Orthosis versus no orthosis for the treatment of thoracolumbar burst fractures without neurologic injury: a multicenter prospective randomized equivalence trial

Bailey, Christopher S.; Urquhart, Jennifer; Dvorak, Marcel F.; Nadeau, Melissa; Boyd, Michael; Thomas, Ken; Kwon, Brian K.; Gurr, Kevin R.; Bailey, Stewart I.; Fisher, Charles G.

doi:10.1016/j.spinee.2013.10.017

Cited by 98 publications

(103 citation statements)

References 25 publications

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“…Controversy remains regarding the evaluation and optimal treatment of many types of spine injuries [1][2][3][4]. In the absence of an outcome instrument specifically designed and validated for spine trauma patients, it is difficult to compare different treatment options, and to develop more rational choices for treatment strategies.…”

Section: Introductionmentioning

confidence: 99%

Universal disease-specific outcome instruments for spine trauma: a global perspective on relevant parameters to evaluate clinical and functional outcomes of thoracic and lumbar spine trauma patients

et al. 2016

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Purpose Besides a patient reported outcome measure, the AOSpine Knowledge Forum Trauma aims to develop a new concept of a surgeon reported outcome measure (SROM) for spine trauma patients. This study aims to identify parameters that spine surgeons consider relevant to evaluate clinical and functional outcomes of thoracic and lumbar spine trauma patients. Methods An international cross-sectional web-based survey was conducted among spine surgeons from the five AOSpine International world regions. They were asked to evaluate the relevance of a compilation of 16 clinical and radiological parameters for thoracic and lumbar spine trauma patients, both for the short term (3 months-2 years) and long term (C2 years), on a five-point scale. The responses were analyzed using descriptive statistics, frequency analysis, and Kruskal-Wallis test.Results Out of the 279 invited members of AOSpine International and the International Spinal Cord Society, 118 (42.3 %) participated in this study. Of the 16 surveyed parameters, 5 were identified as relevant by at least 70 % of the participants. Neurological status was identified as most relevant. In contrast, five parameters were not deemed relevant for any spine region or time period, except for comorbidity. Only minor differences were observed when analyzing the responses according to each world region, spine surgeons' clinical experience, or professional background. Conclusions Including a large and representative sample of spine trauma experts, this study identified parameters to evaluate clinical and functional outcomes of thoracic and lumbar spine trauma patients. The results form the basis for the development of a SROM for this specific patient population.

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Section: Introductionmentioning

confidence: 99%

Universal disease-specific outcome instruments for spine trauma: a global perspective on relevant parameters to evaluate clinical and functional outcomes of thoracic and lumbar spine trauma patients

et al. 2016

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“…3,28,32 However, the braced cohort in the study by Wood et al suffered significantly less disability than the patients treated with bracing in the study by Siebenga et al 43 In addition, return to work as well as VAS scores in the Siebenga et al study were also poorer than those reported for the other studies presented above. Radiographically, Siebenga et al had superior results to those presented by Wood et al when both surgical cohorts in the 2 studies were compared.…”

Section: Controversies In Treatmentmentioning

confidence: 85%

“…Under the Denis classification, this fracture type represents a 2-column injury and therefore can be considered unstable, but there exists a considerable body of literature that supports nonoperative treatment for these fractures. [2][3][4]6,15,18,22,[26][27][28]31,32,34,37,42,43,46 Burst fractures tend to occur at the thoracolumbar junction between T-11 and L-2. This area of the spine represents an interface between a relatively rigid segment of the thoracic spine, which is stabilized by the ribcage, compared with the relatively mobile segment of the lumbar spine.…”

Section: Controversies In Treatmentmentioning

confidence: 99%

“…2,3 This study included patients with AO Type A3 burst fractures with a kyphotic deformity less than 35°, who were neurologically intact, 16 to 60 years of age, and within 3 days of injury. A total of 96 patients were enrolled in the study, with 47 randomized to treatment with TLSO and 46 randomized to treatment with no orthosis.…”

Section: Controversies In Treatmentmentioning

confidence: 99%

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Bracing for thoracolumbar fractures

Chang¹,

Holly

2014

FOC

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Traumatic fractures of the thoracolumbar spine are relatively common occurrences that can be a source of pain and disability. Similarly, osteoporotic vertebral fractures are also frequent events and represent a significant health issue specific to the elderly. Neurologically intact patients with traumatic thoracolumbar fractures can commonly be treated nonoperatively with bracing. Nonoperative treatment is not suitable for patients with neurological deficits or highly unstable fractures. The role of operative versus nonoperative treatment of burst fractures is controversial, with high-quality evidence supporting both options. Osteoporotic vertebral fractures can be managed with bracing or vertebral augmentation in most cases. There is, however, a lack of high-quality evidence comparing operative versus nonoperative fractures in this population. Bracing is a low-risk, cost-effective method to treat certain thoracolumbar fractures and offers efficacy equivalent to that of surgical management in many cases. The evidence for bracing of osteoporotic-type fractures is less clear, and further investigation will be necessary to delineate its optimal role.

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“…Based on this, we can say that the evidence is not clearly presented because of the existence of disparate results in the published literature, except in the long term follow up (20 years) of patients who underwent conservative treatment, where fewer complications were reported. [16][17][18][19][20][21][22] There is another discrepancy in the recovery time results, whereby patients with conservatively managed burst type fractures at a single level of the thoracolumbar spine without neurological deficit have a greater tendency to return to work following adequate recovery as compared to those treated with conventional surgery, excepting those who were managed surgically via minimally invasive techniques, who resume work activities sooner.…”

Section: Discussionmentioning

confidence: 99%

Conservative Treatment for Thoracolumbar Spine Burst Fractures

Raymundo

Eli³

et al. 2017

Coluna/Columna

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Objective: To identify the category of evidence and the strength of recommendation for the conservative treatment of thoracolumbar spine burst fractures. Method: A systematic review was conducted from April 2014 to June 2015, selecting articles according to their prospective design, related to thoracolumbar spine burst fractures and their treatment. These studies were published in the electronic bibliographic databases from January 2009 to January 2015. Results: A total of 9,504 articles were found in a free search, of which 7 met the selection criteria and were included for analysis in a study of a total of 435 patients, of whom 72 underwent surgical treatment and 363 received some type of conservative treatment, showing predominantly level of evidence "1b", with strength of recommendation type "A". Conclusions: According to the evidence obtained, the conservative treatment is a choice for patients with stable burst fracture in a single level of thoracolumbar spine and with no neurological injury.

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Orthosis versus no orthosis for the treatment of thoracolumbar burst fractures without neurologic injury: a multicenter prospective randomized equivalence trial

Cited by 98 publications

References 25 publications

Universal disease-specific outcome instruments for spine trauma: a global perspective on relevant parameters to evaluate clinical and functional outcomes of thoracic and lumbar spine trauma patients

Universal disease-specific outcome instruments for spine trauma: a global perspective on relevant parameters to evaluate clinical and functional outcomes of thoracic and lumbar spine trauma patients

Bracing for thoracolumbar fractures

Conservative Treatment for Thoracolumbar Spine Burst Fractures

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