CC BY
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HIRURGIA POZVONOCHNIKA 2018;15(4):52-69 © S.V. LIKHACHEV ET AL., 2018
injuries
to the thoracolumbar junction:
bibliometric analysis of english-language literature
S.V. Likhachev1, V.V. Zaretskov1'2, A.E. Shulga1, S.A. Gramma1, I.N. Shchanitsyn1, S.P. Bazhanov1,
A.V. Zaretskov2, A.M. Donnik3
1Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery of Saratov State Medical University
n.a. V.I. Razumovsky, Saratov, Russia 2Saratov State Medical University n.a. V.I. Razumovsky, Saratov, Russia 3Saratov State University n.a. N.G. Chernyshevsky, Saratov, Russia
Objective. To analyze the 50 most cited articles related to the diagnosis, classification and surgical treatment of injuries of the thoracolumbar junction, which influenced the study of this problem.
Material and Methods. The Web of Science database was searched for keywords to detect articles related to thoracolumbar junction surgery. Articles were selected taking into account the title, abstract and the used methods, and then evaluated by the total number of citations to identify the fifty most cited. Characteristics of publications were analyzed.
Results. The United States of America, Thomas Jefferson University and A.R. Vaccaro were the most productive country, institution and author, respectively, dealing with the subject. The 2000s was the most active decade in terms of the number of publications. The greatest attention of scientists dealing with the problems of thoracolumbar injury was attracted by the article by McLain et al. analyzing the causes of the failures of short-segment transpedicular systems in the early postoperative period. The article by Laursen et al. presenting the results of using recombinant bone morphogenetic protein-7 in combination with metal fixation is at the top of the list in terms of average citation index. Most articles are well-designed randomized studies with the evidence level II.
Conclusion. Citation analysis allowed to identify the most relevant articles, the authors of which have made a significant contribution to the problem of surgery of the thoracolumbar junction. Study of the information field through the prism of the most cited articles allows seeing the mainstream and future development of diagnostics, classification and treatment of the injuries of this localization. Key Words: spine, thoracolumbar junction, spondilosynthesis, bibliometric analysis, citation.
Please cite this paper as: Likhachev SV, Zaretskov VV, Shulga AE, Gramma SA, Shchanitsyn IN, Bazhanov SP, Zaretskov AV, Donnik AM. Injuries to the thoracolumbar junction: bibliometric analysis of English-language literature. Hir. Pozvonoc. 2018;15(4):52—69. In Russian. DOI: http://dx.doi.org/10.14531/ss2018A.52-69.
The classification of spinal injuries by localization is dominated by those of thoracolumbar junction, which includes the T11-L2 vertebrae [1-5]. Injuries at the level of transition of the rigid thoracic section to the mobile lumbar one are usually accompanied by the formation of kyphotic spinal deformity and compression of the contents of the spinal canal [6, 7]. Surgical treatment of injuries of the thoracolumbar junction requires knowledge of the anatomy and biomechanics of this area, as well as understanding of the entire spectrum of modern methods of metal fixation [8, 9]. Citation analysis is a bibliometric tool [10, 11] that can be used to quantify the impact of an article on the study of the problem in modern reviews of the
medical literature [12]. Considering the general availability of leading medical journals for a reader over the Internet, a literature review is gradually being transformed from a source of detailed information into a brief description of the main trends that define further independent search for the relevant information. At present, the use of a number of publications that is a multiple of fifty is optimal for reviews based on the principle of bibliometric analysis [13-15]. In this case, the primary search is carried out from 19O0 to the year of writing the article, and the final list contains articles ranging from the most to the least cited work inclusive.
The objective of the study was to use the electronic Web of Science resource
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to select the 50 most cited articles related to the diagnosis, classification and surgical treatment of injuries of the thoracolumbar junction, which influenced the study of this problem.
Material and Methods
After the initial search, 50 articles were selected for inclusion in the final list by the following criteria: papers dedicated to the study of injury or spondylosynthesis of the thoracolumbar junction. Experimental studies on animals were excluded. Articles that discussed surgical aspects of treating injuries to other parts of the spinal column were considered only if the patients with a T12-L2 fracture represented the majority.
HIRURGIA POZVONOCHNIKA 2018;15(4):52-69
s.v. likhachev et al injuries to the thoracolumbar junction
Relevant papers were selected from all journals and databases indexed in Web of Science at the time of this analytical study.
Results and Discussion
To create the final list of 50 articles, a two-step query was run on Web of Science platform.
The first stage consisted of a thematic search for the term "thoracolumbar junction fracture". This search yielded 2430 results, which were subsequently sorted by number of citations. Self-citations were excluded.
The search was limited to years 19002018. The initial list consisted of articles published in 1975-2017. The number of articles (Fig. 1) reached its peak in 2017 (205 articles in a year), and the year 2006 was the most productive in terms of the most cited articles (5).
Articles devoted to the problems of thoracolumbar junction surgery were most often published by Spine (373 articles, 15.3 % of 2430). It was followed by European Spine Journal (229 articles, 9.4 % of 2430) and Journal of Neurosurgery Spine (87 articles, 2.6 % of 2430) respectively (Fig. 2). Most of the articles in the list of the most cited ones were also published in Spine (19 articles, 38.0 %). The second most popular journal is Journal of Bone and Joint Surgery American Volume (6 articles, 12.0 %) and the third place is shared by European Spine Journal and Clinical Orthopaedics and Related Research (4 articles each, 8.0 %).
Most publications (828 articles, 34.0 % of 2430) were written by authors residing in the United States. Authors from Germany (332 articles, 13.7 %) and PRC (252 articles, 10.4 %) occupy the 2nd and 3rd places. The first ten countries by the number of the published articles are shown in Fig. 3.
Fig. 4 shows the first ten institutions by the number of published articles from the full list. The most productive institutions are the Thomas Jefferson University (91 articles), the University of California (88 articles), and the Rothman Institute (67 articles).
