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KMID : 1189320150090060889
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Asian Spine Journal
2015 Volume.9 No. 6 p.889 ~ p.894
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Multilevel Noncontiguous Spinal Fractures: Surgical Approach towards Clinical Characteristics
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Secer Mehmet
Alagoz Fatih
Uckun Ozhan
Karakoyun Oguz Durmus
Ulutas Murat Omer
Polat Omer
Daglioglu Ergun
Dalgic Ali
Belen Deniz
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Abstract
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Study Design: The study retrospectively investigated 15 cases with multilevel noncontiguous spinal fractures (MNSF).
Purpose: To clarify the evaluation of true diagnosis and to plane the surgical treatment.
Overview of Literature: MNSF are defined as fractures of the vertebral column at more than one level. High-energy injuries caused MNSF, with an incidence ranging from 1.6% to 16.7%. MNSF may be misdiagnosed due to lack of detailed neurological and radiological examinations.
Methods: Patients with metabolic, rheumatologic diseases and neoplasms were excluded. Despite the presence of a spinal fracture associated clearly with the clinical picture, all patients were scanned within spinal column by direct X-rays, computed tomography and magnetic resonance imaging. When there were ≥5 intact vertebrae between two fractured vertebral segments, each fracture region was managed with a separated stabilization. In cases with ≤4 intact segments between two fractured levels, both fractures were fixed with the same rod and screw system.
Results: There were 32 vertebra fractures in 15 patients. Eleven (73.3%) patients were male and age ranged from 20 to 64 years (35.9±13.7 years). Eleven cases were the American Spinal Injury Association (ASIA) E, 3 were ASIA A, and one was ASIA D. Ten of the 15 (66.7%) patients returned to previous social status without additional deficit or morbidity. The remaining 5 (33.3%) patients had mild or moderate improvement after surgery.
Conclusions: The spinal column should always be scanned to rule out a secondary or tertiary vertebra fracture in vertebral fractures associated with high-energy trauma. In MNSF, each fracture should be separately evaluated for decision of surgery and planned approach needs particular care. In MNSF with ≤4 intact vertebra in between, stabilization of one segment should prompt the involvement of the secondary fracture into the system.
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KEYWORD
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Spinal column, Spinal fracture, Multilevel, Surgery
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