Surgical management of thoracolumbar junction fractures: An evidence-based algorithm
Background: The management of thoracolumbar junction (TLJ) fractures, involving the restoring anatomical stability and biomechanics properties, still remains a challenge for neurosurgeons.Despite the high frequency of these injuries, specific treatment guidelines, set on biomechanical properties, ha...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-01-01
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| Series: | World Neurosurgery: X |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590139722000369 |
| _version_ | 1811165417190719488 |
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| author | Alice Giotta Lucifero Nunzio Bruno Sabino Luzzi |
| author_facet | Alice Giotta Lucifero Nunzio Bruno Sabino Luzzi |
| author_sort | Alice Giotta Lucifero |
| collection | DOAJ |
| description | Background: The management of thoracolumbar junction (TLJ) fractures, involving the restoring anatomical stability and biomechanics properties, still remains a challenge for neurosurgeons.Despite the high frequency of these injuries, specific treatment guidelines, set on biomechanical properties, have not yet been assumed. The present study is meant to propose an evidence-based treatment algorithm. The primary aim for the protocol validation was the assessment of postoperative neurological recovery. The secondary objectives concerned the evaluation of residual deformity and rate of hardware failure. Technical nuances of surgical approaches and drawbacks were further discussed. Methods: Clinical and biomechanical data of patients harboring a single TLJ fracture, surgically managed between 2015 and 2020, were collected. Patients' cohorts were ranked into 4 groups according to Magerl's Type, McCormack Score, Vaccaro PLC point, Canal encroachment, and Farcy Sagittal Index. The outcome measures were the early/late Benzel-Larson Grade and postoperative kyphosis degree to estimate neurological status and residual deformity, respectively. Results: 32 patients were retrieved, 7, 9, 8, and 8 included within group 1, 2, 3, and 4, respectively. Overall neurological outcomes significantly improved for all patients at every follow-up stage (p < 0.0001). Surgeries gained a complete restoration of post-traumatic kyphosis in the entire cohort (p < 0.0001), except for group 4 which experienced a later worsening of residual deformity. Conclusions: The choice of the most appropriate surgical approach for TLJ fractures is dictated by morphological and biomechanical characteristics of fracture and the grade of neurological involvement. The proposed surgical management protocol was reliable and effective, although further validations are needed. |
| first_indexed | 2024-04-10T15:36:55Z |
| format | Article |
| id | doaj.art-a6ba59c86d6e4b2d82e28a79661caba8 |
| institution | Directory Open Access Journal |
| issn | 2590-1397 |
| language | English |
| last_indexed | 2024-04-10T15:36:55Z |
| publishDate | 2023-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | World Neurosurgery: X |
| spelling | doaj.art-a6ba59c86d6e4b2d82e28a79661caba82023-02-13T04:07:34ZengElsevierWorld Neurosurgery: X2590-13972023-01-0117100151Surgical management of thoracolumbar junction fractures: An evidence-based algorithmAlice Giotta Lucifero0Nunzio Bruno1Sabino Luzzi2Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, ItalyDivision of Neurosurgery, Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, ItalyNeurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Corresponding author. University of Pavia, Via A. Brambilla 74, 27100, Pavia, Italy.Background: The management of thoracolumbar junction (TLJ) fractures, involving the restoring anatomical stability and biomechanics properties, still remains a challenge for neurosurgeons.Despite the high frequency of these injuries, specific treatment guidelines, set on biomechanical properties, have not yet been assumed. The present study is meant to propose an evidence-based treatment algorithm. The primary aim for the protocol validation was the assessment of postoperative neurological recovery. The secondary objectives concerned the evaluation of residual deformity and rate of hardware failure. Technical nuances of surgical approaches and drawbacks were further discussed. Methods: Clinical and biomechanical data of patients harboring a single TLJ fracture, surgically managed between 2015 and 2020, were collected. Patients' cohorts were ranked into 4 groups according to Magerl's Type, McCormack Score, Vaccaro PLC point, Canal encroachment, and Farcy Sagittal Index. The outcome measures were the early/late Benzel-Larson Grade and postoperative kyphosis degree to estimate neurological status and residual deformity, respectively. Results: 32 patients were retrieved, 7, 9, 8, and 8 included within group 1, 2, 3, and 4, respectively. Overall neurological outcomes significantly improved for all patients at every follow-up stage (p < 0.0001). Surgeries gained a complete restoration of post-traumatic kyphosis in the entire cohort (p < 0.0001), except for group 4 which experienced a later worsening of residual deformity. Conclusions: The choice of the most appropriate surgical approach for TLJ fractures is dictated by morphological and biomechanical characteristics of fracture and the grade of neurological involvement. The proposed surgical management protocol was reliable and effective, although further validations are needed.http://www.sciencedirect.com/science/article/pii/S2590139722000369Anterior instrumented fusionBenzel-Larson gradeEvidence-base algorithmFarcy sagittal indexPosterior instrumented fusionThoracolumbar junction fractures |
| spellingShingle | Alice Giotta Lucifero Nunzio Bruno Sabino Luzzi Surgical management of thoracolumbar junction fractures: An evidence-based algorithm World Neurosurgery: X Anterior instrumented fusion Benzel-Larson grade Evidence-base algorithm Farcy sagittal index Posterior instrumented fusion Thoracolumbar junction fractures |
| title | Surgical management of thoracolumbar junction fractures: An evidence-based algorithm |
| title_full | Surgical management of thoracolumbar junction fractures: An evidence-based algorithm |
| title_fullStr | Surgical management of thoracolumbar junction fractures: An evidence-based algorithm |
| title_full_unstemmed | Surgical management of thoracolumbar junction fractures: An evidence-based algorithm |
| title_short | Surgical management of thoracolumbar junction fractures: An evidence-based algorithm |
| title_sort | surgical management of thoracolumbar junction fractures an evidence based algorithm |
| topic | Anterior instrumented fusion Benzel-Larson grade Evidence-base algorithm Farcy sagittal index Posterior instrumented fusion Thoracolumbar junction fractures |
| url | http://www.sciencedirect.com/science/article/pii/S2590139722000369 |
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