Incidence of flexion distraction injuries of thoraco lumbar spine

Background: Thoraco-lumbar spine fractures form majority of spine fractures and is an important cause of morbidity. However, comprehensive data regarding epidemiological pattern of trauma patients with spinal fractures are scarce. Many epidemiological reports about spinal fractures focus on osteoporosis as an etiologic factor. But in Indian population more important etiological factors are road traffic accidents and falls from height. Studies concerning only operatively treated patients with spinal fractures show selective and biased data that might be useful for capacity planning in hospitals or evaluating results of operative treatment, but not for epidemiological purposes. Methods: Among 86 consecutive patients with thoracic or lumbar fractures attending the out-patient department or Emergency department of Sree Gokulam Medical College, Trivandrum were enrolled in the study.  All patients with fractures of the thoracic or lumbar spine were enrolled in this study.Results: Flexion distraction injuries are the second commonest unstable thoracolumbar spine injuries.Conclusions: This study is a prospective cohort study of the epidemiological aspects and pattern of injury and treatment in thoraco-lumbar spine fractures at a tertiary care referral center. A total of 86 patients were enrolled in the study. The most common fracture pattern seen in this study was compression fractures (24.4%) which are stable. This was followed by stable burst fractures (23.2%, unstable burst fractures (18.6%), translational injuries (fracture-dislocations) (16.3%), flexion-distraction injuries (13.9%) and chance fractures (3.5%).

A Study of Fracture Patterns and Preventive Strategies of Thoracolumbar Spine Injuries

Introduction: Thoraco-lumbar spine fractures form majorityof spine fractures and is an important cause of morbidity.However, comprehensive data regarding epidemiologicalpattern of trauma patients with spinal fractures are scarce.Many epidemiological reports about spinal fractures focus onosteoporosis as an etiologic factor. But in Indian populationmore important etiological factors are road traffic accidentsand falls from height. Studies concerning only operativelytreated patients with spinal fractures show selective andbiased data that might be useful for capacity planning inhospitals or evaluating results of operative treatment, but notfor epidemiological purposesMaterial and Methods: 86 consecutive patients with thoracicor lumbar fractures attending the out-patient department orEmergency department of Sree Gokulam Medical CollegeHospital, Trivandrum were enrolled in the study. All patientswith fractures of the thoracic or lumbar spine were enrolledin this study.Result: Distribution of fracture pattern in thoracolumbarspine injuries were studied. And the methods to prevent thosefractures are listed in this study.Conclusion: This study is a prospective cohort study of theepidemiological aspects and pattern of injury and treatment inthoraco-lumbar spine fractures at a tertiary care referral center.A total of 86 patients were enrolled in the study.The mostcommon fracture pattern seen in this study was compressionfractures (24.4%) which are stable. This was followed bystable burst fractures (23.2%, unstable burst fractures (18.6%),translational injuries (fracture-dislocations)(16.3%), flexiondistraction injuries(13.9%) and chance fractures(3.5%).

Delayed-Onset Leg Weakness Caused by Posterior Migration of a Herniated Disc to the Thecal Sac Mimicking Epidural Hematoma in a Flexion-Distraction Injury of the Lumbar Spine: A Case Report / 대한척추외과학회지

STUDY DESIGN: Case report. OBJECTIVES: To document the first known case of posterior migration of a herniated disc in a lumbar flexion-distraction injury. SUMMARY OF LITERATURE REVIEW: Lumbar disc herniation is sometimes confused with epidural hematoma, especially when the disc migrates posterior to the thecal sac. There has been no report of posterior migration of a herniated disc after a lumbar flexion-distraction injury. MATERIALS AND METHODS: A 47-year-old woman with no pertinent medical history was diagnosed with a flexion-distraction injury of the L2–L3 vertebrae after a motor vehicle accident. The patient had no neurological deficit initially. Magnetic resonance imaging (MRI) showed a space-occupying lesion with T2 hyperintensity and T1 isointensity on the dorsal side of the thecal sac at L2–L3. After posterior lumbar fixation and fusion, progressive leg weakness occurred 1 week postoperatively. RESULTS: A second operation revealed no evidence of epidural hematoma, but a sequestrated disc. Decompression and sequestrectomy were performed, and the patient's neurological status had recovered fully at 4 months postoperatively. CONCLUSIONS: This case highlights the potential for posterior migration of a herniated disc with flexion-distraction injuries of the thoracolumbar spine. Discontinuity of the posterior annulus fibrosus on MRI may aid the distinction of posterior migration of a herniated disc from epidural hematoma. Because posterior migration of a herniated disc is associated with progressive neurological deficits, surgeons must consider decompression surgery when such herniation is suspected, even in the absence of neurological symptoms.

Flexion-distraction Injury in Cervico-thoracic Junction: A Case Report / 대한척추외과학회지

Injuries at the cervico-thoracic junction can be difficult to diagnose (with an incidence as high as 9% of all spinal injuries) and to stabilize, because of anatomic complexities. We report a case with that was treated with a lateral mass screw and transpedicular screw-rod fixation for a flexion-distraction injury at the cervico-thoracic junction and we present a review of the literature.

Short Segment Fixation of Flexion-Distraction Injuries in Thoracolumbar Spines

PURPOSE: To evaluate the efficacy of short segment fixation in flexion-distraction injuries of thoracolumbar junction. MATERIALS AND METHODS: Twenty-five patients with a flexion-distraction injury in thoracolumbar junction confirmed by radiogram or MRI and stabilized with a short construct spanning short segment were included in this study. We investigated the location of fractures, type of fractures, anterior or posterior vertebral body height, and preoperative and postoperative kyphotic angle of injuried motion-segments on radiologic examinations and clinical outcome on the Oswestry score. RESULTS: A significant correction of deformity was achieved, from a mean preoperative kyphosis of 17.3 degrees to a mean postoperative kyphosis of 8.4 degrees. The loss of correction were minimal. The mean Oswestry score was 6.9, with 84% of patients having minimal disability (<20%) and no correlation with age, sex, the location of fractures, type of fractures, change of kyphotic angle. CONCLUSION: This study demonstrates the efficacy of posterior open reduction and short segment fixation of flexion-distraction injuries.

Distribution and Patterns of Posterior Column Injury in Flexion-Distraction Injuries of Thoracolumbar Spine / 대한척추외과학회지

STUDY DESIGN: A retrospective analysis of the distribution and patterns of posterior column injury in flexion-distraction injuries of the thoracolumbar spine. OBJECTIVES: To recognize the various types of posterior column injury in terms of the path of the distraction force in flexion-dis-traction injuries of the thoracolumbar spine. SUMMARY OF LITERATURE REVIEW: As posterior column injuries are associated with instability of the spine, many authors have described and classified posterior column injuries. However, there are no descriptions or classifications in terms of the path of the distraction force in the literature. MATERIALS AND METHOD: The preoperative plain X-rays, axial CT, MRI (in 5 patients) and operation records of 34 patients were reviewed in relation to the patterns of posterior column injury. RESULTS: Posterior column injuries can be classified into two main types. In Type I(30/34), the distraction failure started from the spinous process one level above the fractured body (Type IA) or the posterior ligament complex between the spinous processes of the fractured and the level above (Type IB). In Type II(4/34), the distraction failure started from the spinous process of the fractured vertebra and from the interspinous ligament between the fractured level and the level below. CONCLUSIONS: Posterior column injuries can be described according to their starting point and the extent of the distraction force. Of these, Type IB was the most common. Using this classification, the injury of the posterior column in injuries of the thora-columbar spine fracture can be predicted.