SPONTANEOUS REMODELING OF THE SPINAL-CANAL AFTER CONSERVATIVE MANAGEMENT OF THORACOLUMBAR BURST FRACTURES

Study Design. Forty-two conservatively treated patients with a burst f racture of the thoracic, thoracolumbar, or lumbar spine with more than 25% stenosis of the spinal canal were reviewed more than 1 year after injury to investigate spontaneous remodeling of the spinal canal. Obj ectives. To investigate the natural development of the changes in the spinal canal after thoracolumbar burst fractures. Summary of the Backg round Data. Surgical removal of bony fragments from the spinal canal m ay restore the shape of the spinal canal after burst fractures. Howeve r, it was reported that restoration of the spinal canal does not affec t the extent of neurologic recovery. Methods. Using computerized tomog raphy, the authors compared the least sagittal diameter of the spinal canal at the time of injury with the least sagittal diameter at the fo llow-up examination. Results. Remodeling and reconstitution of the spi nal canal takes place within the first 12 months after injury. The mea n percentage of the sagittal diameter of the spinal canal was 50% of t he normal diameter (50% stenosis) at the time of the fracture and 75% of the normal diameter (25% stenosis) at the follow-up examination. Th e correlation was positive between the increase in the sagittal diamet er of the spinal canal and the initial percentage stenosis. There was a negative correlation between the increase of the sagittal diameter o f the spinal canal was not influenced by the presence of a neurologic deficit. Conclusion. Conservative management of thoracolumbar burst fr actures is followed by a marked degree of spontaneous redevelopment of the deformed spinal canal. Therefore, this study provides a new argum ent in favor of the conservative management of thoracolumbar burst fra ctures.