Thoracolumbar Spine Fracture-Dislocation without Neurological Deficit: A Case Report and Review of the Literature

Background: Thoracolumbar spine fracture-dislocations are very unstable and usually secondary to high energy trauma. Due to disruption of the entire vertebrae columns, the absence of neurological deficit is exceptional. Aim: The purpose of this work is to report our experience in the management of this entity in a context of limited resources and to make a review of the literature. Case presentation: A 30-year-old man was admitted with a severe low back pain after a traffic accident. Neurological functions were intact after examination. Radiological assessments revealed a complete L3-L4 fracture-dislocation. The patient underwent an open posterior reduction and internal long segment fixation. The post-operative was marked by a surgical site infection treated with surgical debridement and targeted antibiotic therapy. The neurological functions were preserved. Conclusion: Fracture-dislocations of the thoracolumbar spine are caused by high energy trauma and are remarkably unstable lesions. When they are associated with intact neurorological functions, reduction and stabilization of these fractures are a challenge.

Imaging evaluation of traumatic thoracolumbar spine injuries: Radiological review

Spine fractures account for a large portion of musculoskeletal injuries worldwide. A classification of spine fractures is necessary in order to develop a common language for treatment indications and outcomes. Several classification systems have been developed based on injury anatomy or mechanisms of action, but they have demonstrated poor reliability, have yielded little prognostic information, and have not been widely used. For this reason, the Arbeitsgemeinschaftfür Osteosynthesefragen(AO) committee has classified thorocolumbar spine injuries based on the pathomorphological criteria into3 types(A: Compression; B: Distraction; C: Axial torque and rotational deformity). Each of these types is further divided into 3 groups and 3 subgroups reflecting progressive scale of morphological damage and the degree of instability. Because of its highly detailed sub classifications, the AO system has shown limited interobserver variability. It is similar to its predecessors in that it does not incorporate the patient's neurologic status.The need for a reliable, reproducible, clinically relevant, prognostic classification system with an optimal balance of ease of use and detail of injury description contributed to the development of a new classification system, the thoracolumbar injury classification and severity score(TLICS). The TLICS defines injury based on three clinical characteristics: injury morphology, integrity of the posterior ligamentous complex, and neurologic status of the patient. The severity score offers prognostic information and is helpful in decision making about surgical vs nonsurgical management.

An expert consensus on the evaluation and treatment of acute thoracolumbar spine and spinal cord injury in China

This is an expert consensus on the evaluation and treatment of thoracolumbar spinal injury, estab- lished from February 2009 to July 2010. The expert consensus consists mainly of six parts with a total of 54 recommendations including the overview （one item）; pre-hospital care （one item）; evaluation and diagnosis （13 items）; treatment （23 items）; prevention and treatment of major com- plications （12 items）; and rehabilitation （four items）. This is the first time that Chinese experts have published a consensus on spine and spinal cord injury. The expert consensus was established based on Delphi methods, literature analysis, and clinical experiences. Each recommendation is supported by and was interpreted using multi-level evidences. The level of agreement with the rec- ommendation among the panel members was assessed as either low, moderate, or strong. Each panel member was asked to indicate his or her level of agreement on a 5-point scale, with ＂1＂ cor- respondJng to neutrality and ＂5＂ representJng maxJmum agreement. Scores were aggregated across the panel members and an arithmetic mean was calculated. This mean score was then translated into low, moderate, or strong. After all of the votes were collected and calculated, the results showed no low-level recommendations, 10 moderate-level recommendations, and 44 strong-level recom- mendations. An expert consensus was reached and was recognized by Chinese spine surgeons. Wide-scale adoption of these recommendations is urgent in the management of acute thora- columbar spine and spinal cord injury in a broader attempt to create a standard evaluation and treatment strategy for acute thoracolumbar spine and spinal cord injury in China.

Thoracolumbar spine fracture complicated by simple conus medullaris injury

Between 1990 and 1996, 15 patients with thoracolumbar spine fracture complicated by simple conusmedullaris injury were admitted. All patients were Injured by falling from height (mean, o meters). Clinical symp-toms indicated hypoesthesia or anesthesia of S3-5 sensory region,dysporia and urinary dysfunction. but normal sensation and motion of the bilateral lower extremities. Waston-Jones classified the spinal cord and nerve root injury following thoracolumbar spine fracture into three types. According to our observations, it should be classfied into five types: 1) concussion of the conus medullaris; 2) simple incomplete injury of the conus medullaris; 3) simplecomplete injury of the conus medullaris; 4) spinal cord transection and partial nerve root injury; 5) spinal cordtransection and entire nerve root injury.

Outcome of Long Segment Transpedicular Screw Fixation in Unstable Thoracolumbar Spine Injury with Incomplete Neurological Deficit

Background: Long segment transpedicular screw fixation in thoracolumbar spine injury has gained popularity in the last decades as it provides immediate stability, prevents further risk of complications and allows early mobilization of patient. Objectives: Evaluation of clinical and functional outcome after long segment transpedicular screw fixation in unstable thoracolumbar spine injury with incomplete neurological deficit patients. Methods: This quasi experimental study was conducted at Dhaka Medical College and Hospital (DMCH), Dhaka, Bangladesh from January 2016 to December 2017. A total of twenty four (24) patients with traumatic unstable fracture of the thoracolumbar spine with incomplete neurological deficit underwent long segment transpedicular screw fixation were included in this study. Clinical and radiologic outcomes were assessed pre-operatively and post-operatively. Results: A total of 24 patients aged between 20 - 60 years of both sexes (Male-21, Female-03) were included in this study. Their mean (±SD) age was 33.12 (±8.57) years. Most of them were farmer [09 (37.5%)] and day labour [08 (33.33%)]. Motor vehicle accidents were the most common [16 (66.67%)] cause of injury and then fall from height [08 (33.33%)]. The most common level of injury involved was L1-10 (41.67%) patients, followed by L2-07 (29.17%), T12-05 (20.83%) and T11-02 (8.33%) of the study patients. Burst fracture was the commonest [22 (91.67%)] type of fracture followed by Chance fracture [02 (8.33%)]. Pre-operative mean (±SD) Cobb angle, Kyphotic deformation of vertebral body, Beck index and vertebral compression deformity were 21.83 ± 4.5 degrees, 22.09 ± 4.40 degrees, 0.78 ± 2.65 and 0.18 ± 0.93 mm respectively, after procedure which were significantly (p Conclusions: Long segment transpedicular screw fixation is an effective method of treatment in patients having thoracolumbar spine injury with incomplete neurological deficit.

Exploration and Discussion on the Clinical Therapeutic Effects of the Application of Cross-Injury Vertebral Fixation and Via-Injury Vertebrae Fixation in the Treatment of Bone Tumor with Thoracolumbar Spine Fracture

Objective:To explore and discuss the clinical therapeutic effects of the application of cross-injury vertebral fixation and via-injury vertebrae fixation in the treatment of bone tumor with thoracolumbar spine fracture.Methods:A total of 58 patients with bone tumors and thoracolumbar spine fractures admitted to our hospital from February to February 2019 were selected as the study subjects.They were randomly divided into control group and observation group,with 29 cases in each group.The patients in the control group received cross-injury vertebral fixation treatment,while the patients in the observation group were treated with via-injury vertebral fixation.The therapeutic effects of the two groups were compared.Results:The operation time and hospitalization time of the observation group were significantly shorter than those of the control group(P<0.05),and the postoperative drainage volume of the intraoperative blood loss was significantly less than that of the control group(P<0.05).There was no significant difference in postoperative pain and spinal JOA scores between the two groups(P>0.05);there was no significant difference in the compression ratio of the injured vertebrae and the kyphosis Cobb angle between the two groups(P>0.05),after the operation,the two groups of patients were significantly reduced,and the compression ratio of the injured vertebrae and kyphosis Cobb angle of the observation group were more obvious(P<0.05);the vertebral height loss and Cobb angle loss in the observation group were significantly lower than those in the control group(P<0.05).Conclusion:In the treatment of bone tumor with thoracolumbar spine fracture,compared with cross-injury vertebral fixation,via-injury vertebral fixation has a more significant clinical effect and is more suitable for clinical application and promotion.

