FUNCTIONAL OUTCOME OF BURST FRACTURES OF THE THORACOLUMBAR SPINE MANAGED NON-OPERATIVELY, WITH EARLY AMBULATION, EVALUATED USING THE LOAD SHARING CLASSIFICATION

Abstract

Aim: The purpose of this prospective study was to assess the functional outcome of conservative treatment with early ambulation of thoracolumbar burst spinal fractures, using the Load Shearing classification.

Material – Methods: From 1997 to 2001, 60 consecutive patients with single-level thoracolumbar spinal injury, with no neurological impairment, were classified according to the Load Shearing scoring and were managed non-operatively. A custom-made thoracolumbosacral orthosis was worn by all patients for six months, and early ambulation was recommended. Several radiological parameters were evaluated; the Denis Pain and Work Scale was used to assess the clinical outcome. The average follow-up period was 42 months (range, 24 to 55 months).

Results: During this period the spinal canal occupation was significantly reduced. Other radiological parameters, such as Cobb’s angle and anterior vertebral body compression, showed loss of fracture reduction, which was statistically insignificant. However, the functional outcome was satisfactory in 55 of 60 patients with no complications recorded on completion of treatment. Conclusions: Load Sharing scoring is a reliable and easy-to-use classification for the conservative treatment and prognosis of thoracolumbar spinal fractures. Because of the three characteristics of the fracture site this classification can also predict the structural results of the spinal injury, such as posttraumatic kyphosis, and thereby the functional outcome in conservatively treated patients.