At stage 2, the 50 most cited articles were selected for final inclusion in the list (see Table at the end of the article). Subjects of the articles included classification of injuries, transthoracic and ret-roperitoneal access to the thoracolumbar junction, transpedicular fixation, anterior spinal fusion, decompression intervention, biomechanical features of the injured and instrumented spine.
These 50 articles were published in 1983-2013.
The following information was extracted from each article in the final list: authors, title, year of publication, abstract, total number of citations, average number of citations (sum of the number of citations divided by the number of results found), type of research and level of evidence. The articles represented the following types of research: clinical or experimental. Study design: from randomized controlled trial to clinical cases.
The level of evidence (from I to V) was determined only for clinical studies:
I: evidence obtained from a meta-analysis of a large number of well-planned randomized studies and randomized studies with a low level of false positive and false negative errors;
II: evidence is based on the results of at least one well-designed randomized trial and randomized trials with a high, relative to level I clinical studies, rate of false positive and false negative errors;
III: evidence is based on the results of well-planned non-randomized controlled studies with one group of patients, studies with a group of historical control;
IV: evidence obtained from non-randomized studies, indirect comparative studies, descriptive studies;
V: evidence is based on clinical cases and examples.
The most cited authors who published articles in this field of study are Vaccaro (78 articles, 3.21 % of 2430), Oner (53 articles, 2.181 %) and Kandziora (41 articles, 1.687 %). Vaccaro is also the most cited author among the authors of the 50 most cited articles (3 articles) and he is followed by McAfee, Dai, Kaneda, Knop and Oner (2 articles each). The
remaining 44 authors published one article each.
The most discussed topic (13 publications in the final list) is the short-segment (bisegmental) transpedicular fixation [13, 16-27]. Seven papers [28-34] present the results of surgical treatment of patients with burst fractures of the thoracolumbar junction using decompression and fixation from the anterior approach, and five [35-39] deal with the classification of injuries of the thoraco-lumbar junction.
The most cited article on the analysis of results of surgical treatment of the thoracolumbar junction is the study by McLain et al. [22] discussing cases of short-segment transpedicular systems instability in injuries of T11-L2 vertebrae. The highest average number of citations (31.69) belong to the paper by Laursen et al. [40] devoted to the non-encouraging preliminary results of administration of recombinant bone morphogenetic protein-7 (BMP-7) into the body of the affected vertebra in combination with transpedicular fixation.
The article by a group of authors from the Syracuse Medical Center (USA), which is ranked 3rd in the total number of citations, demonstrates the superiority of CT in determining the method of spondylosynthesis based on the structure of the injury using the example of 100 patients with potentially unstable fractures and dislocation fractures of the thoracolumbar junction [36].
The study by Vaccaro et al., which was published in 2013, is ranked 18th and describes AOSpine thoracolumbar spine injury classification system developed by the authors based on data from 40 patients with a trauma to the thoraco-lumbar junction. Each spinal injury was assessed from the point of the fracture structure, the patient's neurological status, the integrity of the capsule-ligament apparatus and the nature of the accompanying pathology. The classification system was approved by surgeons involved in the study, who confirmed its reliability, accuracy and good reproducibility [38].
The distribution of the 50 most cited articles by year of publication demonstrates several trends. There were 9 such articles published in 1983-1990, 19 in
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Distribution of all articles on the thoracolumbar junction surgery and the 50 most cited articles by year of publication; dynamics of regression of the number of complications
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Fig. 2
The journals that published most of the articles (55.02 %) devoted to issues of the thoracolumbar junction surgery
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1991-2000, 21 in 2001-2010, and only one published from 2001 to the present. Thus, the 2000s can be considered the most productive decade. There were no such articles published in 1986, 1989, 1991, 2008, 2011, 2012, as well as in the period from 2014 to the present. The drop observed in the 2010s can be attributed both to a short period of time since the publication which was insufficient to accumulate large number of citations and to overall stagnation in the study of this problem.
Thus, we can identify 13 articles, which deserve more detailed consideration in the context of bibliometric research.
The review of the most cited articles in each of the decades revealed the following. In the 1980s the most cited arti-
HIRURGIA POZVONOCHNIKA 2018;15(4):52-69
s.v. likhachev et al. injuries to the thoracolumbar junction
USA | | Germany | | China | | Canada | | Japan | | Netherlands | | South Korea | England | | France | | Switzerland □ Other
Fig. 3
Countries that have published most of the articles (55.02 %) devoted to issues of the thoracolumbar junction surgery
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| | Thomas Jeferson University
| | University of California System
| | Rothmen Institute
| Utrecht University
| | University of British Colombia
| | Harvard University
| | Utrecht University Medical Center
| | University of Toronto
| | University of California San Francisco
| | University of Washington
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Fig. 4
Institutions whose staff have published the highest number of articles on issues of the thoracolumbar junction surgery
cle was the study by a group of authors of the Department of Orthopedics of the Syracuse Medical Center (USA), which reflects the technological leap in many branches of medicine associated with the invention X-ray computer tomography in 1970s. The key role of CT data in determining the choice of tactics for treatment of fractures of the thoracolum-bar junction has been demonstrated [36]. In the last decade of the XX century, the article by McLain et al. [22], analyzing the
failure of short-segment transpedicular systems in the early postoperative period attracted the most attention of scientists working in the field of thoracolumbar injuries. This article is also the most cited one in the top 50 list. In the 1990s, the total and relative increase in the number of surgical interventions with the use of immersion metal structures for spinal injuries led to many unsatisfactory results. A significant portion of the clinical studies and literature reviews of the time [4,
41-44] is devoted to search for and analysis of predictors of such complications.
