Background: Oxygen-ozone (O2-O3) gas mixture as a newly prescribed substance became popular among clinicians to relieve low back pain (LBP) in discogenic patients as an alternative method rather than surgery. We developed this study to uncover whether this combination could be helpful in the Middle Eastern population or not.
Methods: In the present randomized clinical trial, we included 40 patients with L1 to S1 disc herniation assigned to schedule for intervention [a single course of ozone (O3) therapy without corticosteroids] or to consider as the control (physiotherapy including exercises based on extension). All patients were followed with a mean time of 12 weeks after injection, and pain severity and level of quality of life (QOL) were assessed. The severity of disc herniations was evaluated by a spine surgeon within the Michigan State University (MSU) classification frame.
Results: The current study represented two identical groups regarding lumbosacral segment involvement during 12 weeks of our survey (P > 0.05). The QOL level was equivalent in two groups. The mean pain score was decreased in the intervention group against the control group after two weeks, but it failed to thrive in the further weeks and was raised afterward. On the other hand, the mean pain score for the control group [6.1; 95% confidence interval (CI): 5.4-6.8] proceeded with a steady slope notably lower than the intervention group (7.5; 95% CI: 6.9-8.2) (P < 0.001).
Conclusion: Patients with LBP do not get more benefit from O2-O3 mixture injection.
{"title":"Is Intradiscal Ozone Injection Effective in Ameliorating Symptoms of Lumbosacral Discopathy?","authors":"Mohammadreza Golbakhsh, Maryam Mirshahi, Mohammadreza Bozorgmanesh, Mazaher Ebrahimian, Seyyed Hossein Shafiei, Babak Siavashi, Farhad Mahdavi, Yousef Fallah","doi":"10.18502/jost.v9i4.13931","DOIUrl":"https://doi.org/10.18502/jost.v9i4.13931","url":null,"abstract":"Background: Oxygen-ozone (O2-O3) gas mixture as a newly prescribed substance became popular among clinicians to relieve low back pain (LBP) in discogenic patients as an alternative method rather than surgery. We developed this study to uncover whether this combination could be helpful in the Middle Eastern population or not.
 Methods: In the present randomized clinical trial, we included 40 patients with L1 to S1 disc herniation assigned to schedule for intervention [a single course of ozone (O3) therapy without corticosteroids] or to consider as the control (physiotherapy including exercises based on extension). All patients were followed with a mean time of 12 weeks after injection, and pain severity and level of quality of life (QOL) were assessed. The severity of disc herniations was evaluated by a spine surgeon within the Michigan State University (MSU) classification frame.
 Results: The current study represented two identical groups regarding lumbosacral segment involvement during 12 weeks of our survey (P > 0.05). The QOL level was equivalent in two groups. The mean pain score was decreased in the intervention group against the control group after two weeks, but it failed to thrive in the further weeks and was raised afterward. On the other hand, the mean pain score for the control group [6.1; 95% confidence interval (CI): 5.4-6.8] proceeded with a steady slope notably lower than the intervention group (7.5; 95% CI: 6.9-8.2) (P < 0.001).
 Conclusion: Patients with LBP do not get more benefit from O2-O3 mixture injection.","PeriodicalId":34870,"journal":{"name":"Journal of Orthopedic and Spine Trauma","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136160050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-28DOI: 10.18502/jost.v9i4.13932
Mohammadreza Minator Sajjadi, Pooneh Dehghan, Akbar Ehsani
Background: Determining the exact details of complex traumatic injuries such as knee ligament rupture will be a crucial point in planning the surgical approach, which is determined through accurate imaging techniques such as magnetic resonance imaging (MRI). We aimed to evaluate the pattern of medial collateral ligament (MCL) rupture in patients who presented with simultaneous rupture of the anterior cruciate ligament (ACL) and MCL.
Methods: We evaluated knee MRI in 44 patients (25 women and 19 men, mean age: 38.6 ± 5.4 years) who suffered from clinically acute simultaneous ACL and MCL injuries. Meniscus status, MCL rupture patterns, and pivot bone bruise were analyzed.
