New classification of thoracolumbar fracture dislocation with fixation by percutaneous screws in intact neurological patients
Study Design: Prospective cohort study Objectives: Thoracic and lumbar fracture dislocations (TLFD) are high velocity injuries and frequently result in gross neurological deficit. Very rarely, such patients present with intact neurology. Patho-mechanics of injury, radiological assessment and surg...
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| Format: | Article |
| Language: | English |
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London Academic Publishing
2019-12-01
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| Series: | Romanian Neurosurgery |
| Subjects: | |
| Online Access: | https://www.journals.lapub.co.uk/index.php/roneurosurgery/article/view/1287 |
| _version_ | 1828438649173180416 |
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| author | Sherief Ahmed ELenany Amin Sabry |
| author_facet | Sherief Ahmed ELenany Amin Sabry |
| author_sort | Sherief Ahmed ELenany |
| collection | DOAJ |
| description | Study Design: Prospective cohort study
Objectives: Thoracic and lumbar fracture dislocations (TLFD) are high velocity injuries and frequently result in gross neurological deficit. Very rarely, such patients present with intact neurology. Patho-mechanics of injury, radiological assessment and surgical fixation by percutaneous screws have not been described previously.
Methods: Prospective study of 20 patients of TLFD without cord injury was performed for demographics, clinical and radiological data, and management. The injuries were classified based on the direction of translation into 4 types – coronal translation (Type 1), sagittal translation (Type 2), combined translation – antero (Type 3a) and retro (Type 3b). The injuries were managed by minimally invasive percutaneous transpedicular screws fixation.
Results: In the 20 patients, the injuries were classified as Type 1 (n=5), Type 2 (n=8), Type 3a (n=4) and Type 3b (n=3). Imaging/ intraoperative observation showed varying degrees of dis-integrity of disc, facet joints, and posterior ligamentous complex in the 4 different injury types. Patients with the different injury types also needed individualistic surgical approaches to aid safe reduction of dislocation. All patients had no neurological deficits. The mean antero-posterior and lateral translation were corrected from 8.3±3.4 to 1.7±1.3 mm, and 4.7±4.8 to 0.7±0.8 mm respectively.
Conclusion: TLFD cases without cord injury are very rare. Knowledge of the different injury types, and principles of safe surgical reduction of the dislocation are important for the treating surgeon to ensure successful outcomes. We explored the feasibility, safety, efficacy and cosmosis of percutaneous approach and compared these aspects to those of other studies. |
| first_indexed | 2024-12-10T20:09:24Z |
| format | Article |
| id | doaj.art-e426f7bd37b64d85b9f0663ca3af7978 |
| institution | Directory Open Access Journal |
| issn | 1220-8841 2344-4959 |
| language | English |
| last_indexed | 2024-12-10T20:09:24Z |
| publishDate | 2019-12-01 |
| publisher | London Academic Publishing |
| record_format | Article |
| series | Romanian Neurosurgery |
| spelling | doaj.art-e426f7bd37b64d85b9f0663ca3af79782022-12-22T01:35:20ZengLondon Academic PublishingRomanian Neurosurgery1220-88412344-49592019-12-0133410.33962/roneuro-2019-081New classification of thoracolumbar fracture dislocation with fixation by percutaneous screws in intact neurological patientsSherief Ahmed ELenanyAmin SabryStudy Design: Prospective cohort study Objectives: Thoracic and lumbar fracture dislocations (TLFD) are high velocity injuries and frequently result in gross neurological deficit. Very rarely, such patients present with intact neurology. Patho-mechanics of injury, radiological assessment and surgical fixation by percutaneous screws have not been described previously. Methods: Prospective study of 20 patients of TLFD without cord injury was performed for demographics, clinical and radiological data, and management. The injuries were classified based on the direction of translation into 4 types – coronal translation (Type 1), sagittal translation (Type 2), combined translation – antero (Type 3a) and retro (Type 3b). The injuries were managed by minimally invasive percutaneous transpedicular screws fixation. Results: In the 20 patients, the injuries were classified as Type 1 (n=5), Type 2 (n=8), Type 3a (n=4) and Type 3b (n=3). Imaging/ intraoperative observation showed varying degrees of dis-integrity of disc, facet joints, and posterior ligamentous complex in the 4 different injury types. Patients with the different injury types also needed individualistic surgical approaches to aid safe reduction of dislocation. All patients had no neurological deficits. The mean antero-posterior and lateral translation were corrected from 8.3±3.4 to 1.7±1.3 mm, and 4.7±4.8 to 0.7±0.8 mm respectively. Conclusion: TLFD cases without cord injury are very rare. Knowledge of the different injury types, and principles of safe surgical reduction of the dislocation are important for the treating surgeon to ensure successful outcomes. We explored the feasibility, safety, efficacy and cosmosis of percutaneous approach and compared these aspects to those of other studies.https://www.journals.lapub.co.uk/index.php/roneurosurgery/article/view/1287spine traumaTLFDthoracolumbar fracturedislocationminimal invasive spine surgery |
| spellingShingle | Sherief Ahmed ELenany Amin Sabry New classification of thoracolumbar fracture dislocation with fixation by percutaneous screws in intact neurological patients Romanian Neurosurgery spine trauma TLFD thoracolumbar fracture dislocation minimal invasive spine surgery |
| title | New classification of thoracolumbar fracture dislocation with fixation by percutaneous screws in intact neurological patients |
| title_full | New classification of thoracolumbar fracture dislocation with fixation by percutaneous screws in intact neurological patients |
| title_fullStr | New classification of thoracolumbar fracture dislocation with fixation by percutaneous screws in intact neurological patients |
| title_full_unstemmed | New classification of thoracolumbar fracture dislocation with fixation by percutaneous screws in intact neurological patients |
| title_short | New classification of thoracolumbar fracture dislocation with fixation by percutaneous screws in intact neurological patients |
| title_sort | new classification of thoracolumbar fracture dislocation with fixation by percutaneous screws in intact neurological patients |
| topic | spine trauma TLFD thoracolumbar fracture dislocation minimal invasive spine surgery |
| url | https://www.journals.lapub.co.uk/index.php/roneurosurgery/article/view/1287 |
| work_keys_str_mv | AT sheriefahmedelenany newclassificationofthoracolumbarfracturedislocationwithfixationbypercutaneousscrewsinintactneurologicalpatients AT aminsabry newclassificationofthoracolumbarfracturedislocationwithfixationbypercutaneousscrewsinintactneurologicalpatients |