Hitchon Burst

8/7/2019 Hitchon Burst

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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

Hitchon Burst

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