Results: Concerning ACL rupture, 38.6% had a partial ACL rupture, and 61.4% had a complete rupture. The meniscus ruptured in 61.4%. The most common site of the meniscus rupture was related to the medial posterior horn (37.0%). The vertical type rupture was the most common (37.0%), followed by the horizontal rupture (29.6%). MCL rupture was present in all patients with grade 2 rupture revealed in 52.3%. Regarding the location of MCL ligament rupture, the highest ratio was found in the femoral site (65.9%). Semimembranosus rupture was observed in 2.3%. Pivot bone bruise was positive in 34.1%. Medial patellofemoral ligament (MPFL) rupture was also revealed in 68.2%. There was a significant relationship between the grade of rupture in the MCL and the presence of pivot bone bruise (P < 0.001).
Conclusion: Femoral detachment of MCL and posterior horn of medial meniscus (PHMM) are the most common sites of MCL injury and meniscus rupture in the context of ACL rupture. Besides, our results show a relevant influence of the extent of bone bruise on the grade of MCL rupture.
{"title":"Pattern in Simultaneous Rupture of the Medial Collateral Ligament and Anterior Cruciate Ligament Assessed by Magnetic Resonance Imaging","authors":"Mohammadreza Minator Sajjadi, Pooneh Dehghan, Akbar Ehsani","doi":"10.18502/jost.v9i4.13932","DOIUrl":"https://doi.org/10.18502/jost.v9i4.13932","url":null,"abstract":"Background: Determining the exact details of complex traumatic injuries such as knee ligament rupture will be a crucial point in planning the surgical approach, which is determined through accurate imaging techniques such as magnetic resonance imaging (MRI). We aimed to evaluate the pattern of medial collateral ligament (MCL) rupture in patients who presented with simultaneous rupture of the anterior cruciate ligament (ACL) and MCL.
 Methods: We evaluated knee MRI in 44 patients (25 women and 19 men, mean age: 38.6 ± 5.4 years) who suffered from clinically acute simultaneous ACL and MCL injuries. Meniscus status, MCL rupture patterns, and pivot bone bruise were analyzed.
 Results: Concerning ACL rupture, 38.6% had a partial ACL rupture, and 61.4% had a complete rupture. The meniscus ruptured in 61.4%. The most common site of the meniscus rupture was related to the medial posterior horn (37.0%). The vertical type rupture was the most common (37.0%), followed by the horizontal rupture (29.6%). MCL rupture was present in all patients with grade 2 rupture revealed in 52.3%. Regarding the location of MCL ligament rupture, the highest ratio was found in the femoral site (65.9%). Semimembranosus rupture was observed in 2.3%. Pivot bone bruise was positive in 34.1%. Medial patellofemoral ligament (MPFL) rupture was also revealed in 68.2%. There was a significant relationship between the grade of rupture in the MCL and the presence of pivot bone bruise (P < 0.001).
 Conclusion: Femoral detachment of MCL and posterior horn of medial meniscus (PHMM) are the most common sites of MCL injury and meniscus rupture in the context of ACL rupture. Besides, our results show a relevant influence of the extent of bone bruise on the grade of MCL rupture.","PeriodicalId":34870,"journal":{"name":"Journal of Orthopedic and Spine Trauma","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136160045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Knee osteoarthritis (OA) and low back pain (LBP) are common and co-occur in the elderly. The LBP in patients who are candidates for knee arthroplasty affects the outcome and prognosis after surgery. In this study, we investigated the LBP in patients with simultaneous knee and lumbar spine OA after total knee arthroplasty.
Methods: In this cross-sectional study, 41 candidates for knee arthroplasty suffering from LBP were included. Demographic and visual analogue scale (VAS) questionnaires for LBP and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire for knee pain and function were completed by patients before surgery. Patients were graded according to VAS index. They were followed up for at least six months to two years.
