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Research ArticleArticles

The Reverse Thomas Position for Thoracolumbar Fracture Height Restoration: Relative Contribution of Patient Positioning in Percutaneous Balloon Kyphoplasty for Acute Vertebral Compressions

Jonathan P. Ng, Derek T. Cawley, Suzanne M. Beecher, Joseph F. Baker and John P. McCabe
International Journal of Spine Surgery January 2016, 10 21; DOI: https://doi.org/10.14444/3021
Jonathan P. Ng
Department of Orthopaedic and Traumatology, Galway University Hospital, Republic of Ireland
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Derek T. Cawley
Department of Orthopaedic and Traumatology, Galway University Hospital, Republic of Ireland
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Suzanne M. Beecher
Department of Orthopaedic and Traumatology, Galway University Hospital, Republic of Ireland
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Joseph F. Baker
Department of Orthopaedic and Traumatology, Galway University Hospital, Republic of Ireland
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John P. McCabe
Department of Orthopaedic and Traumatology, Galway University Hospital, Republic of Ireland
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Article Figures & Data

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  • Fig. 1
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    Fig. 1

    Intraoperative fluoroscopic screening after patient positioning and prior to balloon inflation. Percentage anterior (A) height loss = {1-Af/[(As + Ai)/2]} × 100; and percentage posterior (P) height loss = {1-Pf/[(Ps + Pi)/2]} × 100. (C) The Cobb angle is calculated form the superior endplate of the vertebra above and the inferior endplate of the vertebrae below the fracture vertebra. In cases where two consecutive levels were fractured, a four-level Cobb angle was calculated. (D) The wedge angle was determined as the angle between the superior and inferior endplates of the collapsed index vertebral body.

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    Fig. 2

    Schematic representation of the Reverse Thomas Position.

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    Fig. 3

    Changes in anterior and posterior height, and wedge and kyphosis (Cobb) angles preoperative, intraoperatively and postoperatively. A positive Cobb angle denotes an overall kyphosis and negative denotes an overall lordosis of the lumbar spine.

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    Fig. 4

    Schematic representation of the additional ligamentotaxis of the anterior longitudinal ligament (ALL) achieved by pelvic anteversion. Note the attachment of the ALL to the intervertebral discs, sacral promontory, and the upper and lower edges of each vertebral body, allowing for distraction across fracture site.

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    Table 1

    Demographic details of 26 vertebral compression fractures in 25 patients.

    Demographic VariablesPercentage / Number of Fractures
    Gender
    Male33.3 / 7
    Female66.6 / 14
    Age
    Under 40 years old28.6 / 6
    40 to 60 years old19 / 4
    Mechanism of Injury
    Trauma61.9 / 13
    Metastasis19 / 4
    Insufficiency19 / 4
    Vertebral Level
    T1123.8 / 5
    T1233.3 / 7
    L142.9 / 9
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    Table 2

    Comparisons of sagittal configuration pre and post positioning.

    MeanP ValueConfidence Interval (CI)
    Anterior Height (Post – pre positioning)0.07 of original height0.15-0.28 to 0.17
    Posterior Height (Post – pre positioning)0.04 of original height0.0140.009 to 0.07
    Wedge Angle (Post – pre positioning)3.6°0.0021.5 to 5.7
    Kyphosis Angle (Post – pre positioning)4.7°0.0041.6 to 7.09
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International Journal of Spine Surgery
Vol. 10
1 Jan 2016
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The Reverse Thomas Position for Thoracolumbar Fracture Height Restoration: Relative Contribution of Patient Positioning in Percutaneous Balloon Kyphoplasty for Acute Vertebral Compressions
Jonathan P. Ng, Derek T. Cawley, Suzanne M. Beecher, Joseph F. Baker, John P. McCabe
International Journal of Spine Surgery Jan 2016, 10 21; DOI: 10.14444/3021

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The Reverse Thomas Position for Thoracolumbar Fracture Height Restoration: Relative Contribution of Patient Positioning in Percutaneous Balloon Kyphoplasty for Acute Vertebral Compressions
Jonathan P. Ng, Derek T. Cawley, Suzanne M. Beecher, Joseph F. Baker, John P. McCabe
International Journal of Spine Surgery Jan 2016, 10 21; DOI: 10.14444/3021
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Keywords

  • thoracolumbar fracture
  • patient positioning
  • percutaneous balloon kyphoplasty

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