Pain regulation and health-related quality of life after thoracolumbar fractures of the spine

Abstract

Fractures of the thoracolumbar spine rank among the severest injuries of the human skeleton. Especially in younger patients they often result from high-energy accidents. Recently, a shift in paradigm towards more aggressive treatment strategies including anterior procedures could be observed. However, so far only few data exist reflecting the quality of life (QoL) after such injuries. The aim of this study was to evaluate medium-term QoL and further to identify factors that influence the clinical outcome in patients with fractures of the thoracolumbar spine. Data of 906 patients who were treated during a 10-year period in our institution were evaluated retrospectively. Only patients with single-level traumatic injuries aged between 18 and 65 years without neurological deficits, concomitant injuries of other locations and internal comorbidities were included into the investigation (n = 204). Three different treatment groups (i.e. non-operative, dorsal and dorsoventral stabilisation) were compared to healthy controls as well as different pain populations. The QoL was assessed using established questionnaires (SF-36, HFAQ, VAS-Spinescore, PRQ, and PTSD). Sixty-five percent of the included patients (n = 133) were studied at an average follow-up of 5.3 +/- 1.7 years after injury. All treatment groups revealed an identical gender and age distribution. More severe and unstable injuries were found in the surgical groups associated with higher treatment costs and a longer inability to work. Compared to healthy controls, QoL was compromised to the same extent in all groups. Furthermore, all patients treated in this study did significantly better than low back pain individuals with regard to QoL and pain regulation parameters. In our study, patients with thoracolumbar spine fractures showed a reduced QoL compared to healthy controls. Thus, patients do not seem to regain their former QoL. However, the level of discomfort was comparably low in all groups, even in patients with more severe injuries requiring extensive surgery. Overall, outcome and QoL after traumatic fractures of the thoracolumbar spine rather seem to be determined by the severity of injury than by pain regulation or other psychosocial factors which is likely the case in low back pain disorders.

Association of clinical parameters of operatively treated thoracolumbar fractures with quality of life parameters

“…The influence of the different operative techniques on HRQoL after thoracolumbar spine fracture was not object of this survey, because this would exceed the sample size. Although major multicenter studies [1,14,16] were performed, no correlation between different treatment options and HRQoL could be objectified so far.…”

“…Fractures of the thoracolumbar spine are major injuries that often require surgical intervention and are known to have an important impact on the long-term outcome after trauma [1]. Most of the studies on the outcome after fractures of the thoracolumbar spine focused on radiological parameters, return to work, activity, and pain [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] without consideration of specific HRQoL outcome measures.…”

“…Fractures of the thoracolumbar spine are major injuries that often require surgical intervention and are known to have an important impact on the long-term outcome after trauma [1]. Most of the studies on the outcome after fractures of the thoracolumbar spine focused on radiological parameters, return to work, activity, and pain [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] without consideration of specific HRQoL outcome measures. Assessment of HRQoL after thoracolumbar fractures with generic instruments such as Short Form-36 health survey (SF-36) has only been reported in a few works [1,[17][18][19][20], which are all limited by the low number of the used HRQoL instruments.…”

“…Most of the studies on the outcome after fractures of the thoracolumbar spine focused on radiological parameters, return to work, activity, and pain [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] without consideration of specific HRQoL outcome measures. Assessment of HRQoL after thoracolumbar fractures with generic instruments such as Short Form-36 health survey (SF-36) has only been reported in a few works [1,[17][18][19][20], which are all limited by the low number of the used HRQoL instruments. Only Briem et al [1] used five different measures [Visual Analogue Scale (VAS), SF-36, Hannover Functional Ability Questionnaire (HFAQ), Pain Regulation Questionnaire (PRQ), and Post-traumatic Stress Disorder (PTSD) screening instrument by Stieglitz].…”

“…Assessment of HRQoL after thoracolumbar fractures with generic instruments such as Short Form-36 health survey (SF-36) has only been reported in a few works [1,[17][18][19][20], which are all limited by the low number of the used HRQoL instruments. Only Briem et al [1] used five different measures [Visual Analogue Scale (VAS), SF-36, Hannover Functional Ability Questionnaire (HFAQ), Pain Regulation Questionnaire (PRQ), and Post-traumatic Stress Disorder (PTSD) screening instrument by Stieglitz]. Furthermore, from typical clinical parameters in the outcome assessment after thoracolumbar spinal fractures such as fingertip-to-floor distance (FFD), pressure and percussion pain (PPP) of the thoracolumbar-pelvic area, and alterations of the paravertebral muscle tension, only FFD was reported in two studies after surgical treatment to have a significant association with a spine specific VAS [14,16].…”