Algorhythm for Use of Percutaneous Short Fixation of Fractures Involving the Thoracolumbar Junction and Lumbar Spine

Study Design: Original article. Objective: Guidelines for deciding whether to perform open or percutaneous surgery in burst fractures. Summary of Background Data: The authors propose an algorithm for deciding whether to perform open surgery or percutaneous surgery with short fixation in patients with fractures of the thoracolumbar junction and lumbar spine. Methods: Between July 2005 and July 2009, 72 patients underwent surgical stabilization by posterior route for fractures of the thoracolumbar junction and lumbar spine. In 44 the lesion involved the thoracolumbar junction, in 28 the lumbar spine (L2 in6 cases, L3 in15 cases, L5 in7 cases). The fractures were assessed morphologically according to Magerl’s classification (52 type A, 12 type B, 8 type C). All patients were analyzed according to the algorithm proposed, according to which patients must fulfil certain criteria: the fracture must be Magerl type A.3, it must involve one level, McCormack score must be 6 or less, invasion of the spinal canal must be 25% or less according to Hashimoto’s formula, Magnetic Resonance Imating (MRI) must confirm discoligamentous integrity. Neurologically, the patient must be ASIA E. 25 patients (17 thoracolumbar junction, 8 lumbar spine) fulfilled these criteria and were treated by percutaneous short fixation. Results: The average length of the surgical procedure was 80 minutes and the loss of blood 10 cc. All patients were dismissed without brace and were submitted to follow-upComputed Tomography CTscan 3 and 6 months after surgery. Follow-up ranged from 6 months to 4 years. In all cases CT scan confirmed fusion and there were no cases of rupture of the device. None of the patients presented neurological deficits. Conclusion: The algorithm described permits a proper selection of patients with thoracolumbar fractures who can be treated by percutaneous short fixation, thus avoiding the risks connected with failure of the stabilization system.

Thoracolumbar surgery for degenerative spine diseases complicated with tethered cord syndrome:A case report

BACKGROUND Tethered cord syndrome(TCS) secondary to split cord malformation(SCM) is rare in adulthood.There is as yet no consensus about the optimal treatment method for adult patients with SCMs and degenerative spine diseases such as lumbar stenosis,spondylolisthesis and ossification of the ligamentum flavum(OLF).The tethered cord poses a great challenge to the decompression and fusion procedures for the intraoperative stretching of the spinal cord,which might lead to deteriorated neural deficits.Here,we report on a case to add our treatment experience to the medical literature.CASE SUMMARY We treated a 67-year-old female patient with type II SCM suffering from lumbar disc herniation,degenerative lumbar spondylolisthesis and thoracic OLF.The patient underwent thoracolumbar spinal fusion and decompression surgery for severe lower back pain,extensive left lower limb muscle weakness and intermittent claudication.After the thoracolumbar surgery,without stretching the tethered cord,the patient achieved complete relief of pain and lower extremity weakness at final follow-up.CONCLUSION For adult patients with underlying TCS secondary to SCM coupled with thoracic OLF and lumbar spondylolisthesis,a thoracolumbar fusion surgery could be safe and effective with the tethered cord untreated.It is critical to design individualized surgical protocols to reduce the stretch of the low-lying spinal cord.

Progress in the Treatment of Thoracolumbar Spinal Fractures with Internal Fixation of Injured Vertebrae with Screws

The thoracolumbar spine,due to its large range of motion and relatively fragile anatomical structure,is prone to traumatic fractures and has become one of the common types of fractures in clinical practice.Thoracic and lumbar fractures may lead to spinal instability,spinal stenosis,etc.,and early restoration of vertebral height and sequence is necessary.Although the technique of transpedicular screw internal fixation for traumatic vertebrae is effective in the short term,in the long run,there may be adverse situations such as fixation breakage and loosening,leading to loss of vertebral height and kyphosis deformity.The technique of internal fixation of injured vertebrae with screws is considered to minimize postoperative complications and is worthy of promotion and use.With the advancement of medical technology,imaging,and biomechanics,the treatment methods for thoracolumbar spinal fractures are becoming increasingly diverse.

