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Pseudomeningocele (PMC) is a rare complication following thoracic spinal decompression surgery. The aim of this study is to assess the clinical features and treatment of PMC and provide the technical notes with revision surgery.
Between January 2010 and December 2019, patients who developed PMC after posterior thoracic surgery were enrolled. An additional 25 patients who suffered cerebrospinal fluid leakage (CSFL) but did not develop PMC in the same period were randomly selected. General data, intra-operative factors, CSFL position, cost, modified Japanese Orthopaedic Association (mJOA) scores, patient satisfaction, and clinical features were recorded and compared between the two groups.
Eighteen patients were diagnosed with PMC after thoracic spinal surgery. The average length, width, and depth were 16.25 ± 5.73 cm, 6.96 ± 3.61 cm and 4.39 ± 2.2 cm, respectively. The most common symptom was neurological deficits following incision problems and headache. Compared with the control group, the PMC group showed a longer duration of initial surgery, greater estimated blood loss, an increased rate of CSFL on the ventral side, reduced mJOA scores, and lower patient satisfaction at the final follow-up.
PMC is a rare complication of thoracic surgery with an incidence of 1.12%. PMC typically occurs at the upper and lower thoracic spine, resulting in increased health care costs, poorer neurological recovery, and a lower rate of patient satisfaction. The management of PMC should be individualized depending on diagnosis time and symptoms.

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The Korean Society of Radiology and the National Evidence-based Healthcare Collaborating Agency developed a primary imaging test for suspected traumatic thoracolumbar spine injury. This guideline was developed using an adaptation process involving collaboration between the development committee and the working group. The development committee, consisting of research methodology experts, established the overall plan and provided support on research methodology. The working group, composed of radiologists with expertise in musculoskeletal imaging, wrote the recommendation. The guidelines recommend that thoracolumbar spine computed tomography without intravenous contrast enhancement be the first-line imaging modality for diagnosing traumatic thoracolumbar spine injury in adults.

The pedicle screw placement procedure is the most commonly used technique for spinal fixation and can provide reliable three-column stabilization. Accurate screw placement is necessary in clinical practice. To avoid screw malposition, which may decrease the stiffness of the screw-rod construct or increase the likelihood of neural and vascular injuries, the surgeons must fully understand the regional anatomy. Deformities, such as scoliosis, kyphosis or congenital anomalies, may complicate the application of the pedicle screw placement technique and increase the chance of screw encroachments. Incidences of pedicle screw malposition vary in different districts and hospitals and with surgeons and techniques. Today, the minimally invasive spinal surgery is well developed. However, the narrow corridors and limited views for surgeons increase the difficulty of pedicle screw placement and the possibility of screw encroachment. Evidenced by previous studies, robotic surgery can provide accurate screw placement, especially in settings of spinal deformities, anatomical anomalies, and minimally invasive procedures. Based on the consensus of consultant specialists, the literature review and our local experiences, this guideline introduces the robotic system and describes the workflow of robot-assisted procedures and the precautions to take during procedures. This guideline aims to outline a standardized method for robotic surgery for thoracolumbar pedicle screw placement.

In order to provide the clinical guidelines of acute thoracolumbar injury for the Chinese orthopedic surgeons, the Spine Trauma Group of Chinese Association of Orthopedic Surgeons compiled this guideline. The guideline applies to adult patients with acute (less than 3 weeks) thoracolumbar fracture and(or) dislocation with or without spinal cord, cauda equina or nerve root injuries. The Study Group wrote the guideline by setting up questions, determining search words, screening literatures according to inclusion and exclusion criteria, analyzing the included literatures, confirming evidence levels and then providing recommendations. The guideline include 247 literatures, of which 35 articles were in Chinese and 212 articles were in English. The guidelines set up 20 questions divided into 4 sections: pre-hospital care, diagnosis and evaluation, treatment and prevention of complications, which include 39 recommendations.
为了给中国的骨科医师提供急性胸腰段脊柱脊髓损伤的循证临床诊疗建议，中国医师协会骨科医师分会脊柱创伤工作组组织相关专家撰写了本指南。本指南适用于3周内的成人外伤性胸腰段脊柱骨折和（或）脱位，合并或不合并脊髓、马尾神经、神经根损伤，不包括未成年患者、低能量损伤、无骨折脱位胸腰段脊髓损伤、病理性及合并强直性脊柱炎的骨折脱位。工作组通过设置问题、确定检索词来检索中英文文献，按照纳入和排除标准筛选文献，详细分析最终纳入的证据文献，确定证据等级，给出相应的推荐建议。本指南最终纳入247篇文献，其中中文35篇，英文212篇；设置了20个问题，分为院前急救、诊断与评估、治疗和并发症防治四大部分，共39个推荐条目。.

