Nonoperative treatment versus posterior fixation for thoracolumbar junction burst fractures without neurologic deficit.

摘要

STUDY DESIGN: A prospective clinical trial was conducted. OBJECTIVE: To compare the results of nonoperative treatment versus short-segment posterior fixation using pedicle screws. SUMMARY OF BACKGROUND DATA: A previous study showed that nonoperative treatment with early mobilization produced good results, even when the posterior column was involved. METHODS: This study involved 80 patients. Inclusion criteria required the following: neurologically intact patient, single-level closed burst fracture involving T11-L2, no fracture dislocations or pedicle fractures, age of 18 to 65 years (nonpathologic adult), and no other major organ system or musculoskeletal injuries. Patients in the nonoperative group (n = 47) were allowed activity to the point of pain tolerance beginning on the day of injury using a hyperextension brace. Patients in the operative group (n = 33) underwent three-level, (one above, one at fracture level, and one below) fixation using VSP or TSRH instrumentation. The follow-up period was 2 years. RESULTS: The surgical group had less pain up to 3 months and a better Greenough Low Back Outcome Score up to 6 months, but the outcome was similar afterward. No neurologic deficit in any patient. In the nonoperative group, the kyphosis angle worsened by 4 degrees, and the retropulsion decreased from 34% to 15%. In the operative group, there was one case of superficial infection and two cases of broken screws. The kyphosis angle was improved initially by 17 degrees, but this was gradually lost. Hospital charges were four times higher in the operative group. CONCLUSIONS: Short-segment posterior fixation provides partial kyphosis correction and earlier pain relief, but the functional outcome at 2 years is similar. Early activity to the point of pain tolerance can be safely allowed.