methods: A hundred and ninety-nine patients, who had diagnosed as a thoracolumbar burst fracture, were included in this study. Three orthopedic surgeons independently measured the canal encroachment of the burst fragment in the axial CT images and the sagittal-reconstructed images using the ratio of spinal length (method 1) and the ratio of area (method 2). The validity for the evaluation of the deformity and fracture stability was evaluated. In addition, the reliability of each method was assessed. Results: Sixty-seven stable burst fractures and 132 unstable burst fractures were assessed. The mean kyphotic angle of stable and unstable burst fracture were 11.89 ± 8.49°and 15.90 ± 9.63°(P=0.005). The mean canal encroachment ratios of stable fracture were 17.21 ± 15.82 % (axial-method 1), 16.71 ±16.49 % (axial-method 2), 19.54 ± 17.03 % (sagittal reconstructed-method 1), and 11.75 ± 12.33% (sagittal reconstructed-method 2). The mean canal encroachment ratios of unstable fracture were 31.54 ± 17.10 % (axial-method 1), 29.67 ± 18.47 % (axial-method 2), 28.53 ± 18.60 % (sagittal reconstructed-method 1), and 21.20 ± 15.11 % (sagittal reconstructedmethod 2). There was no relationship between the fracture deformity and the canal encroachment ratio in all 4 methods. All ratios in the 4 method showed significant differences in the evaluation of fracture stability. All methods except method 1 in the sagittal-reconstructed images showed significant differences in the assessment of neurologic compromise. Conclusions: The measurement of a canal encroachment area using axial and sagittal-reconstructed images was valid in the description of fracture stability. Key Words: Thoracolumbar, Burst fracture, Canal encroachment, Computed tomography

Risk factor analysis for predicting vertebral body re-collapse after posterior instrumented fusion in thoracolumbar burst fracture

Jang, Hae-Dong,Bang, Chungwon,Lee, Jae Chul,Soh, Jae-Wan,Choi, Sung-Woo,Cho, Hyeung-Kyu,Shin, Byung-Joon Elsevier 2018 SPINE JOURNAL Vol.18 No.2

<P><B>Abstract</B></P> <P><B>Background Context</B></P> <P>In the posterior instrumented fusion surgery for thoracolumbar (T-L) burst fracture, early postoperative re-collapse of well-reduced vertebral body fracture could induce critical complications such as correction loss, posttraumatic kyphosis, and metal failure, often leading to revision surgery. Furthermore, re-collapse is quite difficult to predict because of the variety of risk factors, and no widely accepted accurate prediction systems exist. Although load-sharing classification has been known to help to decide the need for additional anterior column support, this radiographic scoring system has several critical limitations.</P> <P><B>Purpose</B></P> <P>(1) To evaluate risk factors and predictors for postoperative re-collapse in T-L burst fractures. (2) Through the decision-making model, we aimed to predict re-collapse and prevent unnecessary additional anterior spinal surgery.</P> <P><B>Study Design</B></P> <P>Retrospective comparative study.</P> <P><B>Patient Sample</B></P> <P>Two-hundred and eight (104 men and 104 women) consecutive patients with T-L burst fracture who underwent posterior instrumented fusion were reviewed retrospectively. Burst fractures caused by high-energy trauma (fall from a height and motor vehicle accident) with a minimum 1-year follow-up were included. The average age at the time of surgery was 45.9 years (range, 15–79). With respect to the involved spinal level, 95 cases (45.6%) involved L1, 51 involved T12, 54 involved L2, and 8 involved T11. Mean fixation segments were 3.5 (range, 2–5). Pedicle screw instrumentation including fractured vertebra had been performed in 129 patients (62.3%).</P> <P><B>Outcome Measures</B></P> <P>Clinical data using self-report measures (visual analog scale score), radiographic measurements (plain radiograph, computed tomography, and magnetic resonance image), and functional measures using the Oswestry Disability Index were evaluated.</P> <P><B>Methods</B></P> <P>Body height loss of fractured vertebra, body wedge angle, and Cobb angle were measured in serial plain radiographs. We assigned patients to the re-collapse group if their body height loss progressed greater than 20% at any follow-up time compared with immediate postoperative body height loss; we assigned the remaining patients to the well-maintained group. The chi-square test and <I>t</I> test of SPSS were used for comparison of differences between two groups and multiple logistic regression analysis for risk factor evaluation. Through the decision tree analysis of statistical package R, a decision-making model was composed, and a cutoff value of revealed risk factors and re-collapse rate of each subgroup were identified. The present study wassupported by the University College of Medicine Research Fund (university to which authors belong). There was no external funding source for this study. The authors have no conflict of interest to declare.</P> <P><B>Results</B></P> <P>Re-collapse occurred in 31 of 208 patients (14.9%). In this group, age, the proportion of male gender, preoperative height loss, and preoperative wedge angle were significantly greater than the well-maintained group. Multivariable logistic regression analysis identified two independent risk factors: age (adjusted odds ratio 1.084, p=.002) and body height loss (adjusted odds ratio 1.065, p=.003). According to the decision-making tree, age (>43 years) was the most discriminating variable, andpreoperative body height loss (>54%) was the second. In this model, the re-collapse rate was zero in ages less than 43 years, and among those remaining, nearly 80% patients with greater than 54% of body height loss belonged to the re-collapse group.</P> <P><B>Conclusions</B></P> <P>The independent predictors of re-collapse after posterior instrumented fusion for T-L burst fracture were the age at operation (>43 years old) and preoperative body height loss (>54%). Carefu

