Prognostic value of an immediate lateral standing X-ray with a TLSO in patients with a thoracolumbar burst fracture

Rev Esp Cir Ortop Traumatol. May-Jun 2015;59(3):179-85. doi: 10.1016/j.recot.2014.08.004. Epub 2015 Jan 7.
[Article in English, Spanish]

Abstract

The final collapse of a "stable" thoracolumbar burst fracture is difficult to predict. This collapse was prospectively studied radiologically in patients with T12 or L1 burst fractures who, after evaluating the admission x-rays and the CT scan with the patients themselves, opted for a rigid thoracolumbar brace with support in the sternal manubrium (TLSO). On the other hand, patients with rigid braces sometimes have low back pain on follow-up (due to overload of the L5-S1 joints).

Hypothesis: the standing lateral x-ray with only a TLSO for support (intrinsic mechanical stability) provides information on the final collapse and could also provide information on the low back pain. The study included 50 patients (20 males and 30 females, age: 63+14 years) admitted during 2011 and 2012, with 2 losses to follow-up.

Variables: Farcy index and local kyphosis (Cobb at 3 vertebrae). X-Rays: admission, with TLSO (immediate: Rx0), and at 3 and 6 months. They were compared with the final clinical and radiological results. It was decided to surgically intervene in 4 patients after Rx0. There were no painful sequelae at the fracture level, and 16/44 (31%) had low back pain. Using linear regression mathematical models, the increase in the Farcy index (Rx0-Rx admission) was associated with the appearance of low back pain and with local kyphosis (Rx0-Rx admission), and with the final kyphosis. It is advisable to perform a lateral standing X-ray after TLSO for information on the final collapse of the fracture and the appearance of accompanying low back pain.

Keywords: Brace; Cifosis; Cifosis postraumática; Colapso; Collapse; Columna vertebral; Dolor lumbar bajo; Fractura toracolumbar; Kyphosis; Low back pain; Ortesis; Post-traumatic kyphosis; Spinal column; Thoracolumbar fracture; Tratamiento; Treatment.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Braces*
  • Female
  • Follow-Up Studies
  • Humans
  • Low Back Pain / etiology
  • Lumbar Vertebrae / diagnostic imaging
  • Lumbar Vertebrae / injuries*
  • Male
  • Middle Aged
  • Patient Positioning / instrumentation
  • Patient Positioning / methods*
  • Posture
  • Prognosis
  • Prospective Studies
  • Spinal Fractures / complications
  • Spinal Fractures / diagnostic imaging*
  • Spinal Fractures / therapy
  • Thoracic Vertebrae / diagnostic imaging
  • Thoracic Vertebrae / injuries*
  • Tomography, X-Ray Computed / methods*