Ulus Travma Acil Cerrahi Derg. Ahead of Print: UTD-93735

Management of TLICS 4 Thoracolumbar Fractures After Natural Disasters: Comperative Outcomes of Conservative and Surgical Treatments Following the 2023 Türkiye Earthquake

Halil Gök¹, Abdulsamet Emet¹, Naci Berkay Odabaþý¹, Alisan Daylak¹, Erkan Akgün², Muhammed Erkan Emrahoðlu³, Bilal Abbasoðlu³, Habibullah Dolgun^3
1Department of Orthopedics and Traumatology, Etlik City Hospital, Ankara, Turkey
²Department of Orthopedics and Traumatology, Etlik Lokman Hekim Hospital, Ankara, Turkey
³Department of Neurosurgery, University of Health Sciences Etlik City Hospital, Ankara

Background: This study examines the outcomes of conservative versus surgical treatment for TLICS 4 thoracolumbar fractures in patients injured during the 2023 Türkiye earthquake. It aims to assess clinical and radiographic outcomes while considering the impact of crush syndrome-related complications on treatment decisions.
Methods: This study evaluated 23 patients with TLICS 4 spinal injuries, divided into surgical (12) and conservative (11) groups. Clinical parameters such as age, gender, preoperative spinal measurements, and 1-year postoperative outcomes were assessed. The Roland Morris score was used to evaluate clinical outcomes. Additionally, complications like cardiac, renal, and respiratory issues, infections, and hospital stay duration were analyzed.
Results: The surgical group had significantly higher Roland-Morris scores (RM: 79.3 ± 12.7 vs. 15.0 ± 8.5, p < 0.001). Preoperative acute kidney injury was more common in the conservative group (36.4% vs. 8.3%, p < 0.05), while preoperative pulmonary complications were more frequent in the surgical group (83.3% vs. 36.4%, p < 0.05). No significant differences were found in gender, age, or other complications. Radiological outcomes, including Cobb angle, sagittal index, and ACVBH restoration, showed no significant differences between the groups. Length of hospital stay was similar across groups.
Conclusion: Our study demonstrates that both conservative and surgical treatments are effective for TLICS 4 thoracolumbar fractures in disaster settings, with treatment decisions guided by patient factors and available resources.

Keywords: spine, fracture, TLICS, earthquake, posterior instrumentation

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2023 Türkiye Depremi Sonrasýnda TLICS 4 Torakolomber Kýrýklarýn Yönetimi: Konservatif ve Cerrahi Tedavilerin Karþýlaþtýrmalý Sonuçlarý

Halil Gök¹, Abdulsamet Emet¹, Naci Berkay Odabaþý¹, Alisan Daylak¹, Erkan Akgün², Muhammed Erkan Emrahoðlu³, Bilal Abbasoðlu³, Habibullah Dolgun^3
1Etlik Þehir Hastanesi, Ortopedi ve Travmatoloji Ana Bilim Dalý, Ankara
²Etlik Lokman Hekim Hastanesi, Ortopedi ve Travmatoloji Ana Bilim Dalý, Ankara
³Saðlýk Bilimleri Üniversitesi Etlik Þehir Hastanesi, Beyin ve Sinir Cerrahisi Ana Bilim Dalý, Ankara

Giriþ: Deprem gibi kitlesel afetler, yalnýzca primer yaralanmalarla sýnýrlý kalmayýp, crush sendromu ve diðer sistemik komplikasyonlar gibi ikincil saðlýk sorunlarýný da beraberinde getirerek tedavi sürecini karmaþýklaþtýrmaktadýr. Bu çalýþma, 2023 Türkiye depremi sonrasý yaralanan TLICS 4 torakolomber kýrýklý hastalarda konservatif ve cerrahi tedavi sonuçlarýný deðerlendirmeyi amaçlamaktadýr. Ayrýca, crush sendromu ile iliþkili komplikasyonlarýn tedavi kararlarý üzerindeki etkisi incelenmiþtir.
Gereç ve Yöntem: Çalýþmada 23 TLICS 4 spinal yaralanmalý hasta, cerrahi (n=12) ve konservatif (n=11) tedavi gruplarýna ayrýldý. Yaþ, cinsiyet, ameliyat öncesi spinal ölçümler ve 1 yýllýk postoperatif klinik sonuçlar Roland Morris skoru ile deðerlendirildi. Kardiyak, renal ve solunum komplikasyonlarý, enfeksiyonlar ve hastanede kalýþ süreleri de analiz edildi.
Bulgular: Cerrahi grup, Roland Morris skorlarýnda anlamlý daha iyi sonuçlar gösterdi (79.3 ± 12.7 vs. 15.0 ± 8.5, p < 0.001). Akut böbrek hasarý konservatif grupta daha yaygýndý (%36.4 vs. %8.3, p < 0.05), pulmoner komplikasyonlar ise cerrahi grupta daha sýk gözlendi (%83.3 vs. %36.4, p < 0.05). Yaþ, cinsiyet ve diðer komplikasyonlarda anlamlý fark yoktu. Radyolojik sonuçlar (Cobb açýsý, sagittal indeks, vertebral yüksekliðin restorasyonu) gruplar arasýnda farklýlýk göstermedi. Hastanede kalýþ süreleri benzerdi.
Sonuç: Çalýþmamýz, doðal afet ortamlarýnda TLICS 4 torakolomber kýrýklarýn konservatif ve cerrahi tedavi ile etkili þekilde yönetilebileceðini göstermektedir. Tedavi kararlarý, hasta özellikleri ve mevcut kaynaklar dikkate alýnarak bireyselleþtirilmelidir.

Anahtar Kelimeler: omurga, kýrýk, TLICS, deprem, posterior enstrümantasyon

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