Thoracolumbar fractures · Comprehensive (AO ASIF) classification: Rupture of the ligaments B.3.1.1...
Transcript of Thoracolumbar fractures · Comprehensive (AO ASIF) classification: Rupture of the ligaments B.3.1.1...
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Thoracolumbar fractures
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Two column concept:
Holdsworth F, 1970
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Flexion
Flexion + compression
Torsion
Two column concept:
Holdsworth F, 1970
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Flexion-distraction
Two column concept:
Holdsworth F, 1970
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Two column concept:
Holdsworth F, 1970
Flexion-distraction
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Comprehensive (AO ASIF) classification:
1445 fcs
Two column concept
Three categories –A, B, C (55 individual fracture types)
Magerl F, 1994
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Comprehensive (AO ASIF) classification:
A
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Comprehensive (AO ASIF) classification:
B
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Comprehensive (AO ASIF) classification:
C
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Comprehensive (AO ASIF) classification:
Importance of MRI:
Leferink VJM, 2002
30 % of B-type fractures are initially unrecognised
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Comprehensive (AO ASIF) classification:
Rupture of the ligaments
B.3.1.1
Signs of rotation
Type B
Type A
Type C
Anterior column
Fracture of the vertebral body
Posterior column
Disruption of the disc
Fracture
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T5 T6 T7 T8 T9 T10 T11 T12 L1 L2 L3 L4 L5
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Surgical treatment:
Conservative
Neurol. intact Stable fractures
Operative
Neurol. deficit Unstable fcs Open fcs
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Surgical treatment:
Conservative
Neurol. intact Stable fractures
• bed rest for 4-6 weeks + gradual ambulation + Jewet
• early ambulation + Jewet
Operative
Neurol. deficit Unstable fcs Open fcs
Operative
Neurol. deficit Unstable fcs Open fcs
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Operative
Neurol. deficit Unstable fcs Open fcs
Operative
Neurol. deficit Unstable fcs Open fcs
Surgical treatment:
Timing:
acute neurol. deficit » urgent surgery (life prior to the spinal cord)
Conservative
Neurol. intact Stable fractures
Conservative
Neurol. intact Stable fractures
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Operative treatment:
• posterior (pedicular fixation + augmentation)
• anterior (spacer + fixation)
• combination
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Operative treatment:
• posterior (pedicular fixation + augmentation)
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Operative treatment:
• posterior (pedicular fixation + augmentation)
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lordotisation lordotisation and distraction
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pros
• minor surgical trauma
• cosmetic scar
• preservation of mobile segments (?)
• no permanent HW
• urgent stabilization (SCI, concomittant trauma
Operative treatment:
• posterior (pedicular fixation + augmentation)
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• screw application
• muscle detachment
• orthosis
• HW removal
cons
• posterior (pedicular fixation + augmentation)
Operative treatment:
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Approach technology:
Open - thoracoabdominal
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Approach technology:
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• better spinal canal decompression
• better long term results (radiological, implant failure)
• single level fusion
• mini-invasive technology
• anterior (spacer + fixation)
pros
Operative treatment:
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• day light surgery (team work)
• major surgical trauma (?)
• greater blood loss (?)
• longer hospital stay (?)
• permanent HW
• revision surgery
• anterior (spacer + fixation)
cons
Operative treatment:
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endoscopic techniqes
open
less invasive
Approach technology:
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Approach technology:
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Choice of the approach:
F. Magerl:
anterior approach - fusion
posterior approach - stabilisation
Comined procedure ?
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Load-sharing classification:
Three qualities:
1. Amount of damaged vertebral body
2. Spread of fragments
3. Amount of corrected traumatic kyphosis
McCormack T et al., 1994
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Load-sharing classification:
Σ: 3 - 9 points
1. amount of damage
2. spread of fragments
3. corrected kyphosis
McCormack T et al., 1994
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Typ A
Choice of the approach:
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Type B, LSC 7 Choice of the approach:
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Type B, LSC 5 Choice of the approach:
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Choice of the approach:
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Spine vertebroplasty:
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Spine vertebroplasty:
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Spine vertebroplasty:
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Scoliosis (5)
M. Scheuermann (17)
Spondylosis, spondylathrosis (27)
Trauma C1 - 2
subaxial C (51)
T – L
Specific + non-specific inflammation (24, 26)