Thoracolumbar fracture Case presentation Presenters name Arial 24
Thoracolumbar fracture Case presentation Presenter‘s name Arial 24 pt Meeting Arial 24 pt Presenter‘s title Arial 20 pt City, Month, Year Arial 20 pt
27 -year-old man • Motor vehicle accident • No neurological loss • No other significant injuries
27 -year-old man
27 -year-old man • Status of PLC? • Further imaging?
27 -year-old man • Axial CT • Further imaging?
27 -year-old man • MRI • Plan?
27 -year-old man Intraoperative image showing PLC disruption
27 -year-old man Intraoperative image • In OR within 12 hours of injury Preoperative image
27 -year-old man Postoperative CT and lateral image 15/12 postoperative
19 -year-old woman • • • Motor vehicle accident Back pain Neurologically intact No other injuries Posterior tenderness • Nature of injury? • Other imaging?
19 -year-old woman
19 -year-old woman • Your plan?
Treatment outline for “Type B” fractures B 1–posterior monosegmental bony disruption • Posterior surgery indicated to restore posterior tension band • Fusion generally not required as stability achieved by bony healing • If no fusion performed, plan to remove instrumentation
Postoperative x-rays Post-R/O rods
Treatment outline for “Type B” fractures B 2–PLC disruption • Posterior surgery indicated to restore posterior tension band • Generally requires fusion of disrupted segment • Anterior reconstruction may be indicated if significant anterior column disruption/comminution
Treatment outline for “Type B” fractures B 2–PLC disruption • Anterior reconstruction may be indicated if significant anterior column disruption/comminution
Treatment outline for “Type B” fractures B 2–PLC disruption • Anterior reconstruction may be indicated if significant anterior column disruption/comminution • If anterior reconstruction, limit fusion to one motion segment
Treatment outline for “Type B” fractures B 3–anterior disruption • Unusual injury • May be in akylosed spine • Approach dependent on fracture configuration
Take-home messages • Generally surgical treatment • B 1 and B 2: usually posterior approach for adequate treatment • B 1 and B 2: occasionally requires 360º or anterior approach to reconstruct anterior column • Aim for monosegmental fusion • Plan to remove instrumentation when spanning nonfused segments
Excellence in Spine
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