Neurospine

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Indications for Nonsurgical Treatment of Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations: Nikolay Peev, Mehmet Zileli, Salman Sharif, Shahswar Arif, Zarina Brady; Neurospine 2021;18(4):713-724. Published online December 31, 2021; DOI: https://doi.org/10.14245/ns.2142390.195

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Indications for Nonsurgical Treatment of Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations

Neurospine. 2021;18(4):713-724. Published online December 31, 2021

DOI: https://doi.org/10.14245/ns.2142390.195

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Indications for Nonsurgical Treatment of Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations

Neurospine. 2021;18(4):713-724. Published online December 31, 2021

DOI: https://doi.org/10.14245/ns.2142390.195

Thoracolumbar spine is the most injured spinal region in blunt trauma. Literature on the indications for nonoperative treatment of thoracolumbar fractures is conflicting. The purpose of this systematic review is to clarify the indications for nonsurgical treatment of thoracolumbar fractures. We conducted a systematic literature search between 2010 to 2020 on PubMed/MEDLINE, and Cochrane Central. Up-to-date literature on the indications for nonoperative treatment of thoracolumbar fractures was reviewed to reach an agreement in a consensus meeting of WFNS (World Federation of Neurosurgical Societies) Spine Committee. The statements were voted and reached a positive or negative consensus using the Delphi method. For all of the questions discussed, the literature search yielded 1,264 studies, from which 54 articles were selected for full-text review. Nine studies (4 trials, and 5 retrospective) evaluating 759 participants with thoracolumbar fractures who underwent nonoperative/surgery were included. Although, compression type and stable burst fractures can be managed conservatively, if there is major vertebral body damage, kyphotic angulation, neurological deficit, spinal canal compromise, surgery may be indicated. AO type B, C fractures are preferably treated surgically. Future research is necessary to tackle the relative paucity of evidence pertaining to patients with thoracolumbar fractures.

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Case Reports

Spontaneous Remission of a Big Subligamentous Extruded Disc Herniation: Case Report and Review of the Literature: Veli Çitişli, Muhammet İbrahimoğlu; Korean J Spine 2015;12(1):19-21. Published online March 31, 2015; DOI: https://doi.org/10.14245/kjs.2015.12.1.19

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Spontaneous Remission of a Big Subligamentous Extruded Disc Herniation: Case Report and Review of the Literature

Korean J Spine. 2015;12(1):19-21. Published online March 31, 2015

DOI: https://doi.org/10.14245/kjs.2015.12.1.19

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Spontaneous Remission of a Big Subligamentous Extruded Disc Herniation: Case Report and Review of the Literature

Korean J Spine. 2015;12(1):19-21. Published online March 31, 2015

DOI: https://doi.org/10.14245/kjs.2015.12.1.19

Spontaneous Regression of a Big Subligamentous Extruded Disc Herniation: Case Report And Review of The Literature The most efficient method for the treatment of lumbar disc herniation is still controversial. The most important aspect is the application of the suitable conservative or surgical treatment to the right patient at the right time. In lumbar disc herniation patients, one must not precipitate except for cases that require surgical indications as in cauda equina syndrome, evolutive motor deficit and persistence of pain in spite of the narcotics. However, the spontaneous regression mechanism has not been completely determined yet. The proposed hypotheses are; dehydration, retraction of the disc to the hernia in the annulus fibrosis, enzymatic catabolism and phagocytosis. In this study, the case of a patient with huge lumbar disc hernia regressing by itself has been presented and the potential mechanisms of disc regression have been discussed.

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Predictive Factors for Resorption in Lumbar Disc Herniation: A Systematic Review
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Spontaneous Regression of Lumbar Herniated Intervertebral Disc.: Jin Sang Kil, Ki Seong Eom, Jong Tae Park, Seong Keun Moon, Tae Young Kim; Korean J Spine 2010;7(1):34-36.

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Spontaneous Regression of Lumbar Herniated Intervertebral Disc.

Korean J Spine. 2010;7(1):34-36.

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Spontaneous Regression of Lumbar Herniated Intervertebral Disc.

Korean J Spine. 2010;7(1):34-36.

Although the spontaneous regression of herniated intervertebral disc(HIVD) is well documented, the most useful and effective treatment protocol for symptomatic HIVD remains controversial. Here, we present a rare case of spon- taneous regression of lumbar HIVD. A 43-year-old woman presented with a pain in her lower back and right lower limb radiating from the buttock to the calf. Straight-leg raising test was positive at 30 degrees on the right side. Magnetic resonance imaging(MRI) revealed right-sided extrusion of an L5-S1 disc fragment with caudal migration; the disc fragment compressed the dural sac and nerve root at this level. The patient refused surgery and was, therefore, managed with conservative therapy comprising bed rest, epidural block, muscle relaxants, and nonsteroidal anti- inflammatory drugs(NSAIDs) for 45 days. At a follow-up after 45 days of this therapy, all the initial symptoms of the patient disappeared completely and a follow-up MRI showed regression of the disc fragment. The exact mecha- nism that prompted this regression is still unclear. However, as shown in our case, lumbar HIVD may spontaneously regress, implying that conservative treatment should be given additional importance in the treatment of HIVD.

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Spontaneous Resolution of Spinal Epidural Hematoma: A Case Report.: Hyun Jun Park, Il Sup Kim, Sang Won Lee, Byung Chul Son, Jae Hoon Sung, Jae Taek Hong, Seung Ho Yang; Korean J Spine 2008;5(2):107-109.

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Spontaneous Resolution of Spinal Epidural Hematoma: A Case Report.

Korean J Spine. 2008;5(2):107-109.

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Spontaneous Resolution of Spinal Epidural Hematoma: A Case Report.

Korean J Spine. 2008;5(2):107-109.

Spinal epidural hematoma(SEH) is not common in lumbar spine disorders and can be developed spontaneously without direct trauma. According to the neurologic deficit and clinical condition of patient, surgical intervention can be required. Authors report a case of spontaneous lumbar SEH resolved spontaneously without surgery. A 59-year-old man had suffered back pain and left leg pain for three weeks without trauma while working on his farm. Magnetic resonance imaging MRI demonstrated a lumbar epidural hematoma at L3/4 level. After 3 months of conservative treatment, his clini- cal symptoms were disappeared completely without neurologic deficit, and the follow-up myelocomputed tomogram(CT) showed complete resolution of the SEH. The primary treatment modality of SEH is surgical evacuation of hema- toma in case of neurologic deterioration, but conservative treatment may be considered if the patient has no neurologic deficit.