జర్నల్ ఆఫ్ స్పైన్

Clinical and Radiological Outcomes of a Prospective Cohort of Patients Treated after a Vertebral Traumatic Fracture

Abstract

Javier Pizones, Lorenzo Zúñiga, Felisa Sánchez-Mariscal and Enrique Izquierdo

Study background: There is still controversy on the effectiveness of conservative treatment and the need for surgical intervention in thoracolumbar burst fractures. The aim of the study was to prospectively evaluate the results of a cohort of patients with acute thoracolumbar fractures comparing surgical and conservative treatment.

Methods: Forty-five patients were included. Treatment was decided upon fracture stability and clinical involvement. Two groups were made: surgical (S-group) and conservative (Cgroup). Radiological variables at initial presentation, 1-month, 6-months and at 2-years follow-up were analyzed. Local and regional kyphosis, SF-36 and Oswestry Disability Index (ODI) results, and complications were compared.

Results: 54.8% were type A2-A3 fractures, and 45.2% were type B1-B2 fractures. L1 was the most often affected level, mean age was 40.3±13.2 years, and both groups were homogeneous except for type of fracture according to the AO classification. Group C had mostly A types, group S had mostly B types. Statistically significant differences (p<0.05) were found for local initial kyphosis (C: 12.4º ± 3.6 vs S: 17.5º ± 6); local and regional kyphosis at 1 and 6 months; and final local kyphosis (C: 14.8º ± 6.2 vs S: 7.3º ± 4.6). At the end of follow-up, patients undergoing conservative management showed a +2.6º ± 4.1 increase in local kyphosis, whereas those with surgical treatment showed a -10.3º ± 5.6 improvement (p=0.000). At two years there was a non-significant trend favoring conservative treatment in all SF-36 domains except emotional role. Patients who underwent conservative treatment showed less final disability on the ODI(C: 13.5% vs S: 29.8% p=0.006). Two conservatively treated patients had a >20º increase in kyphosis at final follow-up and one required surgery. In the S group the reoperation rate was 22%.

Conclusion: Fractures with doubtful posterior ligamentous complex instability are better treated by conservative means. Kyphosis would not be restored, but clinical outcomes will result better than if treated surgically, with less complication.