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.