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Two-Nation Comparison of Classification and Treatment of Thoracolumbar Fractures: An Internet-Based Multicenter Study Among Spine Surgeons.
- Source :
-
Spine (03622436) . 11/15/2015, Vol. 40 Issue 22, p1749-1756. 8p. - Publication Year :
- 2015
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Abstract
- <bold>Study Design: </bold>Web-based multicenter study.<bold>Objective: </bold>The aim of the study was to assess and compare the management strategy for traumatic thoracolumbar fractures between German and Dutch spine surgeons.<bold>Summary Of Background Data: </bold>To date, there is no evidence-based treatment algorithm for thoracolumbar spine fractures, thereby an international controversy concerning optimal treatment exists.<bold>Methods: </bold>In this web-based multicenter study (www.spine.hostei.com), computed tomography scans of traumatic thoracolumbar fractures (T12-L2) were evaluated by German and Dutch spine surgeons. Supplementary case-specific information such as age, sex, height, weight, neurological status, and injury mechanism were provided.By using a questionnaire, fractures were classified according to the AO-Magerl Classification, followed by 6 questions concerning the treatment algorithm. Data were analyzed using SPSS (Version 21, 76, Chicago, IL). The interobserver agreement was determined by using Cohen κ. Statistical significance was defined as P < 0.05.<bold>Results: </bold>Twelve surgeons (6 per country) evaluated each 91 cases. The fractures were classified as AO Type A in 82% (898 votes), Type B in 14% (150 votes), and Type C in 4% (44 votes). No significant difference concerning the AO Classification between German and Dutch spine surgeons was found. Overall German spine surgeons had a lower threshold concerning the indication for surgical treatment (Ger 87% vs. NL 30%; P < 0.05). There was a consensus about operative stabilization of AO Type B and C injuries and injuries with neurologic deficit, whereas a discrepancy in the therapeutic algorithm for AO Type A fractures was observed. This difference was most pronounced regarding the indication for posterior (Ger 96.6%; NL 41.2%; P < 0.05) and circumferential stabilization (Ger 53.4%; NL 0%; P < 0.05) for burst fractures.<bold>Conclusion: </bold>There is a consensus to stabilize AO Type B and C fractures, whereas country-specific differences in the treatment of Type A fractures, especially in case of burst fractures, occur. Prospective, controlled multicenter outcome studies may provide more evidence in optimal treatment for thoracolumbar fractures.<bold>Level Of Evidence: </bold>2. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 03622436
- Volume :
- 40
- Issue :
- 22
- Database :
- Academic Search Index
- Journal :
- Spine (03622436)
- Publication Type :
- Academic Journal
- Accession number :
- 112718369
- Full Text :
- https://doi.org/10.1097/BRS.0000000000001143