Spontaneous remodeling of the spinal canal after conservative management of thoracolumbar burst fractures.
METHODS
Forty-two conservatively treated patients with a burst fracture of the thoracic, thoracolumbar, or lumbar spine with more than 25% stenosis of the spinal canal were reviewed more than 1 year after injury to investigate spontaneous remodeling of the spinal canal.


OBJECTIVE
To investigate the natural development of the changes in the spinal canal after thoracolumbar burst fractures.


BACKGROUND
Surgical removal of bony fragments from the spinal canal may restore the shape of the spinal canal after burst fractures. However, it was reported that restoration of the spinal canal does not affect the extent of neurologic recovery.


METHODS
Using computerized tomography, the authors compared the least sagittal diameter of the spinal canal at the time of injury with the least sagittal diameter at the follow-up examination.


RESULTS
Remodeling and reconstitution of the spinal canal takes place within the first 12 months after injury. The mean percentage of the sagittal diameter of the spinal canal was 50% of the normal diameter (50% stenosis) at the time of the fracture and 75% of the normal diameter (25% stenosis) at the follow-up examination. The correlation was positive between the increase in the sagittal diameter of the spinal canal and the initial percentage stenosis. There was a negative correlation between the increase in the sagittal diameter of the spinal canal and age at time of injury. Remodeling of the spinal canal was not influenced by the presence of a neurologic deficit.


CONCLUSIONS
Conservative management of thoracolumbar burst fractures is followed by a marked degree of spontaneous redevelopment of the deformed spinal canal. Therefore, this study provides a new argument in favor of the conservative management of thoracolumbar burst fractures.
de Klerk
L W
LW
Department of Orthopaedics, University Hospital, The Netherlands.
Fontijne
W P
WP
Stijnen
T
T
Braakman
R
R
Tanghe
H L
HL
van Linge
B
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016723:Bone Remodeling; D005260:Female; D017102:Fracture Healing; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000503:physiopathology; D013115:Spinal Canal / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013130:Spinal Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome