Conservative treatment of fractures of the thoracolumbar spine

We reviewed 48 patients with thoracolumbar fractures treated conservatively between 1988 and 1999. The average follow-up was 77.5 (31-137) months and average patient age (23 women, 25 men) was 46 (18-76) years. Twenty-nine patients suffered a fall from a height and 13 patients were injured in traffic accidents. Thirty-two patients had compression-type fractures and 16 burst-type fractures. There were no neurological deficits. Twenty-nine patients were treated by orthosis, 13 by body cast and six by bed rest. In addition to pain and functional scoring, we measured a number of radiographic parameters at the time of admission and at latest follow-up and compared the values. In patients with compression fractures there were significant changes in scoliosis angle and wedging index (p < 0.05). The mean pain score was 1.66 and mean functional score 1.03. In patients with burst fractures, vertebral index, wedging index and height loss increased after treatment (p < 0.05). The mean pain score was 1.26 and functional score 0.93. Compression fractures with kyphosis angle < 30 degrees are supposed to be stable and can be treated conservatively. If the kyphosis angle is more than 30 degrees, magnetic resonance imaging (MRI) should be performed, and if the posterior ligamentous complex is damaged, surgery should be considered. In burst fractures, MRI should always be performed and conservative treatment should only be considered if there is no neurological deficit and the ligaments are intact.