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
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
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
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
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
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
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
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
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
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
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
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