Long Term Results of Treating Thoracolumbar Burst Fractures With or Without Orthosis

Journal of Neurosurgery: Spine

External orthosis application for AO type 3 burst fractures in neurologically intact patients is considered a treatment option with unknown benefit. This study presents long-term follow-up results (mean 7.9 ± 1.1 years) on a subset of patients (n = 20 without and n = 16 with TLSO) from an initial randomized multicenter cohort of 96 neurologically intact adults with T10-L3 AO type 3 fractures and kyphosis <35 degrees. There were no differences in Roland Morris Disability Questionnaire (4.8±1.5 versus 3.6±0.9; p 0.486) and pain scores (2.9±0.7 versus 2.1±0.6; p 0.378) in the without and with TLSO groups, respectively. Similarly, no differences in the SF-12 physical component (45.0±3.8 versus 46.5±3.2; p 0.778) and mental component (55.2±2.4 versus 55.8±2.1; p 0.868) subscores, and satisfaction (5.6±0.5 versus 6.5±0.4; p 0.113) were noted between the two groups at long-term follow-up. Further, no time-weighted average treatment effect differences were observed for the above scores. Finally, average kyphosis was similar between the two groups (18.6°±3.8° versus 18.3°±2.2° for the without and with TLSO groups; p 0.934). Patients in this partial cohort had improved clinical outcomes in the first year with no further change over long-term follow-up time periods, irrespective of external orthosis treatment. This study provides valuable insight into long-term outcomes of non-surgically managed AO type 3 fracture patients.   


H. Francis Farhadi, MD, PhD
Columbus, OH
Vibhu K. Viswanathan, MBBS
Columbus, OH