Late outcome of nonoperative management of thoracolumbar vertebral wedge fractures.

OBJECTIVES

To study the medical and social outcome of nonoperative management of traumatic thoracolumbar vertebral wedge fractures in the absence of neurologic damage.

DESIGN

Retrospective review of data, as elicited from records and from patients.

SUBJECTS AND

METHODS

We retrieved the hospital records of 85 consecutive patients who conformed to the foregoing definition and whose admission for fracture had taken place at least 3 years earlier. The current status of each patient was inquired into by a mailed questionnaire designed to determine: 1) presence and severity of back pain; 2) presence and magnitude of overall disability; and 3) current work capacity, postinjury employment history, and history of litigation concerning the injury. Using the last radiographs of the spine, measurements were taken of anterior column deformity (Willen formula) and degree of local, fracture-related kyphosis (lateral angle of Cobb). Correlations between paired variables and group comparisons with respect to means of pain indices were analyzed statistically by analysis of variance (chi 2) and regression analysis.

RESULTS

Chronic pain predominant in the lower lumbar area was reported in 69.4% of subjects. Mean pain index was 2.94 +/- 2.67 on a scale of 1 to 10. The mean overall disability score was 56.3 +/- 14.2 on a scale of 1 to 100. Pain intensity was correlated with angle of local kyphosis (p = 0.04) but not with magnitude of anterior column deformity. Twenty-five percent of the subjects had changed jobs, mostly from full- to part-time employment. Forty-eight percent of patients who filed lawsuits concerning their injury versus 11% of those who did not (p = 0.04) were absent from work for > or = 6 months.

CONCLUSIONS

Traumatic, uncomplicated thoracolumbar wedge fractures of the vertebral body, below given limits of local kyphosis and anterior column deformity, are adequately managed by a limited period of bed rest alone. Surgery, bracing, and intensive physiotherapy are not indicated.