RESUMO
BACKGROUND: thoracolumbar burst fractures are associated with spinal canal occupation. The indirect decompression of the spinal canal and reduction of the fragment can be achieved with the distraction of the middle column and ligamentotaxis. Nevertheless, the factors that influence the effectiveness of this procedure and its temporality are controversial. METHODS: The aim of this observational, cross-sectional study was to evaluate the effectiveness of indirect reduction by ligamentotaxis in thoracolumbar burst fractures according to the fracture's radiologic characteristics and the procedure's temporality. Patients diagnosed with a thoracolumbar burst fracture between 2010 and 2021 were submitted to indirect reduction by distraction and ligamentotaxis. A retrospective analysis of radiologic characteristics and temporality of the procedure was performed with an independent sample t-test or Pearson's correlation coefficient, as required. RESULTS: A total of 58 patients were included in the analysis. Postoperatively, ligamentotaxis significantly improved all radiologic parameters (canal occupation, endplates distance, and vertebra height). Still, none of the radiological characteristics of the fracture (width, height, position, sagittal angle) were associated with the postoperative change in canal occupation. The endplates distance and the temporality of ligamentotaxis significantly predicted the reduction of the fracture. CONCLUSION: Fragment reduction effectiveness is more significant when performed as early as possible and adequate distraction is achieved using the internal fixator system. The radiologic characteristics of the fractured fragment do not determine its reduction capacity.
Assuntos
Fraturas por Compressão , Fraturas da Coluna Vertebral , Humanos , Estudos Retrospectivos , Estudos Transversais , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Vértebras Lombares/cirurgia , Vértebras Lombares/lesões , Vértebras Torácicas/cirurgia , Vértebras Torácicas/lesões , Fixação Interna de Fraturas/métodosRESUMO
The Toca das Onças cave is one of the most important Quaternary mammal deposits of Brazil. Two different hypotheses have been proposed to explain the preservation mode of its skeletal remains: either the animals climbed down into the cave, or it could have functioned as a natural trap. Evaluation of pathological modifications on three articulated vertebrae of a single adult giant ground sloth Eremotherium laurillardi reveals a particular type of bone fracture caused by compressive force on the vertebral column, which split the vertebral bodies in the sagittal plane. This diagnosis suggests that the animal accidentally fell into the cave, in accordance with the second hypothesis proposed to the incorporation mode of skeletal remains into the cave.
Assuntos
Bichos-Preguiça , Fraturas da Coluna Vertebral , Acidentes , Animais , Restos Mortais , Fósseis , Vértebras Lombares/lesões , Fraturas da Coluna Vertebral/diagnóstico por imagemRESUMO
For vertebromedullary injuries, epidemiological knowledge is essential to guide the choice of the most effective diagnostic method. The objective of this retrospective study was to describe the epidemiological profile of animals and thoracolumbar and lumbosacral spine lesions diagnosed by computed tomography scan. A compilation of CT scan reports for the aforementioned regions performed in a comercial diagnostic center from 04/01/2017 to 04/30/2020, contrasted and non-contrasted, from routine, was performed in order to list the most common lesions and their locations, as well as the species, breeds and ages most affected. There were 1164 CT scans performed in the period evaluated, all of them in dogs, 57,56% (n=670) for the spine, with 89,7% reports accessed (n=601), where the regions mentioned here added up to 73,05% studies (n=439). In both regions, male French Bulldog dogs had the most injuries. For the thoracolumbar region, disk mineralization, followed by extrusion, were the most frequent injuries, while the site was T12-13 and the mean age 6,5±3,63 years old. In the lumbosacral, disk protrusion was most frequent, the most affected site was L7-S1 and age 6,65±3,79 years. It was concluded that the spine is the main target of CT scans, and that lesions related to the intervertebral disk were the main ones identified, with chondrodystrophic animals being more predisposed to injury.
