La radiografía en bipedestación inmediata predice el colapso final de la vértebra fracturada en pacientes añosos con fractura estallido toracolumbar / Immediate standing X-ray predicts the final vertebral collapse in elderly patients with thoracolumbar burst fracture

Objetivo: Ver si, en pacientes añosos con fractura toracolumbar traumática, las radiografías en bipedestación con ortesis a las 24-48h del ingreso permiten predecir el colapso vertebral tras la consolidación. Material y métodos: Estudio prospectivo de 40 pacientes consecutivos con fractura estallido de charnela toracolumbar (T11-L2), mayores de 65 años. Avalado por el Comité Ética Investigación Clínica (CEIC). Criterios de inclusión: edad>65 años, fractura aguda por caída, ingreso hospitalario, tratamiento con corsé. Criterios de exclusión: afectación multinivel, sospecha malignidad, fractura subaguda o sin caída. Variables: índice de Farcy (F), cifosis regional (C: Cobb de vértebra craneal a la caudal a la rota), ambos medidos al ingreso (F0 y C0), a las 24-48h en bipedestación con corsé (F1 y C1) y a los 3 meses, sin corsé (F2 y C2), colapso (incremento de F0 a F1 —F0F1— y de F1 a F2 —F1F2—; así como de C0 a C1 —C0C1— y de C1 a C2 —C1C2—), edad y género. Análisis estadístico: paquete R. Resultados: Serie de 40 pacientes, con una edad media de 75 años (66-87). Nueve varones y 31 mujeres. Ni el género ni la edad se correlacionaron con ninguna variable. Seis requirieron cirugía en el seguimiento. No hubo diferencias en F1, C1, F0F1 ni C0C1 entre los 5 pacientes que requirieron cirugía y los otros 34. Posteriormente se realizó el análisis de los datos solo de aquellos pacientes que no precisaron de cirugía.Los valores obtenidos en el índice de Farcy fueron de 8±7° (F0), de 12±7° (F1) y de 15±8° (F2) y en la cifosis (3 vértebras, Cobb) fueron: C0=8±13°; C1=11,5±14° y C2=13±13°. Hubo correlación de F2 con F0 y F1 (p<0,001), con F0F1 (p=0,038) y F1F2 (p=0,007). La más poderosa fue con F1 (Rho Spearman: 0,889; IC 95%: 0,776-0,947), con una recta de regresión lineal: F2=2,61288+F1×1,01237 (R2=0,79). C2 se correlacionó con C0 y C1 (p<0,001), sobre todo con C1 (Rho de Spearman: 0,952; IC 95%: 0,899-0,977). Regresión lineal: C2=2,23371+C1×0,93758 (R2=0,927)...(AU)

Objective: To see if, in elderly patients with traumatic thoracolumbar fracture, standing X-rays with orthoses 24–48h after admission can predict vertebral collapse after consolidation. Material and methods: Prospective cohort study endorsed by the Clinical Research Ethics Committee. Inclusion criteria: age >65 years, acute thoracolumbar junction fracture due to fall, hospital admission, treatment with orthesis. Exclusion criteria: various levels, suspected malignancy, non-immediate fracture or atraumatic. Variables: Farcy index (F), regional kyphosis (C: Cobb from cranial to caudal to broken vertebra) – both measured at admission (F0 and C0), at 24-48h in standing position with orthesis (F1 and C1) and 3 months, without brace (F2 and C2), collapse (increase from F0 to F1 —F0F1— and from F1 to F2 —F1F2—; as well as from C0 to C1 —C0C1— and from C1 to C2 —C1C2—), age and gender. Statistical analysis: R package. Results: Series of 40 patients, with a mean age of 75 years (66–87). Nine men and 31 women. Neither gender nor age were correlated with any variable. Six required surgery at follow-up. There were no differences in F1, C1, F0F1 or C0C1 between the six patients who required surgery and the other 34. Subsequently, data analysis was performed only for those patients who did not require surgery. The values obtained in the Farcy index were 8°+7° (F0), 12°+7° (F1) and 15°+8° (F2) and in kyphosis (three vertebrae, Cobb) they were: C0=8°+13°; C1=11.5°+14° and C2=13°+13°. There was a correlation of F2 with F0 and F1 (p<.001), with F0F1 (p=.038) and F1F2 (p=.007). The most powerful was with F1 (Rho Spearman=.889 (95% CI=.776-.947), with a Linear Regression line: F2=2.61288+F1×1.01237 (R2=.79). C2 was correlated with C0 and C1 (p<.001), especially with C1 (Rho Spearman=.952, 95% CI=.899-.977). Linear regression: C2=2.23371+C1×0.93758 (R2=.927)...(AU)

