HOW DOES VERTICAL LAMINAR FRACTURE IMPACT THE DECISION-MAKING IN THORACOLUMBAR FRACTURES?
Objective Although vertical laminar fracture (VLF) is generally considered a severity marker for thoracolumbar fractures (TLFs), its exact role in decision-making has never been established. This scoping review aims to synthesize the research on VLF’s role in TLF decision-making. Methods...
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| Format: | Article |
| Language: | English |
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London Academic Publishing
2024-11-01
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| Series: | Romanian Neurosurgery |
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| Online Access: | http://journals.lapub.co.uk/index.php/roneurosurgery/article/view/2803 |
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| author | Mohamed M. Aly |
| author_facet | Mohamed M. Aly |
| author_sort | Mohamed M. Aly |
| collection | DOAJ |
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Objective
Although vertical laminar fracture (VLF) is generally considered a severity marker for thoracolumbar fractures (TLFs), its exact role in decision-making has never been established. This scoping review aims to synthesize the research on VLF’s role in TLF decision-making.
Methods
A systematic review was conducted following PRISMA guidelines. We searched PubMed, Scopus, and Web of Science from inception to 11 June 2023 for studies examining the association of VLF in thoracolumbar fractures with dural lacerations, neurological deficits, radiographic parameters, or treatment outcomes. Additionally, experimental studies that analyze the biomechanics of burst fractures with VLF were included. The studies extracted key findings, objectives, and patient population. A meta-analysis was performed for the association of VLF with dural laceration and neurological deficit, and ORs were pooled with a 95% confidence interval (CI).
Results
Twenty-eight studies were included in this systematic review, encompassing 2,021 patients, and twelve were included in the meta-analysis. According to the main subject of the study, the association of VLF with a dural laceration (n=14), neurological deficit (n=4), radiographic parameters (n=3), thoracolumbar fracture classification (n=2), treatment outcome (n=2). Seven studies with a total of 1010 patients reported a significant association between VLF and neurological deficit (OR= 7.35, 95% CI [3.97, 14.25]; P< 0.001). The pooled OR estimates for VLF predicting dural lacerations was 7.75, 95% CI [2.41, 24.87]; P< 0.001).
Conclusion
VLF may have several important diagnostic and therapeutic implications in managing TLFs. VLF may help to distinguish AO type A3 from A4 fractures. VLF may help to predict preoperatively the occurrence of dural laceration, thereby choosing the optimal surgical strategy. Clinical and biomechanical data suggest VLF may be a valuable modifier to guide the decision-making in burst fractures; however, more studies are needed to confirm its prognostic importance regarding treatment outcomes.
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| format | Article |
| id | doaj-art-15dcfa63c13f405b9aed97a99c8e4d9c |
| institution | Kabale University |
| issn | 1220-8841 2344-4959 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | London Academic Publishing |
| record_format | Article |
| series | Romanian Neurosurgery |
| spelling | doaj-art-15dcfa63c13f405b9aed97a99c8e4d9c2024-11-14T15:47:13ZengLondon Academic PublishingRomanian Neurosurgery1220-88412344-49592024-11-0138Special Issue10.33962/roneuro-2024-080HOW DOES VERTICAL LAMINAR FRACTURE IMPACT THE DECISION-MAKING IN THORACOLUMBAR FRACTURES? Mohamed M. Aly Objective Although vertical laminar fracture (VLF) is generally considered a severity marker for thoracolumbar fractures (TLFs), its exact role in decision-making has never been established. This scoping review aims to synthesize the research on VLF’s role in TLF decision-making. Methods A systematic review was conducted following PRISMA guidelines. We searched PubMed, Scopus, and Web of Science from inception to 11 June 2023 for studies examining the association of VLF in thoracolumbar fractures with dural lacerations, neurological deficits, radiographic parameters, or treatment outcomes. Additionally, experimental studies that analyze the biomechanics of burst fractures with VLF were included. The studies extracted key findings, objectives, and patient population. A meta-analysis was performed for the association of VLF with dural laceration and neurological deficit, and ORs were pooled with a 95% confidence interval (CI). Results Twenty-eight studies were included in this systematic review, encompassing 2,021 patients, and twelve were included in the meta-analysis. According to the main subject of the study, the association of VLF with a dural laceration (n=14), neurological deficit (n=4), radiographic parameters (n=3), thoracolumbar fracture classification (n=2), treatment outcome (n=2). Seven studies with a total of 1010 patients reported a significant association between VLF and neurological deficit (OR= 7.35, 95% CI [3.97, 14.25]; P< 0.001). The pooled OR estimates for VLF predicting dural lacerations was 7.75, 95% CI [2.41, 24.87]; P< 0.001). Conclusion VLF may have several important diagnostic and therapeutic implications in managing TLFs. VLF may help to distinguish AO type A3 from A4 fractures. VLF may help to predict preoperatively the occurrence of dural laceration, thereby choosing the optimal surgical strategy. Clinical and biomechanical data suggest VLF may be a valuable modifier to guide the decision-making in burst fractures; however, more studies are needed to confirm its prognostic importance regarding treatment outcomes. http://journals.lapub.co.uk/index.php/roneurosurgery/article/view/2803vertical laminar fracture |
| spellingShingle | Mohamed M. Aly HOW DOES VERTICAL LAMINAR FRACTURE IMPACT THE DECISION-MAKING IN THORACOLUMBAR FRACTURES? Romanian Neurosurgery vertical laminar fracture |
| title | HOW DOES VERTICAL LAMINAR FRACTURE IMPACT THE DECISION-MAKING IN THORACOLUMBAR FRACTURES? |
| title_full | HOW DOES VERTICAL LAMINAR FRACTURE IMPACT THE DECISION-MAKING IN THORACOLUMBAR FRACTURES? |
| title_fullStr | HOW DOES VERTICAL LAMINAR FRACTURE IMPACT THE DECISION-MAKING IN THORACOLUMBAR FRACTURES? |
| title_full_unstemmed | HOW DOES VERTICAL LAMINAR FRACTURE IMPACT THE DECISION-MAKING IN THORACOLUMBAR FRACTURES? |
| title_short | HOW DOES VERTICAL LAMINAR FRACTURE IMPACT THE DECISION-MAKING IN THORACOLUMBAR FRACTURES? |
| title_sort | how does vertical laminar fracture impact the decision making in thoracolumbar fractures |
| topic | vertical laminar fracture |
| url | http://journals.lapub.co.uk/index.php/roneurosurgery/article/view/2803 |
| work_keys_str_mv | AT mohamedmaly howdoesverticallaminarfractureimpactthedecisionmakinginthoracolumbarfractures |