Conservative treatment of fractures of the thoracolumbar spine

Abstract

We reviewed 48 patients with thoracolumbar fractures treated conservatively between 1988 and 1999. The average follow-up was 77.5 (31-137) months and average patient age (23 women, 25 men) was 46 (18-76) years. Twenty-nine patients suffered a fall from a height and 13 patients were injured in traffic accidents. Thirty-two patients had compression-type fractures and 16 bursttype fractures. There were no neurological deficits. Twentynine patients were treated by orthosis, 13 by body cast and six by bed rest. In addition to pain and functional scoring, we measured a number of radiographic parameters at the time of admission and at latest follow-up and compared the values. In patients with compression fractures there were significant changes in scoliosis angle and wedging index (p<0.05). The mean pain score was 1.66 and mean functional score 1.03. In patients with burst fractures, vertebral index, wedging index and height loss increased after treatment (p<0.05). The mean pain score was 1.26 and functional score 0.93. Compression fractures with kyphosis angle <30°are supposed to be stable and can be treated conservatively. If the kyphosis angle is more than 30°, magnetic resonance imaging (MRI) should be performed, and if the posterior ligamentous complex is damaged, surgery should be considered. In burst fractures, MRI should always be performed and conservative treatment should only be considered if there is no neurological deficit and the ligaments are intact.

Complications in minimally invasive percutaneous fixation of thoracic and lumbar spine fractures and tumors

“…In the literature, the complication rates of nonoperative treatment for vertebral fracture vary from 6.7 to 23.6 % [10,[14][15][16][17]. Some authors compared posterior instrumented arthrodesis with conservative management: surgical treatment showed better results in the short term, but results comparable to conservative treatment in the long term, despite the greater number of complications related to the surgical procedure [10].…”

Fratura toracolombar do tipo explosão: correlação entre a cifose residual e função após o tratamento cirúrgico

“…However, the surgical method is generally proposed for patients whose fractures have led to loss of 50% of the height of the vertebral body and kyphosis greater than 30°, because of inadequate functional results. The authors who have advocated this type of treatment have used shorter hospital stay and early mobility as arguments in its favor (11,13,17,18) .…”

“…However, for thoracolumbar burst fractures without signs of instability and with normal neurological examinations, there are divergences regarding the treatment method. Authors who advocate a surgical procedure affirm that this provides better correction of kyphosis, thereby diminishing pain and future degenerative alterations; prevents neurological deterioration and recurrence of the deformity; and reduces the duration of immobilization, resting and hospital stay (10)(11)(12)(13) .…”

Fratura toracolombar do tipo explosão: correlação entre cifose e função após tratamento conservador

“…As fraturas instáveis com cifose > 30°, perda de altura > 50%, compressão do canal vertebral > 50%, lesão do complexo ligamentar posterior e associadas a déficit neurológico em geral apresentam indicação de tratamento cirúrgico pela maioria dos autores (8)(9)(10)(11)(12)(13)(14)(15)(16)(17) . Entretanto, nas fraturas toracolombares do tipo explosão sem sinais de instabilidade e com exame neurológico normal.…”