DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20170906

Retrospective analysis of conservatively treated thoracolumbar burst fracture

T. K. Sangameswaran, T. Elango, G. Kesavaperumal, E. DineshKarthik

Abstract


Background: Thoracolumbar burst fractures accounts for 10 to 40 percent of the spinal column fractures caries a significant morbidity and mortality. Vertebral fractures are usually followed by chronic pain, deformity, loss of height and crowding of internal organs. A combination of the above problems can adversely affect the self-esteem and ability to carry on the daily activities.The objective of the study was to find proportion of the conservatively treated thoracolumbar burst fracture and the factors associated with the final outcome of the treatment with the clinical, radiological evidences.

Methods: In this study 36 patients with burst fracture of thoracolumbar spine without neurological deficit, treated conservatively from January 2015–August 2016 were included. The overall follow up period was 18 months. Various radiological parameters were taken in to consideration like Cobb angle, canal stenosis, sagittal alignment, and fragment displacement. Treatment outcome was evaluated by short form survey questionnaire (SF-36), Denis score for pain and work and the visual analogue scale (VAS).

Results: The overall functional outcome in this study group 30.55% returned to the previous employment. 25% back to their previous job with restrictions.27.7% unable to return to the previous job but works fulltime in a new job. 16.7% unable to return to full time work. No one is completely disabled. The Cobb angle remains same or decreased in 53% and in 47% with minimum -8 maximum 5. The severe pain score was in 5.6% of cases.

Conclusions: Proper selection of patients and their prior activities, social and educational background and future plans in addition to a thorough physical, neurological and spinal examination are mandatory to achieve satisfactory result.


Keywords


Thoracolumbar fracture, Conservative treatment, Residual deformity, Patient’s sufferings, Treatment outcome

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References


Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine. 1983;8(8):817–31.

Kraemer WJ, Schemitsch EH, Lever J, McBroom RJ, McKee MD, Waddell JP. Functional outcome of thoracolumbar burst fractures without neurological deficit. J Orthop Trauma. 1996;10(8):541–4.

Thomas KC, Bailey CS, Dvorak MF, Kwon B, Fisher C. Comparison of operative and nonoperative treatment for thoracolumbar burst fractures in patients without neurological deficit: a systematic review. J Neurosurg Spine. 2006;4(5):351–8.

Denis F. The three column spine and its significance in the classification of acute Thoraco-lumbar spinal injuries. Spine. 1983;8(8)817-31.

Watson Jones R. Manipulative reduction of crush fractures of the spine. Br Med J. 1931;1(3659):300–2.

Nicoll EA. Fractures of the dorso-lumbar spine. J Bone Joint Surg Am. 1949;31(3):376–94.

Monhanty S, Bhat N, AbrahamR, Keerthi CI. Neurological deficit and canal compromise in Thoracolumbar and lumbar burst fractures. J Othrop Surg. 2008;16(1)20-3.

Fontijine WP, de Klerk LW, Braakman R, Stijnen T, Tanghe HL, SteenbeekR, et al. CT scan prediction of neurological defedi in Thoracolumbar burst fractures. J Bone Joint Surg Br. 1992;74(5):683-5.

Tezer M, Erturer RE, Ozturk C, Ozturk I, Kuzgun U. Conservative treatment of fractures of the thoracolumbar spine. Int Orthop. 2005;29(2):78–82.

Tropiano P, Huang RC, Louis CA, Poitout DG, Louis RP. Functional and radiographic outcome of thoracolumbar and lumbar burst fractures managed by closed orthopaedic reduction and casting. Spine. 2003;28(21):2459–65.

Weinstein JN, Collalto P, Lehmann TR. Thoraco-lumbar burst fractures treated conservatively: A long term followup. Spine. 1988;13:33-8.

Cantor JB, Lebwohl NH, Garvey T, Eismont FJ. Nonoperative management of stable thoracolumbar burst fractures with early ambulation and bracing. Spine. 1993;18:971-6.

Weitzman G. Treatment of stable thoracolumbar spine compression fractures by early ambulation. Clin Orthop. 1971;76:116-22.