Diagnosis and Management of Thoracolumbar Spine Fractures by Alexander R. Vaccaro, David H. Kim,...
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Transcript of Diagnosis and Management of Thoracolumbar Spine Fractures by Alexander R. Vaccaro, David H. Kim,...
![Page 1: Diagnosis and Management of Thoracolumbar Spine Fractures by Alexander R. Vaccaro, David H. Kim, Darrel S. Brodke, Mitchel Harris, Jens Chapman, Thomas.](https://reader035.fdocuments.in/reader035/viewer/2022062421/56649e4b5503460f94b401ed/html5/thumbnails/1.jpg)
Diagnosis and Management of Thoracolumbar Spine Fractures
by Alexander R. Vaccaro, David H. Kim, Darrel S. Brodke, Mitchel Harris, Jens Chapman, Thomas Schildhauer, M.L. Chip Routt, and Rick C. Sasso
J Bone Joint Surg AmVolume 85(12):2456-2470
December 1, 2003
©2003 by The Journal of Bone and Joint Surgery, Inc.
![Page 2: Diagnosis and Management of Thoracolumbar Spine Fractures by Alexander R. Vaccaro, David H. Kim, Darrel S. Brodke, Mitchel Harris, Jens Chapman, Thomas.](https://reader035.fdocuments.in/reader035/viewer/2022062421/56649e4b5503460f94b401ed/html5/thumbnails/2.jpg)
The Denis three-column model of spinal injury1.
Alexander R. Vaccaro et al. J Bone Joint Surg Am 2003;85:2456-2470
©2003 by The Journal of Bone and Joint Surgery, Inc.
![Page 3: Diagnosis and Management of Thoracolumbar Spine Fractures by Alexander R. Vaccaro, David H. Kim, Darrel S. Brodke, Mitchel Harris, Jens Chapman, Thomas.](https://reader035.fdocuments.in/reader035/viewer/2022062421/56649e4b5503460f94b401ed/html5/thumbnails/3.jpg)
Lateral radiograph showing the characteristic wedge-shaped appearance of a thoracolumbar compression fracture with mild local kyphosis.
Alexander R. Vaccaro et al. J Bone Joint Surg Am 2003;85:2456-2470
©2003 by The Journal of Bone and Joint Surgery, Inc.
![Page 4: Diagnosis and Management of Thoracolumbar Spine Fractures by Alexander R. Vaccaro, David H. Kim, Darrel S. Brodke, Mitchel Harris, Jens Chapman, Thomas.](https://reader035.fdocuments.in/reader035/viewer/2022062421/56649e4b5503460f94b401ed/html5/thumbnails/4.jpg)
Denis classification of thoracolumbar compression fractures (see text).
Alexander R. Vaccaro et al. J Bone Joint Surg Am 2003;85:2456-2470
©2003 by The Journal of Bone and Joint Surgery, Inc.
![Page 5: Diagnosis and Management of Thoracolumbar Spine Fractures by Alexander R. Vaccaro, David H. Kim, Darrel S. Brodke, Mitchel Harris, Jens Chapman, Thomas.](https://reader035.fdocuments.in/reader035/viewer/2022062421/56649e4b5503460f94b401ed/html5/thumbnails/5.jpg)
Denis classification of thoracolumbar burst fractures (see text).
Alexander R. Vaccaro et al. J Bone Joint Surg Am 2003;85:2456-2470
©2003 by The Journal of Bone and Joint Surgery, Inc.
![Page 6: Diagnosis and Management of Thoracolumbar Spine Fractures by Alexander R. Vaccaro, David H. Kim, Darrel S. Brodke, Mitchel Harris, Jens Chapman, Thomas.](https://reader035.fdocuments.in/reader035/viewer/2022062421/56649e4b5503460f94b401ed/html5/thumbnails/6.jpg)
Lateral radiograph showing the typical appearance of a thoracolumbar burst fracture.
Alexander R. Vaccaro et al. J Bone Joint Surg Am 2003;85:2456-2470
©2003 by The Journal of Bone and Joint Surgery, Inc.
![Page 7: Diagnosis and Management of Thoracolumbar Spine Fractures by Alexander R. Vaccaro, David H. Kim, Darrel S. Brodke, Mitchel Harris, Jens Chapman, Thomas.](https://reader035.fdocuments.in/reader035/viewer/2022062421/56649e4b5503460f94b401ed/html5/thumbnails/7.jpg)
Computed tomography scan demonstrating retropulsion of posterior vertebral bone and spinal canal compromise.
Alexander R. Vaccaro et al. J Bone Joint Surg Am 2003;85:2456-2470
©2003 by The Journal of Bone and Joint Surgery, Inc.
![Page 8: Diagnosis and Management of Thoracolumbar Spine Fractures by Alexander R. Vaccaro, David H. Kim, Darrel S. Brodke, Mitchel Harris, Jens Chapman, Thomas.](https://reader035.fdocuments.in/reader035/viewer/2022062421/56649e4b5503460f94b401ed/html5/thumbnails/8.jpg)
Postoperative lateral radiograph showing the posterior instrumentation used in this patient.
Alexander R. Vaccaro et al. J Bone Joint Surg Am 2003;85:2456-2470
©2003 by The Journal of Bone and Joint Surgery, Inc.
![Page 9: Diagnosis and Management of Thoracolumbar Spine Fractures by Alexander R. Vaccaro, David H. Kim, Darrel S. Brodke, Mitchel Harris, Jens Chapman, Thomas.](https://reader035.fdocuments.in/reader035/viewer/2022062421/56649e4b5503460f94b401ed/html5/thumbnails/9.jpg)
Computed tomography scan with sagittal reconstruction showing a thoracolumbar flexion-distraction injury.
