26-9-2017

1

Thoracolumbale

wervelfracturenWM Bakker

Inhoud

bull Incidentie

bull Lichamelijk onderzoek

bull Aanvullend onderzoek

bull Classificaties

bull Behandeling

bull Osteoporose

bull Follow up

Incidentie

26-9-2017

2

Incidentie

bullGeschatte incidentie 150-650 per miljoen

bull plusmn 2500 opnames per jaar

bullMan vrouw verhouding 21

bullGemiddelde leeftijd 42 plusmn10 jaar

bullOorzakenndash Verkeersongevallen (50)ndash Val van hoogte (35)

Incidentie

Machino et al Yonsei Med J 2013 Jul54(4)1020-1025

Lichamelijk onderzoek

26-9-2017

3

Evidence

bull Lichamelijk onderzoek

JM Hsu et al Injury Int J Care Injured 34 (2003) 426ndash433

Vaak fout

negatieve test

Factoren die lichamelijk onderzoek negatief beinvloedenbull Glasgow coma scale lt 15bull Alcohol of drugs intoxicatie

bull Distracting injury

Neurologisch onderzoek

Aanvullend onderzoek

26-9-2017

4

Radiologische metingen

Cobb hoek VKA = vertebral kyphotic

angle

AVHPVH = vertebral

height ratio

Anterieur

hoogteverlies

O Keynan et al Radiographic Measurement Parameters in TLWK Fractures A Systematic Review

and Consensus Statement of the Spine Trauma Study Group Spine 200631E156ndashE165

gt50 hoogteverlies

gt30 graden kyfoseVermoeden op posterieur letsel

Evidence

bull Aanvullend onderzoek

Gevoeligheid van CT neemt toe bij afname coupe dikte

R Sheridan et al J Trauma 200355665ndash9

26-9-2017

5

Termen

bull Burstfractuur

bull Dekplaat Sluitplaat

bull Voorste middelste achterste pijler

bull Achterste complex

bull Inzakking

bull Osteoporose

bull Stabiel instabiel

bull Brace gipskorset

bull Spondylodese

Classificaties

Wervelfractuur classificatie

Denis classificatie

Spine (Phila Pa 1976) 1983 Nov-Dec8(8)817-31 The three column

spine and its significance in the classification of acute thoracolumbar

spinal injuries Denis F

26-9-2017

2

Incidentie

bullGeschatte incidentie 150-650 per miljoen

bull plusmn 2500 opnames per jaar

bullMan vrouw verhouding 21

bullGemiddelde leeftijd 42 plusmn10 jaar

bullOorzakenndash Verkeersongevallen (50)ndash Val van hoogte (35)

Incidentie

Machino et al Yonsei Med J 2013 Jul54(4)1020-1025

Lichamelijk onderzoek

26-9-2017

3

Evidence

bull Lichamelijk onderzoek

JM Hsu et al Injury Int J Care Injured 34 (2003) 426ndash433

Vaak fout

negatieve test

Factoren die lichamelijk onderzoek negatief beinvloedenbull Glasgow coma scale lt 15bull Alcohol of drugs intoxicatie

bull Distracting injury

Neurologisch onderzoek

Aanvullend onderzoek

26-9-2017

4

Radiologische metingen

Cobb hoek VKA = vertebral kyphotic

angle

AVHPVH = vertebral

height ratio

Anterieur

hoogteverlies

O Keynan et al Radiographic Measurement Parameters in TLWK Fractures A Systematic Review

and Consensus Statement of the Spine Trauma Study Group Spine 200631E156ndashE165

gt50 hoogteverlies

gt30 graden kyfoseVermoeden op posterieur letsel

Evidence

bull Aanvullend onderzoek

Gevoeligheid van CT neemt toe bij afname coupe dikte

R Sheridan et al J Trauma 200355665ndash9

26-9-2017

5

Termen

bull Burstfractuur

bull Dekplaat Sluitplaat

bull Voorste middelste achterste pijler

bull Achterste complex

bull Inzakking

bull Osteoporose

bull Stabiel instabiel

bull Brace gipskorset

bull Spondylodese

Classificaties

Wervelfractuur classificatie

Denis classificatie

Spine (Phila Pa 1976) 1983 Nov-Dec8(8)817-31 The three column

spine and its significance in the classification of acute thoracolumbar

spinal injuries Denis F

26-9-2017

3

Evidence

bull Lichamelijk onderzoek

JM Hsu et al Injury Int J Care Injured 34 (2003) 426ndash433

Vaak fout

negatieve test

Factoren die lichamelijk onderzoek negatief beinvloedenbull Glasgow coma scale lt 15bull Alcohol of drugs intoxicatie

bull Distracting injury

Neurologisch onderzoek

Aanvullend onderzoek

26-9-2017

4

Radiologische metingen

Cobb hoek VKA = vertebral kyphotic

angle

AVHPVH = vertebral

height ratio

Anterieur

hoogteverlies

O Keynan et al Radiographic Measurement Parameters in TLWK Fractures A Systematic Review

and Consensus Statement of the Spine Trauma Study Group Spine 200631E156ndashE165

