Multiple Vertebral Fractures
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Published:
Feb 14, 2022
Keywords:
Spine, trauma, vertebral injuries, associated injuries, kinematics, injury pattern.
Main Article Content
Abstract
Background: Multiple vertebral fractures (MVF) are the result of high-energy trauma. These can be contiguous (CMVF) when there is a fracture of two or more vertebral bodies in an adjacent way and non-contiguous (NCMVF) when there are lesions of various levels separated by at least one vertebra without injury.
Objective: To evaluate clinical features and kinematics, establish distribution, evaluate association with extra-vertebral injuries, detail complications.
Materials and Methods: A multicenter, prospective, and observational study. Patients with MVF.
Results: Sixty-six patients presented 196 vertebral lesions, without neurological deficit in 55; 26 were women and 40 were men, with an average age of 39 years old. Kinematics: 32 car accidents, 27 falls from height, 5 direct traumas and 2 sports traumas. Topography: 2 C0-C3, 4 C3-C7, 8 C7TT1, 61 T1-T10, 91 T10-L2, 28 L2-L5 and 1 sacrum. Combination: 21 thoracolumbar-thoracolumbar and 8 thoracic-thoracic. There were 32 contiguous injuries, 19 non-contiguous injuries, and 15 mixed-pattern injuries. Twenty-six patients presented 47 extra-verterbral injuries (20 multiple trauma, 12 thoracic trauma). 36 patients received non-surgical treatment and 30 patients underwent surgery.
Conclusion: The presence of MVF in spinal cord trauma is frequent, most do not show neurological involvement and are consequences of motor vehicle accidents. The most affected sector was between T2 to L5, the most frequent combination was thoracolumbar-thoracolumbar, followed by thoracic-thoracic; the most frequent were extra-vertebral injuries, mainly head and chest trauma. Complications: one patient hadincreased kyphosis; one, surgical site infection; and one patient died.
Objective: To evaluate clinical features and kinematics, establish distribution, evaluate association with extra-vertebral injuries, detail complications.
Materials and Methods: A multicenter, prospective, and observational study. Patients with MVF.
Results: Sixty-six patients presented 196 vertebral lesions, without neurological deficit in 55; 26 were women and 40 were men, with an average age of 39 years old. Kinematics: 32 car accidents, 27 falls from height, 5 direct traumas and 2 sports traumas. Topography: 2 C0-C3, 4 C3-C7, 8 C7TT1, 61 T1-T10, 91 T10-L2, 28 L2-L5 and 1 sacrum. Combination: 21 thoracolumbar-thoracolumbar and 8 thoracic-thoracic. There were 32 contiguous injuries, 19 non-contiguous injuries, and 15 mixed-pattern injuries. Twenty-six patients presented 47 extra-verterbral injuries (20 multiple trauma, 12 thoracic trauma). 36 patients received non-surgical treatment and 30 patients underwent surgery.
Conclusion: The presence of MVF in spinal cord trauma is frequent, most do not show neurological involvement and are consequences of motor vehicle accidents. The most affected sector was between T2 to L5, the most frequent combination was thoracolumbar-thoracolumbar, followed by thoracic-thoracic; the most frequent were extra-vertebral injuries, mainly head and chest trauma. Complications: one patient hadincreased kyphosis; one, surgical site infection; and one patient died.
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How to Cite
Bazán, P. L., Avero González, R. A., Patalano, L., Borri, Álvaro E., Medina, M., Cortés Luengo, C., Gutiérrez, E. E., Soria Adaro, J. C., Ciccioli, N. M., & Acevedo Yoga, J. (2022). Multiple Vertebral Fractures. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 87(1), 51-56. https://doi.org/10.15417/issn.1852-7434.2022.87.1.1407
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Clinical Research
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References
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7. Vaccaro AR, Schroeder GD, Divi SN, Kepler CK, Kleweno CP, Krieg JC, et al. Description and reliability of the
AOSpine Sacral Classification System. J Bone Joint Surg Am 2020;102(16):1454-63. https://doi.org/ 10.2106/JBJS.19.01153
8. Takami M, Okada M, Enyo Y, Wasaki H, Yamada H, Yoshida M. Noncontiguous double-level unstable spinal
injuries. Eur J Orthop Surg Traumatol 2017;27:79-86. https://doi.org/10.1007/s00590-016-1855-y
9. Richards DP, Clark P, Howard A. Multiple spine fractures in an adolescent snowboarder: case report. J Trauma
2001;50(4):730-2. https://doi.org/10.1097/00005373-200104000-00022
10. Bazán PL, Marín E, Betemps A, Borri ÁE, Medina M, Ciccioli NM, et al. Lesiones toracolumbares en la práctica
de acrobacia en tela. Reporte de casos. Rev Asoc Argent Ortop Traumatol 2020;85(2):119-24.
https://doi.org/10.15417/issn.1852-7434.2020.85.2.1010
11. Wittenberg RH, Hargus S, Steffen R, Muhr G, Bötel U. Noncontiguous unstable spine fractures. Spine (Phila Pa
1976) 2002;27: 254-7. https://doi.org/10.1097/00007632-200202010-00010
12. Kano S, Tanikawa H, Mogami Y, Shibata S, Takanashi S, Oji Y, et al. Comparison between continuous and
discontinuous multiple vertebral compression fractures. Eur Spine J 2012;21:1867-72. https://doi.org/10.1007/s00586-012-2210-6
13. Gupta A, Marsi WS. Multiple spinal injuries: incidence, distribution and neurologic patterns. J Bone Joint Surg Br 1989;71:692-5. https://doi.org/10.1302/0301-620X.71B4.2768324
14. Fleiderman J, Munjin M, Ilabaca F, Yurac R, Marré B. Fractura múltiple no contigua de la columna toracolumbar. Rev Chilena Ortop y Traum 2006;47:59-66. Disponible en:
http://www.josefleiderman.cl/wp-content/uploads/2017/07/Fractura-multiple.pdf
15. Collado Arce MGL, García López OF, Dufoo Olvera M, López Palacios JJ, Goméz Flores G, Ladewig Bernaldez
GI, et al. Multiple vertebral fractures at the “Dr. Manuel dufoo” Spine Clinic. Coluna/Columna 2018;17(2):143-6.
