INTRODUCTION
Multilevel noncontiguous spinal fractures (MNSF) are
defined as fractures of the vertebral column at more than one
level. According to many reports, multilevel noncontiguous
spinal fractures are found at from 3.2% to 16.7%. Multilevel
spine injuries are often uncommon, occur commonly as a
result of high-speed road traffic accidents or falls from a
height. Multilevel spine injuries tend to be more severe than
unilevel because of the other injuries combined. Rapid
diagnosis of MNSF is essential since a misdiagnosis or delayed
diagnosis may complicate the clinical picture. Therefore, the role
of a thorough physical and radiological examination is the key
to not to miss any lesions. Although there are many studies
evaluating and treating single level spine fractures, there have
not been many reports of multilevel spine injuries. In Vietnam,
there are not many researches on this issue. So we work for:
“Morphological characteristics of multilevel thoracic and
lumbar vertebral fracture and the effectiveness of surgical
treatment” with these targets:
1. Describing the morphological characteristic of
multilevel thoracic and lumbar vertebral fractures in
which surgical treatments are indicated at Da Nang
Hospital.
2. Evaluating the outcome of surgical treatment for
multilevel thoracic and lumbar vertebral fractures at Da
Nang Hospital.
New main scientific contributions of the thesis:
-The research subjects are lesions in multilevel thoracic
and lumbar vertebral fractures
-Providing the evidence of the effectiveness of surgical
treatment for multilevel thoracic and lumbar vertebral fractures
- Structure of the thesis: the thesis includes 127 pages
with 40 tables, 27 pictures and 10 charts. Introduction (2
pages); Chapter 1: Overview (31 pages); Chapter 2:
Subjects and Methods of the study (26 pages); Chapter
3: The results of the study (31 pages); Chapter 4:
Discussion (33 pages); Conclusion (2 pages); Petition (1
page); List of published articles related to the results of
the thesis (1 page); References (138 documents
including 33 documents in Vietnamese, 105 documents
in English); The appendices.
SECTION 1
OVERVIEW
1.1. A brief history of treatment of spine fractures.
1.1.1. In the world
Multilevel spine injuries have been reported for a long time.
Griffith H.B., Gleave J. R. W, Taylor R. G. (1966) reported 5
patients accounting for 3.2% of 155 cases of thoracic and
lumbar spine fractures. Lizbeth C. A. M. G. et al. (2018)
reported 47 cases of multilevel spinal surgery at the Center Dr.
Manuel Dufoo Olvera in Mexico. Thus, the multilevel spine
fractures have been studied for a long time, but they are still
separated. There are no single reports on multilevel spinal
injuries.
1.1.2. In Vietnam
Previous studies inside the country have only studied one-
level fractures, there were some authors who mentioned
several cases of multilevel spinal injuries. And there are no
separate studies on multilevel thoracic and lumbar spinal
injuries.
1.2. Classification of multilevel thoracic and lumbar
veterbral fractures
1.2.1. Classification of Denis
In 1983, Denis introduced the definition of "three-column
spine": the anterior, middle and posterior column; and it has
been widely applied.
1.2.2. Classification of Margel (AO)
In 1994, Margel proposed a classification according to AO
(Arbeitsgemeinschaft fur Osteosynthesefragen) which mainly
assess spinal morphological damage.
1.2.3. Load Sharing Classification (LSC)
In 1994, Mc Cormack and colleagues released a new
classification to assess vertebrae damage based on three
criteria: the amount of damaged vertebral body, the spread of
the fragments in the fracture site, the amount of corrected
traumatic kyphosis.
1.2.4. Classification of multilevel thoracic and lumbar
spinal injury based on the severity of lesion.
In 2005 Vaccaro A.R. et al. proposed a Thoracolumbar
Injury Classification and Severity Score (TLICS) which is is
based on three major categories, known as parameters: injury