Orthopedics Commons^™

Mast Cells And Hypoxia Drive Tissue Metaplasia And Heterotopic Ossification In Idiopathic Arthrofibrosis After Total Knee Arthroplasty., Theresa A Freeman, Javad Parvizi, Craig J Dela Valle, Marla J Steinbeck

Department of Orthopaedic Surgery Faculty Papers

ABSTRACT: BACKGROUND: Idiopathic arthrofibrosis occurs in 3-4% of patients who undergo total knee arthroplasty (TKA). However, little is known about the cellular or molecular changes involved in the onset or progression of this condition. To classify the histomorphologic changes and evaluate potential contributing factors, periarticular tissues from the knees of patients with arthrofibrosis were analyzed for fibroblast and mast cell proliferation, heterotopic ossification, cellular apoptosis, hypoxia and oxidative stress. RESULTS: The arthrofibrotic tissue was composed of dense fibroblastic regions, with limited vascularity along the outer edges. Within the fibrotic regions, elevated numbers of chymase/fibroblast growth factor (FGF)-expressing mast cells were …

Reactive Oxygen And Nitrogen Species Induce Protein And Dna Modifications Driving Arthrofibrosis Following Total Knee Arthroplasty., Theresa A Freeman, Javad Parvizi, Craig J Della Valle, Marla J Steinbeck

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Arthrofibrosis, occurring in 3%-4% of patients following total knee arthroplasty (TKA), is a challenging condition for which there is no defined cause. The hypothesis for this study was that disregulated production of reactive oxygen species (ROS) and nitrogen species (RNS) mediates matrix protein and DNA modifications, which result in excessive fibroblastic proliferation.

RESULTS: We found increased numbers of macrophages and lymphocytes, along with elevated amounts of myeloperoxidase (MPO) in arthrofibrotic tissues when compared to control tissues. MPO expression, an enzyme that generates ROS/RNS, is usually limited to neutrophils and some macrophages, but was found by immunohistochemistry to be expressed …

The Otto Aufranc Award Identification Of A 4 Mb Region On Chromosome 17q21 Linked To Developmental Dysplasia Of The Hip In One 18-Member, Multigeneration Family, George Feldman, Chelsea Dalsey, Kasia Fertala, David Azimi, Paolo Fortina, Marcella Devoto, Maurizio Pacifici, Javad Parvizi

Department of Orthopaedic Surgery Faculty Papers

Developmental dysplasia of the hip (DDH) is a disabling condition of the hip that, depending on geography, can afflict between 20-80% of patients with end-stage arthritis of the hip. Despite its prevalence, the etiology of this disease remains unknown. DDH is a complex disorder with both environmental and genetic causes.. Based on the literature, the candidate genes for the disease are HOXB9, collagen type I α1, and DLX 3. The purpose of our study was to map and characterize the gene or genes responsible for this disorder by family linkage analysis. We recruited one 18-member, multigeneration affected family to provide …

Shoulder Arthroscopy Positioning: Lateral Decubitus Versus Beach Chair., Christina M. Peruto, Md, Michael G. Ciccotti, Md, Steven B. Cohen, Md

Department of Orthopaedic Surgery Faculty Papers

Since the introduction of the beach chair position for shoulder arthroscopy, orthopaedic surgeons have debated whether the beach chair or lateral decubitus is superior. Most surgeons use the same patient position to perform all of their arthroscopic shoulder procedures, regardless of the pathology. Each position has its advantages and disadvantages. The evidence regarding the efficiency, efficacy, and risks of the lateral decubitus and the beach chair positions for shoulder arthroscopy does not show one position to be superior. This review presents a comparison of these positions with regard to setup, surgical visualization, access, and patient risk.

