Document Detail


Posttraumatic kyphosis: current state of diagnosis and treatment: results of a multinational survey of spine trauma surgeons.
MedLine Citation:
PMID:  20124914     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY DESIGN: Multinational survey of spine trauma surgeons.
OBJECTIVES: To survey a multinational group of spine trauma surgeons and develop an updated consensus definition of posttraumatic kyphosis (PTK), and the most current methods for diagnosis and treatment.
SUMMARY OF BACKGROUND DATA: PTK remains a potential problematic sequela of thoracolumbar trauma. Although most surgeons have devised their own approaches for detecting and treating this condition, broad agreement in terms of the diagnosis and management of PTK has not been achieved. There is a lack of consensus-based guidelines, as the current literature largely consists of small case series or anecdotal expert opinions.
METHODS: A survey questionnaire was circulated among 35 multinational spine trauma surgeons. The questionnaire consisted of 29 questions divided into 8 domains: definition, diagnosis, risk factors, symptoms, radiographic evaluation, surgical indications, treatment, and expected outcome. Answers from respondents were compiled and evaluated to generate a consensus.
RESULTS: All 35 surgeons completed the survey. Consensus was achieved that PTK represents "a painful kyphotic angulation that can occur anywhere in the posttraumatic spine." Agreement was also reached that asymptomatic PTK can exist, although no true consensus could be reached on the extent of angular deformity that results in PTK. Untreated or maltreated flexion-distraction injuries, or severe burst fractures of the thoracolumbar spine, were felt to be the 2 injuries most likely to produce PTK. Computed tomography, magnetic resonance, and dynamic radiographs were all recommended for evaluation. If surgery is necessary, posteriorly based osteotomies, especially pedicle subtraction osteotomies, have become the principal means of correction.
CONCLUSIONS: An updated understanding of PTK and its treatment has been achieved. Posterior osteotomies seem to be the most popular means of surgical correction. In the future, multicenter prospective studies are necessary to ascertain, with greater precision, the most appropriate treatment for this condition.
Authors:
Andrew J Schoenfeld; Kirkham B Wood; Charles F Fisher; Michael Fehlings; F C Oner; Kim Bouchard; Paul Arnold; Alexander R Vaccaro; Lali Sekhorn; Mitchel B Harris; Christopher M Bono
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of spinal disorders & techniques     Volume:  23     ISSN:  1539-2465     ISO Abbreviation:  J Spinal Disord Tech     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-10-05     Completed Date:  2011-01-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101140323     Medline TA:  J Spinal Disord Tech     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e1-8     Citation Subset:  IM    
Affiliation:
Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02215, USA. ajschoen@neoucom.edu
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MeSH Terms
Descriptor/Qualifier:
Humans
Kyphosis / diagnosis*,  etiology,  therapy*
Osteotomy
Pain / diagnosis,  etiology,  therapy*
Pain Measurement
Questionnaires
Spinal Injuries / complications*,  therapy
Spine / radiography,  surgery

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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