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Comparative Study
. 2020 Nov 10;15(1):514.
doi: 10.1186/s13018-020-02044-3.

Predictors of the failure of conservative treatment in patients with a thoracolumbar burst fracture

Ehsan Alimohammadi  1 , Seyed Reza Bagheri  2 , Paniz Ahadi  3 , Sahar Cheshmehkaboodi  3 , Homa Hadidi  3 , Shokofeh Maleki  4 , Alireza Abdi  5
Affiliations
Comparative Study

Predictors of the failure of conservative treatment in patients with a thoracolumbar burst fracture

Ehsan Alimohammadi et al. J Orthop Surg Res. .

Abstract

Background: There is a controversy about the management of patients with a thoracolumbar burst fracture. Despite the success of the conservative treatment in most of the cases, some patients failed the conservative treatment. The present study aimed to evaluate risk factors for the need for surgery during the follow-up period in these patients.

Methods: We retrospectively evaluated 67 patients with a traumatic thoracolumbar burst fracture who managed conservatively at our center between May 2014 and May 2019. Suggested variables as potential risk factors for the failure of conservative treatment including age, gender, body mass index (BMI), smoking, diabetes, vertebral body compression rate (VBCR), percentage of anterior height compression (PAHC), Cobb angle, interpedicular distance (IPD), canal compromise, and pain intensity as visual analog scale (VAS) were compared between patients with successful conservative treatment and those with failure of non-operative management.

Results: There were 41 males (61.2%) and 26 females (38.8%) with the mean follow-up time of 15.52 ± 5.30 months. Overall, 51 patients (76.1%) successfully completed conservative treatment. However, 16 cases (23.9%) failed the non-operative management. According to the binary logistic regression analysis, only age (risk ratio [RR], 2.21; 95% confidence interval [95%], 1.78-2.64; P = 0.019) and IPD (RR 1.97; 95% CI 1.61-2.33; P = 0.005) were the independent risk factors for the failure of the non-operative management.

Conclusions: Our results showed that older patients and those with greater interpedicular distance are at a higher risk for failure of the conservative treatment. As a result, a closer follow-up should be considered for them.

Keywords: Burst fracture; Conservative treatment; Risk factors; Thoracolumbar.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Cobb angle was measured as the angle between the superior endplate of the vertebra above the fracture and the inferior endplate of the vertebra below the fracture. Vertebral body compression rate (VBCR) and percentage of anterior height compression were calculated as follows: VBCR = AVH/PVH × 100%. PAHC = AVH/[(AVH* + AVH**)/2] × 100%. AVH: Anterior vertebral height of the fractured vertebra, AVH*: Anterior vertebral height of a vertebra above the fracture, AVH**: Anterior vertebral height of a vertebra below the fracture, PVH: posterior vertebral height of fractured vertebra
Fig. 2
Fig. 2
The interpedicular distance (IPD) was calculated by comparing the widening between the pedicles of the fractured vertebrae with the mean of similar values obtained from levels above and below them; IPD = [2D − (D* + D**)/(D* + D**)] × 100%
See this image and copyright information in PMC

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