Nonoperative treatment of burst-type thoracolumbar vertebra fractures: clinical and radiological results of 29 patients

Abstract

The treatment of neurologically intact patients with thoracolumbar burst fractures is still controversial. This study was designed to evaluate the role of nonoperative treatment for 29 neurologically intact patients with two- or three-column-injured thoracolumbar burst fractures. Neurologically intact patients with types A, B and C burst fractures were treated conservatively and divided into groups GI and GII, according to their column involvement, with two and three injured columns, respectively. Local kyphosis angle (LKA), anterior and posterior vertebral heights (AVH and PVH) and canal encroachment (CE) were examined for radiological parameters, while Denis' s work and pain criteria were used for clinical assessment. Remodeling determining factors of canal encroachment and the correlation between radiology and functionality were analyzed. The vertebral column deformity that occurred after the injury was stable in GI, while it was progressive for GII patients. There was significant remodeling of CE, proportional to the amount of initial CE but not related to age and radiological parameters. No correlation was found between radiological and functional parameters. None of the patients had neurological deterioration. Most of the functional results were satisfactory. As a result, it was concluded that nonoperative treatment could be an alternative method for neurologically intact two- and three-column-injured Denis-types A, B and C thoracolumbar burst fractures.