gt50 hoogteverlies

gt30 graden kyfoseVermoeden op posterieur letsel

Evidence

bull Aanvullend onderzoek

Gevoeligheid van CT neemt toe bij afname coupe dikte

R Sheridan et al J Trauma 200355665ndash9

26-9-2017

5

Termen

bull Burstfractuur

bull Dekplaat Sluitplaat

bull Voorste middelste achterste pijler

bull Achterste complex

bull Inzakking

bull Osteoporose

bull Stabiel instabiel

bull Brace gipskorset

bull Spondylodese

Classificaties

Wervelfractuur classificatie

Denis classificatie

Spine (Phila Pa 1976) 1983 Nov-Dec8(8)817-31 The three column

spine and its significance in the classification of acute thoracolumbar

spinal injuries Denis F

26-9-2017

4

Radiologische metingen

Cobb hoek VKA = vertebral kyphotic

angle

AVHPVH = vertebral

height ratio

Anterieur

hoogteverlies

O Keynan et al Radiographic Measurement Parameters in TLWK Fractures A Systematic Review

and Consensus Statement of the Spine Trauma Study Group Spine 200631E156ndashE165

gt50 hoogteverlies

gt30 graden kyfoseVermoeden op posterieur letsel

Evidence

bull Aanvullend onderzoek

Gevoeligheid van CT neemt toe bij afname coupe dikte

R Sheridan et al J Trauma 200355665ndash9

26-9-2017

5

Termen

bull Burstfractuur

bull Dekplaat Sluitplaat

bull Voorste middelste achterste pijler

bull Achterste complex

bull Inzakking

bull Osteoporose

bull Stabiel instabiel

bull Brace gipskorset

bull Spondylodese

Classificaties

Wervelfractuur classificatie

Denis classificatie

Spine (Phila Pa 1976) 1983 Nov-Dec8(8)817-31 The three column

spine and its significance in the classification of acute thoracolumbar

spinal injuries Denis F

26-9-2017

5

Termen

bull Burstfractuur

bull Dekplaat Sluitplaat

bull Voorste middelste achterste pijler

bull Achterste complex

bull Inzakking

bull Osteoporose

bull Stabiel instabiel

bull Brace gipskorset

bull Spondylodese

Classificaties

Wervelfractuur classificatie

Denis classificatie

Spine (Phila Pa 1976) 1983 Nov-Dec8(8)817-31 The three column

spine and its significance in the classification of acute thoracolumbar

spinal injuries Denis F

26-9-2017

6

Wervelfractuur classificatie

McAfee classificatie

J Bone Joint Surg Am 1983 Apr65(4)461-73 The value of computed

tomography in thoracolumbar fractures An analysis of one hundred

consecutive cases and a new classification McAfee PC Yuan HA

Fredrickson BE Lubicky JP

Wervelfractuur classificatie

Magerl (AO) classificatie

Eur Spine J 19943(4)184-201 A comprehensive classification of thoracic

and lumbar injuries Magerl F1 Aebi M Gertzbein SD Harms J Nazarian S

TLICS

Thoracolumbar spine trauma classification the Thoracolumbar Injury Classification and Severity Score system and case examples Patel AA et al J Neurosurg Spine 2009 Mar10(3)201-6

26-9-2017

7

Nieuwe AO

Posterieure

Ligamenten

amp spieren

rarr

Posterior ligament complex

bull Supraspinous ligament (SSL)

bull Interspinous ligament (ISL)

bull Ligamentum flavum (LF)

bull Facet joint capsules

Nieuwe AO classificatie

bull Type-A injuries failure under axial compression of theanterior elements with intact posterior constrainingelements

bull Type-B injuries failure of the posterior constrainingelements

bull Type-C injuries failure of anterior and posterior elements leading to displacement

Eur Spine J 2013 Oct22(10)2184-201 doi 101007s00586-013-2738-0 Epub 2013 Mar 19 AO spine injury classification

system a revision proposal for the thoracic and lumbar spine Reinhold M1 Audigeacute L Schnake KJ Bellabarba C Dai LY Oner FC

26-9-2017

8

Type A

Type B

Type C

26-9-2017

9

Behandeling

Evidence

bull BehandelingConservatief Operatief

Voordelen Geen chirurgische complicaties Herstel van alignement

Minder kosten Directe mobilisatie

Nadelen Geen reductie fractuur Meer complicaties

Risico op progressie deformiteit Hogere kosten

Anatomische stand alignement correleert niet

met klinische en functionele uitkomst

Nonoperative versus operative treatment for thoracolumbar burst fractures without

neurologic deficit a meta-analysis Gnanenthiran SR Adie S Harris IA Clin Orthop

Relat Res 2011470(2) 567-77

Evidence

bull Behandeling conservatief vs operatief

Cochrane review 2013

bull 597 records gescreend rarr 2 geiumlncludeerd

bull Totaal 87 patieumlnten met TLWK burst fractures

bull Follow up 2 jaar

Resultaten

bull 2 studies met tegenstrijdige uitkomsten

Surgical versus non-surgical treatment for thoracolumbar burst fractures without

neurological deficit

Abudou et al Cochrane Database Syst Rev Juni 2013

Conclusie

ldquo2 potentially biased RCTs were

insufficient to draw conclusionsrdquo

26-9-2017

10

Behandeling wereldwijd

Conservatieve therapie

bull Evidence-based management of traumatic thoracolumbar burst fractures a systematic review of nonoperative management

