Early Mobilization in Thoracolumbar Burst Fractures without Neurological Deficit Managed Conservatively
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Abstract
Background: Since long, thoracolumbar burst fractures have been treated either by prolonged bed rest or by surgical fixation. In this study, outcomes of early mobilization with non-operative treatment are evaluated to avoid unnecessary surgery and complications of prolonged bed rest.
Methods: This prospective observational study included 40 patients with thoracolumbar burst fractures with no neurological deficit. Patients were mobilized with Taylor’s brace as soon as acute pain subsided and reviewed for at least two years with standing radiographs. They were evaluated for anterior vertebral height loss (VHL), kyphotic angle (KA), pain by Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and neurological deterioration at presentation, one month, six months, and two years.
Results: The mean progression of kyphosis over two years was 7.8 degrees. The mean VHL also progressed from a mean of 51.9% at presentation to 60.4% at the two-year follow-up, a mean progression of 8.5%. At two years of follow-up, the mean ODI and the mean VAS score were 10.1% and 0.7, respectively. No patient developed a neurological deficit.
Conclusion: Even though there is some deterioration in radiological parameters, there is constant improvement in functional parameters. For these fractures, non-operative management using a brace and early mobilization promises comparable results without the cost and risk of surgery.
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3. Haher TR, Felmy W, Baruch H, Devlin V, Welin D, O'Brien M, et al. The contribution of the three columns of the spine to rotational stability. A biomechanical model. Spine (Phila Pa 1976). 1989;14(7):663-9. doi: 10.1097/00007632-198907000-00003. [PubMed: 2772712].
4. Alanay A, Yazici M, Acaroglu E, Turhan E, Cila A, Surat A. Course of nonsurgical management of burst fractures with intact posterior ligamentous complex: An MRI study. Spine (Phila Pa 1976). 2004;29(21):2425-31. doi: 10.1097/01.brs.0000143169.80182.ac. [PubMed: 15507806].
5. Kim BG, Dan JM, Shin DE. Treatment of thoracolumbar fracture. Asian Spine J. 2015;9(1):133-46. doi: 10.4184/asj.2015.9.1.133. [PubMed: 25705347]. [PubMed Central: PMC4330209].
6. Bedbrook GM. Treatment of thoracolumbar dislocation and fractures with paraplegia. Clin Orthop Relat Res. 1975;(112): 27-43. [PubMed: 1192644].
7. Wood K, Buttermann G, Mehbod A, Garvey T, Jhanjee R, Sechriest
V. Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit. A prospective, randomized study. J Bone Joint Surg Am. 2003;85(5):773-81. doi: 10.2106/00004623-200305000-00001. [PubMed: 12728024].
8. Carl AL, Tromanhauser SG, Roger DJ. Pedicle screw instrumentation for thoracolumbar burst fractures and fracture-dislocations. Spine (Phila Pa 1976). 1992;17(8 Suppl):S317-S324. doi: 10.1097/00007632-199208001-00018. [PubMed: 1523519].
9. Domenicucci M, Preite R, Ramieri A, Ciappetta P, Delfini R, Romanini L. Thoracolumbar fractures without neurosurgical involvement: Surgical or conservative treatment? J Neurosurg Sci. 1996;40(1):1-10. [PubMed: 8913955].
10. Agus H, Kayali C, Arslantas M. Nonoperative treatment of burst-type thoracolumbar vertebra fractures: Clinical and radiological results of 29 patients. Eur Spine J. 2005;14(6):536- 40. doi: 10.1007/s00586-004-0740-2. [PubMed: 15168239]. [PubMed Central: PMC3489243].
11. Eno JJ, Chen JL, Mitsunaga MM. Short same-segment fixation of thoracolumbar burst fractures. Hawaii J Med Public Health. 2012;71(1):19-22. [PubMed: 22413100]. [PubMed Central: PMC3298433].
12. Kim HS, Lee SY, Nanda A, Kim JY, Park JO, Moon SH, et al. Comparison of surgical outcomes in thoracolumbar fractures operated with posterior constructs having varying fixation length with selective anterior fusion. Yonsei Med J. 2009;50(4):546-54. doi: 10.3349/ymj.2009.50.4.546. [PubMed:
19718404]. [PubMed Central: PMC2730618].
13. Shen WJ, Shen YS. Nonsurgical treatment of three-column thoracolumbar junction burst fractures without neurologic deficit. Spine (Phila Pa 1976). 1999;24(4):412-5. doi: 10.1097/00007632-199902150-00024. [PubMed: 10065527].
14. Knight RQ, Stornelli DP, Chan DP, Devanny JR, Jackson KV. Comparison of operative versus nonoperative treatment of lumbar burst fractures. Clin Orthop Relat Res. 1993;(293):112-21. [PubMed: 8339471].
