• Journal of Korean Neurosurgical Society
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• v.64 no.6
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• pp.944-949
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• 2021

Objective : The stability is an important factor to decide the treatment plan in thoracolumbar burst fracture patients. Patients with an unstable burst fracture generally need operative management. Decrease in vertebral body height, local kyphosis, involvement of posterior column, and/or canal compromise are considered important factors to determine the treatment plan. On the other hand, in thoracolumbar injury classification system (TLICS), surgery is recommended in patients with TLICS of more than 5 points. The purpose of this study was to apply the TLICS score in patients with thoracolumbar burst fractures and to distinguish the differences of treatment plan on burst fracture. Methods : All patients, diagnosed as a thoracolumbar burst fracture between January 2006 and February 2019 were included in this study. Unstable thoracolumbar burst fracture was defined as burst fracture with neurologic deficit, three-column injury, kyphosis over 30 degrees, decrease of anterior body height over 40 percent and canal comprise more than 50%. TLICS score was measured with morphology, neurological involvement and posterior ligamentous complex integrity. The existence of instability was compared with TLICS score. Results : Total 233 patients (131 men, 102 women) were included in this study. In Denis classification, 51 patients (21.9%) diagnosed as stable burst fracture while 182 patients (78.1%) had unstable burst fracture. According to TLICS, 72 patients (30.9%) scored less than 4, while 161 patients (69.1%) scored 4 or more. All the patients with stable burst fracture scored 2 in TLICS. Twenty-one patients (9.0) scored 2 in TLICS but diagnosed as unstable burst fracture. Thirteen patients had over 40% of vertebra body compression, four patients had more than 50% of canal compromise, three patients had both body compression over 40% and kyphosis over 30 degrees, one patients had both body compression and canal compromise. Fifteen patients presented kyphosis over 30 degrees, and three (20%) of them scored 2 in TLICS. Seventy-three patients presented vertebral body compression over 40% and 17 (23.3%) of them scored 2 in TLICS. Fifty-three patients presented spinal canal compromise more than 50%, and five (9.4%) of them scored 2 in TLICS. Conclusion : Although the instability of thoracolumbar burst fracture was regarded as a critical factor for operability, therapeutic strategies by TLICS do not exactly match with the concept of instability. According to the concept of TLICS, it should be reconsidered whether the unstable burst fracture truly unstable to do operation.

• Journal of Pharmacopuncture
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• v.13 no.1
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• pp.129-144
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• 2010

Objective : Traumatic lumbar burst fracture causes significant spinal cord injury. This report is intended to estimate the efficacy using oriental treatment on a patient with lumbar burst fracture and spinal cord injury. Methods : From 21th December, 2009 to 5th February, 2010, 1 female inpatient diagnosed with lumbar burst fracture and spinal cord injury was treated with general oriental medicine therapy : mae-sun therapy ; acupuncture ; moxibustion ; pharmacopuncture ; physical therapy and herbal medication. TUG, SCIMII and VAS were used for evaluation of gait disturbance and pain in both feet. Measurement of self voiding amount and remaining amount through CIC was used for evaluation of neurogenic vesical dysfunction. Results : The patient showed a certain degree of improvement in gait disturbance, pain in both feet and neurogenic vesical dysfunction through above evaluation methods. Conclusion : Oriental treatments such as mae-sun therapy, acupuncture and moxibustion therapy, pharmacopuncture therapy and herbal medication can be effective for spinal cord injury due to traumatic lumbar burst fracture.

• Journal of Acupuncture Research
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• v.38 no.2
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• pp.165-169
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• 2021

A burst fracture refers to the fracture of the anterior and middle vertebral columns which are moving into the spinal canal causing neurological impairments, generally requiring surgical treatment. We herein report a rare case of burst fracture with kissing spine in a 90-year-old man who had severe lower back pain that worsened during back extension. Considering the surgical treatment risk, he was hospitalized at a Korean medicine hospital for 85 days and underwent combined Korean medicine treatments including pharmacopuncture, herbal medicine, chuna, deep-fascia meridian therapy, walking practice, and abdominal breathing. Based on patient-reported scales, his pain was alleviated, and his physical function improved. Furthermore, his range of motion and walking time increased. This case report suggests that combined Korean medicine treatments could be an effective alternative for patients with burst fracture who have surgery risks.

• Journal of Trauma and Injury
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• v.30 no.4
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• pp.212-215
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• 2017

The choice of the most appropriate treatment for thoracolumbar or lumbar spine burst fracture remains controversial from conservative treatment to fusion through a posterior or anterior approach. There are many cases where ligamentotaxis is used to reduce the burst fracture. However, indirect reduction using ligamentotaxis is often limited in the magnitude of the reduction that it can achieve. In our patient with severe burst fracture, we were able to restore an almost normal level of vertebral height and secure spinal canal widening by using only ligamentotaxis by posterior instrumentation. Before the operation, the patient had more than 95% encroachment of the spinal canal. This was reduced to less than 10% after treatment.

• Proceedings of the KSME Conference
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• 2008.11a
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• pp.305-310
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• 2008

This paper provides the methods to estimate the burst pressures of the pipes with defects, based on finite element analyses. FE codes are frequently adopted for the simulations of the burst tests of the pipes with defects. However, those do not give the burst pressure directly. Because the post-processing should be followed; determination of the fracture strains in accordance with triaxialities, monitoring the strains of pipes, etc. In the present work, these efforts are implemented in the user subroutine UHARD within the general-purpose FE code, ABAQUS. Four fracture criterions are introduced to estimate the burst pressure of pipes, and a simple fracture strain estimate is also developed. FE analyses for the pipe with gouge and corrosion are performed, and the results are compared with the experiment results.

