MANAGEMENT OPTIONS IN THORACOLUMBAR BURST FRACTURES

BACKGROUND Both surgery and recumbency have been adopted in the treatm ent of spinal fractures. Herein we present the indications for each, a nd our experience with thoracolumbar junction (T12, L1 and L2) burst f ractures. METHODS Sixty-eight patients with thoracolumbar burst fractu res were treated operatively in 36 cases, and nonoperatively in 32 wit h recumbency for 1-6 weeks. Treatment was based on clinical and radiol ogical criteria. Eighty-one percent of the recumbency patients, but on ly 14% of the surgical patients were intact on admission. Patients wer e followed for a mean +/- SD of 9 +/- 10 months in the recumbency grou p, and 21 +/- 21 months in the surgical group. RESULTS Neurological im provement and progressive angular deformity occurred in both groups. T he cost of recumbency in our patients was nearly half that of those wh o required surgery, though the length of hospitalization between the t wo groups was similar at 1 month +/- 2 weeks. CONCLUSION The above stu dy emphasizes that the selection of operative versus nonoperative trea tment in burst fractures should not be random but based on clinical as well as radiological criteria. Recumbency is favored in patients who are intact, with angular deformity less than 20 degrees, a residual sp inal canal greater than 50% of normal, and an anterior body height exc eeding 50% of the posterior height. Surgical intervention is generally indicated in patients with partial neurological deficit, and those wi th severe instability. (C) 1998 by Elsevier Science Inc.