title: Radiological Prediction of Posttraumatic Kyphosis After Thoracolumbar Fracture.
abstract: OBJECTIVE
  Classification methods that are currently being used for clinical decision making in thoracolumbar fractures, are limited by reproducibility and prognostic value. Additionally, they do not include kyphosis. As a posttraumatic kyphosis is related to persistent pain, it is of importance to determine a risk of posttraumatic kyphosis based on fracture type and patient characteristics.
  
  
  OBJECTIVE
  To determine risk factors (AO classification, age, gender, localization) that may lead to progressive kyphosis after a thoracolumbar fracture.
  
  
  METHODS
  Retrospective radiographic analysis of a consecutive patientcohort that presented in our clinic with a traumatic fracture of the thoracolumbar spine between 2004 and 2011. Cobb angle, Gardner angle, vertebral compression angle and anterior vertebral body compression were measured on plain radiographs, direct post-trauma and at follow-up.
  
  
  RESULTS
  Age and localization are not significantly correlated, but there seems to be an increased risk of progression of kyphosis in age > 50 years and fractures localized at Th12 or L1. A3 type fractures are significantly more at risk for posttraumatic kyphosis compared to A1 and A2 type fractures. 30-50% of the A3 type fractures have an end Gardner angle and end vertebral compression angle of more than 20 degrees.
  
  
  CONCLUSIONS
  AO-type A3 fractures appear to be at risk of progression of kyphosis. Localization at Th12-L1 and age above 50 years seem to be risk factors for significant posttraumatic kyphosis. These findings should be used in patient counseling and a meticulous evaluation by weekly radiographs is recommended to determine the treatment strategy of thoracolumbar fractures.
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Atrium Medical Centre, Heerlen, The Netherlands.
authors.forename: Inez
authors.initials: I
authors.lastname: Curfs
authors.affiliation: AHORSE Research Institute, Atrium Medical Center, Heerlen, The Netherlands.
authors.forename: Bernd
authors.initials: B
authors.lastname: Grimm
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Atrium Medical Centre, Heerlen, The Netherlands.
authors.forename: Matthijs
authors.initials: M
authors.lastname: van der Linde
authors.affiliation: Department of Orthopaedic Surgery, MUMC, Maastricht, The Netherlands.
authors.forename: Paul
authors.initials: P
authors.lastname: Willems
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Atrium Medical Centre, Heerlen, The Netherlands.
authors.forename: Wouter
authors.initials: W
authors.lastname: van Hemert
keywords: Classification; fracture; prognosis; radiological prediction; spine; treatment