Immediate standing X-ray predicts the final vertebral collapse in elderly patients with thoracolumbar burst fracture

Abstract

Objective: To see if, in elderly patients with traumatic thoracolumbar fracture, standing X-rays with orthoses 24-48h after admission can predict vertebral collapse after consolidation.

Material and methods: Prospective cohort study endorsed by the Clinical Research Ethics Committee.

Inclusion criteria: age >65 years, acute thoracolumbar junction fracture due to fall, hospital admission, treatment with orthesis.

Exclusion criteria: various levels, suspected malignancy, non-immediate fracture or atraumatic.

Variables: Farcy index (F), regional kyphosis (C: Cobb from cranial to caudal to broken vertebra) - both measured at admission (F0 and C0), at 24-48h in standing position with orthesis (F1 and C1) and 3 months, without brace (F2 and C2), collapse (increase from F0 to F1 -F0F1- and from F1 to F2 -F1F2-; as well as from C0 to C1 -C0C1- and from C1 to C2 -C1C2-), age and gender.

Statistical analysis: R package.

Results: Series of 40 patients, with a mean age of 75 years (66-87). Nine men and 31 women. Neither gender nor age were correlated with any variable. Six required surgery at follow-up. There were no differences in F1, C1, F0F1 or C0C1 between the six patients who required surgery and the other 34. Subsequently, data analysis was performed only for those patients who did not require surgery. The values obtained in the Farcy index were 8°+7° (F0), 12°+7° (F1) and 15°+8° (F2) and in kyphosis (three vertebrae, Cobb) they were: C0=8°+13°; C1=11.5°+14° and C2=13°+13°. There was a correlation of F2 with F0 and F1 (p<.001), with F0F1 (p=.038) and F1F2 (p=.007). The most powerful was with F1 (Rho Spearman=.889 (95% CI=.776-.947), with a Linear Regression line: F2=2.61288+F1×1.01237 (R²=.79). C2 was correlated with C0 and C1 (p<.001), especially with C1 (Rho Spearman=.952, 95% CI=.899-.977). Linear regression: C2=2.23371+C1×0.93758 (R²=.927).

Conclusions: Immediate standing collapse predicts alignment at consolidation (3 months). It is therefore advisable to perform that radiography in the follow-up protocol.

Keywords: Burst; Charnela; Columna; Estallido; Fractura; Fracture; Junction; Ortesis; Orthesis; Spine; Thoracolumbar; Toracolumbar.