Reactive Oxygen And Nitrogen Species Induce Protein And Dna Modifications Driving Arthrofibrosis Following Total Knee Arthroplasty., Theresa A Freeman, Javad Parvizi, Craig J Della Valle, Marla J Steinbeck

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Arthrofibrosis, occurring in 3%-4% of patients following total knee arthroplasty (TKA), is a challenging condition for which there is no defined cause. The hypothesis for this study was that disregulated production of reactive oxygen species (ROS) and nitrogen species (RNS) mediates matrix protein and DNA modifications, which result in excessive fibroblastic proliferation. RESULTS: We found increased numbers of macrophages and lymphocytes, along with elevated amounts of myeloperoxidase (MPO) in arthrofibrotic tissues when compared to control tissues. MPO expression, an enzyme that generates ROS/RNS, is usually limited to neutrophils and some macrophages, but was found by immunohistochemistry to be expressed …

Isolated Polyethylene Exchange Versus Acetabular Revision For Polyethylene Wear, Camilo Restrepo, Elie Ghanem, Carrie Houssock, Mathew Austin, Javad Parvizi, William J. Hozack

Department of Orthopaedic Surgery Faculty Papers

Polyethylene wear and osteolysis are not uncommon in THA mid- and long-term. In asymptomatic patients the dilemma faced by the orthopaedic surgeon is whether to revise the cup and risk damage to the supporting columns and even pelvic discontinuity or to perform isolated polyethylene exchange and risk a high rate of postoperative recurrent instability and dislocation that will necessitate further surgery. We retrospectively reviewed 62 patients (67 hips) who underwent revision arthroplasty for polywear and osteolysis. Thirty-six hips had isolated polyethylene exchange, while 31 had full acetabular revision. The minimum followup was 2 years (mean, 2.8 years; range, 2-5 years). …

The Efficacy Of Surgical Decompression Before 24 Hours Versus 24 To 72 Hours In Patients With Spinal Cord Injury From T1 To L1--With Specific Consideration On Ethics: A Randomized Controlled Trial., Vafa Rahimi-Movaghar, Soheil Saadat, Alexander R Vaccaro, Seyed Mohammad Ghodsi, Mohammad Samadian, Arya Sheykhmozaffari, Seyed Mohammad Safdari, Bahram Keshmirian

Department of Neurosurgery Faculty Papers

BACKGROUND: There is no clear evidence that early decompression following spinal cord injury (SCI) improves neurologic outcome. Such information must be obtained from randomized controlled trials (RCTs). To date no large scale RCT has been performed evaluating the timing of surgical decompression in the setting of thoracolumbar spinal cord injury. A concern for many is the ethical dilemma that a delay in surgery may adversely effect neurologic recovery although this has never been conclusively proven. The purpose of this study is to compare the efficacy of early (before 24 hours) verse late (24-72 hours) surgical decompression in terms of neurological …

An Approach To The Failed Ankle Arthrodesis, Steven M. Raikin, Venkat Rampuri

Department of Orthopaedic Surgery Faculty Papers

Ankle arthrodesis remains the gold standard of surgical treatment for advanced ankle joint arthritis. Failure can occur as a result of infection, nonunion or malunion, resulting in pain and poor function. This paper offers a systematic approach to preventing, and managing these problems should they occur. Revision arthrodesis performed with a detailed understanding of the appropriate alignment and mechanics of the ankle joint, combined with meticulous attention to understanding and reversing the cause of the failure can result in successful salvage and restoration of function.

Hemorrhage Into An Occult Spinal Ependymoma After Epidural Anesthesia, Peter G. Campbell, John K. Birknes, Ashwini D. Sharan, James S. Harrop, Alexander R. Vaccaro, John K. Ratliff

Department of Orthopaedic Surgery Faculty Papers

Summary of Background Data: Five cases of hemorrhage into a spinal neoplasm after spinal or epidural anesthesia are reported in the literature. Presentation ranges from severe low back pain to acute cauda equina syndrome.

Methods: A case study of a patient who hemorrhaged into an intradural, extramedullary spinal cord mass was performed. A detailed literature review is also provided.

Results: A 27 year old female underwent epidural anesthesia for Cesarean section delivery. She presented with a 3 week history of increasing low back pain with bilateral radiculopathy. Imaging studies revealed a large hemorrhagic intradural mass compressing the lower conus medullaris …

Anthony Frederick Depalma, Md: Educator, Researcher And Clinical Care Doctor., Phillip J. Marone

Department of Orthopaedic Surgery Faculty Papers

My first meeting with Dr. DePalma was in 1957 as an intern in his office on the 6th floor of the Curtis Clinic. He and I spoke for a while about the residency and he looked at me and said “you know you are going to be 33 years old before you make a plug nickel.” I replied, “well I don’t make any money now, so what is the difference?” He laughed and I got the residency. In the next two years, I spent many hours in the operating room with Dr. DePalma and learned quickly how skilled a surgeon …

