***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: INTRODUCTION Vertebroplasty and balloon kyphoplasty have shown to improve pain and functional outcome in cases with symptomatic vertebral fractures . Although restoration of the vertebral body height and kyphosis seemed to be easier with balloon kyphoplasty , it became clear that some of the correction achieved by the balloon is lost once it was deflated . Vertebral body stent was developed to eliminate this phenomenon . To our knowledge this is the first study in describing this technique in clinical setting s. MATERIAL S AND METHODS Seventeen patients with 20 fractured vertebral bodies were included . All fractures were Type A1.3 or A3.1 ( incomplete burst ) .  Information about pain ( visual analogue scale-VAS ) and function ( Oswestry disability index-ODI ) and vertebral body deformity ( vertebral angle-VA ) was recorded in a prospect i ve way at regular intervals . Patients were classified into osteoporotic group ( 7 patients ) and traumatic groups ( 10 patients , younger than 60 years ) . RESULTS There were 6 male and 11 female patients with mean age of 58.1 years ( 31 - 88 years ) . Mean follow up was 12 months . The preoperative pain level showed a mean VAS score of 8.9 in osteoporotic group and 9.7 in traumatic group . Postoperatively , in osteoporotic group , mean VAS was 4.8 at 6 weeks , 4.0 at 6 months and 2.5 at 12 months compared with traumatic fracture group where it was 2.7 at 6 weeks , 2.2 at 6 months and 1.6 at 12 months . Mean ODI in osteoporotic group was 41.7 % ( 14 - 58 % ) and in traumatic group it was 20.4 % ( 6 - 33 % ) . Mean vertebral body angle prior to surgery in osteoporotic group was 9.7 whilst postoperatively it was 5.2 ° ; so the mean correction achieved was 4.5 ° . In traumatic group preoperative VA was 13 ° whilst postoperatively it was 5.7 ° ; therefore the mean correction achieved was 7.3 ° . None of the patients lost reduction at their last follow up . CONCLUSION Vertebral body stenting leads to satisfactory improvement in pain , function and kyphosis correction in the treatment of osteoporotic and traumatic fractures . Anterior spinal column , especially the fragmented superior endplate is nicely reconstructed by the stent provided it is inserted accurately . With addition of posterior transpedicular instrumentation , indications for this technique may be wider covering some Type B and C fractures with similar vertebral body damage PURPOSE The role of clinical examination in the diagnosis of thoracolumbar ( TL ) spine injuries is highly controversial . The aim of this study was to assess the sensitivity and specificity of a st and ardized clinical examination for diagnosing TL spine injuries after blunt trauma . METHODS This was a prospect i ve observational study conducted at a level I trauma center from March 2008 to September 2008 . After Institutional Review Board approval , all evaluable blunt trauma patients older than 15 years were evaluated by a senior resident or attending surgeon for TL spine deformity , tenderness to palpation , and neurologic deficits . Patients were followed through their hospital course to capture all TL spine injury diagnoses , all imaging performed , and any immobilization or stabilization procedures . RESULTS Of the 884 patients enrolled , 81 ( 9 % ) had a TL spine injury . More than half ( 55.6 % ) had two or more fractures with 30.9 % having three or more . Isolated L-spine fractures occurred in 56.8 % , T-spine fractures occurred in 34.6 % only , and combination injuries sustained in 8.6 % . The most commonly identified fractures were of the transverse process ( 67.9 % ) followed by the vertebral body ( 30.9 % ) and spinous process ( 12.3 % ) . Among the 666 patients who were evaluable , 56 ( 8 % ) had a TL spine fracture . Of these , 29 ( 52 % ) had a negative clinical examination , of which 2 ( 7 % ) had clinical ly significant compression fractures . For evaluable patients who had localized pain or tenderness elicited on examination , although the finding triggered imaging appropriately , the site of pain correlated to the site of actual injury in only 61.5 % of cases . The sensitivity and specificity of clinical examination  for TL spine fractures were 48.2 % and 84.9 % , respectively , for all fractures and 78.6 % and 83.4 % for those that were clinical ly significant . CONCLUSION Clinical examination as a st and -alone screening tool for evaluation of the TL spine is inadequate . In this series , all