Bakhsheshian J Dahdaleh NS Fakurnejad S ScheerJK Smith ZA Neurosurg Focus 2014 Jul37(1)

bull Orthosis for thoracolumbar burst fractures without neurologic deficit A systematic review of prospective randomized controlled trials

Alcalaacute-Cerra G Paternina-Caicedo AJ Diacuteaz-Becerra C Moscote-Salazar LR Fernandes-Joaquim A J Craniovertebr Junction Spine 2014 Jan5(1)25-32

The Spine Journal 14 (2014) 2557ndash2564

26-9-2017

11

Bailey et al

110 assessed for eligibility

49 assigned NO

48 received NO

1 received surgery

47 assigned TLSO

43 received TLSO

4 received surgery

14 excluded

3 resided outside Canada

8 refused to participate

3 ambulated prior to consent

July 2002- July

2009

Inclusion criteria

bull 16-60 yr

bull isolated AO A3

bull Th10-L3

bull kyfosislt 35deg

bull neurologically

intact

Bailey et al

bull Geen verschil in Roland Morris DisabilityQuestionnaire

bull Geen verschil in pijn

bull Geen verschil in tevredenheid

bull Geen verschil in toename in kyfose hoek

Osteoporose

26-9-2017

12

Osteoporose

Evidence

bull Conservatieve behandeling

Exercise for improving outcomes afterosteoporotic vertebral fracture

Giangregorio LM Macintyre NJ Thabane L Skidmore CJ Papaioannou A

Cochrane Database Syst 2013 Jan 31(1)CD008618

AUTHORS CONCLUSIONS No definitive conclusions can be made regarding the benefits of exercise for individuals with vertebral fracture Although individual trials did report benefits forsome pain physical function and quality of life outcomes the findings should be interpretedwith caution given that findings were inconsistent and the quality of evidence was very low The small number of trials and variability across trials limited our ability to pool outcomes or make conclusions Evidence regarding the effects of exercise after vertebral fracture particularly for men is scarce A high-quality randomized trial is needed to inform exerciseprescription for individuals with vertebral fractures

Evidence

bull Conservatieve behandeling

Spinal Orthoses for Vertebral Osteoporosis and OsteoporoticVertebral Fracture A Systematic Review

Newman M Minns Lowe C Barker K

Arch Phys Med Rehabil 2016 Jun97(6)1013-25

CONCLUSIONSThe limited evidence about orthoses after acute OVF is inconclusive better evidence of efficacy is needed particularly when considering complications

26-9-2017

13

Evidence

bull Fysiotherapie

Physiotherapy Rehabilitation for Osteoporotic Vertebral Fracture (PROVE) study protocol for a randomised controlled trialBarker KL Javaid MK Newman M Minns Lowe C Stallard N Campbell H Gandhi V Lamb STrials 2014 Jan 141522

Build better bones with exercise protocol for a feasibility study of a multicenter randomized controlled trial of 12 months of home exercise in women with a vertebral fractureGiangregorio LM Thabane L Adachi JD Ashe MC Bleakney RR Braun EA Cheung AM Fraser LA Gibbs JC Hill KD Hodsman AB Kendler DL Mittmann N Prasad S Scherer SC Wark JD Papaioannou APhys Ther 2014 Sep94(9)1337-52

Too Fit To Fracture exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fractureGiangregorio LM Papaioannou A Macintyre NJ Ashe MC Heinonen A Shipp K Wark J McGill S Keller H Jain R Laprade J Cheung AMOsteoporos Int 2014 Mar25(3)821-35

Follow up

Follow up

8 maanden na L1

26-9-2017

14

Saggitale balans

Deformiteit grote impact op ADL

Patieumlnten scoren

slechter

dan andere chronische

ziekten

Met name

bull physical functioning

(PF)

bull role-physical (RP)

bull bodily pain (BP)Impact on health related quality of life of adult spinal deformity compared with other chronic

conditions

Pellise et al Eur Spine J 2015243-11

25000 patieumlnten waarvan 766 met rug

deformiteiten

Correctie is grote operatie

Smith-Petersen osteotomie

bull Max 10 gr

correctieniveau

bull Relatief eenvoudig

bull Relatief laag risico

Pedikel subtractie osteotomie

bull plusmn 30 graden correctie

bull Complexe ingreep

bull Hoog complicatie risico

(25)

26-9-2017

15

Take Home

bull Testen lichamelijk onderzoek vaak fout negatief

bull Cave osteoporose

bull In follow up denk aan de saggitale balans rol voor fysiotherapeut

26-9-2017

16

26-9-2017

8

Type A

Type B

Type C

26-9-2017

9

Behandeling

Evidence

bull BehandelingConservatief Operatief

Voordelen Geen chirurgische complicaties Herstel van alignement

Minder kosten Directe mobilisatie

Nadelen Geen reductie fractuur Meer complicaties

Risico op progressie deformiteit Hogere kosten

Anatomische stand alignement correleert niet

met klinische en functionele uitkomst

Nonoperative versus operative treatment for thoracolumbar burst fractures without

neurologic deficit a meta-analysis Gnanenthiran SR Adie S Harris IA Clin Orthop

Relat Res 2011470(2) 567-77

Evidence

bull Behandeling conservatief vs operatief

Cochrane review 2013

bull 597 records gescreend rarr 2 geiumlncludeerd

bull Totaal 87 patieumlnten met TLWK burst fractures

bull Follow up 2 jaar

Resultaten

bull 2 studies met tegenstrijdige uitkomsten

Surgical versus non-surgical treatment for thoracolumbar burst fractures without

neurological deficit

Abudou et al Cochrane Database Syst Rev Juni 2013

Conclusie

ldquo2 potentially biased RCTs were

insufficient to draw conclusionsrdquo

26-9-2017

10

Behandeling wereldwijd

Conservatieve therapie

bull Evidence-based management of traumatic thoracolumbar burst fractures a systematic review of nonoperative management