[Translated article] Immediate standing X-ray predicts the final vertebral collapse in elderly patients with thoracolumbar burst fracture / La radiografía en bipedestación inmediata predice el colapso final de la vértebra fracturada en pacientes añosos con fractura-estallido toracolumbar

Objective: To see if, in elderly patients with traumatic thoracolumbar fracture, standing X-rays with orthoses 24–48h after admission can predict vertebral collapse after consolidation. Material and methods: Prospective cohort study endorsed by the Clinical Research Ethics Committee. Inclusion criteria: age >65 years, acute thoracolumbar junction fracture due to fall, hospital admission, treatment with orthesis. Exclusion criteria: various levels, suspected malignancy, non-immediate fracture or atraumatic. Variables: Farcy index (F), regional kyphosis (C: Cobb from cranial to caudal to broken vertebra) – both measured at admission (F0 and C0), at 24-48h in standing position with orthesis (F1 and C1) and 3 months, without brace (F2 and C2), collapse (increase from F0 to F1 —F0F1— and from F1 to F2 —F1F2—; as well as from C0 to C1 —C0C1— and from C1 to C2 —C1C2—), age and gender. Statistical analysis: R package. Results: Series of 40 patients, with a mean age of 75 years (66–87). Nine men and 31 women. Neither gender nor age were correlated with any variable. Six required surgery at follow-up. There were no differences in F1, C1, F0F1 or C0C1 between the six patients who required surgery and the other 34. Subsequently, data analysis was performed only for those patients who did not require surgery. The values obtained in the Farcy index were 8°+7° (F0), 12°+7° (F1) and 15°+8° (F2) and in kyphosis (three vertebrae, Cobb) they were: C0=8°+13°; C1=11.5°+14° and C2=13°+13°. There was a correlation of F2 with F0 and F1 (p<.001), with F0F1 (p=.038) and F1F2 (p=.007). The most powerful was with F1 (Rho Spearman=.889 (95% CI=.776-.947), with a Linear Regression line: F2=2.61288+F1×1.01237 (R2=.79). C2 was correlated with C0 and C1 (p<.001), especially with C1 (Rho Spearman=.952, 95% CI=.899-.977). Linear regression: C2=2.23371+C1×0.93758 (R2=.927)...(AU)

Objetivo: Ver si, en pacientes añosos con fractura toracolumbar traumática, las radiografías en bipedestación con ortesis a las 24-48h del ingreso permiten predecir el colapso vertebral tras la consolidación. Material y métodos: Estudio prospectivo de 40 pacientes consecutivos con fractura estallido de charnela toracolumbar (T11-L2), mayores de 65 años. Avalado por el Comité Ética Investigación Clínica (CEIC). Criterios de inclusión: edad>65 años, fractura aguda por caída, ingreso hospitalario, tratamiento con corsé. Criterios de exclusión: afectación multinivel, sospecha malignidad, fractura subaguda o sin caída. Variables: índice de Farcy (F), cifosis regional (C: Cobb de vértebra craneal a la caudal a la rota), ambos medidos al ingreso (F0 y C0), a las 24-48h en bipedestación con corsé (F1 y C1) y a los 3 meses, sin corsé (F2 y C2), colapso (incremento de F0 a F1 —F0F1— y de F1 a F2 —F1F2—; así como de C0 a C1 —C0C1— y de C1 a C2 —C1C2—), edad y género. Análisis estadístico: paquete R. Resultados: Serie de 40 pacientes, con una edad media de 75 años (66-87). Nueve varones y 31 mujeres. Ni el género ni la edad se correlacionaron con ninguna variable. Seis requirieron cirugía en el seguimiento. No hubo diferencias en F1, C1, F0F1 ni C0C1 entre los 5 pacientes que requirieron cirugía y los otros 34. Posteriormente se realizó el análisis de los datos solo de aquellos pacientes que no precisaron de cirugía.Los valores obtenidos en el índice de Farcy fueron de 8±7° (F0), de 12±7° (F1) y de 15±8° (F2) y en la cifosis (3 vértebras, Cobb) fueron: C0=8±13°; C1=11,5±14° y C2=13±13°. Hubo correlación de F2 con F0 y F1 (p<0,001), con F0F1 (p=0,038) y F1F2 (p=0,007). La más poderosa fue con F1 (Rho Spearman: 0,889; IC 95%: 0,776-0,947), con una recta de regresión lineal: F2=2,61288+F1×1,01237 (R2=0,79). C2 se correlacionó con C0 y C1 (p<0,001), sobre todo con C1 (Rho de Spearman: 0,952; IC 95%: 0,899-0,977). Regresión lineal: C2=2,23371+C1×0,93758 (R2=0,927)...(AU)

[Translated article] Immediate standing X-ray predicts the final vertebral collapse in elderly patients with thoracolumbar burst fracture.

