Looks more than 50% collapse, needs CTscan for better evaluation. if you don’t fuse them they may develop painful kyphosis in the future.
Dr.Freih Odeh Abu Hassan, M.D(Orth.), F.R.C.S(Eng.), F.R.C.S.(Tr.&Orth.), Asst.Professor of Orthopedics & Pediatrics Orthopedics Surgery, University of Jordan — Amman.
Salaam Doc, I wanted to know that how i can enter for MRCS(ortho & Trauma) exam and what are the requirements for the same.Since I an doing my aspirantura tr. & ortho.(3yrs) in Military medical academy, Saint Petersburg. Thank you.
Agreed, except that loss of posterior vertebral body height on the lateral radiograph suggests middle column involvement as well, and therefore a diagnosis of burst fracture. This is confirmed on the AP by (albeit subtle) widening of the pedicles at the level of injury. In keeping with this diagnosis, the lateral also suggests retropulsion of fracture fragments into the canal. I concur that unless there is associated facet subluxation or interspinous widening on CT (possible, but unlikely given the well-maintained alignment and given that on the AP radiograph the spinous processes seem reasonably equidistant) this is a stable burst fracture that I would treat with a TLSO for 3 months.
This presumablly is a stable compression of the body of T8 or thereabout, without neurology. Keep him in bed until the acute pain subsides and then start him on physiotherapy.
The lack of any neurological sysmptoms suggests that this man has a stable fracture despite losing 50% of his vertebral height. Initial management would be analgesia and bedrest until comfortable, and then the application of a hyperextension brace to prevent kyphosis. With this fitted he can be mobilised and can sit, and provided home situation is reasonable, should be able to go home after only a few days, with the proviso that he is still flat for part of the day. I would expect him to wear the brace for at least 2 months. Internal fixation may enable him to be up and about more quickly, but the overall timescale for full recovery is probably not much quicker than conservative management with a brace, plus the complicaton of infection associated with surgery.
Anthony Morgan Senior Physiotherapist James Paget Hospital, Great Yarmouth, Norfolk NR31 6BW, United Kingdom.
Close observation , and if you like you could put Jewett brace on.
A CT scan to know the narrowness of the spinal cannal, A MRI scan to know the condition of the spinal cord. The above two examtionation will give you a better view of the future of the case. As for the treatment now, conservative treatment is my choice for such condition. Our protocol for treating such case is bed-rest for 3 months or bedrest for 6 weeks and then supported with the application of brace cast for mobilization. During the treatment, osteoporosis treatment will be considered together. Surgery is not recommended only if the CT scan or the MRI scan shows a bone fractured fragment in the spinal canal make the spinal cord be risk in compressed or injured after a improper movement or position of the spine.
Ma Zhen-sheng, MD Department of Orthopedics, Xijing Hospital 15th Changle West Road, Xi’an 710032, China.