Artikel
Hyperextension injuries of the thoracolumbar spine – shift of incidence, typical fracture morphologies and treatment options
Hyperextensionsverletzungen der thorakolumbalen Wirbelsäule – Inzidenzentwicklung, typische Verletzungsmorphologien und deren differenzierte Behandlung
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Autoren
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Timo Michael Heintel
- Universitätsklinikum Würzburg, Klinik und Poliklinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie, Würzburg, Deutschland
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Fabian Gilbert
- Universitätsklinikum Würzburg, Klinik und Poliklinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie, Würzburg, Deutschland
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Martin Cornelius Jordan
- Universitätsklinikum Würzburg, Klinik und Poliklinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie, Würzburg, Deutschland
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Sebastian Jovic
- Universitätsklinikum Würzburg, Klinik und Poliklinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie, Würzburg, Deutschland
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Hendrik Jansen
- Universitätsklinikum Würzburg, Klinik und Poliklinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie, Würzburg, Deutschland
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Rainer H. Meffert
- Universitätsklinikum Würzburg, Klinik und Poliklinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie, Würzburg, Deutschland
| Veröffentlicht: | 26. Juni 2020 |
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Gliederung
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Objective: Hyperextension injuries [HEIs] of the thoracolumbar spine are supposed to be rare. Their frequency of occurrence ranges from 0.2 to 2.5 %. Corresponding to this, the literature only contains small numbers of case reports and studies with small numbers of participants. In the last 25 years a striking increase in the frequency of HEIs was noticed. Different treatment concepts are proposed. Aim of this study was to investigate incidence, localization, typical fracture morphologies, treatment options and outcome.
Methods: Between 01/1997 and 12/2018 our prospective data base included 154 patients with 165 HEIs of the thoracolumbar spine (41 women and 113 men, average age at the time of the accident 71.3 ± 13.5 years, range 25 – 93 years). The data were analyzed retrospectively. Computed tomographic scans and MRI scans were evaluated. The injury patterns of the anterior column were differentiated into 3 groups: transosseous, transdiscal and combined forms, in which both the disc space and the vertebral body were affected. At the posterior column, osseous and ligamentous injuries were differentiated. A classification system with 6 different types of HEIs resulted from the combinations of these groups (Figure 1 [Fig. 1]).Values were expressed as the mean and standard error of the mean.
Results: In the last 25 years, more than a tenfold increase in patients with HEIs has been registeredin our institution. 154 patients with 165 HEIs of the thoracolumbar spine were analyzed. 122 (74%) HEIs were associated with DISH, 23 (14%) with ankylosing spondylitis, and 11 (7%) with Spondylosis deformans. Only 9 (5%) of these injuries involved patients without ankylosing spinal disease. HEIs in ankylosing spondylitis and DISH showed in part highly significant differences in the injury morphology. 45 HEIs, all patients with type 1, 2 or. 3 injuries without neurological deficit received non-operative treatment. 14 of the 154 patients (8%) died within the first 12 months after injury. 121 of the 140 surviving patients ware followed up for an average of 31.3 ± 12.7 months after injury. Within the first year, 96% of surgically treated and 98% of conservatively treated extension injuries recovered and attained stability.
Conclusion: To our knowledge, this study is by far the largest cohort of patients with HEIs of the thoracolumbal spine. The study provides important data for epidemiology, localization, accompanying pathologies, fracture morphology and the need for therapy.
Figure 1 [Fig. 1]
Figure 2 [Fig. 2]
