TY - JOUR
T1 - An updated management algorithm for incorporating minimally invasive techniques to treat thoracolumbar trauma
AU - Greenberg, Jacob K.
AU - Burks, Stephen Shelby
AU - Dibble, Christopher F.
AU - Javeed, Saad
AU - Gupta, Vivek P.
AU - Yahanda, Alexander T.
AU - Perez-Roman, Roberto J.
AU - Govindarajan, Vaidya
AU - Dailey, Andrew T.
AU - Dhall, Sanjay
AU - Hoh, Daniel J.
AU - Gelb, Daniel E.
AU - Kanter, Adam S.
AU - Klineberg, Eric O.
AU - Lee, Michael J.
AU - Mummaneni, Praveen V.
AU - Park, Paul
AU - Sansur, Charles A.
AU - Than, Khoi D.
AU - Yoon, Jon J.W.
AU - Wang, Michael Y.
AU - Ray, Wilson Z.
N1 - Funding Information:
Dr. Greenberg was supported by grants from the Agency for Healthcare Research and Quality (1F32HS027075-01A1), the Thrasher Research Fund (#15024), and a Young Investigator Research Grant Award from AO Spine North America. This study received no specific dedicated funding.
Funding Information:
Dr. Dailey has research funding from K2M; is a consultant for Medtronic, K2M, and Zimmer-Biomet; and receives honoraria from AO Spine. Dr. Dhall is a consultant for DePuy Spine; patent holder with Greater Circle Technologies; and receives honoraria from DePuy Synthes and Globus. Dr. Hoh reports receiving a stipend as a member of The Spine Journal editorial board; serves on the board of Journal of Neurosurgery: Spine; is an officer of the CNS, and is on the executive committee of AANS/ CNS Joint Section of Disorders of the Spine and Peripheral Nerves. Dr. Kanter reports receiving royalties from NuVasive and Zimmer Biomet. Dr. Gelb receives payment for lectures and for development of educational presentations from AO Spine NA; receives royalties from DePuy Synthes Spine; and has stock in Advanced Spinal Intellectual Property, Inc. Dr. Klineberg reports being a consultant for DePuy Synthes, Stryker, and Medicrea/ Medtronic; receiving honoraria from AO Spine; being on the speakers bureau of AO Spine, and receiving a fellowship grant from AO Spine. Dr. Lee has received funding from DePuy Synthes, Stryker Spine, and Globus Medical as a paid consultant. Dr. Mummaneni reports being a consultant for Stryker Spine, DePuy Synthes, and Globus; having direct stock ownership in Spinicity/ISD; receiving royalties from DePuy Synthes, Thieme Publishers, and Springer Publishers; and receiving support of non–study-related clinical or research effort from AO Spine, NREF, NIH and ISSG. Dr. Park reports being a consultant for Globus and NuVasive; receiving royalties from Globus; and receiving support of non–study-related clinical or research effort from DePuy, ISSG, SI-BONE, and Cerapedics. Dr. Sansur reports being a consultant for NuVasive and Stryker; receiving royalties from Stryker; and having ownership in Maryland Development Corp. Dr. Than reports being a consultant to Bioventus, DePuy Synthes, and Integrity Implants; and receiving honoraria from LifeNet Health and Globus. Dr. Yoon reports ownership in MedCyclops and Kinesiometrics; and is a consultant for Johnson & Johnson, Biderman Motech, and Ethicon. Dr. Wang reports being a consultant for DePuy Synthes Spine, Medtronic, Stryker, Globus, and Spineology; being a patent holder with DePuy Synthes Spine; and having direct stock ownership in ISD, Kinesiometrics, and Medical Device Partners. Dr. Ray reports stock/equity in Acera Surgical; consulting support from DePuy/Synthes, Globus, and NuVasive; and royalties from Acera Surgical.
Publisher Copyright:
© 2022 AANS.