the clinical ly significant missed fractures were diagnosed on computed tomography ( CT ) obtained for evaluation of the visceral torso . A combination of both clinical examination and CT screening based on mechanism will likely be required to ensure adequate sensitivity with an acceptable specificity for the diagnosis of clinical ly significant injuries of the TL spine . Further research is warranted , targeting the at-risk patient with a negative clinical examination , to determine what injury mechanisms warrant evaluation with a screening CT Objectives : To evaluate and compare nonoperative treatment methods for traumatic thoracic and lumbar compression fractures and burst fractures . Design : Prospect i ve r and omized controlled trial with long-term follow-up . Setting : Two general hospitals in the Netherl and s. Patients / Participants : Patients with a traumatic thoracic or lumbar spine fracture , without neurologic damage , with less than 50 % loss of height of the anterior column and less than 30 % reduction of the spinal canal were included . Intervention : Patients in the compression group were r and omized to physical therapy and postural instructions , a brace for 6 weeks , or a Plaster of Paris cast for 6 or 12 weeks . Patients in the burst group received a brace or a Plaster of Paris cast , both for 12 weeks . Main Outcome Measurements : Follow-up examinations included radiographs , Visual Analogue Scores for toleration of treatment and persistent pain , and an Oswestry Disability Index at long-term follow-up . Results : There were 133 patients : 108 in the compression group and 25 in the burst group . For compression fractures , physical therapy and brace were considered the most tolerable . Brace therapy scored significantly better on the Visual Analogue Scores for residual pain and on the Oswestry Disability Index . None of the treatments had any significant effect on the residual deformity measurements . For burst fractures , no significant differences were found . Conclusions : Brace treatment with supplementary physical therapy is the treatment of choice for patients with compression fractures of the thoracic and lumbar spine . Furthermore , more than 20 % of all patients had moderate or severe back pain at long-term follow-up OBJECT The load-sharing score ( LSS ) of vertebral body comminution is predictive of results after short-segment posterior instrumentation of thoracolumbar burst fractures . Some authors have posited that an LSS > 6 is predictive of neurological injury , ligamentous injury , and the need for surgical intervention . However , the authors of the present study hypothesized that the LSS does not predict ligamentous or neurological injury . METHODS The prospect ively collected spinal cord injury data base from a single institution was queried for thoracolumbar burst fractures .  Study inclusion criteria were acute ( < 24 hours ) burst fractures between T-10 and L-2 with preoperative CT and MRI . Flexion-distraction injuries and pathological fractures were excluded . Four experienced spine surgeons determined the LSS and posterior ligamentous complex ( PLC ) integrity . Neurological status was assessed from a review of the medical records . RESULTS Forty-four patients were included in the study . There were 4 patients for whom all observers assigned an LSS > 6 , recommending operative treatment . Eleven patients had LSSs ≤ 6 across all observers , suggesting that nonoperative treatment would be appropriate . There was moderate interobserver agreement ( 0.43 ) for the overall LSS and fair agreement ( 0.24 ) for an LSS > 6 . Correlations between the LSS and the PLC score averaged 0.18 across all observers ( range -0.02 to 0.34 , p value range 0.02 - 0.89 ) . Correlations between the LSS and the American Spinal Injury Association motor score averaged -0.12 across all observers ( range -0.25 to -0.03 , p value range 0.1 - 0.87 ) . Correlations describing the relationship between an LSS > 6 and the treating physician 's decision to operate averaged 0.17 across all observers ( range 0.11 - 0.24 , p value range 0.12 - 0.47 ) . CONCLUSIONS The LSS does not uniformly correlate with the PLC injury , neurological status , or empirical clinical decision making . The LSSs of only one observer correlated significantly with PLC injury . There were no significant correlations between the LSS as determined by any observer and neurological status or clinical decision making Background : Use of a pedicle screw at the