Long-term follow-up of nonoperatively treated thoracolumbar spine fractures

Little information is available regarding the long-term results of nonoperative treatment for fractures of the thoracolumbar spine. One thousand six hundred ninety-one fractures of the spine seen at the University of Iowa from 1935 to 1975 were reviewed; 83 fractures met strict inclusion criteria of fractures involving T10–L5. In all cases, nonoperative treatment was the only treatment received. 42 patients (51 per cent) were contacted and completed questionnaires. Twenty (48%) of these 42 patients also returned to University Hospital for a complete physical examination as well as anteroposterior and lateral flexion–extension radiographs. The average time from injury to follow-up was 20.2 years, (range 11–55 years). The average age at follow-up was 43 years (range 28–70). There were 31 men and 11 women. Seventy-one percent of the injuries were the result of motor vehicle accidents. The most common sites of injury were T12–L2, which accounted for 64% of the injuries; 78% of the patients had no neurologic deficits at the time of injury. At follow-up, the average back pain score was 3.5, (0 = no pain at all, and 10 = very severe pain). No patient demonstrated a decrease in neurologic status at follow-up, and no patient required narcotic medication for pain control. Eighty-eight percent of the patients were able to work at their usual level of activity. Follow-up radiographs revealed an average kyphosis angle of 26.4° in flexion and 16.8° in extension. The degree of kyphosis did not correlate with pain or function parameters in the 20 examined patients. Based on this review, nonoperative treatment of thoracolumbar burst fractures remains as a viable alternative in patients without neurologic deficit and can lead to acceptable long term results.