Treatment of thoracolumbar burst fractures has traditionally involved spinal instrumentation with fusion performed with standard open surgical techniques. Novel surgical strategies, including instrumentation without fusion and percutaneous instrumentation alone, have been considered less invasive and more efficient treatments.
To review the current literature and determine the role of fusion in instrumented fixation, as well as the role of percutaneous instrumentation, in the treatment of patients with thoracolumbar burst fractures.
The task force members identified search terms/parameters and a medical librarian implemented the literature search, consistent with the literature search protocol (see Appendix I), using the National Library of Medicine PubMed database and the Cochrane Library for the period from January 1, 1946 to March 31, 2015.
A total of 906 articles were identified and 38 were selected for full-text review. Of these articles, 12 articles met criteria for inclusion in this systematic review.
There is grade A evidence for the omission of fusion in instrumented fixation for thoracolumbar burst fractures. There is grade B evidence that percutaneous instrumentation is as effective as open instrumentation for thoracolumbar burst fractures.
Does the addition of arthrodesis to instrumented fixation improve outcomes in patients with thoracic and lumbar burst fractures?
It is recommended that in the surgical treatment of patients with thoracolumbar burst fractures, surgeons should understand that the addition of arthrodesis to instrumented stabilization has not been shown to impact clinical or radiological outcomes, and adds to increased blood loss and operative time. Strength of Recommendation: Grade A.
How does the use of minimally invasive techniques (including percutaneous instrumentation) affect outcomes in patients undergoing surgery for thoracic and lumbar fractures compared to conventional open techniques?
Stabilization using both open and percutaneous pedicle screws may be considered in the treatment of thoracolumbar burst fractures as the evidence suggests equivalent clinical outcomes. Strength of Recommendation: Grade B The full version of the guideline can be reviewed at: https://www.cns.org/guideline-chapters/congress-neurological-surgeons-systematic-review-evidence-based-guidelines/chapter_12.

Does the choice of surgical approach (anterior, posterior, or combined anterior-posterior) improve clinical outcomes in patients with thoracic and lumbar fractures?
In the surgical treatment of patients with thoracolumbar burst fractures, physicians may use an anterior, posterior, or a combined approach as the selection of approach does not appear to impact clinical or neurological outcomes. Strength of Recommendation: Grade B With regard to radiologic outcomes in the surgical treatment of patients with thoracolumbar fractures, physicians may utilize an anterior, posterior, or combined approach because there is conflicting evidence in the comparison among approaches. Strength of Recommendation: Grade Insufficient With regard to complications in the surgical treatment of patients with thoracolumbar fractures, physicians may use an anterior, posterior, or combined approach because there is conflicting evidence in the comparison among approaches. Strength of Recommendation: Grade Insufficient The full version of the guideline can be reviewed at: https://www.cns.org/guideline-chapters/congress-neurological-surgeons-systematic-review-evidence-based-guidelines/chapter_11.

Thoracic and lumbar burst fractures in neurologically intact patients are considered to be inherently stable, and responsive to nonsurgical management. There is a lack of consensus regarding the optimal conservative treatment modality. The question remains whether external bracing is necessary vs mobilization without a brace after these injuries.
To determine if the use of external bracing improves outcomes compared to no brace for neurologically intact patients with thoracic or lumbar burst fractures.
A systematic review of the literature was performed using the National Library of Medicine PubMed database and the Cochrane Library for studies relevant to thoracolumbar trauma. Clinical studies specifically comparing external bracing to no brace for neurologically intact patients with thoracic or lumbar burst fractures were selected for review.
Three studies out of 1137 met inclusion criteria for review. One randomized controlled trial (level I) and an additional randomized controlled pilot study (level II) provided evidence that both external bracing and no brace equally improve pain and disability in neurologically intact patients with burst fractures. There was no difference in final clinical and radiographic outcomes between patients treated with an external brace vs no brace. One additional level IV retrospective study demonstrated equivalent clinical outcomes for external bracing vs no brace.
This evidence-based guideline provides a grade B recommendation that management either with or without an external brace is an option given equivalent improvement in outcomes for neurologically intact patients with thoracic and lumbar burst fractures. The decision to use an external brace is at the discretion of the treating physician, as bracing is not associated with increased adverse events compared to no brace.
Does the use of external bracing improve outcomes in the nonoperative treatment of neurologically intact patients with thoracic and lumbar burst fractures?
The decision to use an external brace is at the discretion of the treating physician, as the nonoperative management of neurologically intact patients with thoracic and lumbar burst fractures either with or without an external brace produces equivalent improvement in outcomes. Bracing is not associated with increased adverse events compared to not bracing. Strength of Recommendation: Grade B The full version of the guideline can be reviewed at: https://www.cns.org/guideline-chapters/congress-neurological-surgeons-systematic-review-evidence-based-guidelines/chapter_8.