Surgical Versus Nonsurgical Therapy For Lumbar Spinal Stenosis., James N Weinstein, Tor D Tosteson, Jon D Lurie, Anna N A Tosteson, Emily Blood, Brett Hanscom, Harry Herkowitz, Frank Cammisa, Todd Albert, Scott D Boden, Alan Hilibrand, Harley Goldberg, Sigurd Berven, Howard An

Rothman Institute Papers

BACKGROUND: Surgery for spinal stenosis is widely performed, but its effectiveness as compared with nonsurgical treatment has not been shown in controlled trials.

METHODS: Surgical candidates with a history of at least 12 weeks of symptoms and spinal stenosis without spondylolisthesis (as confirmed on imaging) were enrolled in either a randomized cohort or an observational cohort at 13 U.S. spine clinics. Treatment was decompressive surgery or usual nonsurgical care. The primary outcomes were measures of bodily pain and physical function on the Medical Outcomes Study 36-item Short-Form General Health Survey (SF-36) and the modified Oswestry Disability Index at 6 weeks, …

Surgical Versus Nonsurgical Therapy For Lumbar Spinal Stenosis., James N Weinstein, Tor D Tosteson, Jon D Lurie, Anna N A Tosteson, Emily Blood, Brett Hanscom, Harry Herkowitz, Frank Cammisa, Todd J Albert, Scott D Boden, Alan Hilibrand, Harley Goldberg, Sigurd Berven, Howard An

Rothman Institute Papers

BACKGROUND: Surgery for spinal stenosis is widely performed, but its effectiveness as compared with nonsurgical treatment has not been shown in controlled trials.

METHODS: Surgical candidates with a history of at least 12 weeks of symptoms and spinal stenosis without spondylolisthesis (as confirmed on imaging) were enrolled in either a randomized cohort or an observational cohort at 13 U.S. spine clinics. Treatment was decompressive surgery or usual nonsurgical care. The primary outcomes were measures of bodily pain and physical function on the Medical Outcomes Study 36-item Short-Form General Health Survey (SF-36) and the modified Oswestry Disability Index at 6 weeks, …

Bone Stress Injury Of The Ankle In Professional Ballet Dancers Seen On Mri., Ilan Elias, Adam C Zoga, Steven M Raikin, Judith R Peterson, Marcus P Besser, William B Morrison, Mark E Schweitzer

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Ballet dancers have been shown to have a relatively high incidence of stress fractures of the foot and ankle. It was our objective to examine MR imaging patterns of bone marrow edema (BME) in the ankles of high performance professional ballet dancers, to evaluate clinical relevance. METHODS: MR Imaging was performed on 12 ankles of 11 active professional ballet dancers (6 female, 5 male; mean age 24 years, range 19 to 32). Individuals were imaged on a 0.2 T or 1.5 T MRI units. Images were evaluated by two musculoskeletal radiologists and one orthopaedic surgeon in consensus for location …

Aoa Symposium. Orthopaedists Partnering With Other Physicians To Provide Musculoskeletal Care., Alan Hilibrand, Kurt P Spindler, Scott D Boden

Rothman Institute Papers

No abstract provided.

Regional Variability In Use Of A Novel Assessment Of Thoracolumbar Spine Fractures: United States Versus International Surgeons, John Ratliff, Neel Anand, Alexander R. Vaccaro, Moe R. Lim, Joon Y. Lee, Paul Arnold, James S. Harrop, Raja Rampersaud, Christopher M. Bono, Ralf H. Gahr, Trauma Study Group Spine

Department of Orthopaedic Surgery Faculty Papers

Background: Considerable variability exists in clinical approaches to thoracolumbar fractures. Controversy in evaluation and nomenclature contribute to this confusion, with significant differences found between physicians, between different specialties, and in different geographic regions. A new classification system for thoracolumbar injuries, the Thoracolumbar Injury Severity Score (TLISS), was recently described by Vaccaro. No assessment of regional differences has been described. We report regional variability in use of the TLISS system between United States and non-US surgeons.

