[The efficacy of non-operative treatment of burst fractures of the thoracolumbar vertebrae].

OBJECTIVES

We evaluated the efficacy of non-operative treatment of thoracolumbar burst fractures.

METHODS

The study included 26 patients (19 males, 7 females; mean age 36 years; range 18 to 67 years) who underwent conservative treatment for single-level thoracolumbar fractures without posterior column involvement. None of the patients had neurologic deficits and canal encroachment was 50% or less in all fractures. Functional results were evaluated with the use of Denis' pain and work scales. Relationships were sought between functional results and follow-up time, progression in kyphosis angle, residual kyphosis, and residual canal stenosis, and between radiologic parameters.

RESULTS

Functional results were excellent or good in 65.3%, and poor in 7.7%. Three patients required surgery because of pain. Final follow-up evaluations showed a significant progression in the mean Cobb angle (p<0.001) and a significant remodelization in the mean canal encroachment (p<0.001). No significant correlations were found between progression in kyphosis, residual kyphosis, residual canal stenosis, and functional results (p>0.05). The mean initial Cobb angle was correlated with the mean initial canal encroachment (p<0.05). There was also a correlation between the initial canal encroachment and final remodelization (p<0.001).

CONCLUSION

Although non-operative management of thoracolumbar fractures has considerable efficacy, it may yield poor results in a small percentage of patients, some of whom require surgery because of pain. Thus, further prospective, randomized, and comparative studies with longer follow-up periods are required to define prognostic factors that may predict poor results following non-operative treatment.