15. Seybold EA, Sweeney CA, Fredrickson BE, Warhold LG, Bernini PM. Functional outcome of low lumbar burst fractures. A multicenter review of operative and nonoperative treatment of L3-L5. Spine (Phila Pa 1976). 1999;24(20):2154-61. doi: 10.1097/00007632-199910150-00016. [PubMed: 10543015].
16. Resch H, Rabl M, Klampfer H, Ritter E, Povacz P. Surgical vs. conservative treatment of fractures of the thoracolumbar transition. Unfallchirurg. 2000;103(4):281-8. [In German]. doi: 10.1007/s001130050537. [PubMed: 10851954].
17. Jacobs RR, Asher MA, Snider RK. Thoracolumbar spinal injuries. A comparative study of recumbent and operative treatment in 100 patients. Spine(Phila Pa 1976). 1980;5(5):463-77. [PubMed: 7455777].
18. McLain RF, Sparling E, Benson DR. Early failure of short- segment pedicle instrumentation for thoracolumbar fractures. A preliminary report. J Bone Joint Surg Am. 1993;75(2):162-7. doi: 10.2106/00004623-199302000-00002. [PubMed: 8423176].
19. Ozturk I, Erturer E, Sonmez MM, Sari S, Seker A, Seckin MF. Early mobilization with customized TLSO brace in thoracolumbar burst fractures. Acta Orthop Traumatol Turc. 2012;46(5):373-8. [PubMed: 23268823].
20. Li A, Chen JK, Li KC, Hsieh CH. Long-term results of transpedicle body augmenter in treating burst fractures. Indian J Orthop. 2007;41(4):362-7. doi: 10.4103/0019-5413.37001. [PubMed: 21139792]. [PubMed Central: PMC2989517].
21. Cantor JB, Lebwohl NH, Garvey T, Eismont FJ. Nonoperative management of stable thoracolumbar burst fractures with early ambulation and bracing. Spine (Phila Pa 1976). 1993;18(8):971-6. doi: 10.1097/00007632-199306150-00004. [PubMed: 8367784].
22. Tezer M, Erturer RE, Ozturk C, Ozturk I, Kuzgun U. Conservative treatment of fractures of the thoracolumbar spine. Int Orthop. 2005;29(2):78-82. doi: 10.1007/s00264-004-0619-1. [PubMed: 15714305]. [PubMed Central: PMC3474508].
23. Celebi L, Muratli HH, Dogan O, Yagmurlu MF, Aktekin CN, Bicimoglu A. The efficacy of non-operative treatment of burst fractures of the thoracolumbar vertebrae. Acta Orthop Traumatol Turc. 2004;38(1):16-22. [In Turkish]. [PubMed: 15054293].
2. Zoccali C, Rossi B, Walter CM, Baaj AA. Short-segment versus long-segment stabilization in thoracolumbar burst fracture: A review of the literature. J Orthop Spine Trauma. 2017;3(2): e65649. doi: 10.5812/jost.65649.
3. Haher TR, Felmy W, Baruch H, Devlin V, Welin D, O'Brien M, et al. The contribution of the three columns of the spine to rotational stability. A biomechanical model. Spine (Phila Pa 1976). 1989;14(7):663-9. doi: 10.1097/00007632-198907000-00003. [PubMed: 2772712].
4. Alanay A, Yazici M, Acaroglu E, Turhan E, Cila A, Surat A. Course of nonsurgical management of burst fractures with intact posterior ligamentous complex: An MRI study. Spine (Phila Pa 1976). 2004;29(21):2425-31. doi: 10.1097/01.brs.0000143169.80182.ac. [PubMed: 15507806].
5. Kim BG, Dan JM, Shin DE. Treatment of thoracolumbar fracture. Asian Spine J. 2015;9(1):133-46. doi: 10.4184/asj.2015.9.1.133. [PubMed: 25705347]. [PubMed Central: PMC4330209].
6. Bedbrook GM. Treatment of thoracolumbar dislocation and fractures with paraplegia. Clin Orthop Relat Res. 1975;(112): 27-43. [PubMed: 1192644].
7. Wood K, Buttermann G, Mehbod A, Garvey T, Jhanjee R, Sechriest
V. Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit. A prospective, randomized study. J Bone Joint Surg Am. 2003;85(5):773-81. doi: 10.2106/00004623-200305000-00001. [PubMed: 12728024].
8. Carl AL, Tromanhauser SG, Roger DJ. Pedicle screw instrumentation for thoracolumbar burst fractures and fracture-dislocations. Spine (Phila Pa 1976). 1992;17(8 Suppl):S317-S324. doi: 10.1097/00007632-199208001-00018. [PubMed: 1523519].
9. Domenicucci M, Preite R, Ramieri A, Ciappetta P, Delfini R, Romanini L. Thoracolumbar fractures without neurosurgical involvement: Surgical or conservative treatment? J Neurosurg Sci. 1996;40(1):1-10. [PubMed: 8913955].