PCDH17 restricts dendritic spine morphogenesis by regulating ROCK2-dependent control of the actin cytoskeleton,modulating emotional behavior

Proper regulation of synapse formation and elimination is critical for establishing mature neuronal circuits and maintaining brain function.Synaptic abnormalities,such as defects in the density and morphology of postsynaptic dendritic spines,underlie the pathology of various neuropsychiatric disorders.Protocadherin 17(PCDH17)is associated with major mood disorders,including bipolar disorder and depression.However,the molecular mechanisms by which PCDH17 regulates spine number,morphology,and behavior remain elusive.In this study,we found that PCDH17 functions at postsynaptic sites,restricting the number and size of dendritic spines in excitatory neurons.Selective overexpression of PCDH17 in the ventral hippocampal CA1 results in spine loss and anxiety-and depression-like behaviors in mice.Mechanistically,PCDH17 interacts with actin-relevant proteins and regulates actin filament(F-actin)organization.Specifically,PCDH17 binds to ROCK2,increasing its expression and subsequently enhancing the activity of downstream targets such as LIMK1 and the phosphorylation of cofilin serine-3(Ser3).Inhibition of ROCK2 activity with belumosudil(KD025)ameliorates the defective F-actin organization and spine structure induced by PCDH17 overexpression,suggesting that ROCK2 mediates the effects of PCDH17 on F-actin content and spine development.Hence,these findings reveal a novel mechanism by which PCDH17 regulates synapse development and behavior,providing pathological insights into the neurobiological basis of mood disorders.

Curved Spine:The Shape of Spine in Taoist Body Diagrams and Its Influence on Medical Body Diagrams

From the early Taoist diagrams of the human body to the end of the Qing dynasty and the beginning of the Republic of China,Taoists exaggerated and deformed the human spine in a shape-shifting manner.It is likely that medical practitioners were influenced by this style of representation,and there are also numerous diagrams of the human body with the curved spine in the lateral-view diagrams of viscera and Ming Tang Tu(明堂图Acupuncture and Moxibustion Chart),which constantly show the human torso in an elliptical“egg shape”.No later than the Ming dynasty,medical practitioners began to depict the actual physiological spinal curve of the human body.By the Qing dynasty,the depiction of the spinal curve in medical diagrams of the human figure showed a tendency to part ways with the Taoist freehand style of the previous generation.Although the representation of the curve of the spine was very crude,later medical images of the human body at least gradually straightened the spine and no longer depicted it in a shape-shifting manner.However,the curved spine in Taoist diagrams of the human body continued to exist,and the presentation of the curved spine never changed.This way of depicting its appearance,which is very different from reality,is shaped by Taoism's special way of perceiving and viewing the body,and may also contain another form of truth.

Ethanol changes Nestin-promoter induced neural stem cells to disturb newborn dendritic spine remodeling in the hippocampus of mice

Adolescent binge drinking leads to long-lasting disorders of the adult central nervous system,particularly aberrant hippocampal neurogenesis.In this study,we applied in vivo fluorescent tracing using NestinCreERT2::Rosa26-tdTomato mice and analyzed the endogenous neurogenesis lineage progression of neural stem cells(NSCs)and dendritic spine formation of newborn neurons in the subgranular zone of the dentate gyrus.We found abnormal orientation of tamoxifen-induced tdTomato+(tdTom^(+))NSCs in adult mice 2 months after treatment with EtOH(5.0 g/kg,i.p.)for 7 consecutive days.EtOH markedly inhibited tdTom^(+)NSCs activation and hippocampal neurogenesis in mouse dentate gyrus from adolescence to adulthood.EtOH(100 mM)also significantly inhibited the proliferation to 39.2%and differentiation of primary NSCs in vitro.Adult mice exposed to EtOH also exhibited marked inhibitions in dendritic spine growth and newborn neuron maturation in the dentate gyrus,which was partially reversed by voluntary running or inhibition of the mammalian target of rapamycinenhancer of zeste homolog 2 pathway.In vivo tracing revealed that EtOH induced abnormal orientation of tdTom+NSCs and spatial misposition defects of newborn neurons,thus causing the disturbance of hippocampal neurogenesis and dendritic spine remodeling in mice.

