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    Streamlining the Journey of Research Into Clinical Practice: Making Your Patients and Practice Flourish Optimizing Management and Minimizing Risk of Osteoporotic Vertebral Fractures – Perspectives of the AO Spine KF Trauma and Infection Group Key Opinion Leaders
    (2024)
    Andrei F. Joaquim
    ;
    Sebastian F. Bigdon
    ;
    Richard Bransford
    ;
    Harvinder Singh Chhabra
    ;
    YURAC BARRIENTOS, RATKO JOVAN  
    <jats:sec><jats:title>Study Design</jats:title><jats:p> Literature review with clinical recommendations. </jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p> To highlight important studies about osteoporotic spinal fractures (OF) that may be integrated into clinical practice based on the assessment of the AO Spine KF Trauma and Infection group key opinion leaders. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> 4 important studies about OF that may affect current clinical practice of spinal surgeons were selected and reviewed with the aim of providing clinical recommendations to streamline the journey of research into clinical practice. Recommendations were graded as strong or conditional following the GRADE methodology. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> 4 studies were selected. Article 1: a validation of the Osteoporotic Fracture (OF)-score to treat OF fractures. Conditional recommendation to incorporate the OF score in the management of fractures to improve clinical results. Article 2: a randomized multicenter study comparing romosozumab/alendronate vs alendronate to decrease the incidence of new vertebral fractures. Strong recommendation that the group receiving romosozumab/alendronate had a decreased risk of new OF when compared with the alendronate only group only. Article 3: a systematic literature review of spinal orthoses in the management of. Conditional recommendation to prescribe a spinal orthosis to decrease pain and improve quality of life. Article 4: post-traumatic deformity after OF. A conditional recommendation that middle column injury and pre-injury use of steroids may lead to high risk of post-traumatic deformity after OF. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Management of patients with OF is still complex and challenging. This review provides some recommendations that may help surgeons to better manage these patients and improve their clinical practice. </jats:p></jats:sec>
      10Scopus© Citations 1
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    Variations in management of A3 and A4 cervical spine fractures as designated by the AO Spine Subaxial Injury Classification System
    (2022)
    Barry Ting Sheen Kweh
    ;
    Jin Wee Tee
    ;
    Sander Muijs
    ;
    F. Cumhur Oner
    ;
    Klaus John Schnake
    <jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>Optimal management of A3 and A4 cervical spine fractures, as defined by the AO Spine Subaxial Injury Classification System, remains controversial. The objectives of this study were to determine whether significant management variations exist with respect to 1) fracture location across the upper, middle, and lower subaxial cervical spine and 2) geographic region, experience, or specialty.</jats:p> </jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>A survey was internationally distributed to 272 AO Spine members across six geographic regions (North America, South America, Europe, Africa, Asia, and the Middle East). Participants’ management of A3 and A4 subaxial cervical fractures across cervical regions was assessed in four clinical scenarios. Key characteristics considered in the vignettes included degree of neurological deficit, pain severity, cervical spine stability, presence of comorbidities, and fitness for surgery. Respondents were also directly asked about their preferences for operative management and misalignment acceptance across the subaxial cervical spine.</jats:p> </jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>In total, 155 (57.0%) participants completed the survey. Pooled analysis demonstrated that surgeons were more likely to offer operative intervention for both A3 (p &lt; 0.001) and A4 (p &lt; 0.001) fractures located at the cervicothoracic junction compared with fractures at the upper or middle subaxial cervical regions. There were no significant variations in management for junctional incomplete (p = 0.116) or complete (p = 0.342) burst fractures between geographic regions. Surgeons with more than 10 years of experience were more likely to operatively manage A3 (p &lt; 0.001) and A4 (p &lt; 0.001) fractures than their younger counterparts. Neurosurgeons were more likely to offer surgical stabilization of A3 (p &lt; 0.001) and A4 (p &lt; 0.001) fractures than their orthopedic colleagues. Clinicians from both specialties agreed regarding their preference for fixation of lower junctional A3 (p = 0.866) and A4 (p = 0.368) fractures. Overall, surgical fixation was recommended more often for A4 than A3 fractures in all four scenarios (p &lt; 0.001).</jats:p> </jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>The subaxial cervical spine should not be considered a single unified entity. Both A3 and A4 fracture subtypes were more likely to be surgically managed at the cervicothoracic junction than the upper or middle subaxial cervical regions. The authors also determined that treatment strategies for A3 and A4 subaxial cervical spine fractures varied significantly, with the latter demonstrating a greater likelihood of operative management. These findings should be reflected in future subaxial cervical spine trauma algorithms.</jats:p> </jats:sec>
      17Scopus© Citations 3
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    Minimally Invasive Surgery for Traumatic Thoracolumbar Fractures: A Cross-Sectional Study of Spine Surgeons
    (2023)
    Guillermo A. Ricciardi
    ;
    Juan Ignacio Cirillo Totera
    ;
    Juan P. Cabrera
    ;
    Alfredo Guiroy
    ;
    Charles A. Carazzo
      7Scopus© Citations 3
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    Surgical timing prevails as the main factor over morphologic characteristics in the reduction by ligamentotaxis of thoracolumbar burst fractures
    (2023)
    Juan Ignacio Cirillo
    ;
    Ignacio Farias
    ;
    Cristóbal Del Pino
    ;
    Marcos Gimbernat
    ;
    Alejandro Urzúa
    <jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>thoracolumbar burst fractures are associated with spinal canal occupation. The indirect decompression of the spinal canal and reduction of the fragment can be achieved with the distraction of the middle column and ligamentotaxis. Nevertheless, the factors that influence the effectiveness of this procedure and its temporality are controversial.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>The aim of this observational, cross-sectional study was to evaluate the effectiveness of indirect reduction by ligamentotaxis in thoracolumbar burst fractures according to the fracture’s radiologic characteristics and the procedure’s temporality. Patients diagnosed with a thoracolumbar burst fracture between 2010 and 2021 were submitted to indirect reduction by distraction and ligamentotaxis. A retrospective analysis of radiologic characteristics and temporality of the procedure was performed with an independent sample t-test or Pearson’s correlation coefficient, as required.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>A total of 58 patients were included in the analysis. Postoperatively, ligamentotaxis significantly improved all radiologic parameters (canal occupation, endplates distance, and vertebra height). Still, none of the radiological characteristics of the fracture (width, height, position, sagittal angle) were associated with the postoperative change in canal occupation. The endplates distance and the temporality of ligamentotaxis significantly predicted the reduction of the fracture.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Fragment reduction effectiveness is more significant when performed as early as possible and adequate distraction is achieved using the internal fixator system. The radiologic characteristics of the fractured fragment do not determine its reduction capacity.</jats:p> </jats:sec>
      1Scopus© Citations 3  2
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      13Scopus© Citations 7
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      11Scopus© Citations 2
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    Risk Factors for Postoperative Complications After Surgical Treatment of Type B and C Injuries of the Thoracolumbar Spine
    (2022)
    Juan P. Cabrera
    ;
    Charles A. Carazzo
    ;
    Alfredo Guiroy
    ;
    Kevin P. White
    ;
    Joana Guasque
      9Scopus© Citations 4