Bakhsheshian J Dahdaleh NS Fakurnejad S ScheerJK Smith ZA Neurosurg Focus 2014 Jul37(1)

bull Orthosis for thoracolumbar burst fractures without neurologic deficit A systematic review of prospective randomized controlled trials

Alcalaacute-Cerra G Paternina-Caicedo AJ Diacuteaz-Becerra C Moscote-Salazar LR Fernandes-Joaquim A J Craniovertebr Junction Spine 2014 Jan5(1)25-32

The Spine Journal 14 (2014) 2557ndash2564

26-9-2017

11

Bailey et al

110 assessed for eligibility

49 assigned NO

48 received NO

1 received surgery

47 assigned TLSO

43 received TLSO

4 received surgery

14 excluded

3 resided outside Canada

8 refused to participate

3 ambulated prior to consent

July 2002- July

2009

Inclusion criteria

bull 16-60 yr

bull isolated AO A3

bull Th10-L3

bull kyfosislt 35deg

bull neurologically

intact

Bailey et al

bull Geen verschil in Roland Morris DisabilityQuestionnaire

bull Geen verschil in pijn

bull Geen verschil in tevredenheid

bull Geen verschil in toename in kyfose hoek

Osteoporose

26-9-2017

12

Osteoporose

Evidence

bull Conservatieve behandeling

Exercise for improving outcomes afterosteoporotic vertebral fracture

Giangregorio LM Macintyre NJ Thabane L Skidmore CJ Papaioannou A

Cochrane Database Syst 2013 Jan 31(1)CD008618

AUTHORS CONCLUSIONS No definitive conclusions can be made regarding the benefits of exercise for individuals with vertebral fracture Although individual trials did report benefits forsome pain physical function and quality of life outcomes the findings should be interpretedwith caution given that findings were inconsistent and the quality of evidence was very low The small number of trials and variability across trials limited our ability to pool outcomes or make conclusions Evidence regarding the effects of exercise after vertebral fracture particularly for men is scarce A high-quality randomized trial is needed to inform exerciseprescription for individuals with vertebral fractures

Evidence

bull Conservatieve behandeling

Spinal Orthoses for Vertebral Osteoporosis and OsteoporoticVertebral Fracture A Systematic Review

Newman M Minns Lowe C Barker K

Arch Phys Med Rehabil 2016 Jun97(6)1013-25

CONCLUSIONSThe limited evidence about orthoses after acute OVF is inconclusive better evidence of efficacy is needed particularly when considering complications

26-9-2017

13

Evidence

bull Fysiotherapie

Physiotherapy Rehabilitation for Osteoporotic Vertebral Fracture (PROVE) study protocol for a randomised controlled trialBarker KL Javaid MK Newman M Minns Lowe C Stallard N Campbell H Gandhi V Lamb STrials 2014 Jan 141522

Build better bones with exercise protocol for a feasibility study of a multicenter randomized controlled trial of 12 months of home exercise in women with a vertebral fractureGiangregorio LM Thabane L Adachi JD Ashe MC Bleakney RR Braun EA Cheung AM Fraser LA Gibbs JC Hill KD Hodsman AB Kendler DL Mittmann N Prasad S Scherer SC Wark JD Papaioannou APhys Ther 2014 Sep94(9)1337-52

Too Fit To Fracture exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fractureGiangregorio LM Papaioannou A Macintyre NJ Ashe MC Heinonen A Shipp K Wark J McGill S Keller H Jain R Laprade J Cheung AMOsteoporos Int 2014 Mar25(3)821-35

Follow up

Follow up

8 maanden na L1

26-9-2017

14

Saggitale balans

Deformiteit grote impact op ADL

Patieumlnten scoren

slechter

dan andere chronische

ziekten

Met name

bull physical functioning

(PF)

bull role-physical (RP)

bull bodily pain (BP)Impact on health related quality of life of adult spinal deformity compared with other chronic

conditions

Pellise et al Eur Spine J 2015243-11

25000 patieumlnten waarvan 766 met rug

deformiteiten

Correctie is grote operatie

Smith-Petersen osteotomie

bull Max 10 gr

correctieniveau

bull Relatief eenvoudig

bull Relatief laag risico

Pedikel subtractie osteotomie

bull plusmn 30 graden correctie

bull Complexe ingreep

bull Hoog complicatie risico

(25)

