hitchon burst
TRANSCRIPT
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Surgery vs Recumbency in
Thoracolumbar Fractures Professor of Neurosurgery andBioengineering Director of Spine Fellowship University of Iowa Hospitals andClinics
Patrick W. Hitchon, MD
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Surgery vs Recumbency inThoracolumbar Fractures
P.W.HitchonDept of Neurosurgery
University of Iowa College of Medicine
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Non-operative management of burst fractures
What factors determine success orfailure of non-operative treatment??
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Level of burst fractures
0
2
4
6
8
10
12
14
T4 T11 T12 L1 L2 L3 L4 L5
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Non-operative management of
burst fractures 15 patients failed conservative
treatment Because of pain Surgery within an average of 5 months
Some patients had been seen elsewhere
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Initial Non-operative management of burst fractures
Non-operative Operative
Number of pts 29 15
M:F 14:15 6:19
Injury-surgery 5.4+/- 6.3 mon
Age 47+/- 19 yrs 64+/- 16 yrs
Admission Frankel 5 4.4+/- 0.6Residual canal 61+/- 11% 54+/- 21%
Initial angle 2+/- 9 12+/- 12
Final angle 12+/- 8 10+/- 12
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Surgical treatment
Anterior corpectomy, PEEK grafting,screw+rod fixation 8
Posterior pedicle screw fixation 5 Vertebroplasty 3
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Neurological Performance with Treatment Across Time
0
1
2
3
4
5
6
Admission Follow-up
Time
F r a n
k e
l S c o r e
( I n
t a c
t = 5 )
Recumbency
Surgery
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Progress of Angulation
0
2
4
6
8
10
12
Admission Discharge Follow-up
SurgeryNon-operative
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Surgery Group Charges
010,00020,00030,00040,000
50,00060,00070,00080,000
Complete Partial IntactDeficit
D o l
l a r s
PhysicianSurgeryHospitalTotal
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Recumbency Group Charges
0
5,00010,00015,00020,00025,00030,00035,00040,000
Complete Partial Intact
Deficit
D o
l l a r s Physician
HospitalTotal
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Non-operative management of burst
fractures
Younger patients who are intact, with lesscanal compromise, and angulation willmost likely succeed without surgery
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Iowa Algorithm for Management of Th-lumbar Fractures
B33 col
C3Deficit
B1, B21 col, 2 col
R1 R2ang>10 canal
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6/7/0219-year-old male fell 20 feetwhile in construction, landingon his feet.He experienced low back painWithout deficit.
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1/11/108 years later
Bone remodellingCanal reconstituted
Would he have beenBetter off with surgery?
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Iowa Algorithm for Management of Th-lumbar Fractures
B33 col
C3Deficit
B1, B21 col, 2 col
R1 R2ang>10 canal