Abstract
Aim. Burst fractures without neurological deficit are often treated successfully without surgery. A subgroup may fail non-operative treatment owing to pain, and opt for surgery.The following review was conducted to identify predictors of success or failure in the non-operative treatment of thoracolumbar burst fractures. Methods. A cohort of 60 patients with T11-L4 thoracolumbar burst fractures were treated non-operatively, with bed rest and bracing until the pain abated sufficiently to allow mobilization. Patients were followed prospectively for a mean ± SD of 12 ± 14 months, and their data were reviewed retrospectively. Results. Fifty-one patients successfully completed non-operative treatment. Owing to intractable pain in nine, surgery was undertaken. Ages in the non-operative and operative groups were 46 ± 18 and 68 ± 15 years respectively (p = 0.002). The residual canal and angulation at the site of the fracture were 63 ± 12% and 1.6 ± 8.4° in the non-operative group and 47 ± 15% and 6.6 ± 13.6° in the surgical group (p = 0.001 and 0.149 between groups, respectively). Regression analysis of age, gender, angulation, and residual canal showed that only age (OR, 1.099; 95% CI, 1.022–1.183; p = 0.011) and residual canal (OR, 0.795; 95% CI, 0.642–0.985; p = 0.035) were significant predictors of failure, ultimately undergoing surgery. Conclusion. Non-surgical treatment was more likely to prove sufficient in patients aged 46 ± 18 years, and residual canal of 63 ± 12%, than in older patients with ages of 68 ± 15, and canal of 47 ± 15%. The latter group was more likely to fail, undergoing surgery because of pain or instability.
Acknowledgements
The authors wish to thank Faith Vaughn for her invaluable help in the preparation of this manuscript.
Declaration of interest: The authors report no declarations of interest. The authors alone are responsible for the content and writing of the paper.
Patrick W. Hitchon is the recipient of research support for the Neurosurgery Biomechanics Laboratory from DePuy Spine, Raynham, MA.