A pilot evaluation of the role of bracing in stable thoracolumbar burst fractures without neurological deficit.
METHODS
Prospective, 2-center, observer-blinded, randomized controlled trial.


OBJECTIVE
Investigate clinical and radiologic outcomes of bracing versus no-bracing in the treatment of stable thoracolumbar burst fractures.


BACKGROUND
Management of thoracolumbar burst fractures depends upon clinical presentation of neurological deficit and radiographic features of fracture severity. Neurologically intact patients with mild deformity and biomechanical stability may be treated with conservative therapy.


METHODS
Patients with stable (AO type A3), single level, thoracolumbar burst fractures between T12 and L2 with no neurological deficit were randomized to nonoperative treatment with a customized thoracolumbosacral orthosis (TLSO) or no-brace. Self-reported clinical outcomes of pain, disability, and health-related quality of life, and radiographic outcomes of kyphotic progression and loss of vertebral height, assessed by 2 independent reviewers blinded to treatment group, were measured at 6 months follow-up.


RESULTS
Twenty-three consecutive eligible patients were included (TLSO: n=12; no-brace: n=11). There were no between-group differences regarding level of injury (P=0.75) and baseline spine geometry including fractional canal compromise (P=0.49), anterior loss of vertebral body height (P=0.28), and sagittal Cobb angle (P=0.13). In-hospital stay was significantly shorter in the no-brace group (mean: 2.8±3.0 d) compared with the TLSO group (mean: 6.3±2.1 d; P=0.004). At follow-up there were no differences in anterior loss of vertebral body height (TLSO: 12.5%±10.2% vs. no-brace: 11.9%±8.1%; P=0.88), kyphotic progression (TLSO: 5.3±4.4 degrees vs. no-brace 5.2±3.6 degrees; P=0.93), adverse events, or self-reported clinical outcomes.


CONCLUSIONS
Neurologically intact patients with stable thoracolumbar burst fractures treated with or without bracing had similar radiographic and clinical outcomes at 6 months follow-up. The no-brace group had shorter in-hospital lengths of stay. Conservative therapy involving early mobilization without brace immobilization may be warranted. Further studies with a larger series of patients and longer follow-up are required for conclusive findings.
*Division of Neurosurgery, University of Toronto, Toronto Western Hospital, Toronto †Clinical Epidemiology Program, Ottawa Hospital Research Institute ‡University of Ottawa Spine Program §Division of Orthopaedic Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, ON ∥Division of Orthopaedic Surgery, McGill University Health Centre, Montreal General Hospital, Montreal, QC, Canada.
Mohammed F
MF
Shamji
Darren M
DM
Roffey
Darryl K
DK
Young
Rudy
R
Reindl
Eugene K
EK
Wai
D000328:Adult; D000368:Aged; D001915:Braces; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000601:surgery; D007902:Length of Stay; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D011788:Quality of Life; D011859:Radiography; D016037:Single-Blind Method; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D015599:Trauma Severity Indices; D016896:Treatment Outcome