Dataset Information

Relationship between spinal alignment and functional disability after thoracolumbar spinal fractures: A systematic review.

ABSTRACT:

Background

Thoracolumbar spinal fractures (TLSF) can cause pain, neurological deficits, and functional disability. Operative treatments aim to preserve neurological function, improve functional status, and restore spinal alignment and stability. In this review, we evaluate the relationship between spinal alignment and functional impairment in patients with TLSF.

Methods

We performed a systematic review in accordance with the PRISMA guidelines to identify full-text articles that evaluate the correlation between spinal alignment and functional outcomes of TLSF. The artificial intelligence software Rayyan assisted the screening process. Functional outcomes referred to activity/disability, quality of life, and pain scores, as well as return to work metrics. Radiological assessments included were vertebral compression angle, Cobb and Gardner angles, sagittal vertical axis, pelvic incidence, and pelvic tilt. Statistical analyses were performed for the data provided by articles using the SPSS v24.

Results

Of 1,616 articles reviewed, 6 were included for final analysis. Only 1 study primarily addressed the effects of spinopelvic parameters and functional outcomes. Four studies correlated Cobb angles with functional outcome, while 3 others compared vertebral compression angles with functional outcomes. Outcomes were assessed using work status or a combination of VAS pain and spine score, ODI, SF-36, and RMDQ-24. Neither the analysis done within the articles, nor the one made with the raw data provided by them, showed a significant correlation between the radiological measurements assessed at time of injury and final functional outcomes.

Conclusions

A correlation between the assessed spinal radiological measurements assessed with the functional outcomes of TLSF was not found in this review. Further well-designed prospective studies are necessary to evaluate spinal alignment measurements in TLSF with functional outcomes.

SUBMITTER: Andrade de Almeida RA

PROVIDER: S-EPMC11365384 | biostudies-literature | 2024 Sep

REPOSITORIES: biostudies-literature

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Publications

Relationship between spinal alignment and functional disability after thoracolumbar spinal fractures: A systematic review.

Andrade de Almeida Romulo Augusto RA Call-Orellana Francisco F Joaquim Andrei Fernandes AF

North American Spine Society journal 20240718

<h4>Background</h4>Thoracolumbar spinal fractures (TLSF) can cause pain, neurological deficits, and functional disability. Operative treatments aim to preserve neurological function, improve functional status, and restore spinal alignment and stability. In this review, we evaluate the relationship between spinal alignment and functional impairment in patients with TLSF.<h4>Methods</h4>We performed a systematic review in accordance with the PRISMA guidelines to identify full-text articles that ev ...[more]

PMID: 39221091

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Project description:BackgroundThoracolumbar fractures are classified into four categories according to the mechanism of injury and fracture morphology into compression fracture, burst fracture, flexion-distraction injury, and fracture dislocation. Unfortunately, the management of spinal fracture has lacked standardization given the many unanswered yet relevant questions regarding the outcome. However, management is generally divided into surgical and nonsurgical treatment such as orthosis. We aim to compare the clinical and the radiological outcomes of operative spinal fractures in patients with thoracolumbar spinal orthoses (TLSO) and patients without TLSO. Up to our knowledge, there are no similar studies comparing such management approaches in Saudi Arabia.MethodsThis is a retrospective cohort study conducted in King Saud Medical City which included patients over 18 years of age from the past 10 years who underwent spinal fixation with or without the use of orthotics and had at least 6 months follow-up. We have excluded any patients with degenerative diseases, spinal tuberculosis or spinal tumors. Our primary outcome was radiological outcomes and clinical outcomes among groups using orthotics postoperatively versus groups who didn't use orthotics. Statistical analysis was done utilizing The Statistical Package for the Social Sciences (SPSS) IBM statistical computing program version 21 was used for the statistical data analysis and the alpha significance level was considered at 0.050 level.ResultsThe patients were divided into two groups, patients given TLSO postoperatively (group A) (53.1%) and patients not given TLSO postoperatively (group B) (46.9%). Most of the patients had a burst fracture and most (86.4%) had endured a single level spine fracture. Bivariate Pearson's correlations test showed the patients mean perceived pain level [the visual analogue scale (VAS)] had correlated negatively and significantly with their emotional well-being (EM-WB) score, r=-0.132, P<0.05. Moreover, the patients self-rated pain level had correlated negatively and significantly with their satisfaction level with their comfort subscale score, r=-0.156, P<0.05. The patients mean measured kyphotic angle had correlated positively with their mean comfort level satisfaction, r=0.158, P<0.05. A non-parametric Mann-Whitney U test showed that the patients who used TLSO had perceived significantly greater general health (GH) score (mean GH score =77.44) compared to those who have not used TLSO (mean GH score =70.79), Z=2.38, P=0.02. Group A perceived significantly lower satisfaction with their social limitations (mean score =71.32) compared to group B (mean score =89.47) on average, Z=2.10, P=0.040. Group B (n=38) measured a significant decline in their pain level across the three time-point measured pain levels (P<0.001).ConclusionsOur study concludes that both groups have noticeable reductions in pain postoperatively and have shown decent results with regards to the Short Form 36 (SF-36) scores. However, further research is necessary to gain a comprehensive understanding of the varying effects of bracing versus non bracing long-term outcomes in upper thoracic and thoracolumbar fractures.