Comparison of Posterior Fixation Alone and Supplementation with Posterolateral Fusion in Thoracolumbar Burst Fractures

Hwang, Jong-Uk,Hur, Jin-Woo,Lee, Jong-Won,Kwon, Ki-Young,Lee, Hyun-Koo The Korean Neurosurgical Society 2012 Journal of Korean neurosurgical society Vol.52 No.4

Objective : We compared the radiological and clinical outcomes between patients who underwent posterior fixation alone and supplemented with fusion following the onset of thoracolumbar burst fractures. In addition, we also evaluated the necessity of posterolateral fusion for patients treated with posterior pedicle screw fixation. Methods : From January 2007 to December 2009, 46 consecutive patients with thoracolumbar burst fracture were included in this study. On the basis of posterolateral fusion, we divided our patients into the non-fusion group and the fusion group. The radiological assessment was performed according to the Cobb's method, and results were obtained at immediately, 3, 6, 12 months after surgery. The clinical outcomes were evaluated using the modified Mcnab criteria at the final follow-up. Results : The demographic data and the mean follow-up period were similar between the two groups. Patients of both groups achieved satisfactory clinical outcomes. The mean loss of kyphosis correction showed that patients of both groups experienced loss of correction with no respect to whether they underwent the posterolateral fusion. There was no significant difference in the degree of loss of correction at any time points of the follow-up between the two groups. In addition, we also compared the effect of fixed levels (i.e., short versus long segment) on loss of correction between the two groups and there was no significant difference. There were no major complications postoperatively and during follow-up period. Conclusion : We suggest that posterolateral fusion may be unnecessary for patients with thoracolumbar burst fractures who underwent posterior pedicle screw fixation.

Long-term Follow-up Results of Short-segment Posterior Screw Fixation for Thoracolumbar Burst Fractures

Lee, Yoon-Soo,Sung, Joo-Kyung The Korean Neurosurgical Society 2005 Journal of Korean neurosurgical society Vol.37 No.6

Objective: Despite general agreement on the goals of surgical treatment in thoracolumbar burst fractures, considerable controversy exists regarding the choice of operative techniques. This study is to evaluate the efficacy of short-segment fixation for thoracolumbar burst fractures after long-term follow-up and to analyze the causes of treatment failures. Methods: 48 out of 60 patients who underwent short-segment fixation for thoracolumbar burst fractures between January 1999 and October 2002 were enrolled in this study. Their neurological status, radiological images, and hospital records were retrospectively reviewed. Simple radiographs were evaluated to calculate kyphotic angles and percentages of anterior body compression (%ABC). Results: The average kyphotic angles were $20.0^{\circ}$ preoperatively, $9.6^{\circ}$ postoperatively, and $13.1^{\circ}$ at the latest follow-up. The average %ABC were 47.3% preoperatively, 31.2% postoperatively, and 33.3% at the latest follow-up. The treatment failure, defined as correction loss by $10^{\circ}$ or more or implant failure, was detected in 6 patients (12.5%). 5 out of 6 patients had implant failures. 2 out of 5 patients were related with osteoporosis, and the other 2 were related with poor compliance of spinal bracing. 3 patients with poor initial postoperative alignment had implant failure. 4 patients with screws only on the adjacent vertebrae and not on the injured vertebra itself showed poor initial and overall correction. Conclusion: With proper patient selection, adequate intraoperative reduction with screw fixation involving the injured vertebra, and strict postoperative spinal bracing, the short-segment fixation is an efficient and safe method in the treatment of thoracolumbar burst fracture.

