NONOPERATIVE TREATMENT OF THORACOLUMBAR FRACTURES

Between 1986 and 1992, 32 thoracolumbar fractures in 32 patients were treated nonoperatively with 4-6 weeks on a rotorest bed followed by br acing with a thoracolumbosacral orthosis for a total of 3-6 months. Th e fractures were classified as 20 burst, six fracture dislocations, fi ve severe compression fractures, and one gunshot wound. There were 12 multilevel. fractures. Nine patients had incomplete neurological injur ies and three had complete neurological injuries. The average age was 36.8 years (range 17-63) and the average follow-up was 22.3 months (ra nge 12-60). Fifty three percent (17/32) of these had multisystem injur ies including visceral trauma and long extremity fractures. There were only two complications; a deep vein thrombosis and a heel ulcer. Neit her of these complications extended the patients' hospital stay. All n ine of those with incomplete neurological injuries improved at least o ne Frankel grade. Fifteen of 24 patients who were employed returned to their previous jobs, and only nine patients had persistent back pain requiring medication. Surgical treatment of thoracolumbar fractures is often favored over conservative treatment in the multitrauma and neur ologically injured patient because of complications related to bedrest . However, by using a rotorest bed and aggressive physical therapy, co nservative treatment may actually result in lower morbidity.