Abstract
Study Design: A retrospective review of the functional outcome of neurologically intact patients with burst fractures of the first lumbar vertebra.
Objective: To assess the functional outcome of patients treated either surgically or conservatively following burst fractures of L1.
Methods: A retrospective review of 38 neurologically intact patients with burst fractures of L1 was performed. Follow-up clinical evaluation was obtained from 26 patients, eleven of whom were treated surgically and fifteen of whom were managed conservatively. Patients were assessed with regard to pain, employment status, ability to partake in recreational activities and their overall satisfaction with treatment. Radiographic evaluation of anterior body compression and vertebral kyphosis was performed at the time of injury. Computed tomography scanning of spinal canal compromise was also recorded at the time of injury. Subsequent recordings of vertebral kyphosis were assessed at the time of remobilisation and at 3-month follow-up evaluation.
Results: Mean follow-up time for the 26 patients was 43.02 months. At final clinical follow-up of the fifteen patients managed conservatively, 6 patients (40%) had little or no pain; 12 patients (80%) had returned to work with 6 (40%) stating that they had little or no restrictions in their ability to work; 8 patients (53%) had returned to the same level of recreational activity as prior to their injury with 7 (47%) stating they had little or no restrictions in their ability to participate in recreational activities. One patient (9%) reported being very dissatisfied with the operative treatment of their spine fracture.
No correlation was found between kyphotic deformity, extent of canal compromise and clinical outcome.
Conclusions: Non-operative management of burst fractures of the first lumbar vertebra is a very safe and effective method of treatment. It reduces hospitalisation time and avoids the costs and risk of surgery. Patients return to the functional activities of daily living quickly and have a better clinical outcome when compared with operative management.
The abstracts were prepared by Emer Agnew. Correspondence should be addressed to Irish Orthopaedic Association, Secretariat, c/o Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland.