Project description:BackgroundThoracolumbar burst fractures are a common traumatic vertebral fracture in the spine, and pedicle screw fixation has been widely performed as a safe and effective procedure. However, after the stabilization of the thoracolumbar burst fractures, whether or not to remove the pedicle screw implant remains controversial. This review aimed to assess the benefits and risks of pedicle screw instrument removal after fixation of thoracolumbar burst fractures.MethodsData sources, including PubMed, EMBASE, Cochrane Library, Web of Science, Google Scholar, and Clinical trials.gov, were comprehensively searched. All types of human studies that reported the benefits and risks of implant removal after thoracolumbar burst fractures, were selected for inclusion. Clinical outcomes after implant removal were collected for further evaluation.ResultsA total of 4051 papers were retrieved, of which 35 studies were eligible for inclusion in the review, including four case reports, four case series, and 27 observational studies. The possible risks of pedicle screw removal after fixation of thoracolumbar burst fractures include the progression of the kyphotic deformity and surgical complications (e.g., surgical site infection, neurovascular injury, worsening pain, revision surgery), while the potential benefits of pedicle screw removal mainly include improved segmental range of motion and alleviated pain and disability. Therefore, the potential benefits and possible risks should be weighed to support patient-specific clinical decision-making about the removal of pedicle screws after the successful fusion of thoracolumbar burst fractures.ConclusionsThere was conflicting evidence regarding the benefits and harms of implant removal after successful fixation of thoracolumbar burst fractures, and the current literature does not support the general recommendation for removal of the pedicle screw instruments, which may expose the patients to unnecessary complications and costs. Both surgeons and patients should be aware of the indications and have appropriate expectations of the benefits and risks of implant removal. The decision to remove the implant or not should be made individually and cautiously by the surgeon in consultation with the patient. Further studies are warranted to clarify this issue.Level of evidencelevel 1.

Project description:PurposeMany minimally invasive surgical (MIS) techniques have been developed for instrumentation of spine. These MIS techniques restore stability, alignment while achieving return to function quite early as compared to open spine surgeries. The main aim of this review was to evaluate role, indications and complications of these MIS techniques in Thoracolumbar and Lumbar fractures.MethodsPubmed search using key words such as"Percutaneous pedicle screw for Thoracolumbar fractures" and "Video Assisted Thoracoscopy, Thoracoscopic, VATS for thoracolumbar, Lumbar and Spine fractures" were used till July 2016 while doing literature search. Authors analyzed all the articles, which came after search; the articles relevant to the topic were selected and used for the study. Both prospective and retrospective case control studies and randomized control trials (RCT's) were included in this review. Case reports and reviews were excluded. Studies demonstrating use of MIS in cases other than spine trauma and studies with lack of clinical follow up were excluded from this review. Variables such as number of patients, operative time and complications were evaluated in each study.ResultsAfter pubmed search, we found total 68 studies till July 2016 out of which eight studies were relevant for analysis of Video Assisted Thoracoscopy for thoracolumbar and lumbar fractures. Total 72 articles for Percutaneous pedicle screws in thoracolumbar and lumbar fractures were retrieved out of which percutaneous pedicle screws were analyzed in eleven studies and twelve studies involved comparison of percutaneous pedicle screws and conventional open techniques.ConclusionRole and Indications of the MIS techniques in spinal trauma are expanding quite rapidly. MIS techniques restore stability, alignment while achieving early return to function and lower infection rates as compared to open spine surgeries. In long term, they provide good kyphosis correction and stable fixation and fusion of spine. They are associated with long learning curve and technical challenges but with careful patient selection and in expert hands, MIS techniques may produce better results than open trauma spine surgeries.

