Early mobilisation of thoracolumbar burst fractures without neurology

Jaffray, David; Eisenstein, S. M.; Balain, Birender; Trivedi, Jayesh; Ede, Matthew Newton

doi:10.1302/0301-620x.98b1.36121

Cited by 17 publications

(15 citation statements)

References 23 publications

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“…The longer-term follow-up results at one center from an original multicenter trial showed that, as compared with patients treated with a TLSO, those patients treated using early mobilization without orthosis maintain similar pain relief and functional improvement through 5-10 years after sustaining a stable AO Type A3 thoracolumbar burst fracture without neurological injury. Although many studies have shown that nonsurgical treatments such as body casting or bracing are safe and effective, 5,11,19,20 the present study is the first to report on the long-term outcomes in treating these fractures without any external orthosis.…”

Section: Discussionmentioning

confidence: 77%

“…The favorable clinical outcomes reported here are in agreement with those in previous studies of conservative treatment. 9,11,25 In a randomized clinical trial by Wood et al, 25 patients treated nonoperatively with a cast or brace were compared with those treated surgically at 4 and 20 years' follow-up. At 4 years after injury, the nonsurgically treated patients had residual disability (median RMDQ Score 2, range 0-24) and pain (median visual analog scale score 1.5 cm, range 0-9 cm) similar to that in our patients but a slight improvement in function according to the RMDQ score between the 4-and 20-year time points (median RMDQ Score 1, range 0-9).…”

Section: Discussionmentioning

confidence: 99%

“…1,2,9,21,25 Nonoperative treatment has evolved from long-term bed rest in the hospital to early mobilization in an adjustable thoracolumbosacral orthosis (TLSO). 5,6,11,13,15,16,19,20,22,24 The inherent stability of the fracture and the limitations associated with the use of a brace, including accessibility, cost, resource utilization, and patient deconditioning, lead to the question of whether a brace is even necessary. 4 In a recent multicenter prospective randomized trial, we compared the treatment of AO Type A3 burst fractures between T10 and L-3 with kyphotic deformity less than 35° either with or without a TLSO.…”

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confidence: 99%

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Treatment of thoracolumbar burst fractures: extended follow-up of a randomized clinical trial comparing orthosis versus no orthosis

Urquhart

Alrehaili

Fisher

et al. 2017

Journal of Neurosurgery: Spine

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OBJECTIVEA multicenter, prospective, randomized equivalence trial comparing a thoracolumbosacral orthosis (TLSO) to no orthosis (NO) in the treatment of acute AO Type A3 thoracolumbar burst fractures was recently conducted and demonstrated that the two treatments following an otherwise similar management protocol are equivalent at 3 months postinjury. The purpose of the present study was to determine whether there was a difference in long-term clinical and radiographic outcomes between the patients treated with and those treated without a TLSO. Here, the authors present the 5- to 10-year outcomes (mean follow-up 7.9 ± 1.1 years) of the patients at a single site from the original multicenter trial.METHODSBetween July 2002 and January 2009, a total of 96 subjects were enrolled in the primary trial and randomized to two groups: TLSO or NO. Subjects were enrolled if they had an AO Type A3 burst fracture between T-10 and L-3 within the previous 72 hours, kyphotic deformity < 35°, no neurological deficit, and an age of 16–60 years old. The present study represents a subset of those patients: 16 in the TLSO group and 20 in the NO group. The primary outcome measure was the Roland Morris Disability Questionnaire (RMDQ) score at the last 5- to 10-year follow-up. Secondary outcome measures included kyphosis, satisfaction, the Numeric Rating Scale for back pain, and the 12-Item Short-Form Health Survey (SF-12) Mental and Physical Component Summary (MCS and PCS) scores. In the original study, outcome measures were administered at admission and 2 and 6 weeks, 3 and 6 months, and 1 and 2 years after injury; in the present extended follow-up study, the outcome measures were administered 5–10 years postinjury. Treatment comparison between patients in the TLSO group and those in the NO group was performed at the latest available follow-up, and the time-weighted average treatment effect was determined using a mixed-effects model of longitudinal regression for repeated measures averaged over all time periods. Missing data were assumed to be missing at random and were replaced with a set of plausible values derived using a multiple imputation procedure.RESULTSThe RMDQ score at 5–10 years postinjury was 3.6 ± 0.9 (mean ± SE) for the TLSO group and 4.8 ± 1.5 for the NO group (p = 0.486, 95% CI −2.3 to 4.8). Average kyphosis was 18.3° ± 2.2° for the TLSO group and 18.6° ± 3.8° for the NO group (p = 0.934, 95% CI −7.8 to 8.5). No differences were found between the NO and TLSO groups with time-weighted average treatment effects for RMDQ 1.9 (95% CI −1.5 to 5.2), for PCS −2.5 (95% CI −7.9 to 3.0), for MCS −1.2 (95% CI −6.7 to 4.2) and for average pain 0.9 (95% CI −0.5 to 2.2).CONCLUSIONSCompared with patients treated with a TLSO, patients treated using early mobilization without orthosis maintain similar pain relief and improvement in function for 5–10 years.

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Treatment of thoracolumbar burst fractures: extended follow-up of a randomized clinical trial comparing orthosis versus no orthosis

Urquhart

Alrehaili

Fisher

et al. 2017

Journal of Neurosurgery: Spine

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“…This was a good attempt at trying to fill a gap in the knowledge about appropriate management of spinal injuries. Interestingly, about a quarter of patients described in Jaffray et al's paper 11 had TLICS scores that would suggest surgical treatment, although conservative management did well for these patients. This suggests that the literature is moving in the right direction, but more work needs to be done to improve decision making at grass root levels.…”

mentioning

confidence: 98%

“…Wood et al published their results of non-operative treatment of burst fractures 9 and recently updated these results, 10 which are favourable for non-operative management in the long term. Jaffray et al 11 also published on the natural history of burst fractures without neurological deficit. Vaccaro et al 12 proposed the TLICS classification in an attempt to help surgeons decide when to operate and when to treat these injuries conservatively.…”

mentioning

confidence: 99%