Para lesões vertebromedulares é indispensável o conhecimento epidemiológico para direcionar a escolha do método diagnóstico mais eficaz. O objetivo desse estudo retrospectivo foi descrever o perfil epidemiológico dos animais e das lesões em coluna vertebral toracolombar e lombossacral diagnosticadas através de exame tomográfico. Realizou-se a compilação de laudos de tomografias computadorizadas para as referidas regiões realizadas em centro diagnóstico comercial, entre 01/04/2017 a 30/04/2020, contrastadas e não-contrastadas, provenientes da rotina, a fim de relacionar as lesões e seus locais de ocorrência, bem como a espécie, raças e idades mais comuns. Foram realizados 1164 exames tomográficos no período avaliado, sendo 57,56% (n=670) para a coluna, com 89,7% laudos acessados (n=601), nos quais as regiões toracolombar e lombossacral somaram 73,05% dos estudos (n=439). Em ambas as regiões, os cães Bulldog Francês machos foram os que mais apresentaram lesões. Para a região toracolombar, a mineralização de disco, seguida pela extrusão, foram as lesões mais frequentes, enquanto o local foi T12-13 e a média de idade 6,5±3,63 anos. Na lombossacral, a protusão de disco foi mais frequente, o local mais afetado foi L7-S1 e idade de 6,65±3,79 anos. Concluiu-se que a coluna vertebral é o principal alvo de tomografias, e que as lesões relacionadas ao disco intervertebral foram as principais identificadas, sendo os animais condrodistróficos mais predispostos a lesões.
Assuntos
Animais , Gatos , Cães , Traumatismos da Coluna Vertebral/veterinária , Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X/veterinária , Gatos/lesões , Cães/lesões , Disco Intervertebral/lesões , Vértebras Lombares/lesões , Região Lombossacral/anormalidadesRESUMO
Thoracolumbar burst fractures are a great challenge for spine surgeons and that is why the aim of this study was to perform a systematic review analyzing the current literature regarding the different factors to take into account in their management. Material and methods: Systematic search in PubMed, Cochrane, MedlinePlus sites. "Thoracolumbar Burst Fractures" were the keywords. Titles, abstracts and full text were analyzed from two independent observers. Results: Six studies were included, five (83.33%) were prospective cohort studies and only one (16.67%) was retrospective. There were a total of 289 patients among all samples. The mean age was 38.48 years and the sex ratio was male to female of 1.7:1. Conclusion: Thoracolumbar burst fractures remain controversial in their treatment with published literature of low level of evidence and without establishing a consensus at the time of decision making with different options depending on the surgeon's experience and preference. However, most of them are inclined towards treatment with short segment posterior fixation but without long-term follow-up. Regarding neurological deficit, surgical decompression achieved consensus among all surgeons.
Las fracturas por estallido toracolumbar son un gran desafío para los cirujanos de columna, es por ello que el objetivo de este estudio fue realizar una revisión sistemática analizando la literatura actual respecto a los diferentes factores a tener en cuenta en el manejo de las mismas. Material y métodos: Búsqueda sistemática en los sitios PubMed, Cochrane, MedlinePlus. "Thoracolumbar Burst Fractures" fueron las palabras claves. Se analizaron los títulos, resúmenes y texto completo a partir de dos observadores independientes. Resultados: Seis estudios han sido incluidos, cinco (83.33%) fueron de cohorte prospectivos y sólo uno (16.67%) retrospectivo. Hubo un total de 289 pacientes entre todas las muestras. La media de edad fue 38.48 años y la relación respecto al sexo fue masculino-femenino de 1.7:1. Conclusión: Las fracturas por estallido toracolumbar siguen siendo controversiales en su tratamiento con bibliografía publicada de bajo nivel de evidencia y sin establecer un consenso en el momento de la toma de decisiones con diferentes opciones según la experiencia y preferencia del cirujano. Sin embargo, la mayoría de los mismos se inclinan hacia el tratamiento con fijación posterior de segmento corto pero sin seguimiento a largo plazo. Respecto al déficit neurológico, la descompresión quirúrgica logró consenso entre todos los cirujanos.
