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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
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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 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
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
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HPI - Pt fell from tree about 30 feet while intoxicated. On arrival was moving b/l extremities. Injuries include
1. L1 and L3 burst fx
2. type 1 hangman's fx
3. non-displaced fx of posterior arch of C6
4. R proximal humerus fx
5. left distal radius fx
6. nonoperative subdural hemorrhage.
After 2 days in hospital went into DTs and went into respiratory distress. Pt has pneumothrax and chest tube was placed. Pt was intubated to protect airway due to agitated state. Sedation required. Pt developed right lobe pneumonia, possibly from aspiration.
Orthopaedic spine consulted after pt intubated and sedated. While very difficult to determine examine, pt appeared to have slowly increasing weakness on bilateral lower extremity. During state of agitation initially would bring knees off bed. This was slowly lost over course of several days. Difficulty to tell if it was due to a systemic process (sedation, mental status changes) or due to stenosis at L3.
Would you perform operative L3 decompression +/- stabilization on this patient at this time (mental status changes, likely progressive weakness but unreliable exam)?
HPI - S/P snowmobile accident. C/O severe LBP, R leg pain, parasthesia and weakness.
What would be your choice of treatment?