Methods: Twenty-eight spine surgeons (8 neurosurgeons and 20 orthopedic surgeons) reviewed 56 clinical thoracolumbar injury case histories, which included pertinent imaging studies. Cases were classified …

Does ‘Excessive’ Anticoagulation Predispose To Periprosthetic Infection?, Javad Parvizi, Elie Ghanem, Ashish Joshi, Peter F. Sharkey, William J. Hozack, Richard H. Rothman

Department of Orthopaedic Surgery Faculty Papers

Background
Although persistent drainage and hematoma formation are recognized risk factors for the development of periprosthetic infection, it is not known if excess anticoagulation is a predisposing factor.

Methods
We conducted a 2 to 1 case-control study with 78 cases who underwent revision for septic failure. The controls underwent the same index procedure but did not develop consequent infection. Patient comorbidities, medications, intraoperative, and postoperative factors were compared.

Results
Postoperative wound complications including development of hematoma and wound drainage were significant risk factors for periprosthetic infection. A mean international normalized ratio of greater than 1.5 was found to be more …

Diet, Nutrition, Obesity And Their Role In Arthritis, Peter F. Sharkey, David L. Paskin, Thomas D. Meade, Richard H. Rothman

Department of Orthopaedic Surgery Faculty Papers

Obesity and poor nutrition, individually and together, have created costly musculoskeletal disease epidemic in the United States. Processed food, with abundant "empty" calories, has contributed greatly to our dietary woes. Much of the food consumed today is packed with calories but refined to the point that essential nutrients are lacking. Even worse, processed food may have ingredients added that are detrimental to good health. Abundant research has documented a close relationship between obesity, poor diet and orthopaedic problems. Dietary supplements have been proven to provide both disease prevention and therapeutic benefits. Unfortunately, many weight loss programs and methods are ineffective …

Concave Pit-Containing Scaffold Surfaces Improve Stem Cell-Derived Osteoblast Performance And Lead To Significant Bone Tissue Formation., Antonio Graziano, Riccardo D'Aquino, Maria Gabriella Cusella-De Angelis, Gregorio Laino, Adriano Piattelli, Maurizio Pacifici, Alfredo De Rosa, Gianpaolo Papaccio

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Scaffold surface features are thought to be important regulators of stem cell performance and endurance in tissue engineering applications, but details about these fundamental aspects of stem cell biology remain largely unclear.

METHODOLOGY AND FINDINGS: In the present study, smooth clinical-grade lactide-coglyolic acid 85:15 (PLGA) scaffolds were carved as membranes and treated with NMP (N-metil-pyrrolidone) to create controlled subtractive pits or microcavities. Scanning electron and confocal microscopy revealed that the NMP-treated membranes contained: (i) large microcavities of 80-120 microm in diameter and 40-100 microm in depth, which we termed primary; and (ii) smaller microcavities of 10-20 microm in diameter …

Acute Proximal Hamstring Rupture, Steven B. Cohen, James Bradley

Department of Orthopaedic Surgery Faculty Papers

Hamstring strain is common in athletes, and both diagnosis and surgical treatment of this injury are becoming more common. Nonsurgical treatment of complete ruptures has resulted in complications such as muscle weakness and sciatic neuralgia. Surgical treatment recently has been advocated to repair the complete rupture of the hamstring tendons from the ischial tuberosity. Surgical repair involves a transverse incision in the gluteal crease, protection of the sciatic nerve, mobilization of the ruptured tendons, and repair to the ischial tuberosity with the use of suture anchors. Reports in the literature of surgical treatment of proximal hamstring rupture are few, and …

Surgical Versus Nonsurgical Treatment For Lumbar Degenerative Spondylolisthesis., James N Weinstein, Jon D Lurie, Tor D Tosteson, Brett Hanscom, Anna N A Tosteson, Emily A Blood, Nancy J O Birkmeyer, Alan Hilibrand, Harry Herkowitz, Frank P Cammisa, Todd J Albert, Sanford E Emery, Lawrence G Lenke, William A Abdu, Michael Longley, Thomas J Errico, Serena S Hu

Rothman Institute Papers

BACKGROUND: Management of degenerative spondylolisthesis with spinal stenosis is controversial. Surgery is widely used, but its effectiveness in comparison with that of nonsurgical treatment has not been demonstrated in controlled trials.