Assuntos
Fraturas por Compressão , Fraturas da Coluna Vertebral , Adulto , Descompressão , Feminino , Fixação Interna de Fraturas , Humanos , Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Masculino , Estudos Prospectivos , Estudos Retrospectivos , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgiaRESUMO
STUDY DESIGN: A systematic review and single-arm meta-analysis of randomized clinical trials. OBJECTIVE: The aim of this study was to evaluate whether the load-sharing classification (LSC) is reliable to predict the best surgical approach for thoracolumbar burst fracture (TBF). SUMMARY OF BACKGROUND DATA: There is no previous review evaluating the efficacy of the use of LSC as a guide in the surgical treatment of burst fractures. METHODS: On April 19th, 2019, a broad search was performed in the following databases: EMBASE, PubMed, Cochrane, SCOPUS, Web of Science, LILACS, and gray literature. This study was registered on the International Prospective Register of Systematic Reviews. We included clinical trials involving patients with TBF undergoing posterior surgical treatment, classified by load-sharing score, and that enabled the analysis of the outcomes loss of segmental kyphosis and implant failure (IF). We performed random- or fixed-effects models meta-analyses depending on the data homogeneity. Heterogeneity between studies was estimated by I2 and τ2 statistics. RESULTS: The search identified 189 references, out of which nine studies were eligible for this review. All articles presenting LSC up to 6 proved to be reliable in indicating that only posterior instrumentation is necessary, without screw failures or loss of kyphosis correction. For cases where the LSC was >6, only 2.5% of the individuals presented IF upon posterior approach alone. For loss of kyphosis correction, only 5% of patients had this outcome where LSC >6. For both outcomes together, we had 6% of postoperative problems (I2â=â77%, τ2â<â0.0015, Pâ<â0.01). CONCLUSION: Load-sharing scores up to 6 are 100% reliable, only requiring posterior instrumentation for stabilization. For scores >6, the risk of implant breakage and loss of kyphosis correction in posterior fixation alone is low. Thus, other factors should be considered to define the best surgical approach to be adopted.Level of Evidence: 1.
Assuntos
Vértebras Lombares/lesões , Fraturas da Coluna Vertebral/classificação , Vértebras Torácicas/lesões , Suporte de Carga , Adulto , Parafusos Ósseos , Feminino , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Fraturas por Compressão/classificação , Fraturas por Compressão/cirurgia , Humanos , Cifose/classificação , Cifose/cirurgia , Vértebras Lombares/fisiologia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/classificação , Complicações Pós-Operatórias/etiologia , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/fisiologia , Vértebras Torácicas/cirurgia , Suporte de Carga/fisiologiaRESUMO
The spine is the main stabilizer and load bearer of the axial skeleton. It is also important for the protection of neural structures, such as the spinal cord, nerve roots, and cauda equina. In the healthy skeleton, most injuries are a consequence of high-energy trauma and can lead to severe dysfunction, such as tetraplegia or paraplegia. In order to avoid such disabilities, it is important to recognize details that will guide treatment, and that will determine the necessity or not to have surgery. Familiarity with radiography, CT, and MRI in evaluating spine trauma is necessary, as, in some cases, all three methods will be useful in determining management and surgical planning. The most important factor in determining management in the thoracolumbar spine is the posterior ligamentous complex (PLC). Therefore, familiarity with its anatomy, primary and secondary signs of its injuries, is essential for radiologists in the emergency setting. Spine fractures are a very heterogeneous group of disorders. Management can be both conservative and surgical. It is important for radiologists to be aware of classifications and patterns for these injuries.