Primary thoracolumbar intraspinal malignant melanoma:A case report

BACKGROUND Primary intraspinal malignant melanoma is a very rare tumor that most often occurs in the cervical,thoracic,or thoracolumbar segment.CASE SUMMARY A rare case of primary thoracolumbar malignant melanoma is described.A 45-year-old female patient complained of low back pain with numbness and fatigue in both lower limbs.MR revealed an intradural space-occupying lesion at the thoracic 12 to lumbar 1 level.The tumor was partially excised,and a malignant melanoma was confirmed by histopathology.CONCLUSION Primary intraspinal malignant melanoma has rarely been reported,and surgical resection and related characteristics and diagnoses have been discussed.

Demineralized Bone Matrix Fibers plus Allograft Bone for Multilevel Posterolateral Spine Fusion: A Game Changer?

Introduction: While autograft bone is the gold standard for multilevel posterolateral lumbar fusion, bone substitutes and graft extenders such as allograft bone, ceramics and demineralized bone matrix (DBM) have been used to avoid the morbidity and insufficient quantity associated with harvesting autologous bone. The primary objective of this retrospective study was to determine whether, in patients with increased risk of operative nonunion related to multilevel fusion, adding DBM fibers to mineralized bone allograft resulted in better fusion than using allograft alone. The secondary objectives were to evaluate how adding DBM fibers affects functional disability, low back pain, intraoperative blood loss and the nonunion rate. Methods: This retrospective study involved a chart review of consecutive patients who underwent multilevel lumbar spinal fusion and were operated on by a single surgeon. The patients were divided into two groups: 14 patients received mineralized bone allograft (control group) and 14 patients received a combination of mineralized bone allograft and DBM (experimental group). Patients were reviewed at a mean of 16.4 ± 2.2 months after surgery at which point CT scans were analyzed to determine whether fusion had occurred;Oswestry disability index (ODI) and pain were also evaluated. Results: A mean of 5 levels [min 2, max 13] were fused in these patients. Posterolateral fusion as defined by the Lenke classification was not significantly different between groups. The experimental DBM group had a significantly better composite fusion score than the control group (P Discussion: Adding DBM fibers to allograft bone during multilevel posterolateral spinal fusion was safe and produced better composite fusion than using allograft only as an autograft extender.

Clinical Study of Tianji Robotic-Assisted Surgery for Upper Cervical Spine Fractures

Object: To compare the safety, clinical efficacy, and complication rate of “Tianji” robot-assisted surgery with traditional open surgery in the treatment of cervical vertebrae fracture. Methods: 60 patients with upper cervical vertebrae fracture admitted to Baise People’s Hospital between November 2018 and April 2024 were retrospectively analyzed. Among these patients, 29 underwent “Tianji” robot-assisted surgery (Robot group), and 31 underwent traditional C-arm fluoroscopy-assisted open surgery (Open group). Statistical analysis of the data was performed using SPSS 27.0 software to compare general data (gender, age, BMI), preoperative and postoperative visual analogue scale (VAS) scores, neck disability index (NDI), intraoperative blood loss, accuracy of screw placement on imaging, and the number of complications in both groups for comprehensive evaluation. A P value < 0.05 was deemed to have achieved statistical significance. Results: There was no significant difference in preoperative VAS scores between the two groups (Robot group: 8.34 ± 0.61;Open group: 8.26 ± 0.68, P = 0.317). There was also no significant difference in VAS scores at 1 week postoperatively (Robot group: 6.90 ± 0.31;Open group: 6.94 ± 0.36, P = 0.3237). Preoperative NDI scores showed no significant difference between the two groups (Robot group: 43.31 ± 2.67;Open group: 43.84 ± 2.67, P = 0.2227), and the difference in NDI scores at 1 week postoperatively was also not significant (Robot group: 35.69 ± 4.24;Open group: 37.35 ± 3.48, P = 0.0509). Intraoperative blood loss in the Robot group was significantly lower than in the Open group (246.21 ± 209 ml vs 380.65 ± 328.04 ml, P = 0.0308), with a statistically significant difference. The operation time was longer in the Robot group (3.75 ± 0.74 h) compared to the Open group (2.74 ± 0.86 h). In terms of screw placement accuracy, the Robot group had a higher accuracy rate for Class A screws compared to the Open group (102 screws vs 94 screws, P = 0.0487), and the accuracy rate for Class B screws was also higher in the Robot group (13 screws vs 29 screws, P = 0.0333), with both differences being statistically significant. There was no significant difference in the number of complications between the two groups (Robot group: 8 cases;Open group: 10 cases, P = 0.6931). Conclusion: Patients treated with “Tianji” robot-assisted surgery for upper cervical vertebrae fracture had lower intraoperative blood loss and higher screw placement accuracy compared to those undergoing traditional C-arm fluoroscopy-assisted open surgery, indicating that this robot-assisted surgery can effectively reduce intraoperative blood loss and improve screw placement accuracy.

