Functional Outcome of Thoracolumbar Burst Fractures Without Neurological Deficit

Abstract

Thoracolumbar burst fractures are a major cause of disability; however, there are few studies on the functional outcome of patients with this injury. The purpose of this study is to evaluate the functional outcome of patients with thoracolumbar burst fractures using a generic and a condition-specific health status survey. The SF-36 survey (generic) and the Roland scale (condition-specific) were administered to 24 patients who had a minimum of 2 years follow-up after a thoracolumbar burst fracture without neurologic deficit. The average SF-36 score was 65% (compared to 45% for dialysis and 66% for diabetes) and the Roland score was 65% (compared to 58% for low back pain). Of the patients, 33% were able to return to their previous employment, but only 8% were able to return to their pre-injury level of sports. There was a strong correlation (r = 0.71) between the Roland scale and the SF-36 pain scale. There were poor correlations between the Roland scale and residual kyphosis (r = 0.003), and between the SF-36 pain scale and residual kyphosis (r = 0.10). There was no significant difference in the functional outcome of those patients treated operatively versus nonoperatively.

Nonoperative versus Operative Treatment for Thoracolumbar Burst Fractures Without Neurologic Deficit: A Meta-analysis

“…Reid et al [38] reported that much of this progression also appears to occur in the initial period after injury, with relative stabilization of kyphosis within 12 to 18 months. Furthermore, our meta-analysis showed no association between degree of kyphosis and pain and function, which is consistent with findings from other studies [10,12,13,27,34,47,51]. There is limited evidence that pain is more common with a kyphotic angle greater than 30° [22,49], a level of deformity that vastly exceeded the mean kyphosis observed at last followup in operatively and nonoperatively treated patients in our analysis.…”

“…There is limited evidence that pain is more common with a kyphotic angle greater than 30° [22,49], a level of deformity that vastly exceeded the mean kyphosis observed at last followup in operatively and nonoperatively treated patients in our analysis. Therefore although kyphosis is a common outcome measure in the literature, the importance attributed to this anatomic parameter in studies is difficult to justify, as its clinical importance is questionable [27,43,50].…”

“…Spinal fractures include compression, burst, flexiondistraction, and fracture-dislocation injuries, with burst fractures accounting for 10% to 20% [22,27,29]. The mechanism of injury is usually a fall from a height or a motor vehicle accident, occurring in 34% to 59% and 25% to 43% of cases, respectively [47,50].…”

“…Clinical features of burst fractures include acute back pain and restricted motion, which might be accompanied by neurologic deficits, including motor or sensory changes and sphincter disturbances [27]. Approximately 50% of thoracolumbar burst fractures have an associated neurologic deficit, with the deficit predominantly occurring at the time of injury [9,20,28].…”

“…This is associated with kyphosis progression of 1°to 8.3°, spontaneous spinal canal remodeling (from an average of 26% to 36% compression at the time of injury to 12% to 18% at last followup) [3, 4, 10-14, 27, 41, 44], and rare cases of neurologic deterioration [21,34]. Observational studies of operative treatment suggest the majority of patients experience satisfactory pain and functional outcomes, kyphosis correction of 0.5°to 10.2°, reduction in canal stenosis, and no neurologic deterioration at last followup [1,2,5,10,11,21,27,41,42,52].…”