Predictors of Recovery After Conservative Treatment of AO-Type A Thoracolumbar Spine Fractures Without Neurological Deficit.
METHODS
Prospective, correlational, exploratory, clinical research.


OBJECTIVE
To identify the factors determining a patient's recovery after conservative treatment of compression fractures of the thoracolumbar spine.


BACKGROUND
The reported results of compression fractures are poor. These results are not influenced by the severity of compression, the fracture site, or the residual deformity. Otherwise, the factors that determine a patient's recovery are unknown.


METHODS
In 48 conservatively treated patients the preinjury versus the 12-month follow-up differences (Δ) in back pain (visual analogue scale for pain), Oswestry disability index (ODI), and the Greenough and Fraser low back outcome scale were prospectively recorded. For these differences and for time lost from work and satisfaction, multiple linear regressions with combinations of 16 factors were performed.


RESULTS
At 1 year, patients with an income-insurance were 9% (P = 0.096) more disabled than those without. They reported a 15% less favorable global outcome and 27% less participation. Smokers were 13% (P = 0.010) more disabled and 11% (P = 0.044) less satisfied. With each increase of the AO-fracture type from A1 to A3 the disability was 8% worse. Patients with pre-existent chronic low back pain (CLBP) returned two points (on a visual analogue scale [VAS] pain total of 10) more closely (P = 0.041) to their preinjury pain level than those without but were 21% (P = 0.001) less satisfied. Our model offers an explanation for more than 25% of the variability of ΔODI and of the satisfaction. For sick leave, no significant predictors were found.


CONCLUSIONS
Smoking and insurance status are the strongest negative predictors for recovery. LBP patients returned more closely to their preinjury back pain level, but were less satisfied. The AO fracture type had a marked influence on disability, the sagittal deformity had not. The time lost from work did not depend on patient or injury-related factors.


METHODS
N/A.
Vorlat
Peter
P
Department of Orthopedics, Mariaziekenhuis, Overpelt, Belgium.
Leirs
Geert
G
Department of Orthopedics, Mariaziekenhuis, Overpelt, Belgium.
Tajdar
Farhad
F
Department of Orthopedics, AZ Sint-Lucas Brugge, Belgium.
Hulsmans
Heinz
H
Department of Orthopedics, Universitair Ziekenhuis Brussel, Brussel, Belgium.
De Boeck
Hugo
H
Department of Orthopedics, ZNA Middelheim Antwerpen, Belgium.
Vaes
Peter
P
Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussel, Belgium.
D000328:Adult; D000368:Aged; D000072700:Conservative Treatment; D006233:Persons with Disabilities; D005260:Female; D050815:Fractures, Compression / Q000628:therapy*; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011379:Prognosis; D011446:Prospective Studies; D016103:Spinal Fractures / Q000628:therapy*; D013904:Thoracic Vertebrae / Q000293:injuries*; D016896:Treatment Outcome