Results: The mean age of 41 patients was 64.30 ± 6.46 years. The mean of the preoperative VAS index was 5.15 ± 2.75, while postoperative VAS decreased to 4.34 ± 3.53 (P = 0.024). Of the total number of patients in preoperative evaluation, 24.4% were in low grades based on the VAS index, followed by moderate (41.5%) and severe (34.1%) grades. The greatest improvement in the VAS index was related to those in mild and moderate grades before surgery. The mean preoperative WOMAC index was 55.1 ± 23.7, while it was postoperatively reduced to 42.9 ± 30.6 (P < 0.001). Postoperative WOMAC was found to be correlated with postoperative VAS (P = 0.004).
Conclusion: In patients with mild to moderate LBP and knee OA, their back pain would improve if they had knee arthroplasty. However, in patients with severe LBP and knee OA, the spine should be examined further.
{"title":"Comparison of Clinical Signs Associated with Lumbar Spine in Patients with Simultaneous Knee Osteoarthritis and Lumbar Spine Osteoarthritis before and after Knee Arthroplasty","authors":"Mohammadkazem Emamimeybodi, Alireza Rahimnia, Hamid Hesarikia, Sajjad Mohammadnabi, Mohammad Mahdi Shater","doi":"10.18502/jost.v9i4.13930","DOIUrl":"https://doi.org/10.18502/jost.v9i4.13930","url":null,"abstract":"Background: Knee osteoarthritis (OA) and low back pain (LBP) are common and co-occur in the elderly. The LBP in patients who are candidates for knee arthroplasty affects the outcome and prognosis after surgery. In this study, we investigated the LBP in patients with simultaneous knee and lumbar spine OA after total knee arthroplasty.
 Methods: In this cross-sectional study, 41 candidates for knee arthroplasty suffering from LBP were included. Demographic and visual analogue scale (VAS) questionnaires for LBP and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire for knee pain and function were completed by patients before surgery. Patients were graded according to VAS index. They were followed up for at least six months to two years.
 Results: The mean age of 41 patients was 64.30 ± 6.46 years. The mean of the preoperative VAS index was 5.15 ± 2.75, while postoperative VAS decreased to 4.34 ± 3.53 (P = 0.024). Of the total number of patients in preoperative evaluation, 24.4% were in low grades based on the VAS index, followed by moderate (41.5%) and severe (34.1%) grades. The greatest improvement in the VAS index was related to those in mild and moderate grades before surgery. The mean preoperative WOMAC index was 55.1 ± 23.7, while it was postoperatively reduced to 42.9 ± 30.6 (P < 0.001). Postoperative WOMAC was found to be correlated with postoperative VAS (P = 0.004).
 Conclusion: In patients with mild to moderate LBP and knee OA, their back pain would improve if they had knee arthroplasty. However, in patients with severe LBP and knee OA, the spine should be examined further.","PeriodicalId":34870,"journal":{"name":"Journal of Orthopedic and Spine Trauma","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136231902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Lower back pain is a common cause of disability that affects mobility and quality of life (QOL) in both adult and elderly patients. Initial management of lower back pain includes anti-inflammatory drugs, analgesics, physiotherapy, and epidural steroid infiltration. Despite multiple attempts of conservative management, if a patient develops refractory radicular pain with or without neurologic deficit and claudication, surgery is indicated. The two main approaches to surgical intervention include decompression (laminectomy only) and decompression with fusion [transforaminal lumbar interbody fusion (TLIF)].
Methods: The study was done between May 2019 and November 2022. In this randomized study, we compared the clinical outcome of TLIF and laminectomy for single-level lumbar canal stenosis with grade 1 and 2 spondylolisthesis. Forty patients with single-level lumbar canal stenosis with grade 1 and 2 spondylolisthesis were randomly divided into two equal groups. Patients in both groups were followed up for 2 years.
