Page 6 - Kansas Journal of Medicine, Volume 10 Issue 2, May 2017
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KANSAS JOURNAL of M E D I C I N E                                     omy, contribute to the high incidence of fractures of this region.
                                                                        Despite the fact that this is a common fracture, the treatment
    	                                                                   of burst and compression fractures remains controversial re-
                                                                        garding the ideal management. Previous studies have proposed
       Functional Outcomes of Thoracolumbar                             treatment guidelines such as canal compromise, neurologic
                   Junction Spine Fractures                             deficit, loss of vertebral body height, and kyphosis as relative
                                                                        indications for operative treatment versus non-operative treat-
              Bradford A. Wall, M.D.1, Alan Moskowitz, M.D.1,2,         ment of this type of injury. The advantages of surgery include
           M. Camden Whitaker, M.D.1,3, Teresa L. Jones, MPH1,2,        better correction of kyphotic deformity, greater initial stability,
          Ryan M. Stuckey, M.D.1, Catherine L. Carr-Maben, B.S.         an opportunity to perform direct or indirect decompression of
          L.R.T.(R)(CT)2, Alexander CM. Chong, MSAE, MSME1­,4           neural elements, decreased requirements for external immobi-
           1University of Kansas School of Medicine-Wichita, KS         lization, and an earlier return to work.6-8 In the body of liter-
                                                                        ature concerning the degree of kyphosis that can be accepted
                            Department of Orthopaedics                  or required, surgical correction continues to be questioned.
                 2Kansas Orthopaedic Center, PA, Wichita, KS            	 To address the questions that surround the treatment of
         3Orthopaedic & Sports Medicine at Cypress, Wichita, KS         acute thoracolumbar fractures, it is important to elucidate the
           4Via Christi Health, Department of Graduate Medical          correlation between residual kyphotic deformity and patient’s
                                                                        functional outcome. Kraemer et al.4 performed a retrospec-
                               Education, Wichita, KS                   tive chart review and concluded that patients with kyphosis of
                                                                        greater than 25° were affected more severely and have poorer
    ABSTRACT                                                            outcomes. Shen et al.9 commented the majority of studies
    Introduction. Few studies have evaluated the functional             have been on patients with less than 30° kyphosis, therefore,
    outcomes of traumatic thoracic and lumbar vertebral body            it is impossible to comment on these cases having more severe
    fractures. This study evaluated the functional and clini-           sagittal angulation in regards to outcome. The purpose of this
    cal outcomes of patients, who sustained a fracture to the           study was to evaluate the functional and clinical outcomes of
    thoracolumbar area of the spine (T10 to L2 region), with            patients, who sustained a fracture to the thoracolumbar area
    ≥ 25° kyphosis versus those with less kyphotic curvature.           of the spine (T10 to L2 region), with greater than or equal to
                                                                        25° of kyphosis versus those with less kyphotic curvature.
    Methods. The trauma registry records of two level 1 trauma
    centers using ICD-9 codes for fracture to the thoracolumbar         METHODS
    juncture (T10 to L2 region) were reviewed. Kyphosis angle           	 The trauma registry records of two Midwest Level 1
    was measured on the standing lateral thoracolumbar (T1 -            regional trauma centers for the last 5.5 years using ICD-9
    L5) radiograph at initial trauma and at clinical follow-up.         codes (code: 805.2 - 805.5, 806.20 - 806.40, 806.5, 806.60 - 806.79)
    Functional outcome questionnaires, including the Oswestry           were reviewed in a prospective cohort study to identify pa-
    Disability Questionnaire (ODQ), the Roland Morris Disabil-          tients with spinal fracture. Both Level 1 regional trauma cen-
    ity Questionnaire (RMDQ), and the Nottingham Health Pro-            ters from which the records were obtained served a rural
    file (NHP), were evaluated at clinical follow-up. Work sta-         catchment area for a multi-state region. Before commencing,
    tus and medication used after trauma also were recorded.            this study protocol and amendments were reviewed and ap-
                                                                        proved by three local Institutional Review Boards (IRB).
    Results. A total of 38 patients met the inclusive criteria. Seven-  	 The inclusion criteria for this study were for patients between
    teen patients (45%) had ≥ 25° kyphosis and 21 patients (55%)        18 and 65 years of age with burst or compression vertebral body
    had < 25° kyphosis at follow-up. These two groups were simi-        fracture at the thoracolumbar junction. These fractures resulted
    lar based on sex and age. Based on the ODQ Score, the RMDQ          from a high energy traumatic event such as fall, motor vehicle
    Score, and the NHP, no statistically significant differences        accident, motorcycle accident, or sporting event accident. Pa-
    were detected between the two groups in regards to energy,          tients with a fracture that was not located on the vertebral body,
    pain, mobility, emotional reaction, social isolation, and sleep.    had neurovascular involvement, osteoporosis, previous spinal
                                                                        fracture, or prior spinal surgery were excluded from this study.
    Conclusions. Patients who sustained a fracture to the tho-          	 The standing lateral thoracolumbar (T1 - L5) radiograph of
    racolumbar area of the spine with ≥ 25° kyphosis do not             potential patients was reviewed (at initial trauma), and was used
    report worse clinical outcomes. When using the kypho-               to measure the amount of kyphosis at the fracture site from the
    sis angle as an indication for surgery, it should be used with      next adjacent intact vertebrae above and below using the Cobb
    caution and not exclusively. KS J Med 2017;10(2):30-34.             method (Figure 1). This measuring method is similar to one pre-
                                                                        viously reported.10 Each potential patient was contacted through
    INTRODUCTION                                                        a recruitment letter or by telephone, and reimbursement for their
     	 Fractures of thoracic and lumbar spine, especially at the tho-   research-related expenses was offered to recruit participants.
    racolumbar junction (T10 to L2), often are related to high en-
    ergy trauma1, and represent nearly 90% of traumatic spine frac-
    tures.2-5 The thoracolumbar junction represents a transition zone
    of the spine, and high energy forces, coupled with the local anat-

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