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academies
Journal of Neurology and Neurorehabilitation Research | Volume 3
November 26-27, 2018 | Dubai, UAE
Spine and Spine Disorders
Addiction Research and Therapy
3rd International Conference on
International Conference on
Joint Event
&
Adjacent disc injuries in Thoracolumbar fracture - Assessments and its significance. Development of
the new DISC injury classification
Raman V Kalyan
1
, A Hamilton
2
, P Nolan
2
, E Cooke
2
, N Eames
2
, M Crone
2
and
D Marsh
1
1
Royal National Orthopaedic Hospital, UK
2
Royal Victoria Hospital, UK
Objectives:
To measure short-term outcome of stable Thoraco-
lumbar fracture and to analyse aspects of injury severity for
their ability to predict outcome. To develop a new disc injury
severity grading system in thoraco-lumbar spine fractures.
Study design: Prospective observational.
Patient sample:
44 patients with stable fractures between
T11 and L5 vertebra, with no neurological deficit and treated
conservatively were selected.
Methods:
All had X-rays, CT and MRI imaging. Bony injury
severity was scored on a seven-point ordinal scale based on a)
comminution, b) apposition and c) kyphosis. Disc injury severity
was scored on a newly developed six-point ordinal scale.
Outcome (5 domains of pain and function each) was assessed
at 1 to 2 years from injury. The data (patient demographic,
pre-injury health status, injury and outcome variables) was
analyzed by non-parametric correlation (for predictors of
outcome) and stepwise linear regression analyses (to compare
predictive value). Results: According to AO classification, the
fractures were A1, A2, A3 and B1. The Spear-man correlation
coefficients between injury severity and outcome were
consistently higher with disc injury severity than bony e.g. for
pain intensity the respective correlation was: .63 (p<.0001) and
.28 (not significant), and for SF36-PCS: .41 (p<.01) and .25 (not
significant). The predictive value of pain was 29% for disc injury
severity and it increased by further 9%, 9% and 6% by addition
of each of the following 3 variables respectively: “patient’s pre-
injury mental status”, “legal and Compensation issues pending”
and “physical demand of job”. The predictive value of function
was 16% for disc injury severity and it increased to 31% by
the addition of “physical demand of the job” variable. The
predictive value further increased by 5% by addition of variable
“Legal and Compensation issues pending”. All other variables
were not significant.
Conclusion:
A new grading system of disc injury severity was
developed, and it showed good predictive value to pain and
functional outcome. Disc injury severity has a better predictive
value of short-term outcome compared to the bony injury
severity. In the spectrumof injuries studied, theAOclassification
and the degree of kyphosis provided no prediction of outcome.
Speaker Biography
Raman V Kalyan is a Consultant Spine Surgeon from UK working in North East
England. His busy practice covers a wide spectrum of both Adult and Paediatric
Spine Pathologies. He is an Honorary Consultant in James Cook University Hospital,
UK. From 1992 to 2000, he has gained extensive experience from working in
numerous renowned spinal centres in UK, Europe and India. He started his training
in Spinal Surgery in the famous institution Christian Medical College Hospital in
India in 1992. In Europe, he got specialized training in spinal surgery by attaining the
prestigious fellowship in France (under Prof J Dubousset, 1998) and Germany (Prof.
J. Harms, 1997). In UK, he undertook further spinal training and fellowships under
eminent surgeons in Edinburgh (Mr M Mc Master), Belfast and London (Stanmore
Hospital). He obtained his dual accreditation (clinical and academic) in Trauma and
Orthopaedics, by undertaking the Northern Ireland and Stanmore rotations. In
1996, he was elected for the TNOA travelling fellowship to visit few distinguished
spinal surgeons. He was awarded the MD degree in Belfast for his research work
in Spinal fractures and has won prizes for his research work. As a Clinical lecturer
in UCL University London (2008 - 2009), he gained experience in conducting
courses and teaching programmes. His research interests focus on Spinal Pain, Less
invasive management of spinal pathologies, spinal fractures and spinal deformity.
e
:
vkalyanv@hotmail.com