Nonoperative Management of Isolated Thoracolumbar Flexion Distraction Injuries: A Single-Center Study.

Autor:	Butler R; Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA., Donley C; Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA., Mohammed Z; Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA., Lepard J; Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA., Vess E; Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA., Andrews N; Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA., McGwin G; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA., Rajaram S; Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA., Theiss SM; Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA stheiss@uabmc.edu.
Jazyk:	angličtina
Zdroj:	International journal of spine surgery [Int J Spine Surg] 2024 Sep 12; Vol. 18 (4), pp. 383-388. Date of Electronic Publication: 2024 Sep 12.
DOI:	10.14444/8619
Abstrakt:	Background: Nonoperative management is an appealing option for purely transosseous thoracolumbar flexion-distraction injuries given the prospects of osseous healing and restoration of the posterior tension band complex. This study seeks to examine differences in outcomes following flexion-distraction injuries after operative and nonoperative management. Methods: This study reviews all patients at a single Level 1 trauma center from 2004 to 2022 with AO Spine B1 thoracolumbar injuries treated operatively vs nonoperatively. Inclusion criteria were age greater than 16 years, computed tomography-confirmed transosseous flexion-distraction injuries, and at least 3 months of follow-up with available imaging. The primary outcome assessed was a change in local Cobb angles, with secondary outcomes consisting of complications, time to return to work, and need for subsequent operative fixation. Results: Initial Cobb angles in the operative ( n = 14) vs nonoperative group ( n = 13) were -5° and -13°, respectively ( P = 0.225), indicating kyphotic alignment in both cohorts. We noted a significant difference in Cobb angles between cohorts at first follow-up (2.6° and -13.9°, P = 0.015) and within the operative cohort from presentation to first follow-up ( P = 0.029). At the second follow-up, there was no significant difference in Cobb angles between cohorts (3.6° and -12.6°, P = 0.07). No significant differences were noted in complication rates ( P = 1), time to return to work ( P = 0.193), or resolution of subjective back pain ( P = 0.193). No crossover was noted. Conclusions: Nonoperative management of minimally displaced transosseous flexion-distraction injuries is a safe alternative to surgery. Patient factors, such as compliance with follow-up, and location of the injury should be factored into the surgeon's management recommendation. Clinical Relevance: Overall, no significant differences in outcomes and complications were noted following nonoperative management of AO Spine B1 injuries, indicating the potential for these injuries to be managed conservatively. Competing Interests: Declaration of Conflicting Interests : Sakthivel Rajaram has previously received grant funding from K2M and AO Spine North America and previously received consulting fees from Cerapedics. Steven Thiess has previously received grant funding from AO Spine North America. The remaining authors have nothing to disclose. (This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2024 ISASS. To see more or order reprints or permissions, see http://ijssurgery.com.)
Databáze:	MEDLINE
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