By the 2000s, the need for a classification system allowing standardization of the algorithm for choosing treatment tactics for patients with spinal fractures became obvious. Previously existing classifications were no longer compatible with the increased capabilities of spinal surgery [45]. Vaccaro et al. [39] proposed the TLICS classification, which allows determining the type of damage and selecting the appropriate conservative or surgical treatment based on CT data on the fracture structure, MRI data on the dorsal ligamentous complex, as well as on the patient's neurological status [46, 47].
The second decade of the XXI century is the period of review and analysis of the colossal amount of data accumulated over previous years about spinal cord injury and methods of its treatment [3]. While continuing his work on the classification of thoracolumbar injuries, Vacca-ro et al. [38] devoted special attention to availability of the developed instrument to the practical surgeons. The statistically similar results of determining the type of injury according to the AOSpine TL Injury Classification System in one group of patients by different independent experts allow recommending this classification for widespread use. This fact, apparently, defined the status of this publication as the most cited one in the 2010s.
The important role of evolution of algorithmic approach to choosing the type of spondylosynthesis depending on the nature of the injury should be noted. In our opinion, this factor, along with the development of minimally invasive techniques, is responsible for the significant reduction in the incidence of complications of surgical treatment of injuries of the thoracolumbar junction in the 2000s.
Ranking based on the average number citations puts one of the first articles describing the results of administration of BMP-7 in combination with metal fixation [40] at the top of the list. The second-ranked paper in the average number of citations is devoted to one of the controversial aspects in the choice of treat-
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HIRURGIA POZVONOCHNIKA 2018;15(4):52-69
s.v. likhachev et al. injuries to the thoracolumbar junction
ment tactics for patients with thoraco-lumbar junction injuries: comparing the functional outcomes of uncomplicated comminuted fractures after surgical and conservative approach [48]. Remarkably, the conclusions about similar results of conservative and surgical treatment of uncomplicated injuries [26, 49] coexist in the final list of the articles with publications demonstrating the unequivocal superiority of active surgical tactics [11, 13, 40, 44]. It should be noted, however, that the number of the latter prevails.
The article that ranks 3rd in the average number of citations is an experimental study on cadaveric material, confirming the unstable nature of burst fractures of the thoracolumbar junction. It has been established that the damaged spine is the least resistant to rotational loads. This biomechanical study [50] and others like it [44] can be considered as a step towards the development of a modern complex of indications for a stabilizing intervention.
Four literature reviews [1, 10, 39, 52] included in the final list occupy a special place among the most cited articles.
Boerger et al. [10] published an analysis of data from 275 articles on the surgical treatment of burst fractures of the thoracolumbar localization, which allows concluding that there is no correlation between the completeness of decompression and postoperative regression of neurological deficit. Verlaan et al. [1] analyzed the evolution of surgical techniques for reconstruction of the thoraco-lumbar junction in 1970-2001. A team of authors headed by Vaccaro [39] conducted an analysis of the literature to determine predictors of instability of injuries of the thoracolumbar localization in a 2005. The mechanism of injury (based on the morphology of damage), the integrity of the posterior ligamentous complex and the neurological status are important for determining the choice of spondylo-synthesis technique. The Vaccaro's classification is based on the findings of this review. Dai et al. [52] search in PubMed
for articles devoted to treatment of injuries of the thoracolumbar junction, suggest the superiority of surgical techniques over conservative one. Thus, the listed literature reviews can be considered a reflection of the key trends in spinal surgery over the past two decades.
The most productive country, institution and author based on the analysis of the 50 most cited articles are the USA, the Thomas Jefferson University and Vaccaro, respectively. However, as can be seen from Fig. 3 and 4, the overall vision of the problem has been developed by the multinational and multi-institutional academic community.
The distribution of articles included in the final list by level of evidence is as follows: level I, 5 papers, level II, 15, level III and IV, 11 papers each; there are no studies with level of evidence V (clinical cases) among the articles with a high number of citations. In addition to the original articles, there are studies that are not ranked in the level of evidence: one discussion of the developed classification, four literature reviews and three experimental in vitro studies.
Limitations of the study. The authors are aware of some of the limitations of the study conducted by the means of bibliometric analysis. Citation analysis is, by definition, a biased assessment tool. Citing does not always demonstrate the direct influence of the literary source on the research that refers to it. Often, the authors provide a vast array of literature references in the "Relevance of the study" section, citing related articles or papers, the content of which has not been analyzed thoroughly. Another important limitation is the factor of self-citation, that is, quoting one's own works. Self-citations artificially increase the total number of citations of the article, which may cause an incorrect assessment of the impact of the publication in the relevant field. After we removed self-citations the total number of citations decreased, on average, by 9 per article. Another limitation is associated with the date of publica-
tion; an earlier study has more chances to accumulate citations than a more recent one. The use of average number of citations allows circumventing this limitation. The structure of the list of most cited articles reflects this phenomenon: the article ranked 3rd was published in 1983, whereas the 2013 paper, devoted to the most relevant issue of the classification of spinal injuries, ranks only 18 th.
The average number of citations is also not a perfect tool for assessing the significance of the article. The more time has passed since publication, the higher the denominator is in the equation for calculating this value. This, in fact, dilutes the total number of citations of this article.
One must assume that only a comprehensive assessment of such indicators as the total number of citations and the average number of citations provides an objective picture of the significance of the published study for analyzing the state of affairs in any subject field in general and in surgery of the thoracolumbar junction in particular.
Conclusion
We used Web of Science service to identify 50 most cited articles devoted to the study of traumatic injuries to the thoracolumbar junction. Diagnosis, classification and surgical treatment of this pathology remain a subject of debate even today. There is a notable shift in the interests of scientists from particular aspects of surgical tactics in 19801990 to the problems of classifications, algorithmic approaches and analysis of accumulated information in 20002010. The higher number of studies with a level of evidence II-V compared to level I studies confirms the advisability of further work in this field.
The study did not have sponsorship. The authors declare no conflict of interest.
