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Chiropractic Research Review

Conservative Care vs. Surgery for Burst Fractures

Operative and nonoperative approaches are currently utilized in the management of thoracolumbar spine burst fractures. Recently, a prospective clinical trial compared the short and long-term efficacy of both approaches - specifically, nonoperative treatment compared to short-segment posterior fixation using pedicle screws.

This study involved 80 patients meeting strict inclusion criteria for a single-level closed burst fracture involving T11-L2. Patients in the nonoperative group were placed in hospital beds and allowed activity to the point of pain beginning the day of injury. These patients were fitted with an anterior hyperextension brace, which they were instructed to wear at all times, except when bathing, for three months. Patients were discharged from the hospital when their pain was controlled. For the following three months, the patients were prevented from participating in heavy work and sports, but allowed activities of daily living and sedentary work. Patients in the operative group underwent three-level fixation (one above, one at fracture level, and one below), with a follow-up period of two years.

Results: Although the surgical group had less pain up to three months, and a better Greenough Low Back Outcome Score up to six months, outcomes were comparable to the nonsurgical group at two-year follow-up. In the operative group, there was one case of superficial infection and two cases of broken screws. The kyphosis angle improved initially by 17 degrees, but this gradually diminished. Hospital charges were four times higher in the operative group. In the nonoperative group, the kyphosis angle worsened by four degrees, and the retropulsion angle decreased from 34 to 15%.

The authors note in their conclusion that short-segment posterior fixation provides partial kyphosis correction and earlier pain relief at four times the cost, but that functional outcomes at two years are similar to nonoperative treatment tactics. They recommend early activity to the point of pain tolerance.

Shen W, Liu T, Shen Y. Nonoperative treatment versus posterior fixation for thoracolumbar junction burst fractures without neurologic deficit. Spine 2001:26(9), pp1038-1045.

Chiropractic Research Review

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