Fractures of the thoracolumbar region of the spine are serious disabling injuries resulting in personal suffering and significant loss to society. These result from many causes, such as high speed auto accidents, falls, blows, sports and ejection of airplane pilots at high speed. There is high risk associated with these injuries because of certain anatomic relationships. The junction of the conus medularis and cauda equina is adjacent to the thoracolumbar junction, the most common site of spinal injury. Further, this junction between the relatively rigid rib cage and the more flexible lumbar spine creates a potential for second injury during the time of transport to and treatment in the hospital. The treatment of these injuries depends to a large degree on the determination of the stability/instability status of the spine. Although there are several clinical guidelines, the decision is often based on subjective judgement. There are no objective experimental studies to help the physician make this important decision. The primary goal of our proposal is to develop such objective guidelines by producing clinically relevant spinal injuries, objectively evaluating their spinal instability, and then correlating one with the other. Fractures and dislocations will be produced dynamically in fresh thoracolumbar spine specimens to simulate clinical situations. Loads, displacements and deformations will be recorded during trauma, using computers and high speed movie cameras. X-rays and CT-scans before and after trauma will be taken. Multi-directional instability will be measured before and after trauma. The injured specimen will be studied morphologically, and its image will be reconstructed using computer graphics for three-dimensional visualization of the fractures. The data will be analyzed to determine relationships between various types of parameters, but especially between the roentgenographic images (x-rays and CT-scans) and the multi-directional spinal instability of the injured specimens. Clinical relevance is one of the primary aims of this study and it may participate in health care cost containment at the level of diagnosis and treatment.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Research Project (R01)
Project #
5R01AR039209-02
Application #
3159186
Study Section
Orthopedics and Musculoskeletal Study Section (ORTH)
Project Start
1989-12-01
Project End
1994-11-30
Budget Start
1990-12-01
Budget End
1991-11-30
Support Year
2
Fiscal Year
1991
Total Cost
Indirect Cost
Name
Yale University
Department
Type
Schools of Medicine
DUNS #
082359691
City
New Haven
State
CT
Country
United States
Zip Code
06520
Wang, Jaw-Lin; Panjabi, Manohar M; Kato, Yoshihiko et al. (2002) Radiography cannot examine disc injuries secondary to burst fracture: quantitative discomanometry validation. Spine (Phila Pa 1976) 27:235-40
Oda, T; Panjabi, M M; Kato, Y (2001) The effects of pedicle screw adjustments on the anatomical reduction of thoracolumbar burst fractures. Eur Spine J 10:505-11
Oda, T; Panjabi, M M (2001) Pedicle screw adjustments affect stability of thoracolumbar burst fracture. Spine (Phila Pa 1976) 26:2328-33
Panjabi, M M; Kato, Y; Hoffman, H et al. (2001) Canal and intervertebral foramen encroachments of a burst fracture: effects from the center of rotation. Spine (Phila Pa 1976) 26:1231-7
Panjabi, M M; Hoffman, H; Kato, Y et al. (2000) Superiority of incremental trauma approach in experimental burst fracture studies. Clin Biomech (Bristol, Avon) 15:73-8
Panjabi, M M; Kato, Y; Hoffman, H et al. (2000) A study of stiffness protocol as exemplified by testing of a burst fracture model in sagittal plane. Spine (Phila Pa 1976) 25:2748-54
Panjabi, M M; Oda, T; Wang, J L (2000) The effects of pedicle screw adjustments on neural spaces in burst fracture surgery. Spine (Phila Pa 1976) 25:1637-43
Isomi, T; Panjabi, M M; Kato, Y et al. (2000) Radiographic parameters for evaluating the neurological spaces in experimental thoracolumbar burst fractures. J Spinal Disord 13:404-11
Nibu, K; Panjabi, M M; Oxland, T et al. (1998) Intervertebral disc distraction with a laparoscopic anterior spinal fusion system. Eur Spine J 7:142-7
Vahldiek, M J; Panjabi, M M (1998) Stability potential of spinal instrumentations in tumor vertebral body replacement surgery. Spine (Phila Pa 1976) 23:543-50

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