European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Comparative Study
Classification of thoracic and lumbar spine fractures: problems of reproducibility. A study of 53 patients using CT and MRI.
Reproducibility of fracture classification systems in general has been a matter of controversy. The reproducibility of spinal fracture classifications has not been sufficiently studied. We studied the inter-observer and intra-observer reproducibility of the Magerl (AO) classification using radiograms, CTs and MRIs of 53 patients. ⋯ The agreement was, in general, better with the Denis classification, but the variance was higher due to the difficulty of finding proper categories for some injury patterns. Although the AO classification allows proper registration of all kinds of injury, the reproducibility, especially at the type level, is problematic. Use of MRI and better definition of the distinctive properties of the three different types may enhance the reproducibility of the scheme.
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The authors present a retrospective clinical and radiological study addressing the outcome after posterior stabilisation of thoracolumbar fractures with intervertebral fusion via transpedicular bone grafting. The study included computed tomographic (CT) scan after implant removal for analysis of the intervertebral fusion and incorporation of the intervertebral bone graft and its influence on postoperative re-kyphosing. Twenty-nine patients with acute fractures of the thoracolumbar spine, treated between 1988 and 1995 at the Department of Trauma Surgery, Hannover Medical School, underwent posterior stabilisation and interbody fusion with transpedicular cancellous bone grafting. ⋯ In nine patients (31%) neither interbody fusion nor incorporation of the transpedicular graft was achieved. A frequent and reliable intervertebral fusion could not be achieved with the described technique of transpedicular bone grafting. The ineffectiveness of the intervertebral graft was found to be a reason for postoperative re-kyphosing.
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Whiplash-associated disorders (WAD) are described and analysed 17 years after involvement in a motor vehicle accident. A self-report questionnaire was mailed to 121 patients registered at emergency departments in Gothenburg in 1983 because of neck complaints following a car collision. The questionnaire contained items on symptoms referred to WAD, treatment, work disability, involvement in settlement of claims, medical disability and the Neck Disability Index (NDI). ⋯ There was no significant correlation between the patients' degree of medical disability and the scores on the NDI. The results of the study show that approximately half of the patients with neck complaints following motor vehicle accidents in Gothenburg in 1983 suffered frequent residual symptoms 17 years after the accident, mostly comprising neck pain, radiating pain, and headache. The residual disorders contributed to the patients' overall disability.
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Anterior and posterior thoracic cage translations in the sagittal plane have not been reported for their range of motion and effects on the lumbar spine and pelvis. Twenty subjects volunteered for full-spine radiography in neutral, anterior, and posterior thoracic cage translation postures in a standing position. While grasping an anterior vertical pole, with hands at elbow level, subjects were instructed on how to translate their thoracic cage without any flexion/extension, utilizing a full-length mirror. ⋯ In anterior translation, pelvic tilt and Ferguson's sacral base angle increased by 15.1 degrees and 12.8 degrees, respectively. The findings of this study show that thoracic cage anterior/posterior translations cause significant changes in thoracic kyphosis (26 degrees ), lumbar curve, and pelvic tilt. An understanding of this main motion and consequent coupled movements might aid the understanding of spinal injury kinematics and spinal displacement analysis on full spine lateral radiographs of low back pain and spinal disorder populations.