NO BENEFICIAL EFFECT OF BRACING IN THE TREATMENT OF COMPRESSION TYPE THORACOLUMBAR VERTEBRAL FRACTURES: A COMPARATIVE STUDY BETWEEN BRACING AND BED REST

Abstract

Aim: To compare the radiological and functional outcomes of compression type thoracolumbar vertebral fractures treated with cloth-type thoracolumbar orthosis fitted with steel plates and bed rest.

Methods: This prospective comparative study was done between July 2004 and January 2007. Twenty three patients (17 male, 6 female) with compression type (Magerl A1) thoracolumbar vertebral fractures were included. No patient had associated neurogical findings or additional injury. Eleven patients were treated with cloth-type thoracolumbar orthosis and 12 patients with only bed rest. Bed rest group cases were instructed to stand up and walk around as possible as they tolerated after pain relief just only in the house under the supervision of it’s relates. All cases were evaluated at last follow-up with SF-36 questionaire, clinical and radiological examination.

Results: There was no significant difference between two groups with regard to demographic data. Radiological parameters including anterior compression angle, local kyphosis angle, sagittal index and anterior vertebral height were measured and compared on initial admittion, on the third month and at the last visit showing no significant difference (p> 0.05). Clinical evaluation was performed via work and pain criteria described by Denis. We found no significant difference between both groups for functional criteria (p> 0.05). Mental and physical points of SF-36 questionaire were recorded and compared dispaying no difference (pmental=0.15, pphysical=0.44).

Conclusion: Magerl type A1 thoracolumbar fractures can be treated via bed rest by allowing controlled ambulation in home without bracing. This functional therapy can prevent complications due to absolute bed rest or related to bracing. However patient’s cooperation is the most important factor while choosing functional therapy.