Surgical Techniques for Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations

Salman Sharif,Yousuf Shaikh,Onur Yaman,Mehmet Zileli 대한척추신경외과학회 2021 Neurospine Vol.18 No.4

To formulate the specific guidelines for the recommendation of thoracolumbar fracture regarding surgical techniques and nonfusion surgery. WFNS (World Federation of Neurosurgical Societies) Spine Committee organized 2 consensus meeting. For nonfusion surgery and thoracolumbar fracture, a systematic literature search in PubMed and Google Scholar database was done from 2010 to 2020. The search was further refined by excluding the articles which were duplicate, not in English or were based on animal or cadaveric subjects. After thorough shortlisting, only 50 articles were selected for full review in this consensus meeting. To generate a consensus, the levels of agreement or disagreement on each item were voted independently in a blind fashion through a Likert-type scale from 1 to 5. 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. A magnitude of prospective papers were analyzed to formulate consensus on various surgical techniques that can be employed to address different types of thoracolumbar fractures. Surgical treatment of thoracolumbar fractures can be a better option over the nonoperative approach, especially for those who cannot tolerate months in an orthosis or cast, such as those with multiple extremity injuries, skin lesions, obesity, and so forth. It generally allows early mobilization, less hospital stay, reduced pulmonary complications, and better correction of sagittal balance. Current available literature fails to demonstrate any statistically significant benefit of fusion surgery over nonfusion in thoracolumbar fractures.

Indications for Nonsurgical Treatment of Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations

Nikolay Peev,Mehmet Zileli,Salman Sharif,Shahswar Arif,Zarina Brady 대한척추신경외과학회 2021 Neurospine Vol.18 No.4

Thoracolumbar spine is the most injured spinal region in blunt trauma. Literature on the indications for nonoperative treatment of thoracolumbar fractures is conflicting. The purpose of this systematic review is to clarify the indications for nonsurgical treatment of thoracolumbar fractures. We conducted a systematic literature search between 2010 to 2020 on PubMed/MEDLINE, and Cochrane Central. Up-to-date literature on the indications for nonoperative treatment of thoracolumbar fractures was reviewed to reach an agreement in a consensus meeting of WFNS (World Federation of Neurosurgical Societies) Spine Committee. The statements were voted and reached a positive or negative consensus using the Delphi method. For all of the questions discussed, the literature search yielded 1,264 studies, from which 54 articles were selected for full-text review. Nine studies (4 trials, and 5 retrospective) evaluating 759 participants with thoracolumbar fractures who underwent nonoperative/surgery were included. Although, compression type and stable burst fractures can be managed conservatively, if there is major vertebral body damage, kyphotic angulation, neurological deficit, spinal canal compromise, surgery may be indicated. AO type B, C fractures are preferably treated surgically. Future research is necessary to tackle the relative paucity of evidence pertaining to patients with thoracolumbar fractures.

외상성 흉·요추접합부 파열골절의 Kaneda 기구를 이용한 내고정술에 대한 임상적 검토 : Results of Anterior Decompression and Stabilization with Kaneda Device

장주호,김수한,정신,김재휴,강삼석,이제혁 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.4

The authors report clinical results of twenty-three traumatic thoracolumbar burst fractures treated by internal fixation with Kaneda device after anterior decompression during recent three years. Thoracolumbar injuries made up 28.9% of total spinal injuries and the burst fractures treated by anterior decompression and stabilization with Kaneda device constituted 19.0% of all spinal injuries. The burst fractures occurred most frequently at the age of twenties and thirties. The main causes of injury were fall and vehicle accident. Superior end-plate fracture type was most common according to the types of burst fracture. The first and the second lumbar vertebrae were frequently involved. No patient showed neurological deterioration after surgery. Conus medullaris lesions in burst fractures of the thoracolumbar junction have a high potentiality for functional recovery because the lesions are not due to discontinuity or severe crush injury but due to simple compression by bony fragments. The Kaneda device offered enough stability to enable early ambulation with good alignment and solid fusion.

흉요추 이행부 안정성 방출성 골절시 한시적인 척추 후방고정술의 예비보고

장호근,김영우,정종철,김형수,이기병 대한척추외과학회 2002 대한척추외과학회지 Vol.9 No.4