Outcome of Non-operative Treatment of Extension Fractures in Patients with Ankylosed Spines – A Case Series
Bibliographic record
Abstract
Background Surgical treatment is the mainstay of management in patients having fractures in fused spines. However, these patients also tend to be older and have comorbidities resulting in increased morbidity and mortality with operative management. Therefore, there has been more recent interest in the risks and benefits of nonoperative treatment in these patients. Objective Extension pattern fractures have an intact posterior element hinge resulting in lower risk of translation. Therefore, we wanted to determine the outcome of nonoperative treatment of extension pattern fractures in patients with fused spines. Methods We conducted a retrospective review of all patients with fused spines having extension thoracolumbar fractures without neurologic deficit treated nonoperatively at a University Health Sciences Centre over an 8-year period. Results We had a complete set of data for 14 patients. There was a morbidity rate of 29% and a mortality rate of 14%. All of our patients had a significant positive change in their Cobb angle, indicating closure of the fracture gap without translation in either the sagittal or coronal planes. Remodelling of the fracture lines was found in all 14 patients and in 11 there were also bridging osteophytes across the fracture. No patients developed neurologic deficits. Conclusion By demonstrating the successful healing of extension fractures treated nonoperatively with morbidity and mortality in keeping with that of reports of patients with fused spines managed operatively, we added support to conducting future randomized studies of operative versus nonoperative treatment in this patient population.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".