FUNCTIONAL OUTCOME OF NON-OPERATIVE TREATMENT OF BURST FRACTURES AT THE THORACOLUMBAR JUNCTION.

Abstract

Controversy exists as to whether burst fractures without neurological deficit should be treated operatively or non operatively. We assessed the functional outcomes of non operative treatment of burst fractures using the Oswestry disability index (ODI).

57 Patients who were treated non operatively (bed rest for one week and a corset for 3 months) were assessed using the Oswestry disability index (ODI) over a 6 month period. Assessments were done at an average of 4.8 years (range 18 months–7 years) post injury. There were 37 males and 22 females with an average age of 39 years. Fifty-three percent (31) injuries were due to a fall and twenty-two percent (22) followed an MVA. 90% Of fractures occurred between T12 and L2. Plain x-rays and CT scans were obtained to evaluate the burst fracture.

The initial average Cobb angle was nineteen degrees (19⁰) (range 6⁰–53⁰) with an average progression in Cobb angle was 7⁰ and the average final Cobb angle was 26⁰ (9⁰–71⁰) The average ODI was 17.32% (range 0 48%). Personal care, sexual activity and sleeping were not significantly affected (ODI : 0 or 1 each). Fifty-five percent (11/20) who were previously unemployed returned to work and none of those patients who were previously unemployed, were employed at a later date. All 11 housewives experienced no difficulty with household chores. This study revealed that 31 patients occasionally used analgesia (paracetamol).

The authors conclude that non operative treatment of burst fractures is a viable option in neurologically intact patients.