Aly, Mohamed M; Dandurand, Charlotte; Dvorak, Marcel F; Öner, Cumhur F; Schnake, Klaus; Mujis, Sanders; Benneker, Lorin M; Vialle, Emiliano; Rajasekaran, Shanmuganathan; El-Skarkawi, Mohammad; Kanna, Rishi M; Holas, Martin; Popescu, Eugen Cezar; Tee, Jin W; Camino-Willhuber, Gaston; Joaquim, Andrei Fernandes; Kenyan, Ory; Chhabra, Harvinder Singh; Bigdon, Sebastian; Spiegel, Ulrich; ... (2024). The Influence of Comminution and Posterior Ligamentous Complex Integrity on Treatment Decision Making in Thoracolumbar Burst Fractures Without Neurologic Deficit? Global spine journal, 14(1_suppl), 41S-48S. Sage 10.1177/21925682231196452
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STUDY DESIGN
A prospective study.
OBJECTIVE
to evaluate the impact of vertebral body comminution and Posterior Ligamentous Complex (PLC) integrity on the treatment recommendations of thoracolumbar fractures among an expert panel of 22 spine surgeons.
METHODS
A review of 183 prospectively collected thoracolumbar burst fracture computed tomography (CT) scans by an expert panel of 22 trauma spine surgeons to assess vertebral body comminution and PLC integrity. This study is a sub-study of a prospective observational study of thoracolumbar burst fractures (Spine TL A3/A4). Each expert was asked to grade the degree of comminution and certainty about the PLC disruption from 0 to 100, with 0 representing the intact vertebral body or intact PLC and 100 representing complete comminution or complete PLC disruption, respectively.
RESULTS
≥45% comminution had a 74% chance of having surgery recommended, while <25% comminution had an 86.3% chance of non-surgical treatment. A comminution from 25 to 45% had a 57% chance of non-surgical management. ≥55% PLC injury certainity had a 97% chance of having surgery, and ≥45-55% PLC injury certainty had a 65%. <20% PLC injury had a 64% chance of having non-operative treatment. A 20 to 45% PLC injury certainity had a 56% chance of non-surgical management. There was fair inter-rater agreement on the degree of comminution (ICC .57 [95% CI 0.52-.63]) and the PLC integrity (ICC .42 [95% CI 0.37-.48]).
CONCLUSION
The study concludes that vetebral comminution and PLC integrity are major dterminant in decision making of thoracolumbar fractures without neurological deficit. However, more objective, reliable, and accurate methods of assessment of these variables are warranted.
Item Type: |
Journal Article (Original Article) |
|---|---|
Division/Institute: |
04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Orthopaedic Surgery |
UniBE Contributor: |
Bigdon, Sebastian |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
2192-5682 |
Publisher: |
Sage |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
12 Feb 2024 15:46 |
Last Modified: |
13 Feb 2024 15:22 |
Publisher DOI: |
10.1177/21925682231196452 |
PubMed ID: |
38324603 |
Uncontrolled Keywords: |
A3 A4 AO spine thoracolumbar injury classification burst fractures computed tomography equipoise study magnetic resonance imaging posterior ligamentous complex thoracolumbar fractures vertebral comminution |
BORIS DOI: |
10.48350/192664 |
URI: |
https://boris.unibe.ch/id/eprint/192664 |
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