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.

Aim: The evaluation of the results of the posterior application of the combination of the implants Varifix (transcervical screws)/Varigrip (new generation under compression hook with middle line pedicle fixation) to the imstable thoracic and lumbar vertebral fractures.

Patients and Methods: During the years 1999–2001, 30 patients have been operated on with the combination of the implants Varifix/Varigrip to the unstable thoracic (T3–T10: 4), thoracolumbar (T11–L2:21) and lumbar (L3–L5:5) vertebral fractures. Mean age was 33, 5 years and sex variation was 22 men and 8 women. Road traffic accidents were the most common cause and the thoracic and lower limp injuries were the most common (17%) accompanied injuries. For the fracture type and the treatment indications the combination of Gertzbein & Gaines classification was used.

Results: The evaluation of the results was with radiological and clinical examination. Mean surgical time was 170 min (120–240) and the mean blood loss was 500ml (350–800). According to special questionnaire, 25 of the 30 patients (83, 5%) were free of pain and able to return to their previous activities. There was no deterioration in the 24 patients who were in Frankel E neurological condition and the mean post surgical improvement according to Frankel classification was 1, 4 points. In the radiological evaluation (compression percentage, Gardner ankle, conquest of the spinal canal) there was statistical significant difference (p < 0, 05, p < 0, 01, p < 0, 05) between pro and post surgical values. Two patients with acute infection were dealt with surgical cleaning, washing and closing of the wound in second time surgery. One failure of the hook in one patient with osteoporosis was dealt with removal of it.

Conclusions: TheVarifix/Varigrip combination has nearly the same surgical results with traditional partial implants. The satisfactory reduction during the operation in the 30 patients was preserved during the follow up time. The posterior Varigrip system acts with cross link splinting and provides multidirectional spinal stability when it is used alone or supporting the system Varifix for avoiding the detachment or break of the transcervical screws. We suggest the use of these systems for all the unstable thoracic and lumbar injuries because of their safe fixation and easy application.