Results: In this study, we also noted estimated amount of blood loss, procedure time, time taken for ambulation, length of hospitalization, and demography. The Oswestry Disability Index (ODI) scores improved significantly postoperatively. The modified MacNab criteria suggest the outcomes rated as excellent/good rate of 90% in TLIF and 85% in laminectomy.
Conclusion: We evaluated that TLIF procedures were associated with slightly more significant improvement in clinical outcomes in all of the scoring systems that were applied; TLIF provides early ambulation but a higher cost of treatment and longer hospital stay compared to laminectomy. Laminectomy procedures are associated with lesser economic burden, hospital stay, and blood loss, as well as shorter surgical duration compared to TLIF.
{"title":"The Clinical Outcome of Transforaminal Lumbar Interbody Fusion and Laminectomy for Single-Level Lumbar Canal Stenosis with Grade 1 and 2 Spondylolisthesis","authors":"Ashok Sharma, Tarachand Suthar, Mudit Mathur, Vishnu Mittal, Shiv Bhagwan Sharma, Gaurav Mehta","doi":"10.18502/jost.v9i4.13933","DOIUrl":"https://doi.org/10.18502/jost.v9i4.13933","url":null,"abstract":"Background: Lower back pain is a common cause of disability that affects mobility and quality of life (QOL) in both adult and elderly patients. Initial management of lower back pain includes anti-inflammatory drugs, analgesics, physiotherapy, and epidural steroid infiltration. Despite multiple attempts of conservative management, if a patient develops refractory radicular pain with or without neurologic deficit and claudication, surgery is indicated. The two main approaches to surgical intervention include decompression (laminectomy only) and decompression with fusion [transforaminal lumbar interbody fusion (TLIF)].
 Methods: The study was done between May 2019 and November 2022. In this randomized study, we compared the clinical outcome of TLIF and laminectomy for single-level lumbar canal stenosis with grade 1 and 2 spondylolisthesis. Forty patients with single-level lumbar canal stenosis with grade 1 and 2 spondylolisthesis were randomly divided into two equal groups. Patients in both groups were followed up for 2 years.
 Results: In this study, we also noted estimated amount of blood loss, procedure time, time taken for ambulation, length of hospitalization, and demography. The Oswestry Disability Index (ODI) scores improved significantly postoperatively. The modified MacNab criteria suggest the outcomes rated as excellent/good rate of 90% in TLIF and 85% in laminectomy.
 Conclusion: We evaluated that TLIF procedures were associated with slightly more significant improvement in clinical outcomes in all of the scoring systems that were applied; TLIF provides early ambulation but a higher cost of treatment and longer hospital stay compared to laminectomy. Laminectomy procedures are associated with lesser economic burden, hospital stay, and blood loss, as well as shorter surgical duration compared to TLIF.","PeriodicalId":34870,"journal":{"name":"Journal of Orthopedic and Spine Trauma","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136231905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-25DOI: 10.18502/jost.v9i3.13034
H. Shojaei, Imran Bagha, A. Shojaei
Background: The presence of sudden-onset fibromyalgia (FM) is poorly understood, characterized, and appreciated in both previous literature and the clinical setting. In this case series, we present 10 cases of sudden-onset FM seen in a community-based pain clinic, to characterize the presentation of this condition, stemming from both external trauma and idiopathic etiology. Methods: This retrospective case series identified 10 patients diagnosed with FM attending the pain clinic. These patients were referred to chronic pain management clinic in Thunder Bay, Ontario, Canada, from January 2019 until December 2021 and met the diagnostic criteria for FM. Information was collected on sex, gender, age, details of signs and symptoms, and FM severity score as well as clinical findings and outcomes. Results: The case series identified 10 community residents (9 women and 1 man, F/M: 9/1, age range: 34-64 years, mean age: 51.7 years), with symptoms attributed to FM. Majority of patients suffered from total body pain and mental disorders such as depression. 60% of patients were on opioids at the time of referral. Combination of pharmacological and non-pharmacological management improved their pain symptoms within 3-6 months on follow-up. Conclusion: Overall, effectively identifying sudden-onset FM can help clinicians improve patient-oriented outcomes and avoid the use of unnecessary narcotics in addition to better treating their patients.
