[Long-term results of conservative treatment for thoracolumbar compression fractures].
OBJECTIVE
We evaluated the radiologic and clinical outcomes of conservative treatment for thoracolumbar compression fractures.


METHODS
Forty-three patients (28 males, 15 females; mean age 39 years; range 24 to 54 years) were treated conservatively for 47 thoracolumbar compression fractures. All the patients were assessed by plain radiograms and computed tomography. According to the Denis classification, there were eight type A, 20 type B, 12 type C, and seven type D fractures. Involvement was at L1 in 30, L2 in five, and T12 in 12 fractures. There were no neurological deficits. Treatment involved use of a body cast for two months, followed by a thoracolumbosacral orthosis for four months. Radiographically, local kyphosis angle and sagittal index were measured before treatment, after casting, and at the final follow-ups. Pain and functional scales proposed by Denis et al. were also utilized. The mean follow-up was 7.5 years (range 6 to 11 years).


RESULTS
The mean local kyphosis angle and sagittal index were measured as 12.6 and 13.7 degrees before treatment, and 5.9 and 7.0 degrees after casting, respectively (p<0.05). However, both did not differ significantly from the baseline at the final measurements (12.7 and 13.9, respectively; p>0.05). The mean pain and functional scores were 1.4 and 1.6, respectively. Four patients had moderate to severe back pain despite mean kyphosis angles of 12 (baseline), 13.5 (after casting), and 14.8 (final). Two patients required substitution of the body cast for orthosis due to excessive sweating, and three patients received local treatment for skin problems secondary to the use of orthosis.


CONCLUSIONS
If the kyphosis angle is less than 30 degrees, compression fractures are supposed to be stable to be treated conservatively with satisfactory clinical results. Functional results seem to be unaffected from the fact that casting does not improve radiographic parameters in the long-term.
Department of Orthopedics and Traumatology (Ortopedi ve Travmatoloji Kliniği), Okmeydani Training and Research Hospital, Istanbul, Turkey. mtonbul@gmail.com
Murat
M
Tonbul
Mehmet Reşat
MR
Yilmaz
Mehmet Uğur
MU
Ozbaydar
Müjdat
M
Adaş
Egemen
E
Altan
D000328:Adult; D001416:Back Pain / Q000453:epidemiology / Q000209:etiology; D002370:Casts, Surgical; D005260:Female; D005500:Follow-Up Studies; D017102:Fracture Healing; D050815:Fractures, Compression / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009989:Orthotic Devices; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging* / Q000473:pathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult