Traumatic multiple-level continuous and noncontinuous thoracolumbar spinal fractures management in adult patients: A single-center experience

BACKGROUND: This study aimed to describe our clinical experience with surgical approaches and patient management for traumatic multiple-level continuous and noncontinuous thoracolumbar spinal fractures.
METHODS: We retrospectively evaluated patients with continuous and noncontinuous multiple-level thoracolumbar fractures who were operated on by the same surgical team from 2019 to 2021. These patients were divided into two groups: Group 1 (n=12, continuous fractures) and Group 2 (n=14, noncontinuous fractures). We assessed the patients’ age, gender, fracture levels, fracture type, classification according to the AO (Arbeitsgemeinschaft für Osteosynthesefragen) Spine Thoracolumbar Fracture Classification, status of posterior ligament damage, presence of additional traumatic pathology, status of decompression via laminectomy, levels of stabilization and fusion, preoperative and postoperative neurological status, presence of cervical trauma, duration of operation, amount of blood loss, duration of hospitalization, and lordosis and kyphosis angles in terms of fusion status and postoperative follow-up over two years. The study excluded patients over the age of 65, those with single-level fractures, and pathological fractures caused by osteoporosis, infection, or spinal tumors.
RESULTS: Gender, age, neurological status, application of laminectomy, surgical complications, status of cervical fracture, duration of operation, amount of blood loss, duration of hospitalization, lordosis, and kyphosis angles were uniformly distributed between the groups. All patients underwent fusions, ranging from three to eight, with a median of two (range 2-4) fracture levels, and a median of five instrumented vertebrae, ranging from four to seven. Significant differences between the two groups were observed in terms of operation duration (p=0.001), blood loss (p=0.010), duration of hospitalization (p=0.003), number of fusions (p<0.001), and instrumented vertebral segments (p=0.011).
CONCLUSION: Thus, a surgical approach involving decompression, vertebral fusion screws, allografts, and bone substitutes can enhance surgical outcomes for patients with continuous and noncontinuous vertebral fractures.

Yetiþkin hastalarda travmatik çok seviyeli ardýþýk ve ardýþýk olmayan torakolomber spinal kýrýklarýn yönetimi: Tek merkez deneyimi

AMAÇ: Bu çalýþmanýn amacý travmatik çok seviyeli ardýþýk ve ardýþýk olmayan torakolomber omurga kýrýklarýnda cerrahi yaklaþýmlar ve hasta yönetimi konusundaki klinik deneyimimizi aktarmaktýr.
GEREÇ VE YÖNTEM: 2019-2021 yýllarý arasýnda ayný cerrahlar tarafýndan ameliyat edilen ardýþýk ve ardýþýk olmayan torakolomber çok seviye kýrýklý hastalar retrospektif olarak deðerlendirildi. Hastalar iki gruba ayrýldý: grup 1 (n=12, ardýþýk kýrýklar) ve grup 2 (n=14, ardýþýk olmayan kýrýklar). Hastalarýn yaþý, cinsiyeti, kýrýk seviyeleri, kýrýk tipi, AO Spine Torakolomber Kýrýk Sýnýflamasýna göre sýnýflandýrýlmasý, arka ligaman hasar durumu, ek travmatik patolojinin varlýðý, dekompresyon (laminektomi) durumu, stabilizasyon ve füzyon düzeyleri, ameliyat öncesi ve sonrasý nörolojik durum, servikal travma varlýðý, operasyon süresi, kan kaybý miktarý, hastanede kalýþ süresi, lordoz açýlarý ve kifoz açýlarý, füzyon durumu ve postoperatif takip (2 yýl) açýsýndan deðerlendirildi. Çalýþmaya 65 yaþ üstü, tek seviyeli kýrýklarý, osteoporoza baðlý patolojik kýrýklarý, enfeksiyon ve spinal tümörleri olan hastalar dahil edilmedi.
BULGULAR: Cinsiyet, yaþ, nörolojik durum, laminektomi uygulamasý, cerrahi komplikasyonlar, servikal kýrýk durumu, operasyon süresi, kan kaybý miktarý, hastanede kalýþ süresi, lordoz ve kifoz açýlarý gruplar arasýnda eþit olarak daðýldý. Ayrýca, tüm hastalarda medyan 2 (2-4) kýrýk seviyesinde, medyan 4 (3-8) füzyon ve medyan 5 (4-7) enstrümante vertebral segment vardý. Ýki grup operasyon süresi (p=0.001), kan kaybý miktarýz(p=0.010), hastanede kalýþ süresi (p=0.003), füzyon sayýsý (p<0.001) ve enstrümante vertebra segmentler (p=0.011) açýsýndan anlamlý þekilde farklýlýk gösterdi.
SONUÇ: Dekompresyon, vertebral vida fiksasyonu ile allogreft ve otogrefler tarafýndan desteklenen bir cerrahi yaklaþým, ardýþýk ve ardýþýk olmayan vertebra kýrýðý hastalarý için baþarýlý cerrahi sonuçlar saðlayabilmektedir.