THE ROLE OF WEIGHT BEARING RADIOGRAPHS IN THE ASSESSMENT OF THORACOLUMBAR FRACTURES

Abstract

Introduction: The threshold for internal fixation of thoracolumbar junction fractures is controversial. Most authorities would agree that indications would include neurological deficit and severe deformity. The definition of severe deformity many would regard as a kyphus angle of 20° or more and/or compression of more than 50% of the anterior body height. Patients are only assessed on supine films alone. The aim of this study was to ascertain whether weight-bearing films altered the deformity and if so did this subsequently alter management.

Methods: A prospective study of patients who had suffered a fracture of the thoracolumbar junction (T11- L2). All patients who had a neurological deficit or a kyphus angle of greater than 20° and/or greater than 50% anterior body collapse were excluded. Only patients with a deformity less than the above were entered into the study. These patients then had weight-bearing views (standing or sitting) as soon as they had developed trunk control. A kyphus angle of greater than 20° or more than 50% body collapse were used as a criteria for fixation.

Results: 16 patients were entered into the study over a one year period. Five (31% ) of the 16 patients had a significant increase in their deformity on weight-bearing films that caused them to pass the threshold for fixation, and subsequently had surgery .

Conclusion: The authors recommend that weight-bearing views should always be taken on fractures of the thoracolumbar spine if conservative treatment is being considered.