Abstract
Introduction
Type B3 thoracic and lumbar fractures are often found in spines with previous hyperossification processes. They occur most frequently because of the high-energy trauma in a healthy spine and as fall-related domestic injury in a spine affected by hyperossification. They are less frequent than type B3 cervical spine fractures.
Patients and Methods
Between March 2003 and March 2014, 39 patients with type B3 injuries (Magerl classification) were treated in our centers. The thoracic spine was involved in 28 and the lumbar spine in 11 patients. The patients' average age was 64.5 years, with a range of 33 to 87 years. There were 6 women and 33 men. Overall, 10 fractures occurred in previously healthy spines, 9 and 20 were in AS- and DISH-affected spines, respectively.
Results
All nine patients with AS suffered low-energy fractures while patients with previously healthy spines had high-energy injuries in eight cases and low-energy in two. The patients with DISH had both low-energy (12) and high-energy (8) fractures. Type B3.1.1 fractures were diagnosed in 4 patients with AS and 10 patients with DISH, and 2 in previously healthy patients. Type B3.1.2 fractures were found in one patient with AS, four patients with DISH, and three previously healthy patients. Type B3.2 fracture occurred in two patients with a previously healthy spine, in three patients with AS, and three patients with DISH. Type B3.3 fractures were in five patients with previously healthy spines and in to with DISH. Neurological deficit was found in nine injured patients. Overall, 38 patients had an elevated BMI, ranging from 25.1 to 42.2; the average value was 31.1, which is within grade 1 obesity. Only one patient had BMI 24.7 kg/m2. Associated injuries were found in 18 patients, mostly in those with high-energy trauma, one of them suffered with traumatic aneurysma dissecans of aorta. A total of 33 patients were treated surgically, 6 conservatively. Posterior long stabilization was performed in 22 patients who had either AS or DISH conditions; 11 patients had a short spinal stabilization. Three patients with short instrumentation were operated from anterior as well. Complications included early infection in three patients, cerebrospinal fluid fistula in one, urinary tract infection in three, and confused state of mind in two patients. We also found multiorgan failure (three), respiratory insufficiency (one), sespis (one), and three patients died. Survived patients healed well.
Conclusion
In the majority of publications, these injuries are reported in patients suffering from hyperossification disorders such as AS or DISH. In patients with healthy spines, they occur less frequently and the traumatic hyperextension mechanism must have great intensity. Fractures of a hyperossified spine are related to obesity and this was also confirmed by our study in which all patients were overweight or obese. This factor plays an important role in the hyperextension mechanism that produces a sudden overcoming of the resistance of a spinal segment to force, resulting in a type B3 fracture.
In patients with AS and DISH, the diagnosis may be delayed because these patients suffer from chronic spine pain and the pain due to fracture may be attributed to an accelerated chronic condition.