Functional and Radiographic Outcome of Thoracolumbar and Lumbar Burst Fractures Managed by Closed Orthopaedic Reduction and Casting

Abstract

Closed reduction and casting of thoracolumbar and lumbar burst fractures is a safe treatment method that yields acceptable functional and radiographic results.

Nonoperative versus Operative Treatment for Thoracolumbar Burst Fractures Without Neurologic Deficit: A Meta-analysis

“…Reid et al [38] reported that much of this progression also appears to occur in the initial period after injury, with relative stabilization of kyphosis within 12 to 18 months. Furthermore, our meta-analysis showed no association between degree of kyphosis and pain and function, which is consistent with findings from other studies [10,12,13,27,34,47,51]. There is limited evidence that pain is more common with a kyphotic angle greater than 30° [22,49], a level of deformity that vastly exceeded the mean kyphosis observed at last followup in operatively and nonoperatively treated patients in our analysis.…”

“…Spinal fractures include compression, burst, flexiondistraction, and fracture-dislocation injuries, with burst fractures accounting for 10% to 20% [22,27,29]. The mechanism of injury is usually a fall from a height or a motor vehicle accident, occurring in 34% to 59% and 25% to 43% of cases, respectively [47,50]. Burst fractures are characterized by failure of the middle and anterior spinal columns secondary to axial compression [20,36].…”

“…Patients with such fractures may be treated with either nonoperative or operative modalities. Nonoperative treatment may include the use of a brace, cast, bed rest, and analgesics [7,11,12,14,34,46,47]. Operative treatment usually involves instrumented intervertebral fusion, with or without spinal decompression.…”

Anterior versus posterior approach for treatment of thoracolumbar burst fractures: a meta-analysis

“…Our review showed that although the anterior approach was associated with better canal remodeling, it was not associated with a greater improvement in Frankel scores or a higher incidence of return to work. This is similar to reports that recovery of neurological function did not depend on the extent of spinal decompression and canal encroachment [37,38]. Among the seven included studies, only Wood et al [26] reported pain scores on a 10-point visual analog pain scale; the results showed that there was no significant difference in pain reduction between the two groups.…”

“…The relationship between the extent of canal encroachment and neurological function has been studied; although concerns have been raised regarding inadequate spinal canal remodeling after treatment via the posterior approach, there is no evident association between the percentage of canal encroachment and clinical symptoms [36,37]. Generally, the most important purpose of the surgical management of thoracolumbar fractures is to minimize the change in the patients' lives.…”