{"title":"Sudden-Onset Widespread Body Pain (Fibromyalgia) with or without an Inciting Event: A Case Series","authors":"H. Shojaei, Imran Bagha, A. Shojaei","doi":"10.18502/jost.v9i3.13034","DOIUrl":"https://doi.org/10.18502/jost.v9i3.13034","url":null,"abstract":"Background: The presence of sudden-onset fibromyalgia (FM) is poorly understood, characterized, and appreciated in both previous literature and the clinical setting. In this case series, we present 10 cases of sudden-onset FM seen in a community-based pain clinic, to characterize the presentation of this condition, stemming from both external trauma and idiopathic etiology. \u0000Methods: This retrospective case series identified 10 patients diagnosed with FM attending the pain clinic. These patients were referred to chronic pain management clinic in Thunder Bay, Ontario, Canada, from January 2019 until December 2021 and met the diagnostic criteria for FM. Information was collected on sex, gender, age, details of signs and symptoms, and FM severity score as well as clinical findings and outcomes. \u0000Results: The case series identified 10 community residents (9 women and 1 man, F/M: 9/1, age range: 34-64 years, mean age: 51.7 years), with symptoms attributed to FM. Majority of patients suffered from total body pain and mental disorders such as depression. 60% of patients were on opioids at the time of referral. Combination of pharmacological and non-pharmacological management improved their pain symptoms within 3-6 months on follow-up. \u0000Conclusion: Overall, effectively identifying sudden-onset FM can help clinicians improve patient-oriented outcomes and avoid the use of unnecessary narcotics in addition to better treating their patients.","PeriodicalId":34870,"journal":{"name":"Journal of Orthopedic and Spine Trauma","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43885549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-25DOI: 10.18502/jost.v9i3.13037
P. Kothimbakkam, Anantharamakrishnan Ganesh, ArunKumar Chandhuru, Vijayashankar Murugesan
Background: The interphalangeal (IP) joint dislocation of hallux is a rare occurrence probably due to the presence of strong ligamentous attachments around it. Closed reduction of this kind of dislocation proves to be unsatisfactory. Herein, we are presenting a case of an open dorsomedial type of IP joint dislocation following a road traffic accident. Case Report: A 36-year-old woman with injury to her right great toe following a road traffic accident presented in the casualty of Chettinad Hospital, Kelambakkam, India. On examination, there was a 3 × 2 cm laceration present over the medial-plantar aspect. The bone was exposed. Hallux varus deformity was noted due to the dislocation of the IP joint. The reduction of IP joint dislocation was quite unstable and was fixed with two 1mm Kirschner wires (K-wires) under fluoroscopic guidance. The patient was sequentially followed up on the 4th and 6th weeks post-op. Joint integrity and stability were assessed which were found to be satisfactory after the removal of K-wire on the 6th week post-op. Conclusion: Open IP dislocations of the hallux Miki type 2 are unstable types of injury to deal with. Closed reduction in these injuries is difficult owing to the impinging sesamoid bone along with other soft tissues. These types of injuries should be reduced and fixed with K-wires to have better stability followed by long-term immobilization of around 3 to 4 weeks.
