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Year : 2020  |  Volume : 12  |  Issue : 1  |  Page : 79-85

Outcome of nonoperative management of thoracolumbar burst fractures without neurological deficits – An analysis

1 Department of Orthopaedics, S.C.B. Medical College and Hospital, Cuttack, Odisha, India
2 Department of Orthopedics, S.C.B. Medical College, Cuttack, Odisha, India

Correspondence Address:
Dr. Satyajeet Ray
C/O - Dr. A. K. Ray, Friends Colony, BK Road, Cuttack - 753 001, Odisha
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jotr.jotr_2_20

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Study Design: This was a prospective cohort study. Background: Despite being common injury, management of thoracolumbar burst fractures without neurological deficit remains an enigma. Proponents of surgery showed the debatable advantages of canal clearance, better kyphosis correction, and prevention of neurological deterioration. This study aims to review the outcome of conservative management in these injuries. Materials and Methods: Thirty adult patients of burst fractures of the thoracolumbar spine without neurological deficits, kyphosis angle of <30°, and doubtful posterior ligamentous complex (PLC) lesions irrespective of loss of vertebral body heights were managed with bed rest and spinal bracing with an average follow-up period of 25 months. Results: Radiologically, the kyphosis angle changed from an average of 17.9° at initial presentation to 21.3° in the final follow-up. We also observed an improvement of mean kyphosis angle of 2.6° in 23% of our patients. Anterior vertebral body compression (AVC) percentage, which was 40.83% initially after injury, increased to 44.09% at the final follow-up. Five patients (16.6%) had initial AVC of more than 50% and 10 (33%) had doubtful PLC injuries. The functional outcome scores at the final follow-up using median values of the Visual Analog Scale, Oswestry Disability Index, and Roland-Morris Score were 2, 15%, and 6, respectively. There was no progression of neurological deficit in any case. Conclusion: Thoracolumbar spine burst fractures without neurological deficits can be managed conservatively with good functional outcome without any significant increase in kyphosis or neurological deterioration eliminating risks and cost associated with surgery.

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