Skip to main content

An updated management algorithm for incorporating minimally invasive techniques to treat thoracolumbar trauma.

Publication ,  Journal Article
Greenberg, JK; Burks, SS; Dibble, CF; Javeed, S; Gupta, VP; Yahanda, AT; Perez-Roman, RJ; Govindarajan, V; Dailey, AT; Dhall, S; Hoh, DJ ...
Published in: J Neurosurg Spine
October 29, 2021

OBJECTIVE: Minimally invasive surgery (MIS) techniques can effectively stabilize and decompress many thoracolumbar injuries with decreased morbidity and tissue destruction compared with open approaches. Nonetheless, there is limited direction regarding the breadth and limitations of MIS techniques for thoracolumbar injuries. Consequently, the objectives of this study were to 1) identify the range of current practice patterns for thoracolumbar trauma and 2) integrate expert opinion and literature review to develop an updated treatment algorithm. METHODS: A survey describing 10 clinical cases with a range of thoracolumbar injuries was sent to 12 surgeons with expertise in spine trauma. The survey results were summarized using descriptive statistics, along with the Fleiss kappa statistic of interrater agreement. To develop an updated treatment algorithm, the authors used a modified Delphi technique that incorporated a literature review, the survey results, and iterative feedback from a group of 14 spine trauma experts. The final algorithm represented the consensus opinion of that expert group. RESULTS: Eleven of 12 surgeons contacted completed the case survey, including 8 (73%) neurosurgeons and 3 (27%) orthopedic surgeons. For the 4 cases involving patients with neurological deficits, nearly all respondents recommended decompression and fusion, and the proportion recommending open surgery ranged from 55% to 100% by case. Recommendations for the remaining cases were heterogeneous. Among the neurologically intact patients, MIS techniques were typically recommended more often than open techniques. The overall interrater agreement in recommendations was 0.23, indicating fair agreement. Considering both literature review and expert opinion, the updated algorithm indicated that MIS techniques could be used to treat most thoracolumbar injuries. Among neurologically intact patients, percutaneous instrumentation without arthrodesis was recommended for those with AO Spine Thoracolumbar Classification System subtype A3/A4 (Thoracolumbar Injury Classification and Severity Score [TLICS] 4) injuries, but MIS posterior arthrodesis was recommended for most patients with AO Spine subtype B2/B3 (TLICS > 4) injuries. Depending on vertebral body integrity, anterolateral corpectomy or mini-open decompression could be used for patients with neurological deficits. CONCLUSIONS: Spine trauma experts endorsed a range of strategies for treating thoracolumbar injuries but felt that MIS techniques were an option for most patients. The updated treatment algorithm may provide a foundation for surgeons interested in safe approaches for using MIS techniques to treat thoracolumbar trauma.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

J Neurosurg Spine

DOI

EISSN

1547-5646

Publication Date

October 29, 2021

Start / End Page

1 / 10

Location

United States

Related Subject Headings

  • Orthopedics
  • 3209 Neurosciences
  • 1109 Neurosciences
  • 1103 Clinical Sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Greenberg, J. K., Burks, S. S., Dibble, C. F., Javeed, S., Gupta, V. P., Yahanda, A. T., … Ray, W. Z. (2021). An updated management algorithm for incorporating minimally invasive techniques to treat thoracolumbar trauma. J Neurosurg Spine, 1–10. https://doi.org/10.3171/2021.7.SPINE21790
Greenberg, Jacob K., Stephen Shelby Burks, Christopher F. Dibble, Saad Javeed, Vivek P. Gupta, Alexander T. Yahanda, Roberto J. Perez-Roman, et al. “An updated management algorithm for incorporating minimally invasive techniques to treat thoracolumbar trauma.J Neurosurg Spine, October 29, 2021, 1–10. https://doi.org/10.3171/2021.7.SPINE21790.
Greenberg JK, Burks SS, Dibble CF, Javeed S, Gupta VP, Yahanda AT, et al. An updated management algorithm for incorporating minimally invasive techniques to treat thoracolumbar trauma. J Neurosurg Spine. 2021 Oct 29;1–10.
Greenberg, Jacob K., et al. “An updated management algorithm for incorporating minimally invasive techniques to treat thoracolumbar trauma.J Neurosurg Spine, Oct. 2021, pp. 1–10. Pubmed, doi:10.3171/2021.7.SPINE21790.
Greenberg JK, Burks SS, Dibble CF, Javeed S, Gupta VP, Yahanda AT, Perez-Roman RJ, Govindarajan V, Dailey AT, Dhall S, Hoh DJ, Gelb DE, Kanter AS, Klineberg EO, Lee MJ, Mummaneni PV, Park P, Sansur CA, Than KD, Yoon JJW, Wang MY, Ray WZ. An updated management algorithm for incorporating minimally invasive techniques to treat thoracolumbar trauma. J Neurosurg Spine. 2021 Oct 29;1–10.

Published In

J Neurosurg Spine

DOI

EISSN

1547-5646

Publication Date

October 29, 2021

Start / End Page

1 / 10

Location

United States

Related Subject Headings

  • Orthopedics
  • 3209 Neurosciences
  • 1109 Neurosciences
  • 1103 Clinical Sciences