Outcomes in Thoracolumbar Burst Fractures With a Thoracolumbar Injury Classification Score (TLICS) of 4 Treated With Surgery Versus Initial Conservative Management
| Autor: | Frank Kortbeek, Andrew S. Jack, Ihsan Ihsanullah, Andrew Nataraj, Shawn Nomani, Richard Fox |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Visual analogue scale Conservative Treatment Thoracic Vertebrae 03 medical and health sciences symbols.namesake 0302 clinical medicine Burst fracture Medicine Humans Orthopedics and Sports Medicine Fisher's exact test Aged Retrospective Studies 030222 orthopedics Univariate analysis Lumbar Vertebrae business.industry Retrospective cohort study Middle Aged medicine.disease Surgery Oswestry Disability Index symbols Injury Severity Score Regression Analysis Spinal Fractures Female Neurology (clinical) business 030217 neurology & neurosurgery Cohort study |
| Zdroj: | Clinical spine surgery. 31(6) |
| ISSN: | 2380-0194 |
| Popis: | Study design This is a single-center, retrospective, observational cohort study. Objective To determine whether surgery or nonoperative treatment has better clinical outcomes in neurologically intact patients with an intermediate severity thoracolumbar burst fracture. Summary of background data Optimal management, whether initial operative or nonoperative treatment, for thoracolumbar injury classification score (TLICS) 4 burst fractures remains controversial. Better insight into the treatment which affords patients a better clinical outcome could significantly affect patient care. Materials and methods This retrospective study included consecutive cases of TLICS 4 burst fracture patients from 2007 to 2013 and minimum 6-month follow-up. Potential confounders examined included age, sex, injury severity score, initial kyphotic angle, injured facets, and interspinous widening. Outcomes were determined by standardized questionnaires [Oswestry Disability Index (ODI), 12-item Short Form Physical Component Score (SF-12 PCS), and back pain Visual Analog Scale (VAS)] and analyzed using regression analysis. Results A total of 230 patients with burst fractures were identified, of which 67/230 (29%) were TLICS 4 and 47/67 (70%) had completed follow-up. No difference on univariate analysis was found between nonsurgical and surgical groups in mean ODI scores (P=0.27, t test), nor mean time to return to work (P=0.10, t test).Regarding outcomes, linear regression analysis revealed no association between having surgery and ODI (P=0.29), SF-12 PCS (P=0.59), or VAS (P=0.33). Furthermore, no difference was found between groups for employed patients working versus not working (P=0.09, the Fisher test), nor in mean time to return to work (P=0.30, Cox regression). Conclusions This is one of the largest studies examining TLICS 4 burst fracture patients, adjusting for both clinical and radiologic confounders and reporting patient outcomes with minimum 6-month follow-up. No differences were found in outcomes between patients treated either surgically or nonsurgically. Studies focusing on early postoperative differences or cost-effectiveness might help in decision making. Level of evidence Level III. |
| Databáze: | OpenAIRE |
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