Evidence map›Paper›PMID 39247015›Full record

ArticleCureus2024

A4 Thoracolumbar Fracture Class Is Associated With a Greater Degree of Vertebral Height Loss in Conservatively Managed Patients.

Ashwin Ghadiyaram, Asha Krishnakumar, Janan Leppo, Megan M Rajagopal, Nora T Poulos, Charles F Opalak, William C Broaddus, Brian M Cameron

Abstract read
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Article in Cureus, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

8 authors.

Ashwin GhadiyaramDepartment of Neurosurgery, Virginia Commonwealth University Health System, Richmond, USA.
Asha KrishnakumarDepartment of Neurosurgery, Virginia Commonwealth University Health System, Richmond, USA.
Janan LeppoDepartment of Internal Medicine, University of California San Diego, San Diego, USA.
Megan M RajagopalDepartment of Neurosurgery, Virginia Commonwealth University Health System, Richmond, USA.
Nora T PoulosDepartment of Neurosurgery, Virginia Commonwealth University Health System, Richmond, USA.
Charles F OpalakNeurosurgery, Prisma Health Southeastern Neurosurgical and Spine Institute, Greenville, USA.
William C BroaddusDepartment of Neurosurgery, Virginia Commonwealth University Health System, Richmond, USA.
Brian M CameronDepartment of Neurosurgery, Virginia Commonwealth University Health System, Richmond, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionThoracolumbar (TL) junction fractures are common, often resulting from high-energy trauma or osteoporosis, and may lead to neurological deficits, deformities, or chronic pain. Treatment decisions for neurologically intact patients remain controversial, with nonsurgical management often favored. The AO classification system has been used to characterize thoracolumbar fractures using fracture morphology and clinical factors affecting clinical decision-making for fracture management. This study aims to assess the radiographic outcomes of utilizing a thoracolumbosacral orthosis (TLSO) brace in neurologically intact patients with TL fractures based on the AO classification system.

methodsA retrospective analysis of 43 patients was conducted using data from the VCU Spine Database on patients with TL fractures managed conservatively with a TLSO brace from 2010 to 2019. Demographic variables and radiographic measurements of anterior height loss were analyzed and stratified by AO fracture class.

resultsSignificant differences were observed in anterior height loss between AO fracture classes, with A4 fractures showing significantly greater anterior height loss at initial presentation (27.6 + 4.8%) compared to A1/A2 (16.1 + 2.2%; p=0.049). At follow up, A4 fractures had a significantly greater anterior height loss (40.2 + 6.6%) than both the A1/A2 (22.4 + 2.9%; p=0.029) and A3 fracture classes (20.5 + 3.6; p=0.020).

conclusionsThe study highlights significant differences in anterior height loss among AO fracture classes, suggesting varying degrees of severity and potential implications for clinical management. While conservative treatment with TLSO braces may provide pain relief, surgical intervention may offer better structural recovery, especially in more severe fractures. Conservative management of TL fractures with TLSO braces may result in greater anterior height loss, particularly in A4 fractures, emphasizing the need for individualized treatment decisions. Further research, including prospective studies, is warranted to validate these findings and guide clinical practice effectively.

Indexed as

conservative managementspinal fracturethoracolumbar fracturethoracolumbosacral orthosistlso brace

Identifiers

PMID39247015
PMCPMC11379500

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