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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The goal of the current study is to establish a surgical algorithm to accompany the AOSpine thoracolumbar spine injury classification system. ⋯ The current algorithm uses a meaningful injury classification and worldwide surgeon input to determine the initial treatment recommendation for thoracolumbar injuries. This allows for a globally accepted surgical algorithm for the treatment of thoracolumbar trauma.
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The AOSpine thoracolumbar (TL) spine injury classification system is based mainly on computed tomography (CT). The main purpose of this study was to evaluate the reliability of CT scan in the diagnosis of posterior ligamentous complex (PLC) injury in thoracolumbar spine trauma (TLST). ⋯ In this study, the use of CT scan as the only diagnostic tool could identify PLC injury in most cases and demonstrated satisfactory reliability. Dislocation could satisfactorily diagnose type C injury, while IID was the best parameter to differentiate between type A and B injuries.
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Comparative Study
Anterior versus posterior approach in surgical treatment of tuberculous spondylodiscitis of thoracic and lumbar spine.
The aim of this study is to compare the clinical, radiological and functional outcome of anterior versus posterior surgical debridement and fixation in patients with thoracic and lumbar tuberculous spondylodiscitis. ⋯ Both anterolateral and posterolateral approaches are sufficient for achieving the goals of surgical treatment of thoracic and lumbar Pott's disease but posterolateral approach allows significant better kyphotic angle correction, less angle loss, better improvement in back pain but unfortunately more operative time and blood loss.
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The commonly described congenital atlanto-axial dislocation and Basilar-Invagination is antero-posterior or rotational or vertical plane. However, congenital dislocation in lateral plane has received scant attention. The purpose of this manuscript is to describe this unusual entity and discuss its management. ⋯ The acute angulation of joint on one side and near normal on other side leads to differential vertical movement, further accentuated by splaying of bifid C1. The entity is seen in young patients and often present with neck tilt and spastic quadriparesis. Management requires reshaping the joints and facet manipulation. If the reshaping is inappropriate, the joint is likely to redislocate before fusion occurs.
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Facet joint dislocation is a traumatic injury, which frequently results in devastating clinical outcomes. In Western Australia (WA), Royal Perth Hospital (RPH) provides a statewide Spinal Trauma Service and accepts all referrals from the entirety of the state. The economies of distance in WA mean that there is often a considerable delay between initial presentation at the peripheral hospital and enlocation of the dislocation in Perth. This study aims to identify any prejudicial clinical outcomes as a consequence of this delay. ⋯ This study confirms the challenges of management of these injuries in a large geographical area, with a centralised spinal trauma service. Generally, facet joint dislocations that had delayed reductions had a poorer outcome. We hope that the proposed protocol would deliver better management of these injuries.