Abstract
Between 1986 and 1992, 32 thoracolumbar fractures in 32 patients were treated non-operatively with 4-6 weeks on a rotorest bed followed by bracing with a thoracolumbo-sacral orthosis for a total of 3-6 months. The fractures were classified as 20 burst, six fracture dislocations, five severe compression fractures, and one gunshot wound. There were 12 multilevel fractures. Nine patients had incomplete neurological injuries and three had complete neurological injuries. The average age was 36.8 years (range 17-63) and the average follow-up was 22.3 months (range 12-60). Fifty three percent (17/32) of these had multisystem injuries including visceral trauma and long extremity fractures. There were only two complications; a deep vein thrombosis and a heel ulcer. Neither of these complications extended the patients' hospital stay. All nine of those with incomplete neurological injuries improved at least one Frankel grade. Fifteen of 24 patients who were employed returned to their previous jobs, and only nine patients had persistent back pain requiring medication. Surgical treatment of thoracolumbar fractures is often favored over conservative treatment in the multitrauma and neurologically injured patient because of complications related to bedrest. However, by using a rotorest bed and aggressive physical therapy, conservative treatment may actually result in lower morbidity.
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References
Bedbrook G . Treatment of thoracolumbar dislocation and fractures with paraplegia. Clin Orthop 1975; 112: 27.
Bednar D A . Experience with the ‘fixateur interne’: initial clinical results. J Spinal Disord 1992; 5: 93.
Benson D R et al. Unstable thoracolumbar and lumbar burst fractures treated with the AO fixateur interne. J Spinal Disord 1992; 5: 335–343.
Cantor J B, Lebwohl N H, Garvey T, Eismont F J . Nonoperative management of stable thoracolumbar burst fractures with early ambulation and bracing. Spine 1993; 18: 971.
Carl A L, Tromanhauser S G, Roger D J . Pedicle screw instrumentation for thoracolumbar burst fractures and fracture-dislocations. Spine 1992; 17: 317.
Chan D, Ngian K S, Kaan K T . Nonoperative treatment in burst fractures of the lumbar spine (L2-L5) without neurologic deficits. Spine 1992; 17: 317.
Davies W E, Morris J H, Hill V . An analysis of conservative (nonsurgical) management of thoracolumbar fracture and fracture dislocation with neural damage. J Bone Joint Surg Am 1980; 62: 7324.
Dickson J H, Harrington P R, Erwin W D . Results of reduction and stabilization of the severely fractured thoracic and lumbar spine. J Bone Joint Surg Am 1978; 60: 799.
Esses S I, Botsford D J, Kostuik J P . Evaluation of surgical treatment for burst fractures. Spine 1990; 15: 667.
Gaines R W, Humphreys W G . A plea for judgement in management of thoracolumbar fractures and fracture-dislocations. Clin Orthop 1984; 189.
Jacobs R R, Asher M A, Snider R K . Thoracolumbar spinal injuries: A comparative study of recumbent and operative treatment in 100 patients. Spine 1980; 5: 463.
Lemons V B R, Wagner F C, Montesano P X . Management of thoracolumbar fractures with accompanying neurological injury. Neurosurgery 1992; 30: 667.
Lewis J, McKibbin B . The treatment of unstable fracture-dislocation of the thoracolumbar spine accompanied by paraplegia. J Bone Joint Surg Br 1974; 56: 603.
McEvoy R D, Bradford D S . The management of burst fractures of the thoracic and lumbar spine. Spine 1985; 10: 631.
Bohlman H H . Late progressive paralysis and pain following fracture of the thoracolumbar spine. J Bone Joint Surg Am 1976; 58: 728.
Burke D C, Murray D D . The management of thoracic and thoracolumbar injuries of the spine with neurologic involvement. J Bone Joint Surg Br 1976; 58: 72.
Clohisy J C et al. Neurologic recovery associated with anterior decompression of spine fractures at the thoracolumbar junction (T12-L1). Spine 1992; 17: 325.
Denis F, Armstrong G W D, Searls K, Matta L . Acute thoracolumbar burst fractures in the absence of neurologic deficit: A comparison between operative and nonoperative treatment. Clin Orthop 1984; 189.
Denis F, Armstrong W D . Burst fractures in the lumbar spine. Orthop Trans 1981; 5: 417.
Kaneda K, Abumi K, Fujiya M . Burst fractures with neurologic deficits of the thoracolumbar lumbar spine. Spine 1984; 9: 788.
Lindahl S, Willen J, Irstam L . Unstable thoracolumbar fracture. A comparative radiologic study of conservative treatment and Harrington instrumentation. Acta Radiol Diagn 1984; 26: 67.
McNamara M J, Stephens G C, Spengler D M . Transpedicular short-segment fusions for treatment of lumbar burst fractures. J Spinal Disord 1992; 5: 183.
Maiman D J, Larson S J, Benzel E C . Neurologic improvement associated with late decompression of the thoracolumbar spine. Neurosurgery 1984; 14: 302.
McAfee P C, Bohlman H H, Yuan H A . Anterior decompression of traumatic thoracolumbar fractures with incomplete neurological deficit using tetroperitoneal approach. J Bone Joint Surg Am 1985: 67: 89.
Krompinger W J, Fredrickson B E, Mino D E, Huan H A . Conservative treatment of fractures of the thoracic and lumbar spine. Orthop Clin N Am 1986; 17: 161.
Mumford J, Weinstein J N, Spratt K F, Goel G K . Thoracolumbar burst fractures: The clinical efficacy and outcome of non-operative management. Spine 1993; 18: 955.
Weinstein J N, Collalto P, Lehmann T R . Thoracolumbar burst fractures treated conservatively: A long-term follow-up. Spine 1988; 13: 33.
Denis F . The three-column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine 1983; 8: 817.
McAffee P C, Yuan M A, Lasda N A . The unstable burst fracture. Spine 1982; 7: 365.
Frankel H L et al. The value of postural reduction in initial management of closed injuries of the spine with paraplegia and tetraplegia. Paraplegia 1969; 7: 179.
Malcolm B W, Bradford D S, Winter R A, Chou S N . Posttraumatic kyphosis. J Bone Joint Surg Am 1981; 63: 891.
Whitesides T E . Traumatic kyphosis of the thoracolumbar spine. Clin Orthop 1977; 128: 78.
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Hartman, M., Chrin, A. & Rechtine, G. Non-operative treatment of thoracolumbar fractures. Spinal Cord 33, 73–76 (1995). https://doi.org/10.1038/sc.1995.18
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DOI: https://doi.org/10.1038/sc.1995.18
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