Operative versus conservative treatment of fractures of the thoracolumbar spine

A total of 86 patients suffering from fractures of the thoracolumbar spine were followed up after an average time period of 57 months (12-98). Of thes e patients, 56 were treated operatively and 30 conservatively. According to the AO/ASIF classification, 66% of the operated group were fractures of ty pe A, 29% of type B, and 5% of type C. All patients were operated on by mea ns of dorsal locking instrumentation with pedicular fixation and, apart fro m six patients, with transpedicular cancellous bone grafting. The conservat ive group was treated according to the guidelines of Bohler with closed red uction, plaster cast, and rehabilitation program. All fractures in the cons ervative group were of type A. At follow-up of all operated cases, the local gibbus angle had improved by a reduction of on average 18.6 degrees and was followed by a loss of correc tion of 12.5 degrees ending in a final gain of 6.1 degrees at follow-up. At follow-up of the conservatively treated cases,the local gibbus angle showe d an improvement of 11.1 degrees at reduction and a loss of correction of 1 4.9 degrees after reduction. The remaining result was -3.6 degrees that mea ns an increase of kyphoses compared to the x-ray at admission. In order to be able to compare two homogeneous groups only fractures of type A were use d. Comparison of the two groups showed an improvement of the vertebral body angle of 70% (11.3 degrees) after reduction in the surgical group and 46% (6.1 degrees) in the conservatively treated group. The subsequent loss of c orrection was 19% (3 degrees) in the surgical and 34% (4.5 degrees) in the conservatively treated group. The remaining gain at follow-up was 51% (8.3 degrees) in the surgical and only 12% (1.6 degrees) in the conservative gro up. The local gibbus angle had improved on average by 17.1 degrees after re duction in the surgical and by 11.1 degrees in the conservatively treated g roup. Loss of correction was 71% (12.2 degrees) and 132% (14.9 degrees), re spectively. The final result at follow-up showed a decrease of kyphosis of 4.9 degrees in the surgical and an increase of kyphosis of 3.7 degrees in t he conservatively treated group. The difference was significant. Within the surgical group, 75% of the loss of correction was caused by the discs and 25% by the vertebral body. in the conservatively treated group it was 69% a nd 31%, respectively Concerning loss of correction, no difference was seen between patients with and without intercorporal bone grafting. There was no relationship between radiological and clinical outcome. Wherea s 15% of the patients of the surgical group were not satisfied or moderatel y satisfied with the result, all patients in the conservatively treated gro up were satisfied or very satisfied. Based on the good clinical results of the conservative treatment we can conclude that in stable fractures without severe deformity, and in patients who are in bad general condition, conser vative treatment can considered as an alternative to surgical treatment.