Analysis of multilevel non-contiguous spinal fractures: A retrospective study

Prabha Ramkumar, R (2016) Analysis of multilevel non-contiguous spinal fractures: A retrospective study. Masters thesis, Madras Medical College, Chennai.


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AIM OF THE STUDY: Aim of this study is to evaluate the incidence, levels involved, patterns of fractures, neurological deficits created, treatment options and outcome of noncontiguous multilevel spinal fractures. METHODS: Thrity two patients who presented with spinal fractures at more than one level with atleast one normal vertebra in between the fractured levels to our institute of Orthopaedics and Traumatology during the period of 2013-2015 are studied retrospectively.All patients are taken xrays, CT and MRI.Fractures of more than one level with atleast one normal vertebra in between are selected.Grading of neurological status is done with Frankel grading system. The mode of injury, percent of anterior vertebral body compression, angle of deformity, and displacement percentage were determined for all levels of injury. Calculation of vertebral body angles was made with a modification of Cobb recommendation. Stable fractures are conservatively treated. Unstable fractures are defined as fractures with neurological deficit, more than 50 % axial compression or more than 25 % angulation, wedge compression fractures involving middle column with neurological deficit and fracture dislocations with neurological deficit.Unstable fractures are treated surgically.The patients are followed up and their present Frankel grade , Denis pain and work scale are recorded. Results are analysed. RESULTS: Total number of patients studied is 32.The mean age was 33.5 (Range 17-75 years). More than 30% percent of the patients were 20 to 30 years of age . Twenty six(81%) were male and six (19%) were females. Fall from height injury accounted for 44% and high energy road traffic accident accounted for 54%.followed by Road traffic accident 4 (12.5%) .Most common segment involved is the dorsal and lumbar segment. Two segment involvement is more common.Most common combination is DORSAL + LUMBAR(n=7).Most common Frankel Grade is E(53.5%).Patients were divided into three groups .Group A –conservatively treated.Group B- surgery at one level.Group C- Surgery at two or more levels.Outcome in terms of Denis Pain and work scale was better in all three groups. CONCLUSIONS: In high energy trauma patients with spinal fracture the presence of other levels of fractures must be excluded. Routine clinical and radiological screening should be done in all spinal fractures to rule out multilevel non contiguous fractures. Radiographs of the whole spine is essential in emergency setup. Life support should be the important element in initial management of multi level noncontiguous spinal fractures. Treatment planning should be done after CT and MRI evaluation. Treatment should be individualized from patient to patient depending on the neuro logical status, stability of spine, and patient’s condition. These fractures can be treated either conservatively, surgically or combination of both. Clear knowledge in decision making for individual fractures is essential. Conservatively treated cases should be monitored carefully for deterioration of condition.

Item Type: Thesis (Masters)
Uncontrolled Keywords: multilevel non-contiguous spinal fractures ; Analysis ; retrospective study.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 16 Sep 2017 13:15
Last Modified: 16 Sep 2017 13:15

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