{"title":"Open Hallux Interphalangeal Joint Dislocation: A Rare Case","authors":"P. Kothimbakkam, Anantharamakrishnan Ganesh, ArunKumar Chandhuru, Vijayashankar Murugesan","doi":"10.18502/jost.v9i3.13037","DOIUrl":"https://doi.org/10.18502/jost.v9i3.13037","url":null,"abstract":"Background: The interphalangeal (IP) joint dislocation of hallux is a rare occurrence probably due to the presence of strong ligamentous attachments around it. Closed reduction of this kind of dislocation proves to be unsatisfactory. Herein, we are presenting a case of an open dorsomedial type of IP joint dislocation following a road traffic accident. \u0000Case Report: A 36-year-old woman with injury to her right great toe following a road traffic accident presented in the casualty of Chettinad Hospital, Kelambakkam, India. On examination, there was a 3 × 2 cm laceration present over the medial-plantar aspect. The bone was exposed. Hallux varus deformity was noted due to the dislocation of the IP joint. The reduction of IP joint dislocation was quite unstable and was fixed with two 1mm Kirschner wires (K-wires) under fluoroscopic guidance. The patient was sequentially followed up on the 4th and 6th weeks post-op. Joint integrity and stability were assessed which were found to be satisfactory after the removal of K-wire on the 6th week post-op. \u0000Conclusion: Open IP dislocations of the hallux Miki type 2 are unstable types of injury to deal with. Closed reduction in these injuries is difficult owing to the impinging sesamoid bone along with other soft tissues. These types of injuries should be reduced and fixed with K-wires to have better stability followed by long-term immobilization of around 3 to 4 weeks.","PeriodicalId":34870,"journal":{"name":"Journal of Orthopedic and Spine Trauma","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46912220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-25DOI: 10.18502/jost.v9i3.13033
Sanjeev Kumar, N. Saini, M. Chadha
Background: Since long, thoracolumbar burst fractures have been treated either by prolonged bed rest or by surgical fixation. In this study, outcomes of early mobilization with non-operative treatment are evaluated to avoid unnecessary surgery and complications of prolonged bed rest. Methods: This prospective observational study included 40 patients with thoracolumbar burst fractures with no neurological deficit. Patients were mobilized with Taylor’s brace as soon as acute pain subsided and reviewed for at least two years with standing radiographs. They were evaluated for anterior vertebral height loss (VHL), kyphotic angle (KA), pain by Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and neurological deterioration at presentation, one month, six months, and two years. Results: The mean progression of kyphosis over two years was 7.8 degrees. The mean VHL also progressed from a mean of 51.9% at presentation to 60.4% at the two-year follow-up, a mean progression of 8.5%. At two years of follow-up, the mean ODI and the mean VAS score were 10.1% and 0.7, respectively. No patient developed a neurological deficit. Conclusion: Even though there is some deterioration in radiological parameters, there is constant improvement in functional parameters. For these fractures, non-operative management using a brace and early mobilization promises comparable results without the cost and risk of surgery.
{"title":"Early Mobilization in Thoracolumbar Burst Fractures without Neurological Deficit Managed Conservatively","authors":"Sanjeev Kumar, N. Saini, M. Chadha","doi":"10.18502/jost.v9i3.13033","DOIUrl":"https://doi.org/10.18502/jost.v9i3.13033","url":null,"abstract":"Background: Since long, thoracolumbar burst fractures have been treated either by prolonged bed rest or by surgical fixation. In this study, outcomes of early mobilization with non-operative treatment are evaluated to avoid unnecessary surgery and complications of prolonged bed rest. \u0000Methods: This prospective observational study included 40 patients with thoracolumbar burst fractures with no neurological deficit. Patients were mobilized with Taylor’s brace as soon as acute pain subsided and reviewed for at least two years with standing radiographs. They were evaluated for anterior vertebral height loss (VHL), kyphotic angle (KA), pain by Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and neurological deterioration at presentation, one month, six months, and two years. \u0000Results: The mean progression of kyphosis over two years was 7.8 degrees. The mean VHL also progressed from a mean of 51.9% at presentation to 60.4% at the two-year follow-up, a mean progression of 8.5%. At two years of follow-up, the mean ODI and the mean VAS score were 10.1% and 0.7, respectively. No patient developed a neurological deficit. \u0000Conclusion: Even though there is some deterioration in radiological parameters, there is constant improvement in functional parameters. For these fractures, non-operative management using a brace and early mobilization promises comparable results without the cost and risk of surgery.","PeriodicalId":34870,"journal":{"name":"Journal of Orthopedic and Spine Trauma","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42949650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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