[Comparative radiographic analysis of surgical and conservative treatment of unstable injuries of the thoracic and lumbar spine].
BACKGROUND
Treatment of fractures and dislocations of the thoracolumbar spine is aimed at achieving a stable and painless spine. Concerning mode of treatment therapists are divided into two groups--those for conservative approach and those who advocate operative stabilization of spinal column. The objective of this paper was to compare radiological findings of both modes of treatment on the basis of our clinical material.


METHODS
The examination included radiographs of 96 patients with radiolographic signs of unstable spine, treated at Clinic of Orthopaedic Surgery and Traumatology of the Institute of Surgery of the Clinical Center in Novi Sad from 1984 to 1998. Among 48 operated patients (average age of 40.7), there were more females--25, and among nonoperated, there were more males--33. The average age of conservatively treated patients was 52. Dynamic radiographs evaluated the angle of local kyphosis on the spot of injury (Cobb's angle), reduction of dimensions of the body of injured vertebra and sagittal movement of the body on affected level. Measured values were corrected by values of sagittal index.


RESULTS
Initially the average angle of local kyphosis among operated was 26.9, among conservatively treated it was 19.7. Control values for operated were 14.7 and for conservatively treated 25.6. Initially, a wedge-shaped deformity larger than half of the front part of the injured vertebra body had 42 nonoperated and 32 operated patients. Initially, the average sagittal movement of the injured vertebra body among operated patients was 6.97 mm, and at control 1.34 mm. Among nonoperated, the average movement of the body was 1.71 mm initially and 3.23 mm at control.


CONCLUSIONS
Similar results of angular deformity were found by other examiners. Their results are also in favor of operative treatment of unstable injuries of Th-L spine. The number of those proclaiming good results of conservative treatment of injures of thoracolumbar spine in patients with initially high values of angular deformity is much less. Willen, Mumford, Andreycik and others using wedge-shaped deformity and sagittal movement of the body as parameters in their studies had similar results as those in this study, and they conclude that the stability of segment is much higher among operated patients and that operative treatment finally ends in better radiological results.


CONCLUSIONS
Radiological results of operative treatment of unstable injuries of thoracolumbar and lumbar spine are better than those of conservative treatment. In order to obtain a stable spine, which is the aim of treatment of unstable spine injuries, operative stabilization is necessary.
Stanković
M
M
Institut za hirurgiju, Klinicki centar, Novi Sad.
Milicić
A
A
Savić
D
D
Milankov
M
M
Kecojević
V
V
Arbutinov
V
V
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000209:etiology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016103:Spinal Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*