Project description:BackgroundThere is uncertainty regarding delayed removal versus retention of minimally invasive screws following percutaneous fixation for thoracolumbar fractures. We conducted a systematic review and case-control study to test the hypothesis that delayed metalwork removal following percutaneous fixation for thoracolumbar fractures improves outcome.MethodsA systematic review was performed in accordance with the PRISMA guidelines. Our case-control study retrospectively evaluated 55 consecutive patients with thoracolumbar fractures who underwent percutaneous fixation in a single unit: 19 with metalwork retained (controls) and 36 with metalwork removed. Outcomes were the Oswestry Disability Index (ODI), a supplemental questionnaire, and complications.ResultsThe systematic review evaluated nine articles. Back pain was reduced in most patients after metalwork removal. One study found no difference in the ODI after versus before metalwork removal, whereas three studies reported significant improvement. Six studies noted no significant alterations in radiological markers of stability after metalwork removal. Mean complication rate was 1.7% (0-6.7). Complications were superficial wound infection, screw breakage at the time of removal, pull-out screw, and a broken rod. In the case-control study, both groups were well matched. For metalwork removal, mean operative time was 69.5 min (range 30-120) and length of stay was 1.3 days (0-4). After metalwork removal, 24 (68.6%) patients felt better, 10 (28.6%) the same and one felt worse. Two patients had superficial hematomas, one had a superficial wound infection, and none required re-operation. Metalwork removal was a significant predictor of return to work or baseline household duties (odds ratio 5.0 [1.4-18.9]). The ODI was not different between groups.ConclusionsThe findings of both the systematic review and our case-control study suggest that removal of metalwork following percutaneous fixation of thoracolumbar fractures is safe and is associated with improved outcome in most patients.

Project description:Study designA systematic review and meta-analysis.ObjectiveTo update the systematic review comparing the outcomes between surgical and non-surgical treatment for thoracolumbar burst fractures without neurological deficit.MethodsWe registered a protocol in PROSPERO (ID: CRD42021291769) and searched Medline, Embase, Web of Science, and Google Scholar databases. Surgical and non-surgical treatments were compared in patients with thoracolumbar burst fractures without neurological deficits. Predefined outcomes at ≥6 months included pain (defined as a visual analog scale [VAS] of 0-100), functional outcomes (Oswestry Disability Index [ODI] of 0-50 and Roland-Morris Disability Questionnaire [RMDQ] of 0-24), and kyphotic angulation.ResultsNineteen studies involving 1056 patients were included in the analyses. For outcomes at ≥6 months, little to no difference was found in pain VAS score (mean difference, .95 [95% confidence interval {CI}, -6.02 to 7.92]; 827 participants; 15 studies; I2 = 92%), ODI (mean difference, -1.40 [95% CI, -5.11 to 2.31]; 446 participants; 7 studies; I2 = 79%), and RMDQ (mean difference, -.73 [95% CI, -5.13 to 3.66]; 216 participants; 5 studies; I2 = 77%). The kyphotic angulation in the surgery group was 6.35° lower than that in the non-surgery group (mean difference, -6.56° [95% CI, -10.26° to -2.87°]; 527 participants; ten studies; I2 = 86%). The trial sequential analysis indicated all outcomes reached adequate statistical power. The certainty of the evidence for all 4 outcomes was very low. For the analysis of minimally invasive procedures compared to traditional open surgeries, a statistically significant subgroup difference was found for VAS and ODI (P < .01 and P < .04, respectively).ConclusionSurgical and non-surgical treatments showed little or no difference in outcomes at ≥6 months. This review provides a conclusion with adequate statistical power by including non-randomized studies. However, non-randomized studies also lowered the certainty of the evidence to a very low level.

Dataset Information

Relationship between spinal alignment and functional disability after thoracolumbar spinal fractures: A systematic review.

Background

Methods

Results

Conclusions

Publications

Relationship between spinal alignment and functional disability after thoracolumbar spinal fractures: A systematic review.

Similar Datasets

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