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Nonoperative Management in Neurologically Intact Thoracolumbar Burst Fractures: Clinical and Radiographic Outcomes.

Publication ,  Journal Article
Hitchon, PW; Abode-Iyamah, K; Dahdaleh, NS; Shaffrey, C; Noeller, J; He, W; Moritani, T
Published in: Spine (Phila Pa 1976)
March 2016

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The identification of factors that lead to the failure of nonoperative management in neurologically intact thoracolumbar burst fractures. SUMMARY OF BACKGROUND DATA: The treatment of thoracolumbar burst fractures (TLBF) can be controversial, particularly in the neurologically intact. Surgery for intact burst fractures has been advocated for early mobilization and a shorter hospital stay. These goals, however, have not always been achieved, rejuvenating an interest in nonoperative treatment. METHODS: Sixty-eight neurologically intact patients with burst fractures of the thoracolumbar junction (T11-L2), and a thoracolumbar injury classification and severity score (TLICS) of 2, were treated at our institution. Based on CT scans, patients were scored based on the load-sharing classification (LSC) scale. Initial treatment consisted of bracing in clamshell thoracolumbar orthosis and gradual mobilization. RESULTS: Owing to pain limiting mobilization, 18 patients failed nonoperative management and required instrumentation. Those who failed nonsurgical management were significantly more kyphotic (8° ± 10) and stenotic (52% ± 14%) than those successfully treated nonoperatively (3° ± 7 and 63 ± 12%, respectively). The LSC score of those undergoing surgery (6.9 ± 1.1) was also greater than those successfully treated nonoperatively (5.8 ± 1.3, P = 0.006). Length of hospitalization was longer, and hospital charges higher in those requiring surgery compared to the nonoperative group. At follow-up there was no difference between groups in the visual analog score for pain (VAS) or the Oswestry disability index. CONCLUSION: Owing to pain limiting mobilization, a quarter of neurologically intact patients with thoracolumbar burst fractures and a TLICS score of 2 failed nonsurgical management. The greater the kyphosis, stenosis, and fragmentation of the fracture, the more likely patients required surgery. In addition to the TLICS classification, other radiographic and clinical parameters should be included in selecting appropriate treatment strategy. The cost savings with nonoperative treatment of intact burst fractures, when appropriate, are significant.

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Published In

Spine (Phila Pa 1976)

DOI

EISSN

1528-1159

Publication Date

March 2016

Volume

41

Issue

6

Start / End Page

483 / 489

Location

United States

Related Subject Headings

  • Treatment Failure
  • Tomography, X-Ray Computed
  • Thoracic Vertebrae
  • Spinal Fractures
  • Retrospective Studies
  • Orthopedics
  • Middle Aged
  • Male
  • Magnetic Resonance Imaging
  • Lumbar Vertebrae
 

Citation

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Hitchon, P. W., Abode-Iyamah, K., Dahdaleh, N. S., Shaffrey, C., Noeller, J., He, W., & Moritani, T. (2016). Nonoperative Management in Neurologically Intact Thoracolumbar Burst Fractures: Clinical and Radiographic Outcomes. Spine (Phila Pa 1976), 41(6), 483–489. https://doi.org/10.1097/BRS.0000000000001253
Hitchon, Patrick W., Kingsley Abode-Iyamah, Nader S. Dahdaleh, Christopher Shaffrey, Jennifer Noeller, Wenzhuan He, and Toshio Moritani. “Nonoperative Management in Neurologically Intact Thoracolumbar Burst Fractures: Clinical and Radiographic Outcomes.Spine (Phila Pa 1976) 41, no. 6 (March 2016): 483–89. https://doi.org/10.1097/BRS.0000000000001253.
Hitchon PW, Abode-Iyamah K, Dahdaleh NS, Shaffrey C, Noeller J, He W, et al. Nonoperative Management in Neurologically Intact Thoracolumbar Burst Fractures: Clinical and Radiographic Outcomes. Spine (Phila Pa 1976). 2016 Mar;41(6):483–9.
Hitchon, Patrick W., et al. “Nonoperative Management in Neurologically Intact Thoracolumbar Burst Fractures: Clinical and Radiographic Outcomes.Spine (Phila Pa 1976), vol. 41, no. 6, Mar. 2016, pp. 483–89. Pubmed, doi:10.1097/BRS.0000000000001253.
Hitchon PW, Abode-Iyamah K, Dahdaleh NS, Shaffrey C, Noeller J, He W, Moritani T. Nonoperative Management in Neurologically Intact Thoracolumbar Burst Fractures: Clinical and Radiographic Outcomes. Spine (Phila Pa 1976). 2016 Mar;41(6):483–489.

Published In

Spine (Phila Pa 1976)

DOI

EISSN

1528-1159

Publication Date

March 2016

Volume

41

Issue

6

Start / End Page

483 / 489

Location

United States

Related Subject Headings

  • Treatment Failure
  • Tomography, X-Ray Computed
  • Thoracic Vertebrae
  • Spinal Fractures
  • Retrospective Studies
  • Orthopedics
  • Middle Aged
  • Male
  • Magnetic Resonance Imaging
  • Lumbar Vertebrae