Nonoperatively treated type A spinal fractures: mid-term versus long-term functional outcome

Abstract

This study focuses on the mid-term (four years) and long-term (ten years) functional outcome of patients treated nonoperatively for a type A spinal fracture without primary neurological deficit. Functional outcome was measured using the visual analogue scale spine score (VAS) and the Roland–Morris disability questionnaire (RMDQ). The 50 patients included were on average 41.2 years old at the time of injury. Four years post injury, a mean VAS score of 74.5 and a mean RMDQ score of 4.9 were found. Ten years after the accident, the mean VAS and RMDQ scores were 72.6 and 4.7, respectively (NS). No significant relationships were found between the difference scores of the VAS and RMDQ compared with age, gender, fracture sub-classification, and time between measurements. Three (6%) patients had a poor long-term outcome. None of the patients required surgery for late onset pain or progressive neurological deficit. Functional outcome after a nonoperatively treated type A spinal fracture is good, both four and ten years post injury. For the group as a whole, four years after the fracture a steady state exists in functional outcome, which does not change for ten years at least after the fracture.

Treatment of Thoracolumbar Fracture

“…After that, the patient can gradually return to daily life, considering the level of pain. The prognosis of conservative treatment generally seems to be good but a small number of patients may experience persistent pain after the fracture is completely healed [ 42 , 43 , 44 , 45 ]. These clinical outcomes are not always corresponded to radiologic ones.…”

Has the Incidence of Thoracolumbar Spine Injuries Increased in the United States From 1998 to 2011?

“…This apparent increase in incidence is important because thoracolumbar injuries cause pain, loss of function, and sometimes death. Post et al [17] evaluated 10-year outcomes after nonoperative, Type A spinal fractures using a VAS spine score and the Roland-Morris disability questionnaire. Both revealed diminished functional outcomes 10 years after injury and 6% of patients reported poor long-term outcomes [17].…”

“…Post et al [17] evaluated 10-year outcomes after nonoperative, Type A spinal fractures using a VAS spine score and the Roland-Morris disability questionnaire. Both revealed diminished functional outcomes 10 years after injury and 6% of patients reported poor long-term outcomes [17]. Complementing that study, McLain [13] found that in his cohort of patients with spinal fractures treated operatively, only 54% returned to their previous level of employment without restrictions.…”

Bracing for thoracolumbar fractures

“…[26][27][28] Their initial study with 5 years of follow-up consisted of 38 patients, 26 whereas their more recent study included 50 patients who had both 4-year and 10-year data available. 27 The initial study used the VAS, SF-36, and RMDQ as validated outcome measures. This study also included a dynamic lifting test as well as an ergometry test to assess functional capacity as well.…”

“…Under the Denis classification, this fracture type represents a 2-column injury and therefore can be considered unstable, but there exists a considerable body of literature that supports nonoperative treatment for these fractures. [2][3][4]6,15,18,22,[26][27][28]31,32,34,37,42,43,46 Burst fractures tend to occur at the thoracolumbar junction between T-11 and L-2. This area of the spine represents an interface between a relatively rigid segment of the thoracic spine, which is stabilized by the ribcage, compared with the relatively mobile segment of the lumbar spine.…”