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The 50 most cited articles on injuries of the thoracolumbar junction published in 1983—2013 (data retrieved from Web of Science)
№ Authors Year of publication, journal, issue, pages Title of the article Summary of the article Type of study Level of evidence Total number of citations Average number of citations
1 McLain RF, Sparling E, Benson DR J Bone Joint Surg Am. 1993;75:162— 167 Early failure of short-segment pedicle instrumentation for thoracolumbar fractures. A preliminary report The results of short-segment transpedicular fixation of burst fractures of the thoracolumbar localization are presented. Based on the analysis of 10 cases of metal fixation instability in 19 patients operated on using this technique, the author calls for caution in using this arrangement without ventral spinal fusion Retrospective nonrandomized clinical trial IV 293 22.98
2 Vaccaro AR, Lehman RA Jr, Huribert RJ, Anderson PA, Harris M, Hedlund R, Harrop J, Dvorak M, Wood K, Fehlings MG, Fisher C, Zeiller SC, Anderson DG, Bono CM, Stock GH, Brown AK, Kuklo T, Oner FC Spine. 2005;30:2325— 2333 A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status A classification of injuries of the thoracic and lumbar regions, considering the morphology of the damage, involvement of the posterior ligamentous complex and the patient's neurological status, is proposed. Analysis of the reliability and validity of the classification 264 8.50
3 McAfee PC, Yuan HA, Fredrickson BE, Lubicky JP J Bone Joint Surg Am. 1983;65:461— 473 The value of computed tomography in thoracolumbar fractures. An analysis of one hundred consecutive cases and a new classification The example of 100 patients with potentially unstable fractures and fractures of the thoracolumbar localization (50 were operated on) was used to demonstrate the superiority of CT in determining the spondylosynthesis technique based on the structure of the injury. Prospective nonrandomized clinical trial III 245 22.43
4 Wood K, Butterman G, Mehbod A, Garvey T, Jhanjee R, Sechriest V J Bone Joint Surg Am. 2003;85: 773-781 Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit. A prospective, randomized study Comparison of long-term results of surgical (23) and conservative (24) treatment of patients with stable fractures of thoracolumbar junction. No significant benefits of the surgical approach have been identified. Prospective randomized clinical trial II 232 15.78
5 Kaneda K, Taneichi H, Abumi K, Hashimoto T, Satoh S, FujiyaM J Bone Joint Surg Am. 1997;79:69— 83 Anterior decompression and stabilization with the Kaneda device for thoracolumbar burst fractures associated with neurological deficits 150 patients with complicated burst fractures of the thoracolumbar localization were operated on using anterior decompression, fusion and fixation with Kaneda device. Good radiographic and functional results were obtained. Prospective nonrandomized clinical trial III 215 18.73
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The rest of the table
№ Authors Year of publication, journal, issue, pages Title of the article Summary of the article Type of study Level of evidence Total number of citations Average number of citations
6 Verlaan J J, Diekerhof CH, Bus kens E, van der Tweel I, Verbout AJ, Dhert WJA, Oner FC Spine. 2004;29:803-814 Surgical treatment of traumatic fractures of the thoracic and lumbar spine: a systematic review of the literature on techniques, complications, and outcome A total of 132 articles from 1970-2001 were analyzed. The main surgical techniques used in patients with fractures of the thoracic and lumbar vertebrae have been identified and classified. Literature review 195 14.55
7 Denis F, Armstrong GW, S earls K, Matta L Clin Orthop Relat Res. 1984;( 189):142— 149 Acute thoracolumbar burst fractures in the absence of neurologic deficit. A comparison between operative and non-operative treatment Analysis of the long-term outcomes of treatment of 104 patients with unstable fractures of the thoracolumbar localization; 75 % of the operated patients fully returned to their previous work, while 25 % of those treated conservatively only returned on a part-time basis Retrospective randomized clinical trial II 190 25.07
8 Parker JW, Lane JR, Karaikovic EE, Gaines RW Spine. 2000;25:1157— 1170 Successful short-segment instrumentation and fusion for thoracolumbar spine fractures: a consecutive 4 1/2-year series 46 patients with fractures of the thoracolumbar localization were operated on using short-segment fixation (transpedicular fixation or ventral stabilizing systems); algorithmic approach to determining indications for short-segment fixation, depending on the severity of the vertebral injury, from anterior or posterior access allowed for good treatment outcome Retrospective nonrandomized clinical trial IV 180 17.99
9 McAfee PC, Bohlman HH, Yuan HA J Bone Joint Surg Am. 1985;67:89— 104 Anterior decompression of traumatic thoracolumbar fractures with incomplete neurological deficit using a retroperitoneal approach Analysis of the results of decompression and stabilization performed from the retroperitoneal approach in 70 patients with complicated Til—L2 vertebral fractures. Good clinical and radiological outcomes allow the authors to recommend performing decompression and stabilization operations for injuries of the thoracolumbar localization using extrapleural retroperitoneal access described by the authors Retrospective nonrandomized clinical trial III 168 28.60
10 Kane da K, Abumi K, Fujiya M Spine. 1984;9:788-795 Burst fractures with neurologic deficits of the thoracolum-bar-lumbar spine. Results of anterior decompression and stabilization with anterior instrumentation A total of 27 patients with burst complicated fractures of the thoracolumbar localization; decompression, correction and fixation from the anterior access is performed; 15 patients operated on using Kaneda device showed the best functional results Prospective randomized clinical trial II 161 28.23
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№ Authors Year of publication, Title of the article Summary of the article Type of study Level of Total Average
journal, issue, evidence number of number of
pages citations citations
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Spine.
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Short-segment pedicle instrumentation of thoracolumbar burst fractures: does transpedicular intracorporeal grafting prevent early failure?