Thoracic spine infection caused by Pseudomonas fluorescens:A case report and review of literature

BACKGROUND The clinical incidence of spinal infection is gradually increasing,and its onset is insidious,easily leading to missed diagnosis and misdiagnosis,which may lead to serious complications such as nervous system dysfunction,spinal instability and/or deformity,and cause a huge burden on society and families.Early identification of the causative agent and precision medicine will greatly reduce the suffering of patients.At present,the main pathogenic bacteria that cause spinal infection are Staphylococcus aureus,Streptococcus,Pneumococcus,Escherichia coli,and Klebsiella.There are no reports of spinal infection caused by Pseudomonas fluorescens.CASE SUMMARY We report a 32-year-old female patient with spinal infection.She presented with flank pain,initially thought to be bone metastases or bone tuberculosis,and had a family background of tumors.Her clinical features and changes in imaging and laboratory tests led to the suspicion of thoracic spine infection.Histopathology of the lesion showed inflammation,tissue culture of the lesion was negative several times,and the possible pathogen-Pseudomonas fluorescens was found after gene sequencing of the lesion.The patient recovered completely after a full course of antibiotic treatment.CONCLUSION This report increases the range of pathogens involved in spinal infections,highlights the unique advantages of gene sequencing technology in difficult-todiagnose diseases,and validates conservative treatment with a full course of antibiotics for spinal infections without complications.

Radiological findings of February 2023 twin earthquakes-related spine injuries

BACKGROUND The February 6,2023,twin earthquakes in Türkiye caused significant structural damage and a high number of injuries,particularly affecting the spine,which underscores the importance of understanding the distribution and nature of vertebral injuries in disaster victims.AIM To investigate the distribution of radiological findings of vertebral injuries in patients referred to a major tertiary center during the February 6,2023 twin earthquakes in Türkiye.METHODS With the approval of the institutional ethics committee,1216 examinations of 238 patients transferred from the region to a tertiary major hospital after the twin earthquakes of February 6,2023,were retrospectively analyzed for spine injuries.RESULTS Spine computed tomography(CT)scans were performed in 192 of 238 patients with a suspected spinal injury,42 of whom also had an magnetic resonance imaging(MRI).In 86 of 192 patients(44.79%;M:F=33:53)a spinal fracture was detected on CT and in 33 of 42 patients(78.57%;M:F=20:13)a spinal injury was found on MRI.Of the 86 patients in whom vertebral injury was detected,fractures were detected in the Denis-B group in 33,Denis-C in 4,Denis-D in 20 and Denis-E in 11 patients.Among the vertebral bodies:40"compression fractures",17"burst fractures",5"translational dislocation fractures",5"flexion-distraction fractures"and 58"prolonged forced fetal posture fractures"were detected.In addition,isolated transverse or spinous process fractures were found in eighteen vertebrae.CONCLUSION Our study highlights the prevalence and diverse spectrum of spinal injuries following the February 6,2023 twin earthquakes in Turkey underscoring the urgent need for effective management strategies in similar disaster scenarios,and emphasizing the"prolonged forced fetal posture"damage we encountered in earthquake victims who remained under the collapse for a long time.