https://doi.org/10.1590/s1808-185120181702190994
16. Bazán PL, Betemps A, Ciccioli N, Borri A, Medina M. Combination of upper thoracic fracture and sternum fracture. Global Spine J 2017;5(Suppl 1):35. https://doi.org/10.1055/s-0035-1554442
17. Valero J, Ciccioli NM, Bazán PL, Borri AE. Upper thoracic spine fracture associated with fracture of the sternum. Coluna/Columna 2017;16(1):60-3. https://doi.org/10.1590/S1808185120171601151846
recognition. AJR Am J Roentgenol 1978;130:665-9. https://doi.org/10.2214/ajr.130.4.665
2. Lian XF, Zhao J, Hou TS, Yuan JD, Jin GY, Li ZH. The treatment for multilevel noncontiguous spinal fractures. Int
Orthop 2007; 31(5):647-52. https://doi.org/10.1007/s00264-006-0241-5
3. Nelson DW, Martin MJ, Martin ND, Beekley A. Evaluation of the risk of noncontiguous fractures of the spine in
blunt trauma. J Trauma Acute Care Surg 2013;5(1):135-9. https://doi.org/10.1097/ta.0b013e3182984a08
4. Cho Y, Goo Kim Y. Clinical features and treatment outcomes of acute multiple thoracic and lumbar spinal fractures: a comparison of continuous and noncontinuous fractures. J Korean Neurosurg Soc 2019;62 (6):700-11.
https://doi.org/10.3340/jkns.2019.0093
5. Vaccaro AR, Koerner JD, Radcliff KE, Oner FC, Reinhold M, Schnake KJ, et al. AOSpine subaxial cervical spine
injury classification system. Eur Spine J 2016;25:2173-84. https://doi.org/10.1007/s00586-015-3831-3
6. Vaccaro AR, Oner C, Kepler CK, Dvorak M, Schnake K, Bellabarba C, et al. AOSpine spinal cord injury & trauma
knowledge forum. AOSpine thoracolumbar spine injury classification system: fracture description, neurological
status, and key modifiers. Spine (Phila Pa 1976) 2013;38:2028-37. https://doi.org/10.1097/BRS.0b013e3182a8a381
7. Vaccaro AR, Schroeder GD, Divi SN, Kepler CK, Kleweno CP, Krieg JC, et al. Description and reliability of the
AOSpine Sacral Classification System. J Bone Joint Surg Am 2020;102(16):1454-63. https://doi.org/ 10.2106/JBJS.19.01153
8. Takami M, Okada M, Enyo Y, Wasaki H, Yamada H, Yoshida M. Noncontiguous double-level unstable spinal
injuries. Eur J Orthop Surg Traumatol 2017;27:79-86. https://doi.org/10.1007/s00590-016-1855-y
9. Richards DP, Clark P, Howard A. Multiple spine fractures in an adolescent snowboarder: case report. J Trauma
2001;50(4):730-2. https://doi.org/10.1097/00005373-200104000-00022
10. Bazán PL, Marín E, Betemps A, Borri ÁE, Medina M, Ciccioli NM, et al. Lesiones toracolumbares en la práctica
de acrobacia en tela. Reporte de casos. Rev Asoc Argent Ortop Traumatol 2020;85(2):119-24.
https://doi.org/10.15417/issn.1852-7434.2020.85.2.1010
11. Wittenberg RH, Hargus S, Steffen R, Muhr G, Bötel U. Noncontiguous unstable spine fractures. Spine (Phila Pa
1976) 2002;27: 254-7. https://doi.org/10.1097/00007632-200202010-00010
12. Kano S, Tanikawa H, Mogami Y, Shibata S, Takanashi S, Oji Y, et al. Comparison between continuous and
discontinuous multiple vertebral compression fractures. Eur Spine J 2012;21:1867-72. https://doi.org/10.1007/s00586-012-2210-6
13. Gupta A, Marsi WS. Multiple spinal injuries: incidence, distribution and neurologic patterns. J Bone Joint Surg Br 1989;71:692-5. https://doi.org/10.1302/0301-620X.71B4.2768324
14. Fleiderman J, Munjin M, Ilabaca F, Yurac R, Marré B. Fractura múltiple no contigua de la columna toracolumbar. Rev Chilena Ortop y Traum 2006;47:59-66. Disponible en:
http://www.josefleiderman.cl/wp-content/uploads/2017/07/Fractura-multiple.pdf
15. Collado Arce MGL, García López OF, Dufoo Olvera M, López Palacios JJ, Goméz Flores G, Ladewig Bernaldez
GI, et al. Multiple vertebral fractures at the “Dr. Manuel dufoo” Spine Clinic. Coluna/Columna 2018;17(2):143-6.
https://doi.org/10.1590/s1808-185120181702190994
16. Bazán PL, Betemps A, Ciccioli N, Borri A, Medina M. Combination of upper thoracic fracture and sternum fracture. Global Spine J 2017;5(Suppl 1):35. https://doi.org/10.1055/s-0035-1554442
17. Valero J, Ciccioli NM, Bazán PL, Borri AE. Upper thoracic spine fracture associated with fracture of the sternum. Coluna/Columna 2017;16(1):60-3. https://doi.org/10.1590/S1808185120171601151846