Nonoperative treatment versus posterior fixation for thora-columbar junction burst fractures without neurologic deficit
Surgical management of thoracolumbar spine fractures with incomplete neurologic deficits
Late results of tho-racolumbar fractures after posterior instrumentation and transpedicular bone grafting
of T10—L3 vertebrae. Comparison of the results of surgical treatment using short-segment transpedicular fixation and in combination with transpedicular insertion of bone graft (10 patients). No advantages of the combined technique were identified
80 patients with uncomplicated burst fractures of the Til—L2 vertebrae: 47 received conservative treatment, 33 underwent short-segment transpedicular fixation. Surgical treatment allows to correct posttraumatic deformity and provide an early antalgic effect. Long-term outcomes are comparable
Long-term outcomes of surgical treatment of 59 patients with complicated fractures of the thoracolumbar localization. Anterior decompression of the contents of the spinal canal (20 patients) provides better regression of the neurological deficit than posterior decompression (39 patients)
Analysis of late clinical and radiological results of surgical treatment of fractures of the thoracolumbar junction: 76 patients underwent transpedicular fixation in combination with anterior corporeal transpedicular bone graft. The research results do not allow to recommend this technique for widespread use.
randomized clinical trial
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Prospective randomized clinical trial
130
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Retrospective randomized clinical trial
126
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№ Authors Year of publication, journal, issue, pages Title of the article Summary of the article Type of study Level of evidence Total number of citations Average number of citations
15 Farcy JP, Weidenbaum M, Glassman SD Spine. 1990;15:958-965 Sagittal index in management of thoracolumbar burst fractures Analysis of the results of surgical treatment of 62 patients with kyphotic deformity due to burst fractures of T12—L2 vertebrae. In the course of preoperative planning, the sagittal index used to simulate the rods of dorsal combination system (laminar hooks — transpedicular screws) was determined based on X-ray data. The technique allowed to achieve encouraging radiological and clinical results. Prospective nonrandomized clinical trial III 119 18.50
16 Siebeng a J, Leferink VJM, Segers MJM, Elzinga MJ, Bakker FC, Haar man HJ, Rommens PM, ten Duis HJ, Patka P Spine. 2006;31:2881-2890 Treatment of traumatic thoracolumbar spine fractures: a multicenter prospective randomized study of operative versus nonsurgical treatment 34 patients with type A fractures of Til—L2 according to AO: 18 were operated on, 16 received conservative treatment. Analysis of radiological and functional outcomes allows recommending ventral spondylosyndesis in case of A3 fractures according to AO classification. Multicenter prospective randomized trial I 119 9.72
17 Vaccaro AR, Oner C, Kepler CK, Dvorak M, Schnake K, Bellabarba C, Reinhold M, AarabiB, Kandziora F, Chapman J, Shanmuganathan R, Fehlings M, Vialle L Spine. 2013;38:2028-2037 AOSpine Thoracolumbar Spine Injury Classification System Fracture Description, Neurological Status, and Key Modifiers AOSpine Thoracolumbar injury classification system was developed. Data from 40 patients with thoracolumbar trauma were analyzed in the framework of this classification by a group of specialists. The system was highly approved, and its reliability and accuracy were confirmed. The study of the reliability of the classification system based on retrospective data II 109 2.37
18 Hashimoto T, Kaneda K, Abumi K Spine. 1988;13:1268-1272 Relationship between traumatic spinal canal stenosis and neurologic deficits in thoracolumbar burst fractures The relationship between the severity of deficit of the spinal canal lumen in damage to T11—L2 vertebrae and the risk of neurological deficit was identified Retrospective nonrandomized clinical trial III 109 19.28
19 Cho DY, Lee WY, Sheu PC Neurosurgery. 2003;53:1354-1361 Treatment of thoracolumbar burst fractures with poly-methyl methacrylate vertebroplasty and short-segment pedicle screw fixation Analysis of the results of surgical treatment of 70 patients with burst fractures of the thoracolumbar localization: 50 of them underwent short-segment transpedicular fixation, in 20 patients it was supplemented with polymethylmethacrylate vertebroplasty. The combined method allows to achieve a better antalgic effect and reduces the risk of metal structure instability. Prospective randomized clinical trial II 108 14.72
The rest of the table
№ Authors Year of publication, journal, issue, pages Title of the article Summary of the article Type of study Level of evidence Total number of citations Average number of citations
20 Dick W, ICluger P, Magerl F, Woersdorfer O, Zach G. Paraplegia. 1985;23:225-232 A new device for internal fixation of thoracolumbar and lumbar spine fractures: the «fixateur interne» The use of a transpedicular system with increased repositioning opportunities in 45 patients with T12—L2 vertebrae fractures Prospective nonrandomized clinical trial IV 107 23.30
21 Hauser CJ, Visvikis G, Hinrichs C, Eber CD, Cho K, Lavery RF, Livingston DH. J Trauma. 2003;55:228-235 Prospective validation of computed tomographic screening of the thoracolumbar spine in trauma The advantage of CT scan over X-rays in the diagnosis of injuries of the thoracolumbar junction, including in case of combined trauma is demonstrated Prospective nonrandomized clinical trial III 107 14.30
22 Wang ST, Ma HL, Liu CL, Yu WK, Chang MC, Chen TH Spine. 2006;31:2646-2652 Is fusion necessary for surgically treated burst fractures of the thoracolumbar and lumbar spine?: a prospective, randomized study 58 patients with burst fractures of the thoracolumbar localization were operated on using transpedicular fixation: 30 of them underwent a posterior spinal fusion with autograft, 28, had no spinal fusion. No advantage of combining transpedicular fixation with posterior spinal fusion before transpedicular fixation has been identified. Prospective randomized clinical trial II 105 9.71