10. Agus H, Kayali C, Arslantas M. Nonoperative treatment of burst-type thoracolumbar vertebra fractures: Clinical and radiological results of 29 patients. Eur Spine J. 2005;14(6):536- 40. doi: 10.1007/s00586-004-0740-2. [PubMed: 15168239]. [PubMed Central: PMC3489243].
11. Eno JJ, Chen JL, Mitsunaga MM. Short same-segment fixation of thoracolumbar burst fractures. Hawaii J Med Public Health. 2012;71(1):19-22. [PubMed: 22413100]. [PubMed Central: PMC3298433].
12. Kim HS, Lee SY, Nanda A, Kim JY, Park JO, Moon SH, et al. Comparison of surgical outcomes in thoracolumbar fractures operated with posterior constructs having varying fixation length with selective anterior fusion. Yonsei Med J. 2009;50(4):546-54. doi: 10.3349/ymj.2009.50.4.546. [PubMed:
19718404]. [PubMed Central: PMC2730618].
13. Shen WJ, Shen YS. Nonsurgical treatment of three-column thoracolumbar junction burst fractures without neurologic deficit. Spine (Phila Pa 1976). 1999;24(4):412-5. doi: 10.1097/00007632-199902150-00024. [PubMed: 10065527].
14. Knight RQ, Stornelli DP, Chan DP, Devanny JR, Jackson KV. Comparison of operative versus nonoperative treatment of lumbar burst fractures. Clin Orthop Relat Res. 1993;(293):112-21. [PubMed: 8339471].
15. Seybold EA, Sweeney CA, Fredrickson BE, Warhold LG, Bernini PM. Functional outcome of low lumbar burst fractures. A multicenter review of operative and nonoperative treatment of L3-L5. Spine (Phila Pa 1976). 1999;24(20):2154-61. doi: 10.1097/00007632-199910150-00016. [PubMed: 10543015].
16. Resch H, Rabl M, Klampfer H, Ritter E, Povacz P. Surgical vs. conservative treatment of fractures of the thoracolumbar transition. Unfallchirurg. 2000;103(4):281-8. [In German]. doi: 10.1007/s001130050537. [PubMed: 10851954].
17. Jacobs RR, Asher MA, Snider RK. Thoracolumbar spinal injuries. A comparative study of recumbent and operative treatment in 100 patients. Spine(Phila Pa 1976). 1980;5(5):463-77. [PubMed: 7455777].
18. McLain RF, Sparling E, Benson DR. Early failure of short- segment pedicle instrumentation for thoracolumbar fractures. A preliminary report. J Bone Joint Surg Am. 1993;75(2):162-7. doi: 10.2106/00004623-199302000-00002. [PubMed: 8423176].
19. Ozturk I, Erturer E, Sonmez MM, Sari S, Seker A, Seckin MF. Early mobilization with customized TLSO brace in thoracolumbar burst fractures. Acta Orthop Traumatol Turc. 2012;46(5):373-8. [PubMed: 23268823].
20. Li A, Chen JK, Li KC, Hsieh CH. Long-term results of transpedicle body augmenter in treating burst fractures. Indian J Orthop. 2007;41(4):362-7. doi: 10.4103/0019-5413.37001. [PubMed: 21139792]. [PubMed Central: PMC2989517].
21. Cantor JB, Lebwohl NH, Garvey T, Eismont FJ. Nonoperative management of stable thoracolumbar burst fractures with early ambulation and bracing. Spine (Phila Pa 1976). 1993;18(8):971-6. doi: 10.1097/00007632-199306150-00004. [PubMed: 8367784].
22. Tezer M, Erturer RE, Ozturk C, Ozturk I, Kuzgun U. Conservative treatment of fractures of the thoracolumbar spine. Int Orthop. 2005;29(2):78-82. doi: 10.1007/s00264-004-0619-1. [PubMed: 15714305]. [PubMed Central: PMC3474508].
23. Celebi L, Muratli HH, Dogan O, Yagmurlu MF, Aktekin CN, Bicimoglu A. The efficacy of non-operative treatment of burst fractures of the thoracolumbar vertebrae. Acta Orthop Traumatol Turc. 2004;38(1):16-22. [In Turkish]. [PubMed: 15054293].
| Files | ||
| Issue | Vol 9 No 3 (2023) | |
| Section | Research Articles | |
| DOI | https://doi.org/10.18502/jost.v9i3.13033 | |
| Keywords | ||
| Early Ambulation Spinal Fractures Thoracic Vertebrae Lumbar Vertebrae Treatment Outcome | ||
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How to Cite
1.
Sanjeev K, Saini N, chadha M. Early Mobilization in Thoracolumbar Burst Fractures without Neurological Deficit Managed Conservatively. J Orthop Spine Trauma. 2023;9(3):129-32.
