Functional outcome 5 years after non-operative treatment of type A spinal fractures

Abstract

This study was conducted to study the functional outcome after non-operative treatment of type A thoracolumbar spinal fractures without neurological deficit. Functional outcome was determined following the International Classification of Functioning, Disability and Health, measuring restrictions in body function and structure, restrictions in activities, and restrictions in participation/quality of life. All patients were treated non-operatively for a type A thoracolumbar (Th11-L4) spinal fracture at the University Hospital Groningen, The Netherlands. Thirty-three of the eighty-one selected patients agreed to participate in the study (response-rate 41%). Respondents were older than non-respondents (mean 50.5 years vs. 39.2 years), but did not differ from each other concerning injury-related variables. Patients with a neurological deficit were excluded. Treatment consisted either of mobilisation without brace, or of bedrest followed by wearing a brace. Restrictions in body function and structure were measured by physical tests (dynamic lifting test and bicycle ergometry test); restrictions in activities were measured by means of questionnaires, the Roland Morris Disability Questionnaire (RMDQ) and Visual Analogue Scale Spine Score (VAS). Restrictions in participation/quality of life were assessed with the Short Form 36 (SF-36) and by means of return to work status. Thirty-seven per cent of the patients were not able to perform the dynamic lifting test within normal range. In the ergometry test, 40.9% of the patients performed below the lowest normal value, 36.4% of the patients achieved a high VO(2)-max. Mean RMDQ-score was 5.2, the mean VAS-score was 79. No significant differences between patients and healthy subjects were found in SF-36 scores, neither were differences found between braced and unbraced patients in any of the outcome measures. Concerning the return to work status, 10% of the subjects had stopped working and received social security benefits, 24% had arranged changes in their work and 14% had changed their job. We conclude that patients do reasonably well 5 years after non-operative treatment of a thoracolumbar fracture, although outcome is diverse in the different categories and physical functioning seems restricted in a considerable number of patients.

Non-operative vs. percutaneous stabilization in Magerl’s A1 or A2 thoracolumbar spine fracture in adults: is it really advantageous for a good alignment of the spine? Preliminary data from a prospective study

“…Lack of evidence-based practice may result in patients being treated inappropriately and being exposed to unnecessary adverse consequences. With respect to patients' status after treatment of a spinal fracture, literature mostly focuses on radiological aspects [11]. The study of Post et al [11] was developed to gain insight into the functional outcome in patients treated non-operatively for a thoracolumbar spinal fracture.…”

Systematic literature review on ICF from 2001 to 2009: its use, implementation and operationalisation

“…Descriptive statistics for subcategories are reported in Table IV A total of 32 papers described practical applications of the ICF in clinical contexts but not in specific health conditions. They include the development of methodologies and application of tools for health professionals [409,413,425,428,434], and the description of disability of diverse groups of patients from different clinical settings [338,405,419,423,[427][428][429][430][431], and the identification of relevant categories of ICF [407,410,411,414,417,418,420,422,424].…”

A survey of the “surgical and research” articles in the European Spine Journal, 2006

“…In the early weeks such bracing does relieve pain, but probably after a few weeks the discomfort of the brace and the inhibiting effect it may have on rehabilitation, both psychologically and physically as compared with the relief of pain it produces must question its use for other than the first weeks for pain relief. The paper by Post [42] is of interest in this regard. At 5 years there was no functional difference between 15 unbraced patients, and 18 braced patients, the brace having been worn for 9 months, the first 6 months day and night, and the last 3 months at daytime only.…”