26-9-2017

15

Take Home

bull Testen lichamelijk onderzoek vaak fout negatief

bull Cave osteoporose

bull In follow up denk aan de saggitale balans rol voor fysiotherapeut

26-9-2017

16

26-9-2017

9

Behandeling

Evidence

bull BehandelingConservatief Operatief

Voordelen Geen chirurgische complicaties Herstel van alignement

Minder kosten Directe mobilisatie

Nadelen Geen reductie fractuur Meer complicaties

Risico op progressie deformiteit Hogere kosten

Anatomische stand alignement correleert niet

met klinische en functionele uitkomst

Nonoperative versus operative treatment for thoracolumbar burst fractures without

neurologic deficit a meta-analysis Gnanenthiran SR Adie S Harris IA Clin Orthop

Relat Res 2011470(2) 567-77

Evidence

bull Behandeling conservatief vs operatief

Cochrane review 2013

bull 597 records gescreend rarr 2 geiumlncludeerd

bull Totaal 87 patieumlnten met TLWK burst fractures

bull Follow up 2 jaar

Resultaten

bull 2 studies met tegenstrijdige uitkomsten

Surgical versus non-surgical treatment for thoracolumbar burst fractures without

neurological deficit

Abudou et al Cochrane Database Syst Rev Juni 2013

Conclusie

ldquo2 potentially biased RCTs were

insufficient to draw conclusionsrdquo

26-9-2017

10

Behandeling wereldwijd

Conservatieve therapie

bull Evidence-based management of traumatic thoracolumbar burst fractures a systematic review of nonoperative management

Bakhsheshian J Dahdaleh NS Fakurnejad S ScheerJK Smith ZA Neurosurg Focus 2014 Jul37(1)

bull Orthosis for thoracolumbar burst fractures without neurologic deficit A systematic review of prospective randomized controlled trials

Alcalaacute-Cerra G Paternina-Caicedo AJ Diacuteaz-Becerra C Moscote-Salazar LR Fernandes-Joaquim A J Craniovertebr Junction Spine 2014 Jan5(1)25-32

The Spine Journal 14 (2014) 2557ndash2564

26-9-2017

11

Bailey et al

110 assessed for eligibility

49 assigned NO

48 received NO

1 received surgery

47 assigned TLSO

43 received TLSO

4 received surgery

14 excluded

3 resided outside Canada

8 refused to participate

3 ambulated prior to consent

July 2002- July

2009

Inclusion criteria

bull 16-60 yr

bull isolated AO A3

bull Th10-L3

bull kyfosislt 35deg

bull neurologically

intact

Bailey et al

bull Geen verschil in Roland Morris DisabilityQuestionnaire

bull Geen verschil in pijn

bull Geen verschil in tevredenheid

bull Geen verschil in toename in kyfose hoek

Osteoporose

26-9-2017

12

Osteoporose

Evidence

bull Conservatieve behandeling

Exercise for improving outcomes afterosteoporotic vertebral fracture

Giangregorio LM Macintyre NJ Thabane L Skidmore CJ Papaioannou A

Cochrane Database Syst 2013 Jan 31(1)CD008618

AUTHORS CONCLUSIONS No definitive conclusions can be made regarding the benefits of exercise for individuals with vertebral fracture Although individual trials did report benefits forsome pain physical function and quality of life outcomes the findings should be interpretedwith caution given that findings were inconsistent and the quality of evidence was very low The small number of trials and variability across trials limited our ability to pool outcomes or make conclusions Evidence regarding the effects of exercise after vertebral fracture particularly for men is scarce A high-quality randomized trial is needed to inform exerciseprescription for individuals with vertebral fractures

Evidence

bull Conservatieve behandeling

Spinal Orthoses for Vertebral Osteoporosis and OsteoporoticVertebral Fracture A Systematic Review

Newman M Minns Lowe C Barker K

Arch Phys Med Rehabil 2016 Jun97(6)1013-25

CONCLUSIONSThe limited evidence about orthoses after acute OVF is inconclusive better evidence of efficacy is needed particularly when considering complications

26-9-2017

13

Evidence

bull Fysiotherapie

Physiotherapy Rehabilitation for Osteoporotic Vertebral Fracture (PROVE) study protocol for a randomised controlled trialBarker KL Javaid MK Newman M Minns Lowe C Stallard N Campbell H Gandhi V Lamb STrials 2014 Jan 141522

Build better bones with exercise protocol for a feasibility study of a multicenter randomized controlled trial of 12 months of home exercise in women with a vertebral fractureGiangregorio LM Thabane L Adachi JD Ashe MC Bleakney RR Braun EA Cheung AM Fraser LA Gibbs JC Hill KD Hodsman AB Kendler DL Mittmann N Prasad S Scherer SC Wark JD Papaioannou APhys Ther 2014 Sep94(9)1337-52

Too Fit To Fracture exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fractureGiangregorio LM Papaioannou A Macintyre NJ Ashe MC Heinonen A Shipp K Wark J McGill S Keller H Jain R Laprade J Cheung AMOsteoporos Int 2014 Mar25(3)821-35

Follow up

Follow up

8 maanden na L1

26-9-2017

14

Saggitale balans

Deformiteit grote impact op ADL

Patieumlnten scoren

slechter

dan andere chronische

ziekten

Met name

bull physical functioning

(PF)

bull role-physical (RP)

bull bodily pain (BP)Impact on health related quality of life of adult spinal deformity compared with other chronic

conditions

Pellise et al Eur Spine J 2015243-11

25000 patieumlnten waarvan 766 met rug

deformiteiten

Correctie is grote operatie

Smith-Petersen osteotomie

bull Max 10 gr

correctieniveau

bull Relatief eenvoudig

bull Relatief laag risico

Pedikel subtractie osteotomie

bull plusmn 30 graden correctie

bull Complexe ingreep

bull Hoog complicatie risico

(25)

