TAILIEUCHUNG - Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 91

Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 91. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | Thoracolumbar Spinal Injuries Chapter 31 899 a stable and pain-free spinal column. These goals should be accomplished with a minimal risk of morbidity. Hence the main advantage of non-operative treatment of thoracolumbar fracture is avoidance of surgery-related complications such as infection iatrogenic neurological injury failure of instrumentation anesthesia-related complications The relationship between post-traumatic kyphotic deformity and chronic back pain is not well established in the literature. Most clinicians believe that kyphotic deformity of the thoracolumbar area is synonymous with a poor clinical outcome. Although few studies provide some evidence that moderate kyphosis is associated with either pain or disability 47 several studies suggest that there is no direct relationship between kyphosis and back pain or functional impairment 20 73 87 89 116 . Steroid Treatment of Spinal Cord Injury The controversy over steroid treatment of thoracolumbar spinal cord injury is discussed in the previous chapter see Chapter 30 . The overall consensus is that high-dose steroid treatment is regarded as an option for spinal monotrauma in young patients but not as a guideline for standard of care. The main advantage of non-operative treatment is the avoidance of surgery-related complications High-dose steroid treatment is highly controversial Non-operative Treatment Modalities As more and more data are collected information emerges that supports both surgical and non-operative treatment. Non-operative treatment is still a viable and effective treatment for the vast majority of thoracolumbar fractures Table 6 and should be part of the armamentarium available to all clinicians that treat these patients 92 . Table 6. Favorable indications for non-operative treatment pure osseous lesions absence of malalignment absence of neurological deficits absence of gross bony destruction only mild to moderate pain on mobilization absence of osteopenia osteoporosis There are three .

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