The choice of classification to determine the optimal tactics for treatment of the thoracolumbar junction traumatic injuries.

OBJECTIVE: Aim: To evaluate the influence of the degree of detail of the nature of the pathomorphological changes in the osteoligamentous structures on the tactics of treating the patients with the traumatic damage to the thoracolumbar junction. PATIENTS AND METHODS: Materials and Methods: A retrospective analysis of the treatment tactics was carried out in 96 patients with a traumatic injury of the thoracolumbar junction, both those who underwent a surgical treatment and those who underwent a conservative therapy. The lesions were classified using F. Magerl and AOSpine classifications; the neurological status was assessed according to the ASIA scale, the nature of the damage was specified using the McCormack criteria. The statistical data processing was performed using the Random Forest machine learning algorithm. RESULTS: Results: The nature of the injury makes it possible to unambiguously determine the optimal method of therapy when using the F. Magerl classification with a probability of 58.33%, while in relation to the AOSpine classification this figure is 55.21%. When building the models that include the nature of the damage, the level of the neurological disorders and the McCormack criteria, it was found that the use of the F. Magerl classification demonstrates an error in unambiguously determining the most effective treatment method at the level of 26.04%, while the use of AOSpine this figure was 21.88%. CONCLUSION: Conclusions: The application of the AOSpine classification is more promising for the development of a multifactorial algorithm for the treatment of the traumatic injuries of the thoracolumbar junction.

Correlation of fused segmental and total cervical spine alignment in patients with subaxial cervical spine traumatic injury in late postoperative period.

Sagittal balance of operated cervical spine has a great influence on the intensity of pain syndrome, the overall quality of life, the speed and quality of consolidation, and the rate of progression of adjacent segment degeneration. AIM: The aim of this study was to determine the correlation of the local segmental and the total sagittal alignment of cervical spine when performing anterior cervical corpectomy and fusion (ACCF) using different vertebral body replacement systems. MATERIALS AND METHODS: A retrospective analysis of late postoperative radiographs of 260 patients, who underwent ACCF due to subaxial traumatic injury of the cervical spine, was performed. Total cervical lordosis (TCL) and operated segment lordosis (OSL) were measured. Patients were divided into 2 groups depending on type of fusion system (first group: mesh + ventral plate, second: telescopic implant). RESULTS: The average TCL value in patients of the first group was 14.52o (95% CI 11.75o; 17.29o), while in the second group it was 21.58o (95% CI 19.58o; 23.58o), with the range of values being significantly wider in the first group (- 3.5o ..35o) as compared to the second one (3.5o..33.5o). In the first group, the range of OSL varies from 0o to 5.5o, with mean 3.406o (95% CI 2.9354o; 3.8786o) and in second group OSL = 4.153o (95% CI 3.8453o; 4.4608o) and range from 2o to 6o. The difference between the groups is statistically significant (p = 0.0093). Moderate correlation of TCL and OSL (r = 0.702) is recorded in the first group, whereas strong (r = 0.883) the second one. CONCLUSIONS: OSL and TCL in patients one year after performing ACCF may have a linear correlation. The use of monoconstruction probably ensures greater safety of the intraoperatively formed OSL and provides more lordotic TCL. With OSL having equal values, the use of monoconstruction can provide higher TCL indices in comparison with the usage of the combination of a cylinder titanium mesh implant and a ventral plate.