METHODS: Surgical candidates from 13 centers in 11 U.S. states who had at least 12 weeks of symptoms and image-confirmed degenerative spondylolisthesis were offered enrollment in a randomized cohort or an observational cohort. Treatment was standard decompressive laminectomy (with or without fusion) or usual nonsurgical care. The primary outcome measures were the Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36) bodily pain and physical function scores (100-point scales, …

Pathophysiology, Diagnosis, And Treatment Of Spinal Meningoceles And Arachnoid Cysts, Ryan M. Dahlgren, Eli M. Baron, Alexander R. Vaccaro

Department of Orthopaedic Surgery Faculty Papers

Though the nomenclature regarding spinal arachnoid cysts and meningoceles is confusing and sometimes overlapping, spinal arachnoid cysts and meningoceles are distinct entities with different presentations and etiologies. Meningoceles are usually congenital lesions discovered at infancy with a high incidence of associated anomalies. Spinal arachnoid cysts are most often asymptomatic but can cause nerve root and/or cord compression. We review the presentation, pathophysiology, and management of these lesions.

Management Of Morel-Lavallee Lesion Of The Knee: Twenty-Seven Cases In The National Football League, Samir G. Tejwani, Steven B. Cohen, James P. Bradley

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: The Morel-Lavallee lesion is a closed degloving injury most commonly described in the region of the hip joint after blunt trauma. It also occurs in the knee as a result of shearing trauma during football and is a distinct lesion from prepatellar bursitis and quadriceps contusion.

PURPOSE: To review the authors' experience with Morel-Lavallee lesion of the knee in the elite contact athlete to construct a diagnostic and treatment algorithm.

STUDY DESIGN: Case series; Level of evidence, 4.

METHODS: Twenty-seven knees in 24 players were identified from 1 National Football League team's annual injury database as having sustained a …

Rotator Cuff Contusions Of The Shoulder In Professional Football Players: Epidemiology And Magnetic Resonance Imaging Findings, Steven B. Cohen, Jeffrey D. Towers, James P. Bradley

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: No published reports have studied the epidemiology and magnetic resonance imaging findings associated with rotator cuff contusions of the shoulder in professional football players.

PURPOSE: To determine a single professional football team's incidence, treatment, and magnetic resonance imaging appearance of players sustaining rotator cuff contusions of the shoulder.

STUDY DESIGN: Case series; Level of evidence, 4.

METHODS: From 1999 to 2005, a North American professional football team's injury records were retrospectively reviewed for athletes who had sustained a rotator cuff contusion of the shoulder during in-season participation. Those patients who had magnetic resonance imaging of the shoulder with a …

Three-Portal Technique For Anterior Cruciate Ligament Reconstruction: Use Of A Central Medial Portal, Steven B. Cohen, Freddie H. Fu

Department of Orthopaedic Surgery Faculty Papers

Standard endoscopic reconstruction of the anterior cruciate ligament (ACL) is performed with the use of 2 arthroscopic portals. The surgical error most commonly associated with ACL reconstruction is improper positioning of the tunnel. Errors in femoral tunnel position may be related to poor visualization of the lateral wall. When anatomic double-bundle ACL reconstruction is performed, proper visualization of the lateral wall is essential to ensure correct placement of both tunnels. We propose the use of a central portal, in addition to more standard anterolateral and anteromedial portals, to enhance visualization of the lateral wall. In addition, the arthroscope can be …

The Fate Of The Unexpected Positive Intraoperative Cultures After Revision Total Knee Arthroplasty, Robert L. Barrack, Ajay Aggarwal, R. Stephen J. Burnett, John C. Clohisy, Elie Ghanem, Peter Sharkey, Javad Parvizi

Department of Orthopaedic Surgery Faculty Papers

Of a consecutive series of 692 revision total knees at 3 centers, intraoperative cultures were unexpectedly found to be positive in 41 cases (5.9%). Of the 41, 29 (71%) cases had a single positive intraoperative culture and were determined to be a probable false positive based on absence of any other evidence of infection, of which 5 were treated with extended course of intravenous antibiotics after hospital discharge and the remaining 24 received no further treatment. None of these 24 patients manifested any sign of infection at follow-up, averaging 46 months (range, 24-74 months). Twelve patients were determined to have …

Recurrent Burner Syndrome Due To Presumed Cervical Spine Osteoblastoma In A Collision Sport Athlete - A Case Report., Ilan Elias, Michael A Pahl, Adam C Zoga, Maurice L Goins, Alexander R Vaccaro

