Bracing for scoliosis.

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Abstract

[Indexed for MEDLINE] 13. Orthop Traumatol Surg Res. 2023 Oct;109(6):103513. doi: 10.1016/j.otsr.2022.103513. Epub 2022 Dec 14. Thoracolumbar vertebral fracture in unoperated idiopathic scoliosis. Huneidi M(1), Farah K(2), Meyer M(2), Prost S(3), Blondel B(3), Fuentes S(2). Author information: (1)CHU de Bordeaux, Département de Chirurgie Rachidienne, Hôpital Pellegrin, Place Amélie Raba Léon, 33076 Bordeaux, France. Electronic address: Maxime.huneidi@chu-bordeaux.fr. (2)Département de neurochirurgie, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille, 264, rue Saint-Pierre, 13005 Marseille, France. (3)Département de chirurgie orthopédique, traumatique et vertébrale, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille, 264, rue Saint Pierre, 13005 Marseille, France. INTRODUCTION: Traumatic fractures of the thoracolumbar spine are common. Their management considers the fracture type according to the various classifications in existence, as well as the patient's background and age. In some cases, the occurrence of a fracture on a spine with an unoperated scoliotic deformity can be observed. This entity, not described in the literature, can pose a therapeutic challenge and is not present in any existing treatment algorithm. The main objective of this work was to describe the characteristics and management of vertebral fractures in patients with unoperated idiopathic scoliosis. MATERIAL AND METHODS: We carried out a monocentric retrospective study in all patients operated on for a spinal fracture between May 2011 and August 2020, with a history of unoperated adolescent idiopathic scoliosis. We collected epidemiological data including the surgical course of each patient and the final result. The patients were categorized according to the surgical strategy (extensive fusion and correction of the deformity, short osteosynthesis without considering the scoliosis, vertebroplasty and orthopedic treatment) and the final clinical and radiological result evaluated at the last follow-up. RESULTS: Ten patients were included in this study with a total number of 16 fractured vertebrae. The population was 80% female, with an average age of 36.3 years. The majority of fractures were type A, at the thoracolumbar junction. The curves were classified as Lenke 1A in 5 cases, 1B in 2 cases, 1C in 1 case and 5C for 2 patients. Ultimately, 3 patients underwent extended fusion with correction of scoliosis, 6 localized osteosynthesis and 1 percutaneous vertebroplasty. In 50% of cases, a change of surgical strategy had to be made, due to worsening of the deformity or hyperalgesia. The last follow-up was at 19.7 months on average. Five patients had a good final clinical result, 5 patients had persistence of significant pain (lower back pain or cruralgia). CONCLUSION: This is the first study investigating the association of vertebral fractures and the presence of unoperated idiopathic scoliosis. The results of our study highlight the management challenges and difficulties in therapeutic decision-making. The presence of a pre-existing curve is thus an important parameter to consider and should lead to the discussion of performing an extended fusion secondarily in view of the risk of poor results from localized surgery. LEVEL OF EVIDENCE: IV. Copyright © 2022 Elsevier Masson SAS. All rights reserved. DOI: 10.1016/j.otsr.2022.103513