Are "Unstable" Burst Fractures Really Unstable?
Jun Hyuk Woo1, Hyun Woo Lee2, Hong June Choi1
1Department of Neurosurgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea.
Journal of Korean Neurosurgical Society
|October 25, 2021
Summary
The Thoracolumbar Injury Classification System (TLICS) may not perfectly align with surgical instability in burst fractures. Re-evaluation is needed to determine if TLICS accurately identifies fractures requiring operative intervention.
Area of Science:
- Orthopedic Surgery
- Spinal Trauma
- Radiology
Background:
- Fracture stability is crucial for treatment planning in thoracolumbar burst fractures.
- Unstable fractures typically necessitate surgical intervention.
- Key indicators for instability include decreased vertebral height, kyphosis, posterior column involvement, and canal compromise.
Purpose of the Study:
- To apply the Thoracolumbar Injury Classification System (TLICS) to thoracolumbar burst fractures.
- To compare TLICS scoring with traditional instability criteria for treatment decisions.
Main Methods:
- A retrospective study included 233 patients with thoracolumbar burst fractures (2006-2019).
- Instability was defined by neurological deficit, three-column injury, kyphosis >30°, anterior height loss >40%, or canal compromise >50%.
- TLICS scores were calculated based on morphology, neurological status, and posterior ligament integrity.
Main Results:
- 182 patients (78.1%) were classified as unstable by Denis criteria.
- 161 patients (69.1%) scored 4 or more on TLICS, suggesting surgery.
- A significant number of unstable fractures (e.g., 21 patients) received low TLICS scores (2), indicating potential discordance.
Conclusions:
- TLICS therapeutic recommendations may not perfectly align with the clinical definition of instability in thoracolumbar burst fractures.
- The study suggests reconsidering the operative threshold based on TLICS, as some fractures deemed unstable by traditional metrics receive low scores.
- Further evaluation is needed to refine TLICS application for surgical decision-making in these injuries.
Related Concept Videos
01:27Fractures: Bone Repair
4.0K
Treatment for a fracture is based on the type of break, the bone affected, and the patient's age.
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
4.0K
01:24Stress-Strain Diagram - Brittle Materials
2.9K
Brittle materials, including glass, cast iron, and stone, exhibit unique characteristics. They fracture without considerable change in their elongation rate, indicating that their breaking and ultimate strength are equivalent. Such materials also show lower strain levels at the point of rupture. The failure in brittle materials predominantly results from normal stresses, as evidenced by the rupture created along a surface perpendicular to the applied load. These materials do not display...
2.9K
01:14Stability of structures
273
In mechanical engineering, the stability of systems under various forces is critical for designing durable and efficient structures. One fundamental way to explore these concepts is by analyzing systems like two rods connected at a pivot point, O, with a torsional spring of spring constant k at the pivot point. This system is similar in appearance to a scissor jack used to change tires on a car. In this case, the arms of the linkage (equivalent to the rods in this system) are entirely vertical,...
273
01:23Stability of Equilibrium Configuration
569
Understanding the stability of equilibrium configurations is a fundamental part of mechanical engineering. In any system, there are three distinct types of equilibrium: stable, neutral, and unstable.
A stable equilibrium occurs when a system tends to return to its original position when given a small displacement, and the potential energy is at its minimum. An example of a stable equilibrium is when a cantilever beam is fixed at one end and a weight is attached to the other end. If the weight...
A stable equilibrium occurs when a system tends to return to its original position when given a small displacement, and the potential energy is at its minimum. An example of a stable equilibrium is when a cantilever beam is fixed at one end and a weight is attached to the other end. If the weight...
569
01:21Plastic Behavior
315
A material's elastic behavior is characterized by the disappearance of stress once the load is removed, allowing the material to return to its original state. However, when stress surpasses the yield point, yielding commences, marking the onset of plastic deformation or permanent set. This change from elastic to plastic behavior is influenced by the peak stress value and the duration before the load is removed. An intriguing observation occurs when a specimen is loaded, unloaded, and...
315
02:17Microtubule Instability
5.4K
Microtubules are hollow cylindrical filaments having a diameter of approximately 25 nm and a length that varies from 200 nm to 25 μm. GTP-bound tubulin subunits form αβ-heterodimers for microtubule assembly. These core building blocks interact longitudinally, polymerizing into protofilaments. The protofilaments then interact with one another through lateral bonding forces to form stable cylindrical microtubules. These cylindrical filaments are dynamic as they undergo repeated...
5.4K