Introduction: According to the latest version of the Abbreviated Injury Scale (AIS), all Thoraco-Lumbar Compression Fractures (TLCF) with >20% loss of height, were branded code 3 injuries, reflecting a threat for life or permanent disability. However, clinical observation suggests that that TLCF with <40% loss of height and without neurological deficits, have been noted to have a better clinical prognosis, prompting the need to segregate these injuries differently, revise the classification and review outcomes.
Methods: Charts and radiographs of patients admitted to our institution with isolated TLCF between 2008 and 2015 were reviewed. We collected data on severity of compression, treatment, and long-term outcomes to determine the threshold of permanent injury. Vertebral bodies at the level of fracture were measured both anteriorly and posteriorly, and compared to adjacent segments; percentage compression was calculated.
Results: 1470 patient records were reviewed for this effort of traumatic fractures to the thoracic or lumbar spine. 695 isolated compression fractures were identified, of which 195 were in auto accidents. Ages ranged from 19 to 82, with a male : female ration of 60:40. No patient with compression of less than 40% underwent surgery unless presenting with a neurological deficit. The only patients undergoing surgical treatment without neurologic deficit had compression of 40% or higher; those showed evidence of retropulsion of bone into the spinal canal. Only one patient had long-term pain or required long-term treatment for smaller losses in vertebral body height. The use of orthosis in patients with less than 40% compression was of no value in terms of outcomes. Although there were more TLCF in the non MVA population, outcomes were similar. About 35% of the TLCF in the <40% group did not use a brace. The use of orthosis (thoraco-lumbar spine orthotic device, TLSO) in patients with less than 40% compression was of no value in terms of outcomes, as both the brace and without-brace groups had similar outcomes.
Conclusions: These results are consistent with evolving clinical thinking, resulting in decreasing surgical incidence and orthosis use.
Patient Care: Judicious use of bracing in mild-moderate compression fractures in TL Spine, resulting from MVA.
Learning Objectives: Identify TLCF with implications such as surgery, neurologic deficit, or chronic pain, delineating a more reliable cut-off of fracture severity and morbidity, as well as usefulness of bracing.