Assuntos
Fraturas da Coluna Vertebral , Traumatismos da Coluna Vertebral , Humanos , Vértebras Lombares/lesões , Radiografia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Vértebras Torácicas/lesõesRESUMO
Background: Acute spinal traumas can lead to irreversible damage associated with vascular and inflammatory changes in neural tissue. Since spine and spinal cord traumas have an unfavorable prognosis in small animals, and reports of the use of Steinmann pins and polymethylmethacrylate repair of lumbar vertebra fracture-luxation in puppies are rare in the literature, the present paper aimed to report the surgical treatment of transversal fracture through the body of the fourth lumbar vertebra, with dorsocranial displacement of the caudal fragment by using Steinmann pins and polymethylmethacrylate in a 7-month-old Labrador Retriever male dog. Case: A 7-month-old intact male Labrador Retriever dog, weighing 24.0 kg was attended at School Veterinary Hospital with a history of hit by car and paraplegia of the hind limbs. On neurological examination was observed no proprioception and no deep pain sensitivity on the both pelvic limbs. The lumbar spinal palpation showed intense pain, and the motor function and patellar reflexes were reduced. The values of haematological and biochemical analysis remained within the reference values for the species. Radiographs revealed a transversal fracture through the body of the fourth lumbar vertebra, with dorsocranial displacement of the caudal fragment, and was decided to perform a surgical treatment by open reduction and internal fixation of the fracture. The dog was positioned in ventral recumbency for surgery, and a dorsal midline incision was made from the second lumbar vertebra to the sixth lumbar vertebra. Two crossed 1.5 mm Kirschner wires were placed through the caudal articular facets of the fourth lumbar vertebra to provide initial stability...(AU)
Assuntos
Animais , Masculino , Cães , Polimetil Metacrilato , Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Luxações Articulares/veterinária , Pinos Ortopédicos/veterinária , Traumatismos da Medula Espinal/cirurgia , Traumatismos da Medula Espinal/veterináriaRESUMO
Introduction The AOSpine Thoracolumbar Spine Injury Classification (AOSTSIC) system has been proposed to better characterize injury morphologies and improve the classification of thoracolumbar (TL) spine trauma. However, the indications for surgical treatment according to the AOSTSIC system are still debated. Additionally, the proposed Thoracolumbar AOSpine Injury Score (AOSIS) is quite complex, which may preclude its use in daily practice. The objective of this reviewis to discuss the AOSTSIC systemand its indications for initial nonoperative versus surgical management of acute TL spine trauma. Methods We analyzed the literature for each injury type (and subtype, when pertinent) according to the AOSTSIC system as well as their potential treatment options. Results Patients with AOSTSIC subtypes A0, A1, and A2 are neurologically intact in the vast majority of the cases and initially managed nonoperatively. The treatment of A3- and A4-subtype injuries (burst fractures) in neurologically-intact patients is still debated with great controversy, with initially nonoperative management being considered an option in select patients. Surgery is recommended when there are neurological deficits or failure of nonoperativemanagement,with the role of magnetic resonance findings in the Posterior Ligamentous Complex (PLC) evaluation still being considered controversial. Injuries classified as type B1 in neurologically-intact patients may be treated, initially, with nonoperative management, provided that there are no ligamentous injury and non-displacing fragments. Due to severe ligamentous injury, type-B and type-C injuries should be considered as unstable injuries that must be surgically treated, regardless of the neurological status of the patient. Conclusions Until further evidence, we provided an easy algorithm-based guide on the spinal trauma literature to help surgeons in the decision-making process for the treatment of TL spine injuries classified according to the new AOSTSIC system.
