Functional Outcome of Thoracolumbar Burst Fractures Managed With Hyperextension Casting or Bracing and Early Mobilization

Abstract

Nonoperative management of thoracolumbar burst fractures with hyperextension casting or bracing was proven to be a safe and effective method of treatment in selected patients. Clinical results were favorable; no neurologic deterioration was observed; hospitalization times were minimized, and patient satisfaction was high. The authors do not believe that ligamentous injury of the posterior column is a contraindication to nonoperative management of thoracolumbar burst fractures.

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

“…Conservative treatment of stable vertebral fractures has been successfully proposed by many authors [7][8][9][10][11], with bed rest followed by external orthoses, extension gymnastic, plaster jacket in bed or stand reduction [12]. These treatments should be continued for a period of at least 3-4 months during which patient care and cooperation are essential.…”

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

“…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.…”

“…Most studies have been observational, and although several relevant trials have been published, sample sizes have been small, ranging from 10 to 80 patients [1-5, 9-14, 27, 34, 41, 42, 44, 49]. Proponents of nonoperative management argue that avoiding surgery decreases associated costs and surgical complications including infection, hardware-related complications, and iatrogenic injury [11,12,14,34,38,44]. Indications for operative treatment may include neurologic deficit, unstable fracture, severe kyphosis greater than 35°, canal compromise greater than 50%, or posterior ligamentous complex injury [18,38].…”

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

“…Esses instrumentos são validados para uso em nosso meio e de grande valor para análise do resultado do tratamento centrado no paciente, e não apenas com base em critérios radiográ-ficos. De forma similar aos nossos achados, houve falta de correlação evidente entre a cifose e sintomatologia ou função na coluna após o tratamento conservador nas séries de casos levantadas (16,22,23) . Para comparar com nossos achados de 86,1% de retorno às atividades laborativas, Mumford et al (23) , em seu estudo prospectivo de 41 pacientes tratados de modo conservador, acompanhados por dois anos em média, verificaram que 90,3% deles retornaram ao seu trabalho.…”