Department of Orthopaedic Surgery Faculty Papers

We present a case of a 35-year-old active rugby player presenting with a history of recurrent burner syndrome thought secondary to an osteoblastoma involving the posterior arch of the atlas. Radiographically, the lesion had features typical for a large osteoid osteoma or osteoblastoma, including osseous expansion, peripheral sclerosis and bony hypertrophy, internal lucency, and even suggestion of a central nidus. The patient subsequently underwent an en bloc resection of the posterior atlas via a standard posterior approach. The surgery revealed very good clinical results. In this report, we will discuss in detail, the presentation, treatment, and return to play recommendations …

The Sub-Axial Cervical Spine Injury Classification System (Slic): A Novel Approach To Recognize The Importance Of Morphology, Neurology And Integrity Of The Disco-Ligamentous Complex, Alexander R. Vaccaro, R. John Hulbert, Charles Fisher, Marcel Dvorak, Alpesh A. Patel, Ronald A. Lehman Jr., Paul Anderson, James Harrop, F. C. Oner, Paul Arnold, Michael Fehlings, Rune Hedlund, Ignacio Madrazo, Glenn Rechtine, Bizhan Aarabi, Mike Shainline, Spine Trauma Study Group

Department of Orthopaedic Surgery Faculty Papers

Abstract Background Context Despite technological advances in spine surgery, classification of sub-axial cervical spine injuries remains largely descriptive, lacking standardization and any relationship to prognosis or clinical decision making. Purpose The primary purpose of this paper is to define a classification system for sub-axial cervical spine trauma that conveys information about injury pattern and severity as well as treatment considerations and prognosis. The proposed system is designed to be both comprehensive and easy to use. The secondary objective is to evaluate the classification system in the basic principles of classification construction, namely reliability and validity. Study Design/Setting Derivation of the …

Surgical Correction Of Severe Bilateral Thumb Pincer-Nail Deformity, Scott T. Van Duzer, John S. Taras

Department of Orthopaedic Surgery Faculty Papers

A 53 year old woman presented to the office with complaint of severe bilateral thumb nail pain and the deformity shown (Figure 1). She denied previous trauma to her thumb nails and had no history of previous bacterial or fungal infections of her nails. Based on the curvature of her nails, which increased from proximal to distal, a diagnosis of bilateral thumb pincer nail deformity was made.

The Impact Of Four Common Lumbar Spine Diagnoses Upon Overall Health Status, Michael A. Pahl, Brian Brislin, Scott Boden, Alan S. Hilibrand, Alexander Vaccaro, Brett Hanscom, Todd J. Albert

Department of Orthopaedic Surgery Faculty Papers

Background Context: The SF-36 health survey has been shown to be a valid instrument when used to measure the self-reported physical and mental health of patients. The impact of lumbar spinal disorders can be assessed as the difference between the SF-36 scale scores and age-and-gender specific population norms.

Purpose: To establish the impact upon the self-reported health status of patients with one of four common lumbar spinal diagnoses.

Study Design: A cross-sectional, observational assessment of the health status of spine patients.

Methods: Data from patients presenting to the participating centers of the National Spine Network with low back pain and/or …

Surgical Decision Making For Unstable Thoracolumbar Spine Injuries: Results Of A Consensus Panel Review By The Spine Trauma Study Group, Alexander R. Vaccaro, Moe R. Lim, R. John Hurlbert, Ronald A. Lehman, James Harrop, D. Charles Fisher, Marcel Dvorak, D. Greg Anderson, Steven C. Zeiller, Joon Y. Lee, Michael G. Fehlings, F. C. Oner, Spine Trauma Study Group

Department of Orthopaedic Surgery Faculty Papers

Objectives: The optimal surgical approach and treatment of unstable thoracolumbar spine injuries are poorly defined owing to a lack of widely accepted level I clinical literature. This lack of evidence based standards has led to varied practice patterns based on individual surgeon preferences. The purpose of this study was to survey the leaders in the field of spine trauma to define the major characteristics of thoracolumbar injuries that influence their surgical decision making. In the absence of good scientific data, expert consensus opinions may provide surgeons with a practical framework to guide therapy and to conduct future research.

Methods: A …