• Journal of Korean Neurosurgical Society
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• v.40 no.2
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• pp.90-94
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• 2006

Objective : Acute vertebral burst fractures warrant extensive fixation and fusion on the spine. Osteoplasty [vertebroplasty with high density resin without vertebral expansion] has been used to treat osteoporotic vertebral compression fractures. We report our experiences with osteoplasty in acute vertebral burst fractures. Methods : Twenty-eight cases of acute vertebral burst fracture were operated with osteoplasty. Eighteen patients had osteoporosis concurrently. Preoperative MRI was performed in all cases to find fracture level and to evaluate the severity of injury. Preoperative CT revealed burst fracture in the series. The patients with severe ligament injury or spinal canal compromise were excluded from indication. Osteoplasty was performed under local anesthesia and high density polymethylmethacrylate[PMMA] was injected carefully avoiding cement leakage into spinal canal. The procedure was performed unilaterally in 21 cases and bilaterally in 7 cases. The patients were allowed to ambulate right after surgery. Most patients discharged within 5 days and followed up at least 6 months. Results : There were 12 men and 16 women with average age of 45.3[28-82]. Five patients had 2 level fractures and 2 patients had 3 level fractures. The average injection volume was 5.6cc per level Average VAS [Visual Analogue Scale] improved 26mm after surgery. The immediate postoperative X-ray showed 2 cases of filler spillage into spinal canal and 4 cases of leakage into the retroperitoneal space. One patient with intraspinal leakage was underwent the laminectomy to remove the resin. Conclusion : Osteoplasty is a safe and new treatment option in the burst fractures. Osteoplasty with minimally invasive technique reduced the hospital stay and recovery time in vertebral fracture patients.

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.5 no.2
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• pp.85-94
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• 2010

Objectives : The propose of this study is to find out the clinical application of conservative treatment to the patient who has Lumbar incomplete burst fracture. Methods : We examined 1 patient with lumbar burst fracture who admitted Jaseng Hospital of Oriental Medicine. Results : In this study, the patient showed a certain degree of improvement in gait disturbance. Low back and leg pain were also reduced significantly after conservative oriental medical treatment. Conclusions : Conservative oriental medical treatment can be effective for improving symptoms of Lumbar incomplete burst fracture, decreasing pain.

• Journal of Korean Neurosurgical Society
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• v.49 no.2
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• pp.128-130
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• 2011

The low lumbar spine is deeply located in flexible segments, and has a physiologic lordosis. Therefore, burst fractures of the low lumbar spine are uncommon injuries. The treatment for such injuries may either be conservative or surgical management according to canal compromise and the neurological status. However, there are no general guidelines or consensus for the treatment of low lumbar burst fractures especially in neurologically intact cases with severe canal compromise. We report a patient with a burst fracture of the fourth lumbar vertebra, who was treated surgically but without fusion because of the neurologically intact status in spite of severe canal compromise of more than 85%. It was possible to preserve motion segments by removal of screws at one year later. We also discuss why bone fusion was not necessary with review of the relevant literature.

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.6 no.1
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• pp.113-119
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• 2011

Objectives: The purpose of this study is to investigate the clinical application of Chungungyukgye-tang(Chuanxiongrougui-tang) to one patient with lumbar burst fracture. Methods: Patient is hopitalized at Dept. of Oriental Internal Medicine, Bu-Chun Jaseng Oriental Medicine Hospital, diagnosed as lumbar burst fracture and treated mainly with herbal medine ; Chungungyukgye-tang(Chuanxiongrougui-tang). This study was measured by ODI(Oswestry Disability Index) and NRS(Numeric Rating Scale) score. Results: After taking Chungungyukgye-tang(Chuanxiongrougui-tang), the patient's pain was controlled. NRS & ODI score were decreased. Conclusions: As seen in this one case of lumbar burst fracture, Chungungyukgye-tang(Chuanxiongrougui-tang) has a positive effect to control pain with lumbar burst fracture.

• Journal of Korean Neurosurgical Society
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• v.50 no.1
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• pp.11-16
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• 2011

Objective : The purpose of the present study was to determine the incidence of dural tears and predictable factors suggesting dural tears in patients who had lumbar burst fractures with vertical laminar fractures. Methods : A retrospective review was done on thirty-one patients who underwent operative treatment for lumbar burst fractures with vertical laminar fractures between January 2003 and December 2008. All patients were divided into two groups according to existence of dural tears, which were surgically confirmed; 21 patients with dural tears and 10 patients without dural tears. Clinical and radiographic findings were analyzed for their association with dural tears. Results : Among a total of 31 patients, dural tears were detected in 21 (67%) patients. A preoperative neurological deficits and mean separation distances of the edges in laminar fractures were found to be the reliable factors of dural tears (p=0.001 and 0.002, respectively). Decreased ratio of the central canal diameter and interpedicular distance were also the reliable factors suggesting dural tears (p=0.006 and 0.015, respectively). However, dural tears showed no significant association with age, sex, level of injury, absence of a posterior fat pad signal, the angle of retropulsed segment, or site of laminar fracture. Conclusion : Our study of lumbar burst fracture combined laminar fracture revealed that dural tears should be ruled out in cases of a preoperative neurological deficits, wide separation of the laminar fracture, severe canal encroachment, and wider interpedicular distance.