OBJECTIVE: To see if, in elderly patients with traumatic thoracolumbar fracture, standing X-rays with orthoses 24-48h after admission can predict vertebral collapse after consolidation. MATERIAL AND METHODS: Prospective cohort study endorsed by the Clinical Research Ethics Committee. INCLUSION CRITERIA: age >65 years, acute thoracolumbar junction fracture due to fall, hospital admission, treatment with orthesis. EXCLUSION CRITERIA: various levels, suspected malignancy, non-immediate fracture or atraumatic. VARIABLES: Farcy index (F), regional kyphosis (C: Cobb from cranial to caudal to broken vertebra) - both measured at admission (F0 and C0), at 24-48h in standing position with orthesis (F1 and C1) and 3 months, without brace (F2 and C2), collapse (increase from F0 to F1 -F0F1- and from F1 to F2 -F1F2-; as well as from C0 to C1 -C0C1- and from C1 to C2 -C1C2-), age and gender. STATISTICAL ANALYSIS: R package. RESULTS: Series of 40 patients, with a mean age of 75 years (66-87). Nine men and 31 women. Neither gender nor age were correlated with any variable. Six required surgery at follow-up. There were no differences in F1, C1, F0F1 or C0C1 between the six patients who required surgery and the other 34. Subsequently, data analysis was performed only for those patients who did not require surgery. The values obtained in the Farcy index were 8°+7° (F0), 12°+7° (F1) and 15°+8° (F2) and in kyphosis (three vertebrae, Cobb) they were: C0=8°+13°; C1=11.5°+14° and C2=13°+13°. There was a correlation of F2 with F0 and F1 (p<.001), with F0F1 (p=.038) and F1F2 (p=.007). The most powerful was with F1 (Rho Spearman=.889, 95% CI=.776-.947), with a linear regression line: F2=2.61288+F1×1.01237 (R2=.79). C2 was correlated with C0 and C1 (p<.001), especially with C1 (Rho Spearman=.952, 95% CI=.899-.977). Linear regression: C2=2.23371+C1×0.93758 (R2=.927). CONCLUSIONS: Immediate standing collapse predicts alignment at consolidation (3 months). It is therefore advisable to perform that radiography in the follow-up protocol.

Immediate standing X-ray predicts the final vertebral collapse in elderly patients with thoracolumbar burst fracture. / La radiografía en bipedestación inmediata predice el colapso final de la vértebra fracturada en pacientes añosos con fractura estallido toracolumbar.

OBJECTIVE: To see if, in elderly patients with traumatic thoracolumbar fracture, standing X-rays with orthoses 24-48h after admission can predict vertebral collapse after consolidation. MATERIAL AND METHODS: Prospective cohort study endorsed by the Clinical Research Ethics Committee. INCLUSION CRITERIA: age >65 years, acute thoracolumbar junction fracture due to fall, hospital admission, treatment with orthesis. EXCLUSION CRITERIA: various levels, suspected malignancy, non-immediate fracture or atraumatic. VARIABLES: Farcy index (F), regional kyphosis (C: Cobb from cranial to caudal to broken vertebra) - both measured at admission (F0 and C0), at 24-48h in standing position with orthesis (F1 and C1) and 3 months, without brace (F2 and C2), collapse (increase from F0 to F1 -F0F1- and from F1 to F2 -F1F2-; as well as from C0 to C1 -C0C1- and from C1 to C2 -C1C2-), age and gender. STATISTICAL ANALYSIS: R package. RESULTS: Series of 40 patients, with a mean age of 75 years (66-87). Nine men and 31 women. Neither gender nor age were correlated with any variable. Six required surgery at follow-up. There were no differences in F1, C1, F0F1 or C0C1 between the six patients who required surgery and the other 34. Subsequently, data analysis was performed only for those patients who did not require surgery. The values obtained in the Farcy index were 8°+7° (F0), 12°+7° (F1) and 15°+8° (F2) and in kyphosis (three vertebrae, Cobb) they were: C0=8°+13°; C1=11.5°+14° and C2=13°+13°. There was a correlation of F2 with F0 and F1 (p<.001), with F0F1 (p=.038) and F1F2 (p=.007). The most powerful was with F1 (Rho Spearman=.889 (95% CI=.776-.947), with a Linear Regression line: F2=2.61288+F1×1.01237 (R2=.79). C2 was correlated with C0 and C1 (p<.001), especially with C1 (Rho Spearman=.952, 95% CI=.899-.977). Linear regression: C2=2.23371+C1×0.93758 (R2=.927). CONCLUSIONS: Immediate standing collapse predicts alignment at consolidation (3 months). It is therefore advisable to perform that radiography in the follow-up protocol.