23 Mermelstein LE, McLain RF, Yerby SA Spine. 1998;23:664-670 Reinforcement of thoracolumbar burst fractures with calcium phosphate cement. A biome-chanical study Short-segment transpedicular fixation with additional stabilization of the anterior column of the damaged vertebra with calcium phosphate cement demonstrates greater stability compared to standard transpedicular fixation Experimental — biomechanical research 101 31.69
24 Benson DR, Burkus JK, Montesano PX, Sutherland TB, McLain RF J Spinal Disord. 1992;5:335-343 Unstable thoracolumbar and lumbar burst fractures treated with the AO fixateur interne 25 patients with unstable T10— L2 vertebral fractures were operated on using transpedicular fixation. Good outcomes have been achieved in terms of post-traumatic kyphosis correction and spinal canal remodeling Prospective nonrandomized clinical trial III 99 34.80
25 Vaccaro AR, Zeiller SC, Hulbert RJ, Anderson PA, Harris M, Hedlund R, Harrop J, Dvorak M, Wood K, Fehlings MG, Fisher C, Lehman RA Jr, Anderson DG, Bono CM, KukloT, Oner FC J Spinal Disord Tech. 2005;18:209-215 The thoracolumbar injury severity score: a proposed treatment algorithm Literature review to determine predictors of instability of injuries of the thoracolumbar localization. The following factors are significant for determining the choice of spondylosyndesis tactics: injury mechanism (based on the morphology of the damage), integrity of the posterior ligamentous complex, neurological status Literature review 99 15.89
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№ Authors Year of publication, journal, issue, pages Title of the article Summary of the article Type of study Level of evidence Total number of citations Average number of citations
26 Been HD, Bouma GJ Acta Neurochir (Wien). 1999;141:349-357 Comparison of two types of surgery for thoraco-lumbar burst fractures: combined anterior and posterior stabilisation vs. posterior instrumentation only Analysis of the results of surgical treatment of 46 patients with complicated trauma of the thoracolumbar junction. The regression of neurological deficit in 27 patients operated on using decompression-stabilizing operations from the anterior approach did not differ from the results obtained for transpedicular spondylosynthesis and decompression obtained through ligamentoxis Retrospective randomized clinical trial II 97 20.96
27 Danisa OA, Shaffrey CI, Jane JA, Whitehill R, Wang GJ, Szabo TA, Hansen CA, Shaffrey ME, Chan DP J Neurosurg. 1995;83:977-983 Surgical approaches for the correction of unstable thoracolumbar burst fractures: a retrospective analysis of treatment outcomes Based on the analysis of the results of surgical treatment of 49 patients with unstable and burst fractures of the vertebrae of the thoracolumbar junction operated on from the ventral (16), dorsal (27) and combined approaches. There was no significant difference in the long-term results of surgical treatment, spondylosynthesis from the posterior access was performed faster and with lower blood loss Retrospective randomized clinical trial II 97 26.60
28 Lee HM, Kim HS, Kim DJ, Suk ICS, Park JO, Kim NH Spine. 2000;25:2079— 2084 Reliability of magnetic resonance imaging in detecting posterior ligament complex injury in thoracolumbar spinal fractures The integrity of the posterior ligamentous complex in case of an injury to the thoracolumbar junction is best determined by T2-weighted images MRI with fat suppression Prospective nonrandomized clinical trial III 92 14.04
29 Oner FC, van der Rijt RR, Ramos LM, Dhert WJA, Verbout AJ J Bone Joint Surg Br. 1998;80:833— 839 Changes in the disc space after fractures of the thoracolumbar spine Analysis of MRI data for intervertebral discs adjacent to the damaged vertebrae of the thoracolumbar junction 18 months after transpedicular fixation. Changes in the discs are caused by the redistribution of disc tissue in the deformed intervertebral space. Non-randomized study IV 89 21.74
30 Schnee CL, Ansell LV J Neurosurg. 1997;86:48-55 Selection criteria and outcome of operative approaches for thoracolumbar burst fractures with and without neurological deficit An example of satisfactory functional outcomes of surgical treatment of 25 patients with burst fractures of the thoracolumbar localization is used to demonstrate an algorithmic approach to the choice of spondylosynthesis tactics depending on the number of damaged columns, spinal canal lumen deficit, segmental kyphosis, degree of compression, neurological status Non-randomized prospective clinical trial III 88 27.79
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№ Authors Year of publication, journal, issue, pages Title of the article Summary of the article Type of study Level of evidence Total number of citations Average number of citations
31 Rhyne A 3rd, Banit D, Laxer E, Odum S, Nussman D J Orthop Trauma. 2004;18:294-299 Kyphoplasty: report of eighty-two thoracolumbar osteoporotic vertebral fractures 52 patients with compression fractures of the thoracolumbar localization and osteoporosis were operated on using balloon kyphoplasty. Good results in terms of correction of the vertebral body, pronounced antalgic effect were achieved Retrospective nonrandomized clinical trial IV 86 29.93
32 Carl AL, Tromanhauser SG, Roger DJ Spine. 1992;17(8 Suppl):S317—S324 Pedicle screw instrumentation for thoracolumbar burst fractures and fracture-dislocations Good results were obtained using transpedicular fixation in treatment of 38 patients with burst fractures of the thoracolumbar junction. Non-randomized prospective study IV 85 19.71
33 Kraemer WJ, Schemitsch EH, Lever J, McBroom RJ, McKee MD, Waddell JP J Orthop Trauma. 1996;10:541-544 Functional outcome of thoracolumbar burst fractures without neurological deficit 24 patients with fractures of the thoracolumbar junction were observed for two years after injury. Functional capabilities were not related to the magnitude of the residual kyphosis and depended on the pain intensity. No significant difference in functional status depending of treatment tactics has been identified. Retrospective randomized clinical trial II 85 31.45