26-9-2017

15

Take Home

bull Testen lichamelijk onderzoek vaak fout negatief

bull Cave osteoporose

bull In follow up denk aan de saggitale balans rol voor fysiotherapeut

26-9-2017

16

26-9-2017

10

Behandeling wereldwijd

Conservatieve therapie

bull Evidence-based management of traumatic thoracolumbar burst fractures a systematic review of nonoperative management

Bakhsheshian J Dahdaleh NS Fakurnejad S ScheerJK Smith ZA Neurosurg Focus 2014 Jul37(1)

bull Orthosis for thoracolumbar burst fractures without neurologic deficit A systematic review of prospective randomized controlled trials

Alcalaacute-Cerra G Paternina-Caicedo AJ Diacuteaz-Becerra C Moscote-Salazar LR Fernandes-Joaquim A J Craniovertebr Junction Spine 2014 Jan5(1)25-32

The Spine Journal 14 (2014) 2557ndash2564

26-9-2017

11

Bailey et al

110 assessed for eligibility

49 assigned NO

48 received NO

1 received surgery

47 assigned TLSO

43 received TLSO

4 received surgery

14 excluded

3 resided outside Canada

8 refused to participate

3 ambulated prior to consent

July 2002- July

2009

Inclusion criteria

bull 16-60 yr

bull isolated AO A3

bull Th10-L3

bull kyfosislt 35deg

bull neurologically

intact

Bailey et al

bull Geen verschil in Roland Morris DisabilityQuestionnaire

bull Geen verschil in pijn

bull Geen verschil in tevredenheid

bull Geen verschil in toename in kyfose hoek

Osteoporose

26-9-2017

12

Osteoporose

Evidence

bull Conservatieve behandeling

Exercise for improving outcomes afterosteoporotic vertebral fracture

Giangregorio LM Macintyre NJ Thabane L Skidmore CJ Papaioannou A

Cochrane Database Syst 2013 Jan 31(1)CD008618

AUTHORS CONCLUSIONS No definitive conclusions can be made regarding the benefits of exercise for individuals with vertebral fracture Although individual trials did report benefits forsome pain physical function and quality of life outcomes the findings should be interpretedwith caution given that findings were inconsistent and the quality of evidence was very low The small number of trials and variability across trials limited our ability to pool outcomes or make conclusions Evidence regarding the effects of exercise after vertebral fracture particularly for men is scarce A high-quality randomized trial is needed to inform exerciseprescription for individuals with vertebral fractures

Evidence

bull Conservatieve behandeling

Spinal Orthoses for Vertebral Osteoporosis and OsteoporoticVertebral Fracture A Systematic Review

Newman M Minns Lowe C Barker K

Arch Phys Med Rehabil 2016 Jun97(6)1013-25

CONCLUSIONSThe limited evidence about orthoses after acute OVF is inconclusive better evidence of efficacy is needed particularly when considering complications

26-9-2017

13

Evidence

bull Fysiotherapie

Physiotherapy Rehabilitation for Osteoporotic Vertebral Fracture (PROVE) study protocol for a randomised controlled trialBarker KL Javaid MK Newman M Minns Lowe C Stallard N Campbell H Gandhi V Lamb STrials 2014 Jan 141522

Build better bones with exercise protocol for a feasibility study of a multicenter randomized controlled trial of 12 months of home exercise in women with a vertebral fractureGiangregorio LM Thabane L Adachi JD Ashe MC Bleakney RR Braun EA Cheung AM Fraser LA Gibbs JC Hill KD Hodsman AB Kendler DL Mittmann N Prasad S Scherer SC Wark JD Papaioannou APhys Ther 2014 Sep94(9)1337-52

Too Fit To Fracture exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fractureGiangregorio LM Papaioannou A Macintyre NJ Ashe MC Heinonen A Shipp K Wark J McGill S Keller H Jain R Laprade J Cheung AMOsteoporos Int 2014 Mar25(3)821-35

Follow up

Follow up

8 maanden na L1

26-9-2017

14

Saggitale balans

Deformiteit grote impact op ADL

Patieumlnten scoren

slechter

dan andere chronische

ziekten

Met name

bull physical functioning

(PF)

bull role-physical (RP)

bull bodily pain (BP)Impact on health related quality of life of adult spinal deformity compared with other chronic

conditions

Pellise et al Eur Spine J 2015243-11

25000 patieumlnten waarvan 766 met rug

deformiteiten

Correctie is grote operatie

Smith-Petersen osteotomie

bull Max 10 gr

correctieniveau

bull Relatief eenvoudig

bull Relatief laag risico

Pedikel subtractie osteotomie

bull plusmn 30 graden correctie

bull Complexe ingreep

bull Hoog complicatie risico

(25)