Assuntos
Traumatismos da Coluna Vertebral/classificação , Traumatismos Torácicos/classificação , Vértebras Torácicas/cirurgia , Vértebras Lombares/cirurgia , Vértebras Torácicas/lesões , Fraturas da Coluna Vertebral/cirurgia , Vértebras Lombares , Vértebras Lombares/lesõesRESUMO
Introducción: La acrobacia en tela es una práctica circense con muchos adeptos en la población urbana. Consiste en sostenerse en altura tomado por dos extremos de tela, para realizar posturas fijas y cambiar entre ellas mediante deslizamiento y caídas. La práctica profesional no está libre de lesiones. Objetivo: Conocer la naturaleza de la lesión, reconocer los factores predisponentes de lesión y las medidas de prevención utilizadas, evaluar la cinemática, clasificar la lesión y analizar el tratamiento. Materiales y Métodos: Se incluyeron seis pacientes. Se evaluaron la estructura física personal, la cinemática de la caída, los sistemas de protección, la clasificación de las fracturas según la nueva clasificación AO, el cuadro neurológico, el tratamiento y las complicaciones. Resultados: La muestra incluyó a 6 mujeres, con un promedio de edad de 24 años y un índice de masa corporal de 19,29. Caída de 3,08 m de altura, cuatro con colchoneta <5 cm. Las lesiones principales fueron: 6 A1, 4 B2 y 1C. No se observaron déficits neurológicos. Cuatro pacientes fueron sometidas a cirugía. Conclusiones: La práctica de acrobacia en tela es una actividad circense de reciente aparición global. Las mujeres están más expuestas a las lesiones. El entrenamiento riguroso y el empleo de elementos de seguridad son necesarios para evitar las lesiones. No se observó un patrón único de lesión, la causa fue multifactorial. El tratamiento indicado depende de la lesión vertebral. Nivel de Evidencia: IV
Introduction: Aerial silk is a circus practice that has become very popular in urban populations. It involves hanging from two pieces of fabric in order to make fixed positions and change between them by sliding and dropping from different heights. The professional practice is not free of injuries. Objective: To learn the nature of the injury, to recognize the injury predisposing factors and the safety measures used, to study the kinematics, to classify the injury, and to analyze the treatment. Materials and Methods: Six patients were included. The evaluation included individual body structure, drop kinematics, safety measures, classification of fractures according to the new AO classification, neurological symptoms, treatment, and complications. Results: The study included six female patients, averaging 24 years, a body mass index of 19.29 and a fall from 3.08m, 4 of which included mattress <5cm. The main injuries classification resulted in 6 A1, 4 B2 and 1 C. No neurological deficit was found. Four patients underwent surgical treatment. Conclusions: Aerial silk is a circus activity that has recently become a worldwide practice. Women are more exposed. Rigorous training and the use of safety elements are necessary to avoid injuries. We did not observe a unique pattern of injury, because of its multifactorial cause. The therapeutic decision-making is related to the spinal injury. Level of Evidence: IV
Assuntos
Traumatismos em Atletas , Traumatismos da Coluna Vertebral , Vértebras Torácicas/lesões , Fraturas da Coluna Vertebral , Ginástica/lesões , Vértebras Lombares/lesõesRESUMO
STUDY DESIGN: Cross-sectional study. OBJECTIVE: The aim of this study was to map the skin temperature (Tsk) of individuals with SCI and compare able-bodied individuals, and among the groups to demonstrate the effects of differences in the levels of injury (paraplegia and tetraplegia with high and low injuries). SETTING: Outpatient clinic, Brazil. METHODS: Individuals with tetraplegia (n = 20), paraplegia (n = 21), and able-bodied (n = 11) individuals were recruited. A noncontact infrared thermometer (IRT) was used to measure three times the Tsk at the forehead, and at the C2 to S2 dermatomes. Core body temperature was measured at the axilla using the IRT and three other clinical thermometers. RESULTS: Autonomic regulation is impaired by the injury. A Tsk map was constructed for the three groups. Significant differences in the Tsk of dermatomes were observed when comparing individuals with SCI and the able-bodied at the following dermatomes: C3, C7, T2, T3, T8, T9, L1, L2, L4, and S2. When comparing individuals with tetraplegia and able-bodied individuals, the dermatomes that showed significant differences were C5, C6, C8, T1, T10, L3, and S1. Dermatomes C5-C7, and T5 showed significant differences between individuals with tetraplegia and those with paraplegia. For L5 and S1 in paraplegia significant differences were found when comparing high with low injury. CONCLUSION: A Tsk map on dermatomes in individuals with SCI was implemented, and showed a significant difference between able-bodied. As temperature is a parameter for analyzing autonomic function, the study could benefit rehabilitation by providing baseline values when constructing clinical protocols.