34 Shono Y, McAfee PC, Cunningham BW Spine. 1994;19:1711— 1722 Experimental study of thoracolumbar burst fractures. A radiographic and biomechanical analysis of anterior and posterior instrumentation systems The superiority of decompression and stabilization operations using Kaneda anterior screw instrumentation system over the posterior instrumentation has been established Experimental -biomechanical research 85 22.7
35 Boerger TO, Limb D, Dickson RA J Bone Joint Surg Br. 2000;82:629— 635 Does «canal clearance» affect neurological outcome after thoracolumbar burst fracture? Based on the analysis of 275 articles on the surgical treatment of burst fractures of the thoracolumbar localization, the authors conclude that there is no correlation between the completeness of decompression and postoperative regression of the neurological deficit Literature review 84 16.18
36 Ferguson RL, Allen BL Jr Clin Orthop Relat Res. 1984;( 189):77—88 A mechanistic classification of thoracolumbar spine fractures A classification of fractures of the thoracic and lumbar vertebrae depending on the mechanism of injury is presented. Clinical cases corresponding to the proposed classification are presented IV 84 25.20
37 Kramer DL, Rodgers WB, Mansfield FL J Orthop Trauma. 1995;9:499-506 Transpedicular instrumentation and short-segment fusion of thoracolumbar fractures: a prospective study using a single instrumentation system Eleven patients with burst fractures of the thoracolumbar junction were operated on using short-segment transpedicular fixation with posterior spinal fusion with autobone. The instability of metal structures in several patients testified to the inadequacy of the intervention volume, however, the patients with stable constructions demonstrate good functional outcomes. Non-randomized retrospective clinical study IV 82 30.39
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№ Authors Year of publication, journal, issue, pages Title of the article Summary of the article Type of study Level of evidence Total number of citations Average number of citations
38 McDonough PW, Davis R, Tribus C, Zdeblick TA Spine. 2004;29:1901— 1908 The management of acute thoracolumbar burst fractures with anterior corpectomy and Z-plate fixation The corporectomy, fusion and fixation with the extramedullar Z-plate made it possible to achieve good radiological and functional results in 35 patients with burst fractures of the thoracolumbar spine Non-randomized prospective clinical trial IV 82 11.75
39 Oner F, Ramos L, Simmermacher R, King ma P, Diekerhof C, Dhert W, Verbout A Eur Spine J. 2002;11:235-245 Classification of thoracic and lumbar spine frac-tures: problems of reproducibility Comparison of AO and Denis classifications using CT and MRI of 52 patients. The authors propose to increase reproducibility of the AO classification by using MRI Retrospective nonrandomized study III 82 16.09
40 Sanderson PL, Fraser RD, Hall DJ, Cain CM, Osti OL, Potter GR Eur Spine J. 1999;8:495-500 Short segment fixation of thoracolumbar burst fractures without fusion 28 patients with burst fractures of the thoracolumbar localization were operated on using short-segment transpedicular fixation. Performing posterior spinal fusion with autobone did not affect the long-term outcome of the intervention. Retrospective randomized clinical trial II 82 21.56
41 Dai LY, Jiang SD, Wang XY, Jiang LS Surg Neurol. 2007;67:221-231 A review of the management of thoracolumbar burst fractures By analyzing the results of the search for sources devoted to the treatment of injuries of the thoracolumbar junction in PubMed the authors concluded that surgical techniques are superior to conservative treatment Literature review 81 9.30
42 Dai LY, Jiang LS, Jiang SD J Bone Joint Surg Am. 2009;91:1033— 1041 Posterior short-seg-ment fixation with or without fusion for thoracolumbar burst fractures. A five to seven-year prospective randomized study 73 patients with burst fractures of the thoracolumbar junction: 36 were operated on using short-segment transpedicular segmentation, 37, using transpedicular segmentation with posterolateral spinal fusion. No advantages of the combined technique were identified Prospective randomized study I 81 4.68
43 Laursen M, Hoy K, Hansen ES, Gelineck J, Christensen FB, Bunger CE Eur Spine J. 1999;8:485-490 Recombinant bone morphogenetic pro-tein-7 as an intracor-poral bone growth stimulator in unstable thoracolumbar burst fractures in humans: preliminary results Pilot study of the administration of recombinant bone morphogenetic protein-7 into the vertebral body in combination with transpedicular fixation. No promising results were not obtained in 5 patients with thoracolumbar fractures. Non-randomized prospective clinical trial IV 81 41.67
44 Adams MA, Pollintine P, Tobias JH, WakleyGIC, Dolan P J Bone Miner Res. 2006;21:1409— 1416 Intervertebral disc degeneration can predispose to anterior vertebral fractures in the thoracolumbar spine An experimental study based on the determination of effort required to destroy 41 vertebral motor segments of corpses aged 62—94 years. Degenerative changes in the segment reduced the force that causes a vertebral compression fracture. Non-randomized experimental cadaver study III 80 14.53
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№ Authors Year of publication, journal, issue, pages Title of the article Summary of the article Type of study Level of evidence Total number of citations Average number of citations
45 Panjabi MM, Oxland TR, Lin RM, McGowen TW Spine. 1994;19:578-585 Thoracolumbar burst fracture. A biomechanical investigation of its multidirectional flexibility Based on the experiment using cadaveric material, the unstable nature of the burst fractures of the thoracolumbar junction was confirmed. The damaged spine is least resistant to rotational loads Experimental -biomechanical research 79 31.08
