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Traumatische letsels van de thoracolumbale wervelkolom: indicaties voor conservatieve en operatieve behandeling

  • F. C. Öner
  • A. Stadhouder
origineel artikel
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Samenvatting

Wat de beste keuze voor behandeling van bepaalde traumatische wervelfracturen is, blijft onduidelijk. Er zijn zowel conservatieve als operatieve ‘scholen’ zonder sluitend bewijs. Een aantal factoren belemmert het verrichten van goed onderzoek bij patiënten met wervelletsel: het includeren en randomiseren van patiënten, het gebruik van verschillende classificatiesystemen en het ontbreken van goede uitkomstmaten. De twee ‘randomized clinical trials’ (RCT’s) die de afgelopen jaren zijn verricht, laten tegenstrijdige uitkomsten zien. Een recente systematische review laat zien dat er bij de meeste letsels onvoldoende bewijs is voor de keuze voor de ene of de andere behandeling. De Thoracolumbar Injury Classification and Severity Score (TLICS) geeft een aantal handvatten in de beslisboom voor de behandeling van een patiënt met wervelletsel. Morfologie/traumamechanisme, integriteit van het posterieure ligamentaire complex (PLC) en de neurologische status van de patiënt zijn factoren die via een optellend puntensysteem tot een score leiden en een indicatie geven voor operatieve of conservatieve behandeling. Voor de toekomst is van belang dat er wordt gezocht naar alternatieven voor RCT’s bij traumapatiënten, dat er uitkomstmaten specifiek voor traumapatiënten worden ontwikkeld en dat dezelfde classificatiesystemen worden gebruikt. Alleen door internationaal multicentrumonderzoek is het mogelijk voldoende patiëntenaantallen te vergaren om een gefundeerde uitspraak te kunnen doen.

Summary

There is no consensus on the best treatment of certain traumatic thoracolumbar spinal fractures. ‘Schools’ of operative and non-operative treatment exist but both treatments lack evidence of superiority. Several factors hinder setting up sound clinical studies: inclusion and randomization of patients, the use of different classification systems and the lack of applicable outcome measurements. Two recently performed RCTs showed conflicting results and a systematic review demonstrated a lack of evidence for either treatment. The Thoracolumbar Injury Classification and Severity Score (TLICS) may assist in clinical decision making and management of spinal trauma patients. It is based on morphology of the injury, integrity of the posterior ligamentous complex and neurological status of the patient. A composite injury severity score is calculated from these, which may assist in the choice for operative or non-operative treatment. In the future we need to find alternative study designs for trauma patients, develop outcome measurements specific for this patient group and should use universal classification systems. By means of multicentre studies it is possible to gather adequate number of patients to be able to answer questions on the best treatment of thoracolumbar spinal trauma.

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Copyright information

© Bohn Stafleu van Loghum 2008

Authors and Affiliations

  • F. C. Öner
    • 1
  • A. Stadhouder
  1. 1.

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