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. 2015 Sep 4;4(4):346-50.
doi: 10.1016/j.amsu.2015.08.009. eCollection 2015 Dec.

Clinical and radiological outcomes of conservative treatment after stable post-traumatic thoracolumbar fractures in elderly: Is it really best option for all elderly patients?

Deniz Cankaya  1 , Serdar Yilmaz  1 , Alper Deveci  1 , Abdurrahim Dundar  1 , Burak Yoldas  1 , Ali Toprak  2 , Yalcın Tabak  1
Affiliations

Clinical and radiological outcomes of conservative treatment after stable post-traumatic thoracolumbar fractures in elderly: Is it really best option for all elderly patients?

Deniz Cankaya et al. Ann Med Surg (Lond). .

Abstract

Objective: The purpose of this study was to research the effectiveness of conservative treatment of stable post-traumatic thoracolumbar vertebral fractures in elderly patients.

Methods: The study included 21 elderly patients (13 females, 8 males) with post-traumatic thoracolumbar compression fracture who were treated with a brace. Fractures without any trauma history, pathological fractures, patients younger than 60 years old and patients with no malignancy history were excluded from study. Neurological examination and posterior ligamentous complex (PLC) were intact in all patients. Radiological parameters and pain scores were recorded in regular follow-up.

Results: The mean age and follow-up were 71.3 years (range, 60-84 years) and 20.1 months (range, 12-26 months) respectively. During follow-up, 4 patients had significant height loss resulting in kyphotic deformity and intractable pain. There was a significant increase in the local kyphosis angle (p = 0.001) and height loss percentage (p = 0.017). At the final follow-up, the mean Denis Score of pain was 1.62 ± 0.74.

Conclusion: Although there is wide acceptance of conservative treatment of post-traumatic stable thoracolumbar fracture with intact PCL according to the Thoracolumbar Injury Classification and Severity Score (TLICS), elderly female patients with a post-traumatic compression fracture in the junctional region are at great risk of conservative treatment failure. These patients should be well-informed about the possible complications and poor results of conservative treatment, and surgical treatment should be considered in selective cases with the informed consent of the patients.

Keywords: Brace; Conservative treatment; Elderly; Stable thoracolumbar fracture; TLICS.

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Figures

Fig. 1
Fig. 1
AP and lateral thoracolumbar radiographs of a 73-year old female patient in the Emergency Service.
Fig. 2
Fig. 2
CT scans showing anterior compression of L1 vertebra and MRI scans with intact posterior ligamentous complex.
Fig. 3
Fig. 3
AP and lateral thoracolumbar radiographs revealed height loss and local kyphosis at 3-month follow-up.
Fig. 4
Fig. 4
AP and lateral thoracolumbar radiographs revealed significant height loss (76%) and local kyphosis (31°) at 6-month follow-up.
See this image and copyright information in PMC

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