26-9-2017

15

Take Home

bull Testen lichamelijk onderzoek vaak fout negatief

bull Cave osteoporose

bull In follow up denk aan de saggitale balans rol voor fysiotherapeut

26-9-2017

16

26-9-2017

11

Bailey et al

110 assessed for eligibility

49 assigned NO

48 received NO

1 received surgery

47 assigned TLSO

43 received TLSO

4 received surgery

14 excluded

3 resided outside Canada

8 refused to participate

3 ambulated prior to consent

July 2002- July

2009

Inclusion criteria

bull 16-60 yr

bull isolated AO A3

bull Th10-L3

bull kyfosislt 35deg

bull neurologically

intact

Bailey et al

bull Geen verschil in Roland Morris DisabilityQuestionnaire

bull Geen verschil in pijn

bull Geen verschil in tevredenheid

bull Geen verschil in toename in kyfose hoek

Osteoporose

26-9-2017

12

Osteoporose

Evidence

bull Conservatieve behandeling

Exercise for improving outcomes afterosteoporotic vertebral fracture

Giangregorio LM Macintyre NJ Thabane L Skidmore CJ Papaioannou A

Cochrane Database Syst 2013 Jan 31(1)CD008618

AUTHORS CONCLUSIONS No definitive conclusions can be made regarding the benefits of exercise for individuals with vertebral fracture Although individual trials did report benefits forsome pain physical function and quality of life outcomes the findings should be interpretedwith caution given that findings were inconsistent and the quality of evidence was very low The small number of trials and variability across trials limited our ability to pool outcomes or make conclusions Evidence regarding the effects of exercise after vertebral fracture particularly for men is scarce A high-quality randomized trial is needed to inform exerciseprescription for individuals with vertebral fractures

Evidence

bull Conservatieve behandeling

Spinal Orthoses for Vertebral Osteoporosis and OsteoporoticVertebral Fracture A Systematic Review

Newman M Minns Lowe C Barker K

Arch Phys Med Rehabil 2016 Jun97(6)1013-25

CONCLUSIONSThe limited evidence about orthoses after acute OVF is inconclusive better evidence of efficacy is needed particularly when considering complications

26-9-2017

13

Evidence

bull Fysiotherapie

Physiotherapy Rehabilitation for Osteoporotic Vertebral Fracture (PROVE) study protocol for a randomised controlled trialBarker KL Javaid MK Newman M Minns Lowe C Stallard N Campbell H Gandhi V Lamb STrials 2014 Jan 141522

Build better bones with exercise protocol for a feasibility study of a multicenter randomized controlled trial of 12 months of home exercise in women with a vertebral fractureGiangregorio LM Thabane L Adachi JD Ashe MC Bleakney RR Braun EA Cheung AM Fraser LA Gibbs JC Hill KD Hodsman AB Kendler DL Mittmann N Prasad S Scherer SC Wark JD Papaioannou APhys Ther 2014 Sep94(9)1337-52

Too Fit To Fracture exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fractureGiangregorio LM Papaioannou A Macintyre NJ Ashe MC Heinonen A Shipp K Wark J McGill S Keller H Jain R Laprade J Cheung AMOsteoporos Int 2014 Mar25(3)821-35

Follow up

Follow up

8 maanden na L1

26-9-2017

14

Saggitale balans

Deformiteit grote impact op ADL

Patieumlnten scoren

slechter

dan andere chronische

ziekten

Met name

bull physical functioning

(PF)

bull role-physical (RP)

bull bodily pain (BP)Impact on health related quality of life of adult spinal deformity compared with other chronic

conditions

Pellise et al Eur Spine J 2015243-11

25000 patieumlnten waarvan 766 met rug

deformiteiten

Correctie is grote operatie

Smith-Petersen osteotomie

bull Max 10 gr

correctieniveau

bull Relatief eenvoudig

bull Relatief laag risico

Pedikel subtractie osteotomie

bull plusmn 30 graden correctie

bull Complexe ingreep

bull Hoog complicatie risico

(25)

26-9-2017

15

Take Home

bull Testen lichamelijk onderzoek vaak fout negatief

bull Cave osteoporose

bull In follow up denk aan de saggitale balans rol voor fysiotherapeut

26-9-2017

16

26-9-2017

12

Osteoporose

Evidence

bull Conservatieve behandeling

Exercise for improving outcomes afterosteoporotic vertebral fracture

Giangregorio LM Macintyre NJ Thabane L Skidmore CJ Papaioannou A

Cochrane Database Syst 2013 Jan 31(1)CD008618

AUTHORS CONCLUSIONS No definitive conclusions can be made regarding the benefits of exercise for individuals with vertebral fracture Although individual trials did report benefits forsome pain physical function and quality of life outcomes the findings should be interpretedwith caution given that findings were inconsistent and the quality of evidence was very low The small number of trials and variability across trials limited our ability to pool outcomes or make conclusions Evidence regarding the effects of exercise after vertebral fracture particularly for men is scarce A high-quality randomized trial is needed to inform exerciseprescription for individuals with vertebral fractures

Evidence

bull Conservatieve behandeling

Spinal Orthoses for Vertebral Osteoporosis and OsteoporoticVertebral Fracture A Systematic Review

Newman M Minns Lowe C Barker K

Arch Phys Med Rehabil 2016 Jun97(6)1013-25

CONCLUSIONSThe limited evidence about orthoses after acute OVF is inconclusive better evidence of efficacy is needed particularly when considering complications