46 Reinhold M, Knop C, Beisse R, Audige L, Kandziora F, Pizanis A, Pranzl R, Gercelc E, Schultheiss M, Weckbach A, Buhren V, Blauth M Eur Spine J. 2010;19:1657— 1676 Operative treatment of 733 patients with acute thoracolumbar spinal injuries: comprehensive results from the second, prospective, Internet-based multicenter study of the Spine Study Group of the German Association of Trauma Surgery Analysis of epidemiology of spinal injuries, outcomes of surgical treatment of 733 patients: 47% of the injuries are located in the thoracolumbar junction. The best functional results were achieved for dorsal interventions, the best correction for combined (ventral-dorsal) ones, the use of container vertebral prostheses resulted in a smaller loss of correction than the use of autograft. The long-term neurological outcome did not depend on the type of intervention Multicenter study I 77 3.71
47 Knop C, Blauth M, Buhren V, Arand M, Egbers HJ, Hax PM, Nothwang J, Oestern HJ, Pizanis A, Roth R, Weckbach A, Wentzensen A Unfallchirurg. 2001;104:583-600 Operative Behandlung von Verletzungen des th or ako-lumbalen bergangs - Teil 3: Nachuntersuchung The long-term (4—61 months) results of surgical treatment of 372 out of 682 patients with unstable vertebral T10-L2 fractures were analyzed. The advantage of circular spondylosynthesis over dorsal in relation to loss of correction is demonstrated. Prospective randomized multicenter study I 74 19.12
48 Dickman CA, Yahiro MA, Lu HT, Melkerson MN Spine. 1994;19( 20 Suppl):2266S — 2273S Surgical treatment alternatives for fixation of unstable fractures of the thoracic and lumbar spine. A meta-analysis Comparison of the effectiveness of fixation devices for injuries of the thoracolumbar junction Meta-analysis I 74 29.00
49 Ringel F, Stoffel M, Stuer C, Meyer B Neurosurgery. 2006;59(4 Suppl 2):ONS„l-ONS367' Minimally invasive transmuscular pedicle screw fixation of the thoracic and lumbar spine 104 patients were operated on using transcutaneous transpedicular systems: 87% of screws are installed correctly. Authors recommend transcutaneous transpedicular fixation for widespread use. Non-randomized prospective clinical trial IV 70 11.48
50 Sasso RC, Renkens K, Hanson D, Reilly T, McGuire RA Jr, Best NM J Spinal Disord Tech. 2006;19:242-248 Unstable thoracolumbar burst fractures: anterior-only versus short-segment posterior fixation 53 patients with unstable fractures of the thoracolumbar localization. In 40 cases, anterior spondylosynthesis was performed with resection of the vertebral body, fusion and fixation with a plate. In 13 cases, short-seg-ment transpedicular fixation was performed. Anterior spondylosynthesis demonstrates lower loss of correction in the postoperative period. Retrospective randomized clinical trial II 67 8.41
_HIRURGIA POZVONOCHNIKA 2018;15(4):52-69_
s.v. likhachev et al. injuries to the thoracolumbar junction
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48. Kraemer WJ, Schemitsch EH, Lever J, McBroom RJ, McKee MD, Waddell JP. Functional outcome of thoracolumbar burst fractures without neurological deficit. J Orthop Trauma. 1996;10:541-544. DOI: 10.1097/00005131-199611000-00006.
49. Wood K, Butterman G, Mehbod A, Garvey T, Jhanjee R, Sechriest V. Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit. A prospective, randomized study. J Bone Joint Surg Am. 2003;85:773-781. DOI: 10.2106/00004623-200305000-00001.
50. Panjabi MM, Oxland TR, Lin RM, McGowen TW. Thoracolumbar burst fracture. A biomechanical investigation of its multidirectional flexibility. Spine. 1994;19:578-585. DOI: 10.1097/00007632-199403000-00014.
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53. Rhyne A 3rd, Banit D, Laxer E, Odum S, Nussman D. Kyphoplasty: report of eighty-two thoracolumbar osteoporotic vertebral fractures. J Orthop Trauma. 2004;18:294-299. DOI: 10.1097/00005131-200405000-00005.
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Address correspondence to:
Likhachev Sergey Vyacheslavovich
Saratov State Medical University n.a. V.I. Razumovsky,
Chernyshevskogo str., 148,
Saratov, 410002, Russia,
Likha4@mail.ru
Received 14.06.2018 Review completed 14.08.2018 Passed for printing 20.08.2018
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Sergey Vyacheslavovich Likhachev, MD, PhD, senior researcher of the Department of Innovation Projects in Neurosurgery and Vertebrology, Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery of Saratov State Medical University n.a. V.I. Razumovsky, Chernyshevskogo str., 148, Saratov, 410002, Russia, Likha4@mail.ru;
Vladimir Vladimirovich Zaretskov, DMSc, leading researcher of the Department of Innovation Projects in Neurosurgery and Vertebrology, Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery of Saratov State Medical University n.a. V.I. Razumovsky, Chernyshevskogo str., 148, Saratov, 410002, Russia, vvzaretskov@mail. ru;
Alexey Evgenyevich Shulga, MD, PhD, senior researcher of the Department of Innovation Projects in Neurosurgery and Vertebrology, Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery of Saratov State Medical University n.a. V.I. Razumovsky, Chernyshevskogo str., 148, Saratov, 410002, Russia, doc.shulga@yandex.ru;
Svetlana Anfasovna Gramma, head of Bibliographic Information and Document Support Department, Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery of Saratov State Medical University n.a. V.I. Razumovsky, Chernyshevskogo str., 148, Saratov, 410002, Russia, svetagramma@mail.ru; Ivan Nikolaevich Shchanitsyn, MD, PhD, junior researcher of the Department of Innovation Projects in Neurosurgery and Vertebrology, Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery of Saratov State Medical University n.a. V.I. Razumovsky, Chernyshevskogo str., 148, Saratov, 410002, Russia, dr.green@list.ru;
Sergey Petrovich Bazhanov, MD, PhD, senior researcher of the Department of Innovation Projects in Neurosurgery and Vertebrology, Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery of Saratov State Medical University n.a. V.I. Razumovsky, Chernyshevskogo str., 148, Saratov, 410002, Russia, baj.s@mail.ru;
Aleksandr Vladimirovich Zaretskov, MD, PhD, Associate Professor of Traumatology and Orthopedics Department, Saratov State Medical University n.a. V.I. Razumovsky, Chernyshevskogo str., 148, Saratov, 410002, Russia, sgmutravma@mail.ru;
Anna Mikhailovna Donnik, programmer of the Division of High-Performance Computing Systems, Education and Research Institute of Nanostructures and Biosystems, Saratov State University n.a. N.G. Chernyshevsky, Astrakhanskaya str., 83, Saratov, 410012, Russia, mathandon@mail.ru.
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spine injuries
