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. 2018 Sep;8(2 Suppl):34S-45S.
doi: 10.1177/2192568218771668. Epub 2018 Sep 7.

Treatment of Fractures of the Thoracolumbar Spine: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU)

Akhil P Verheyden  1   2 , Ulrich J Spiegl  3   2 , Helmut Ekkerlein  4 , Erol Gercek  5 , Stefan Hauck  1 , Christoph Josten  3 , Frank Kandziora  6 , Sebastian Katscher  7 , Philipp Kobbe  8 , Christian Knop  9 , Wolfgang Lehmann  10 , Rainer H Meffert  11 , Christian W Müller  12 , Axel Partenheimer  13 , Christian Schinkel  14 , Philipp Schleicher  6 , Matti Scholz  6 , Christoph Ulrich  15 , Alexander Hoelzl  16
Affiliations

Treatment of Fractures of the Thoracolumbar Spine: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU)

Akhil P Verheyden et al. Global Spine J. 2018 Sep.

Abstract

Study design: consensus paper with systematic literature review.

Objective: The aim of this study was to establish recommendations for treatment of thoracolumbar spine fractures based on systematic review of current literature and consensus of several spine surgery experts.

Methods: The project was initiated in September 2008 and published in Germany in 2011. It was redone in 2017 based on systematic literature review, including new AOSpine classification. Members of the expert group were recruited from all over Germany working in hospitals of all levels of care. In total, the consensus process included 9 meetings and 20 hours of video conferences.

Results: As regards existing studies with highest level of evidence, a clear recommendation regarding treatment (operative vs conservative) or regarding type of surgery (posterior vs anterior vs combined anterior-posterior) cannot be given. Treatment has to be indicated individually based on clinical presentation, general condition of the patient, and radiological parameters. The following specific parameters have to be regarded and are proposed as morphological modifiers in addition to AOSpine classification: sagittal and coronal alignment of spine, degree of vertebral body destruction, stenosis of spinal canal, and intervertebral disc lesion. Meanwhile, the recommendations are used as standard algorithm in many German spine clinics and trauma centers.

Conclusion: Clinical presentation and general condition of the patient are basic requirements for decision making. Additionally, treatment recommendations offer the physician a standardized, reproducible, and in Germany commonly accepted algorithm based on AOSpine classification and 4 morphological modifiers.

Keywords: conservative therapy; morphological modifiers; operative therapy; therapy recommendations; thoracolumbar spine fracture; traumatic vertebral body fractures.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flow diagram depicting the literature research.
Figure 2.
Figure 2.
Morphological modifier 1 (MM 1): Disorder in the physiological alignment of the vertebral column: monosegmental endplate angle (EPA).
Figure 3.
Figure 3.
Morphological modifier 1 (MM 1): Disorder in the physiological alignment of the vertebral column: bisegmental endplate angle (EPA).
Figure 4.
Figure 4.
Morphological modifier 1 (MM 1): Disorder in the physiological alignment of the vertebral column: scoliosis angle.
Figure 5.
Figure 5.
Individual sagittal profile: The posttraumatic bisegmental kyphotic angle of 20° (a) in a physiologically 5° to 10° lordotic area at L 1 (δEPA of 30°) is more clinical relevance than 20° kyphosis (b) in a physiologically 10° kyphotic area at T 8 (δEPA 10°).
Figure 6.
Figure 6.
Morphological Modifier II (MM II): Comminution of the vertebral body.
Figure 7.
Figure 7.
Morphological Modifier III (MM III): Stenosis of the spinal canal.
See this image and copyright information in PMC

References

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