FUNCTIONAL AND RADIOGRAPHIC OUTCOME OF NON-OPERATIVELY MANAGED THORACOLUMBAR VERTEBRA FRACTURES

Abstract

The purpose of this prospective study was to assess the functional outcome in thoracolumbar vertebra fractures that were treated nonsurgically.

From 1999 to 2005, seventy-four patients with single-level nonpathologic fractures, with angle of kyphosis less than 20° and with no or minor neurological impairment and without neurological deterioration were managed non-operatively. A custom-made thoracolumbosacral orthosis was worn by all patients for six months and early ambulation was recommended. The average follow-up period was 34 months (range, 14 to 59 months). Functional, pain, and employment status were assessed using the Denis system. Radiographic evaluation of vertebral kyphosis, local kyphosis angle, anterior body compression, and sagittal index were performed at time of injury, and final follow-up. Paired t test and Wilcoxon signed rank test were used for statistical analyses.

At final follow-up, 63 patients (86.3%) were rated P1 (no pain), 8 patients (11%) were rated P2 (occasional pain), 2 patients (2.7%) were rated P3 (moderate pain), and 0 patients (0%) were rated P5 (constant severe pain). Sixty-five patients (90%) were able to work at the same level (W1) and the rest was W2 and no W3,4,5. According to radiographic evaluation although all the results showed statistically significant differences, these were too small to be important clinically. The initial local kyphosis angle averaged 14.73° (sd 5.08), and at follow-up it averaged 15.99° (sd 4.98). The initial sagital index averaged 16.1° (sd 5.69), and at follow-up it averaged 16.79° (sd 5.63).

As conclusion nonoperative treatment of selected patients with thoracolumbar vertebral fracture predictably leads to acceptable functional and radiographic results. Conservative management resulted in minimal loss of work potential in these patients and no correlation was found between fracture type and clinical outcome.