26-9-2017

13

Evidence

bull Fysiotherapie

Physiotherapy Rehabilitation for Osteoporotic Vertebral Fracture (PROVE) study protocol for a randomised controlled trialBarker KL Javaid MK Newman M Minns Lowe C Stallard N Campbell H Gandhi V Lamb STrials 2014 Jan 141522

Build better bones with exercise protocol for a feasibility study of a multicenter randomized controlled trial of 12 months of home exercise in women with a vertebral fractureGiangregorio LM Thabane L Adachi JD Ashe MC Bleakney RR Braun EA Cheung AM Fraser LA Gibbs JC Hill KD Hodsman AB Kendler DL Mittmann N Prasad S Scherer SC Wark JD Papaioannou APhys Ther 2014 Sep94(9)1337-52

Too Fit To Fracture exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fractureGiangregorio LM Papaioannou A Macintyre NJ Ashe MC Heinonen A Shipp K Wark J McGill S Keller H Jain R Laprade J Cheung AMOsteoporos Int 2014 Mar25(3)821-35

Follow up

Follow up

8 maanden na L1

26-9-2017

14

Saggitale balans

Deformiteit grote impact op ADL

Patieumlnten scoren

slechter

dan andere chronische

ziekten

Met name

bull physical functioning

(PF)

bull role-physical (RP)

bull bodily pain (BP)Impact on health related quality of life of adult spinal deformity compared with other chronic

conditions

Pellise et al Eur Spine J 2015243-11

25000 patieumlnten waarvan 766 met rug

deformiteiten

Correctie is grote operatie

Smith-Petersen osteotomie

bull Max 10 gr

correctieniveau

bull Relatief eenvoudig

bull Relatief laag risico

Pedikel subtractie osteotomie

bull plusmn 30 graden correctie

bull Complexe ingreep

bull Hoog complicatie risico

(25)

26-9-2017

15

Take Home

bull Testen lichamelijk onderzoek vaak fout negatief

bull Cave osteoporose

bull In follow up denk aan de saggitale balans rol voor fysiotherapeut

26-9-2017

16

26-9-2017

13

Evidence

bull Fysiotherapie

Physiotherapy Rehabilitation for Osteoporotic Vertebral Fracture (PROVE) study protocol for a randomised controlled trialBarker KL Javaid MK Newman M Minns Lowe C Stallard N Campbell H Gandhi V Lamb STrials 2014 Jan 141522

Build better bones with exercise protocol for a feasibility study of a multicenter randomized controlled trial of 12 months of home exercise in women with a vertebral fractureGiangregorio LM Thabane L Adachi JD Ashe MC Bleakney RR Braun EA Cheung AM Fraser LA Gibbs JC Hill KD Hodsman AB Kendler DL Mittmann N Prasad S Scherer SC Wark JD Papaioannou APhys Ther 2014 Sep94(9)1337-52

Too Fit To Fracture exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fractureGiangregorio LM Papaioannou A Macintyre NJ Ashe MC Heinonen A Shipp K Wark J McGill S Keller H Jain R Laprade J Cheung AMOsteoporos Int 2014 Mar25(3)821-35

Follow up

Follow up

8 maanden na L1

26-9-2017

14

Saggitale balans

Deformiteit grote impact op ADL

Patieumlnten scoren

slechter

dan andere chronische

ziekten

Met name

bull physical functioning

(PF)

bull role-physical (RP)

bull bodily pain (BP)Impact on health related quality of life of adult spinal deformity compared with other chronic

conditions

Pellise et al Eur Spine J 2015243-11

25000 patieumlnten waarvan 766 met rug

deformiteiten

Correctie is grote operatie

Smith-Petersen osteotomie

bull Max 10 gr

correctieniveau

bull Relatief eenvoudig

bull Relatief laag risico

Pedikel subtractie osteotomie

bull plusmn 30 graden correctie

bull Complexe ingreep

bull Hoog complicatie risico

(25)

26-9-2017

15

Take Home

bull Testen lichamelijk onderzoek vaak fout negatief

bull Cave osteoporose

bull In follow up denk aan de saggitale balans rol voor fysiotherapeut

26-9-2017

16

26-9-2017

14

Saggitale balans

Deformiteit grote impact op ADL

Patieumlnten scoren

slechter

dan andere chronische

ziekten

Met name

bull physical functioning

(PF)

bull role-physical (RP)

bull bodily pain (BP)Impact on health related quality of life of adult spinal deformity compared with other chronic

conditions

Pellise et al Eur Spine J 2015243-11

25000 patieumlnten waarvan 766 met rug

deformiteiten

Correctie is grote operatie

Smith-Petersen osteotomie

bull Max 10 gr

correctieniveau

bull Relatief eenvoudig

bull Relatief laag risico

Pedikel subtractie osteotomie

bull plusmn 30 graden correctie

bull Complexe ingreep

bull Hoog complicatie risico

(25)

26-9-2017

15

Take Home

bull Testen lichamelijk onderzoek vaak fout negatief

bull Cave osteoporose

bull In follow up denk aan de saggitale balans rol voor fysiotherapeut

26-9-2017

16

26-9-2017

15

Take Home

bull Testen lichamelijk onderzoek vaak fout negatief

bull Cave osteoporose

bull In follow up denk aan de saggitale balans rol voor fysiotherapeut

26-9-2017

16

26-9-2017

16