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All of the following are variables used to calculate the Thoracolumbar Injury Classification and Severity (TLICS) score EXCEPT:
Percent spinal canal compromise
Fracture morphology (compression vs. burst)
Nerve root symptoms
Cauda equina syndrome symptoms
Posterior ligamentous complex integrity
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A 19-year-old male is evaluated in the trauma bay following a snowmobile accident. He is conscious and reporting severe low back pain. On exam, he is ASIA B. Imaging is obtained and demonstrates an L1 burst fracture with 60% retropulsion into the thecal sac, as well as translation of L1 on L2. There is significant edema on the MRI STIR sequence involving the paraspinal musculature, interspinous ligament, and ligamentum flavum. What is the recommended treatment for this injury?
Reassessment upon return of the bulbocavernosus reflex
Pain control and early mobilization with or without bracing
Posterior percutaneous instrumentation utilizing ligamentotaxis for indirect reduction
Corpectomy with placement of an interbody cage
Corpectomy with placement of an interbody cage and posterior instrumentation
A 42-year-old carpenter sustains a 10 foot fall from a ladder and sustains a fracture at L1. On imaging there is fracture extension into the posterior vertebral body and a widened interpedicular distance. Magnetic resonance imaging shows the posterior ligamentous complex is intact. Which of the following statements is true regarding this injury pattern?
Canal compromise greater than 50% warrants decompression and fusion
A nerve root deficit is an absolute indication to proceed with surgery
Patients with adequate pain control can begin early ambulation without bracing
Fusion must involve 3 levels above and below the injured level
Stabilization with percutaneous screws without fusion is contraindicated.
In patients with a stable thoracolumbar burst fracture and no neurologic deficits, operative treatment has what long term outcome when compared to nonoperative management.
Improved sagittal balance
Decreased pain scores
Improved return to work status
Increased disability and complications
You are seeing a 68-year-old female who fell out of her second story apartment window. She complains of severe low back pain and right buttock pain. Her neurologic exam shows she is an ASIA E. Imaging shows a L3 burst fracture with 10 degrees of kyphosis, 30% loss of vertebral body height, and retropulsion of bone with 20% occlusion of the spinal canal. There is no evidence of edema in posterior ligament complex on MRI. What is the most appropriate treatment?
Spinal traction with bedrest for a minimum of 6 weeks
Spinal orthosis and early mobilization as tolerated
Laminectomy and lateral recess decompression
Laminectomy and 4 level posterior instrumented fusion
Anterior corpectomy with decompression and staged 4 level posterior instrumented fusion
In a neurologically intact patient with the injury pattern shown in Figure A, B and C, what is the advantage of surgical treatment compared to early mobilization in a thoracolumbosacral orthosis?
Decreased kyphosis over time
Decreased residual back pain
Lower cost of hospitalization
Earlier return to work
No advantage - equivalent clinical outcomes
A 32-year-old male sustained an L4 burst fracture in a car accident five days ago. On initial presentation he was neurologically intact and treated in a thoracolumbar orthosis. In the last two days he has noticed increasing difficulty voiding, decreased perianal sensation, and weakness to ankle plantar flexion. Radiographs, computed tomography, and magnetic resonance imaging are shown in Figures A through D. What is the most appropriate next step in treatment?
Spinal dose corticosteroids with inpatient observation
A decompressive lumbar laminectomy without fusion
Percutaneous posterior instrumented stabilization from L2 to L5 with indirect decompression via distraction ligamentotaxis
Anterior decompresssion with strut grafting followed by posterior instrumentation
A 32-year-old man presents to the emergency department after sustaining a L1 burst fracture in a fall. A careful neurologic exam shows he is an ASIA E. MRI shows mild vertebral retropulsion with 10% central canal stenosis and no evidence of injury to the posterior ligament complex. Which of the following is true regarding surgical decompression and fixation when compared to nonoperative treatment with bracing?
Patients treated with surgery return to work earlier.
Patients treated with surgery have decreased pain scores.
Patients treated with surgery have increased complication rates.
Patients treated with surgery have improved final SF-36 scores.
All of the above