Alexander R. Vaccaro et al. J Bone Joint Surg Am 2003;85:2456-2470
©2003 by The Journal of Bone and Joint Surgery, Inc.
![Page 10: Diagnosis and Management of Thoracolumbar Spine Fractures by Alexander R. Vaccaro, David H. Kim, Darrel S. Brodke, Mitchel Harris, Jens Chapman, Thomas.](https://reader035.fdocuments.in/reader035/viewer/2022062421/56649e4b5503460f94b401ed/html5/thumbnails/10.jpg)
Radiographs showing the typical appearance of a thoracolumbar fracture-dislocation.
Alexander R. Vaccaro et al. J Bone Joint Surg Am 2003;85:2456-2470
©2003 by The Journal of Bone and Joint Surgery, Inc.
![Page 11: Diagnosis and Management of Thoracolumbar Spine Fractures by Alexander R. Vaccaro, David H. Kim, Darrel S. Brodke, Mitchel Harris, Jens Chapman, Thomas.](https://reader035.fdocuments.in/reader035/viewer/2022062421/56649e4b5503460f94b401ed/html5/thumbnails/11.jpg)
Alexander R. Vaccaro et al. J Bone Joint Surg Am 2003;85:2456-2470
©2003 by The Journal of Bone and Joint Surgery, Inc.
![Page 12: Diagnosis and Management of Thoracolumbar Spine Fractures by Alexander R. Vaccaro, David H. Kim, Darrel S. Brodke, Mitchel Harris, Jens Chapman, Thomas.](https://reader035.fdocuments.in/reader035/viewer/2022062421/56649e4b5503460f94b401ed/html5/thumbnails/12.jpg)
Alexander R. Vaccaro et al. J Bone Joint Surg Am 2003;85:2456-2470
©2003 by The Journal of Bone and Joint Surgery, Inc.
![Page 13: Diagnosis and Management of Thoracolumbar Spine Fractures by Alexander R. Vaccaro, David H. Kim, Darrel S. Brodke, Mitchel Harris, Jens Chapman, Thomas.](https://reader035.fdocuments.in/reader035/viewer/2022062421/56649e4b5503460f94b401ed/html5/thumbnails/13.jpg)
Magnetic resonance image of a patient with a thoracolumbar injury.
Alexander R. Vaccaro et al. J Bone Joint Surg Am 2003;85:2456-2470
©2003 by The Journal of Bone and Joint Surgery, Inc.
![Page 14: Diagnosis and Management of Thoracolumbar Spine Fractures by Alexander R. Vaccaro, David H. Kim, Darrel S. Brodke, Mitchel Harris, Jens Chapman, Thomas.](https://reader035.fdocuments.in/reader035/viewer/2022062421/56649e4b5503460f94b401ed/html5/thumbnails/14.jpg)
Magnetic resonance image of a patient with a flexion-distraction injury, revealing gas in the posterior subcutaneous tissue overlying the level of the thoracolumbar injury.
Alexander R. Vaccaro et al. J Bone Joint Surg Am 2003;85:2456-2470
©2003 by The Journal of Bone and Joint Surgery, Inc.
![Page 15: Diagnosis and Management of Thoracolumbar Spine Fractures by Alexander R. Vaccaro, David H. Kim, Darrel S. Brodke, Mitchel Harris, Jens Chapman, Thomas.](https://reader035.fdocuments.in/reader035/viewer/2022062421/56649e4b5503460f94b401ed/html5/thumbnails/15.jpg)
Sagittal magnetic resonance image of a patient with a T12 burst fracture and an incomplete neurological injury.
Alexander R. Vaccaro et al. J Bone Joint Surg Am 2003;85:2456-2470
©2003 by The Journal of Bone and Joint Surgery, Inc.
![Page 16: Diagnosis and Management of Thoracolumbar Spine Fractures by Alexander R. Vaccaro, David H. Kim, Darrel S. Brodke, Mitchel Harris, Jens Chapman, Thomas.](https://reader035.fdocuments.in/reader035/viewer/2022062421/56649e4b5503460f94b401ed/html5/thumbnails/16.jpg)
Anteroposterior (Fig. 11-B) and lateral (Fig. 11-C) postoperative radiographs.
Alexander R. Vaccaro et al. J Bone Joint Surg Am 2003;85:2456-2470
©2003 by The Journal of Bone and Joint Surgery, Inc.
![Page 17: Diagnosis and Management of Thoracolumbar Spine Fractures by Alexander R. Vaccaro, David H. Kim, Darrel S. Brodke, Mitchel Harris, Jens Chapman, Thomas.](https://reader035.fdocuments.in/reader035/viewer/2022062421/56649e4b5503460f94b401ed/html5/thumbnails/17.jpg)
Sagittal magnetic resonance image of patient with a complete neurological deficit following a substantial flexion-distraction injury.
Alexander R. Vaccaro et al. J Bone Joint Surg Am 2003;85:2456-2470
©2003 by The Journal of Bone and Joint Surgery, Inc.
![Page 18: Diagnosis and Management of Thoracolumbar Spine Fractures by Alexander R. Vaccaro, David H. Kim, Darrel S. Brodke, Mitchel Harris, Jens Chapman, Thomas.](https://reader035.fdocuments.in/reader035/viewer/2022062421/56649e4b5503460f94b401ed/html5/thumbnails/18.jpg)
Following posterior short-segment instrumentation, the fracture was stable and healed uneventfully.
Alexander R. Vaccaro et al. J Bone Joint Surg Am 2003;85:2456-2470
©2003 by The Journal of Bone and Joint Surgery, Inc.