PY - 2022/4
Y1 - 2022/4
N2 - Objective: Minimally invasive surgery (MIS) techniques can effectively stabilize and decompress many thoracolumbar injuries with decreased morbidity and tissue destruction compared with open approaches. Nonetheless, there is limited direction regarding the breadth and limitations of MIS techniques for thoracolumbar injuries. Consequently, the objectives of this study were to 1) identify the range of current practice patterns for thoracolumbar trauma and 2) integrate expert opinion and literature review to develop an updated treatment algorithm. Methods: A survey describing 10 clinical cases with a range of thoracolumbar injuries was sent to 12 surgeons with expertise in spine trauma. The survey results were summarized using descriptive statistics, along with the Fleiss kappa statistic of interrater agreement. To develop an updated treatment algorithm, the authors used a modified Delphi technique that incorporated a literature review, the survey results, and iterative feedback from a group of 14 spine trauma experts. The final algorithm represented the consensus opinion of that expert group. Results: Eleven of 12 surgeons contacted completed the case survey, including 8 (73%) neurosurgeons and 3 (27%) orthopedic surgeons. For the 4 cases involving patients with neurological deficits, nearly all respondents recommended decompression and fusion, and the proportion recommending open surgery ranged from 55% to 100% by case. Recommendations for the remaining cases were heterogeneous. Among the neurologically intact patients, MIS techniques were typically recommended more often than open techniques. The overall interrater agreement in recommendations was 0.23, indicating fair agreement. Considering both literature review and expert opinion, the updated algorithm indicated that MIS techniques could be used to treat most thoracolumbar injuries. Among neurologically intact patients, percutaneous instrumentation without arthrodesis was recommended for those with AO Spine Thoracolumbar Classification System subtype A3/A4 (Thoracolumbar Injury Classification and Severity Score [TLICS] 4) injuries, but MIS posterior arthrodesis was recommended for most patients with AO Spine subtype B2/B3 (TLICS > 4) injuries. Depending on vertebral body integrity, anterolateral corpectomy or mini-open decompression could be used for patients with neurological deficits. Conclusions: Spine trauma experts endorsed a range of strategies for treating thoracolumbar injuries but felt that MIS techniques were an option for most patients. The updated treatment algorithm may provide a foundation for surgeons interested in safe approaches for using MIS techniques to treat thoracolumbar trauma.
AB - Objective: Minimally invasive surgery (MIS) techniques can effectively stabilize and decompress many thoracolumbar injuries with decreased morbidity and tissue destruction compared with open approaches. Nonetheless, there is limited direction regarding the breadth and limitations of MIS techniques for thoracolumbar injuries. Consequently, the objectives of this study were to 1) identify the range of current practice patterns for thoracolumbar trauma and 2) integrate expert opinion and literature review to develop an updated treatment algorithm. Methods: A survey describing 10 clinical cases with a range of thoracolumbar injuries was sent to 12 surgeons with expertise in spine trauma. The survey results were summarized using descriptive statistics, along with the Fleiss kappa statistic of interrater agreement. To develop an updated treatment algorithm, the authors used a modified Delphi technique that incorporated a literature review, the survey results, and iterative feedback from a group of 14 spine trauma experts. The final algorithm represented the consensus opinion of that expert group. Results: Eleven of 12 surgeons contacted completed the case survey, including 8 (73%) neurosurgeons and 3 (27%) orthopedic surgeons. For the 4 cases involving patients with neurological deficits, nearly all respondents recommended decompression and fusion, and the proportion recommending open surgery ranged from 55% to 100% by case. Recommendations for the remaining cases were heterogeneous. Among the neurologically intact patients, MIS techniques were typically recommended more often than open techniques. The overall interrater agreement in recommendations was 0.23, indicating fair agreement. Considering both literature review and expert opinion, the updated algorithm indicated that MIS techniques could be used to treat most thoracolumbar injuries. Among neurologically intact patients, percutaneous instrumentation without arthrodesis was recommended for those with AO Spine Thoracolumbar Classification System subtype A3/A4 (Thoracolumbar Injury Classification and Severity Score [TLICS] 4) injuries, but MIS posterior arthrodesis was recommended for most patients with AO Spine subtype B2/B3 (TLICS > 4) injuries. Depending on vertebral body integrity, anterolateral corpectomy or mini-open decompression could be used for patients with neurological deficits. Conclusions: Spine trauma experts endorsed a range of strategies for treating thoracolumbar injuries but felt that MIS techniques were an option for most patients. The updated treatment algorithm may provide a foundation for surgeons interested in safe approaches for using MIS techniques to treat thoracolumbar trauma.
KW - lumbar
KW - minimally invasive surgery
KW - spine trauma
KW - thoracic
KW - thoracolumbar trauma
UR - http://www.scopus.com/inward/record.url?scp=85127518307&partnerID=8YFLogxK
U2 - 10.3171/2021.7.SPINE21790
DO - 10.3171/2021.7.SPINE21790
M3 - Article
C2 - 34715673
AN - SCOPUS:85127518307
SN - 1547-5654
VL - 36
SP - 558
EP - 567
JO - Journal of Neurosurgery: Spine
JF - Journal of Neurosurgery: Spine
IS - 4
ER -