level of fracture , also known as an intermediate screw , has been shown to improve clinical results in managing lumbar fracture , but there is a paucity of biomechanical studies to support the cl aim . The aim of this study was to evaluate the effect of adding intermediate pedicle screws at the level of a fracture on the stiffness of a short-segment pedicle fixation using monoaxial or polyaxial screws and to compare the strength of monoaxial and polyaxial screws in the calf spine fracture model . Material s and Methods : Flexibility of 12 fresh-frozen calf lumbar spine specimens was evaluated in all planes . An unstable burst fracture model was created at the level of L3 by the pre-injury and dropped-mass technique . The specimens were r and omly divided into monoaxial pedicle screw ( MPS ) and polyaxial pedicle screw ( PPS ) groups . Flexibility was retested without and with intermediate screws ( MPSi and PPSi ) placed at the level of fracture in addition to st and ard screws placed at L2 and L4 . Results : The addition of intermediate screws significantly increased the stability of the constructs , as measured by a decreased range of motion ( ROM ) in flexion , extension , and lateral bending in both MPS and PPS groups ( P < 0.05 ) . There was neither any significant difference in the ROM in the spines of the two groups before injury , nor a difference in the ROM between the MPSi and PPSi groups ( P > 0.05 ) , but there was a significant difference between MPS and PPS in flexion and extension in the short-segment fixation group ( P < 0.05 ) . Conclusions : The addition of intermediate screws at the level of a burst fracture significantly increased the stability of short-segment pedicle screw fixation in both the MPS and PPS groups . However , in short-segment fixation group , monoaxial pedicle screw exhibited more stability in flexion and extension than the polyaxial pedicle screw Purpose If surgery for thoracolumbar incomplete cranial burst fractures ( Magerl A3.1.1 ) is necessary , the ideal stabilization strategy still remains undetermined . To justify posterior – anterior stabilization , which generates higher costs and potentially higher morbidity vs. posterior-only stabilization , clinical trials with sufficient power and adequate methodology are required . This prospect i ve r and omized single-centre pilot trial was design ed to enable sufficient sample -size calculation for a r and omized multicentre clinical trial ( RASPUTHINE ) . Methods Patients with a traumatic thoracolumbar ( Th11–L2 ) incomplete burst fracture ( Magerl A3.1.1 ) were r and omly assigned either to the interventional group ( posterior – anterior ) or to the control group ( posterior-only ) . Primary endpoint of the study was the clinical outcome measured using the Oswestry Disability Index ( ODI ) at 24 months . Radiological outcome was assessed as secondary endpoint by evaluation of mono- and bisegmental kyphotic angulation and monosegmental fusion . Results 21 patients were r and omly assigned to interventional group ( n = 9 ) or control group ( n = 12 ) . One posterior-only treated patient showed a severe initial loss of correction result ing in a crossover to additional anterior bisegmental fusion . The ODI measures at the primary study endpoint showed less but insignificant ( p = 0.67 ) disability for the interventional group over the control group ( 13.3 vs. 19.3 % ) . Comparison of preoperative bisegmental kyphosis in supine position with the bisegmental kyphosis at 24-month FU in upright position showed a worsened kyphosis for the control group ( 10.7 ° → 15.6 ° ) , whereas an improved kyphosis ( 11 ° → 8.3 ° ) was detectable for the interventional group . Conclusion The results of this pilot RCT showed less disability for the posterior – anterior group linked with a significant better restoration of the sagittal profile in comparison with the posterior-only group . To detect a clinical ly significant difference using the ODI and assuming a 20 % loss of FU rate , a total of 266 patients have to be studied in the multicentre trial INTRODUCTION Surgical management of thoracolumbar trauma involves correction of posttraumatic deformity and placement of transpedicular instrumentation . The 
    Output:
    
Results : As regards existing studies with highest level of evidence , a clear recommendation regarding treatment ( operative vs conservative ) or regarding type of surgery ( posterior vs anterior vs combined anterior-posterior ) can not be given .