Functional and radiological outcomes of thoracolumbar traumatic spine fractures managed conservatively according to Thoracolumbar Injury Severity Score

Abstract

Aim:To study the functional and radiological outcomes in cases managed conservatively for single-level traumatic thoracolumbar spine fractures without neurological deficit.Materials and Methods:In this prospective study design, thirty patients who presented to tertiary care hospital and diagnosed with posttraumatic thoracolumbar vertebral fracture without any neurodeficit were recruited. All the patients were managed conservatively as per the protocol which included bed rest, spinal braces, and physiotherapy. Adequate analgesia was given wherever necessary. The patients were followed at regular intervals up to a maximum of 2 years. Clinically visual analog scale (VAS) score and Roland Morris Disability Questionnaire (RMDQ)-24 were assessed and radiologically local vertebral kyphosis, scoliosis, and loss of body height were noted at each follow-up.Results:The data was statistically analyzed and the results were as follows. Thoracolumbar fractures were more in young adults (<26 years) and more so among the males (80% cases). The most common fracture type in our study was compression fracture. The most common site involved in our study was L1 vertebra (36.7%). There was a significant decrease of VAS score (pain score) in 79% cases with the maximum decrease in type A1 fracture. The mean RMDQ-4 score in our study was 5.53. The overall progression of kyphosis was 1.9°. There was no relation found between the kyphotic deformity and the clinical outcomes (VAS and RMDQ-24 scores). Canal size changes were found to be insignificant at the end of 2 years compared to baseline.Conclusion:Study showed favorable outcomes in terms of return to daily activities, making it a good option in managing Type A1 dorsolumbar fractures. Though there was a progression of kyphosis but no neurological deficit was seen.

Is cast an option in the treatment of thoracolumbar vertebral fractures?

“…and Bagga et al . [728] ODI, SF-36, and RMQ are similar to those reported in literature. [72728] Comparing our results with the current literature, we can appreciate that CRC has no inferior performances in clinical results than other conservative treatment protocols, but it is important to underline a better control of deformity in medium-long FU.…”

“…A lot of treatments were proposed for thoracolumbar fractures[567812181920] and the best treatment must be chosen taking in consideration: AO fractures classification, fracture dislocation, neurological status, patients' comorbidities, and compliance. There are several authors supporting conservative treatment with reduction, as well as those reporting excellent results with fracture reduction and stabilization.…”

“…Both surgical and conservative treatments are described in literature with good results. [567] Conservative treatments comprehend bed rest, physiotherapy, spinal braces, and closed reduction associated to casting (CRC); however, in literature, there is no evidence about a better conservative treatment. [8]…”

Natural changes of traumatic vertebral compression fractures during the first 6 months in patients visiting for disability certificates

“…This change corresponds to 18.1 ± 10.4% of the initial height and was smaller than that of osteoporotic VCFs, which decreases by 21.8 ± 14.4% at 6 months. [ 5 ] Traumatic VCFs were reported to show 19.8 ± 7.4% height loss after 2 years, [ 8 ] and therefore about 90% of this height loss was assumed to be obtained during the first six months.…”

“…[ 5 – 7 ] Traumatic VCFs also showed the progression of vertebral collapse in studies involving long-time follow-up. [ 4 , 8 ] Six months after the onset is the minimum duration required before a disability certificate can be issued in several countries; [ 9 – 11 ] it is also the criterion for distinguishing short-term and long-term disability. [ 12 – 14 ] However, it was not reported that changes of traumatic VCFs in the first 6 months were significant enough to justify the waiting of six months for a disability certificate.…”