alexa Clinical and Radiological Outcomes of a Prospective Coh
ISSN: 2165-7939

Journal of Spine
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Research Article

Clinical and Radiological Outcomes of a Prospective Cohort of Patients Treated after a Vertebral Traumatic Fracture

Javier Pizones*, Lorenzo Zúñiga, Felisa Sánchez-Mariscal and Enrique Izquierdo
Department of Orthopaedic Surgery, Spine Unit, Hospital Universitario de Getafe, Madrid, Spain
Corresponding Author : Javier Pizones
Department of Orthopaedic Surgery
Hospital Universitario de Getafe
Carretera de Toledo Km. 12.5 28905, Madrid, Spain
Tel: 0034616644876
Fax: 0034913591351
E-mail: [email protected]
Received May 28, 2014; Accepted August 28, 2014; Published August 30, 2014
Citation: Pizones J, Zúñiga L, Sánchez-Mariscal F, Izquierdo E (2014) Clinical and Radiological Outcomes of a Prospective Cohort of Patients Treated after a Vertebral Traumatic Fracture. J Spine 3:176. doi:10.4172/2165-7939.1000176
Copyright: © 2014 Pizones J, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
 

Abstract

Study background: There is still controversy on the effectiveness of conservative treatment and the need for surgical intervention in thoracolumbar burst fractures. The aim of the study was to prospectively evaluate the results of a cohort of patients with acute thoracolumbar fractures comparing surgical and conservative treatment.

Methods: Forty-five patients were included. Treatment was decided upon fracture stability and clinical involvement. Two groups were made: surgical (S-group) and conservative (Cgroup). Radiological variables at initial presentation, 1-month, 6-months and at 2-years follow-up were analyzed. Local and regional kyphosis, SF-36 and Oswestry Disability Index (ODI) results, and complications were compared.

Results: 54.8% were type A2-A3 fractures, and 45.2% were type B1-B2 fractures. L1 was the most often affected level, mean age was 40.3±13.2 years, and both groups were homogeneous except for type of fracture according to the AO classification. Group C had mostly A types, group S had mostly B types. Statistically significant differences (p<0.05) were found for local initial kyphosis (C: 12.4º ± 3.6 vs S: 17.5º ± 6); local and regional kyphosis at 1 and 6 months; and final local kyphosis (C: 14.8º ± 6.2 vs S: 7.3º ± 4.6). At the end of follow-up, patients undergoing conservative management showed a +2.6º ± 4.1 increase in local kyphosis, whereas those with surgical treatment showed a -10.3º ± 5.6 improvement (p=0.000). At two years there was a non-significant trend favoring conservative treatment in all SF-36 domains except emotional role. Patients who underwent conservative treatment showed less final disability on the ODI(C: 13.5% vs S: 29.8% p=0.006). Two conservatively treated patients had a >20º increase in kyphosis at final follow-up and one required surgery. In the S group the reoperation rate was 22%.

Conclusion: Fractures with doubtful posterior ligamentous complex instability are better treated by conservative means. Kyphosis would not be restored, but clinical outcomes will result better than if treated surgically, with less complication.

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