Percutaneous Fixation as an Option for Traumatic Neurologically Intact Thoracolumbar Vertebral Fractures

Background: The most frequent spinal fracture is the thoracolumbar fracture. Minimally invasive percutaneous fixation of cases having thoracolumbar vertebral fractures without neurological impairments has remained controversial. The advantages of minimally invasive percutaneous fixation are decreasing muscle and soft tissue injury, decreasing blood loss and infection rate, in addition to shortening hospital stay and recovery times. In comparison to the open technique, percutaneous fixation is adequate for treating thoracolumbar (TL) fractures without causing neurological impairments & with satisfactory outcomes in terms of kyphosis decline. Elevated radiation exposure to the surgeon &the patient, lack of decompression and fusion via bone graft, & a steep learning curve are all disadvantages of percutaneous fixation of vertebral fractures. Methods: This study was retrospectively conducted on forty-eight patients, age ranging from 16 to 65 years old, with a thoracolumbar (TL) fracture without causing neurological impairments who were meeting the eligibility criteria for fixation in the period from July 2019 to January 2024. Results: We included the forty-eight patients who met the inclusion criteria (34 males and 14 females) their ages ranged from 16 to 65 years. The most common pathology was L1 fracture in 38 patients. No major complications were experienced, only wound infection in five patients which was treated efficiently with repeated dressings and broad-spectrum antibiotics. Four patients experienced misdirected screws, only in one patient the screw encroach into the spinal canal with no deficit experienced, while the other three showed minimally laterally deviated screws. Conclusion: The advantages of percutaneous pedicle screw fixation in thoracolumbar fractures through preservation of posterior musculature, are less blood loss, shorter operative time, lower infection risk, less post-operative pain, shorter rehabilitation time as well as a shorter hospital stay. Limitations of percutaneous fixation include the inability to achieve direct spinal canal decompression and, not having the option to perform a fusion and also requiring a learning curve to master the anatomy and technique.

Academic Stress Assessment Using Virtual Reality as an Educational Tool in Spine Surgery

Introduction: The evaluation of academic stress in medical students and residents is a topic of significant interest, given the considerable challenges they face during their learning process with traditional teaching methods. The use of technologies like virtual reality presents an opportunity to enhance their skills through simulations and training. The main objective of this study is to qualitatively assess the stress levels experienced by medical students and residents by integrating virtual reality into their current learning methods, aiming to improve their ability to manage stressors in their practice. Material and Methods: A questionnaire was conducted with 12 medical students and 12 Traumatology and orthopedics residents. The purpose of the questionnaire was to evaluate the levels of academic stress using the SISCO inventory. The stress levels were calculated by transforming average values into percentages, and the following criteria were assigned: 0 to 33% for Mild Stress, 34 to 66% for Moderate Stress, and 67 to 100% for Deep Stress. Then, a virtual reality class focused on spine surgery was provided. Both medical students and residents were trained using the Non Nocere SharpSurgeon software platform and Oculus Quest 2 virtual reality glasses. At the end of the session, a second questionnaire related to the practice with virtual reality was conducted with the same evaluation criteria and a comparative analysis was carried out. Results: 12 undergraduate students from Hospital Angeles Mexico, CDMX and 12 traumatology and orthopedics residents at Hospital Santa Fe, Bogota were evaluated. The students in CDMX reported an average qualitative stress of 28.50% during habitual practices, which decreased to an average of 14.67% after virtual reality practice. Residents in Bogotá experienced an average qualitative stress of 30.50% with their current learning methods but this reduced to an average of 13.92% after using virtual reality. These findings indicate that the use of virtual reality has a positive impact on reducing stress levels qualitatively. Conclusions: The use of virtual reality as a learning method for medical students and residents qualitatively improves stress levels. Further studies are required to define the potential uses of Virtual Reality to improve learning methods and emotional state in medical students and residents and for a quantitative assessment to validate the training as certified learning methods.

Progress in The Application of Nursing Care Based on ERAS Concept after Thoracolumbar Fracture Surgery

Thoracic spine fracture is a common orthopedic injury that is usually caused by external forces acting directly on or transmitted to the thoracic spine through other parts of the spine.Thoracic spine fractures can be divided into two types:stable and unstable.An unstable fracture means that the relationship between the vertebral bodies is no longer stable,which may cause serious consequences such as spinal compression,nerve root compression,or spinal cord injury.Surgical treatment is often needed for patients with unstable fractures,nerve root compression,or spinal cord injury to restore stability and function to the thoracic spine.The probability of complications after thoracolumbar fracture surgery is high,which affects the outcome of surgical treatment.To improve postoperative rehabilitation outcomes,this article analyzed the value of nursing care based on the enhanced recovery after surgery(ERAS)concept for patients undergoing thoracolumbar fracture surgery.