Review Question - QID 2911

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Thoracolumbar Burst Fractures TREATMENT Nonoperative QID: 2911 (OBQ09.98)

QID 2911 (Type "2911" in App Search)

You are seeing a 68-year-old female who fell out of her second story apartment window. She complains of severe low back pain and right buttock pain. Her neurologic exam shows she is an ASIA E. Imaging shows a L3 burst fracture with 10 degrees of kyphosis, 30% loss of vertebral body height, and retropulsion of bone with 20% occlusion of the spinal canal. There is no evidence of edema in posterior ligament complex on MRI. What is the most appropriate treatment?

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Spinal traction with bedrest for a minimum of 6 weeks

52/3734

Spinal orthosis and early mobilization as tolerated

88%

3280/3734

Laminectomy and lateral recess decompression

55/3734

Laminectomy and 4 level posterior instrumented fusion

200/3734

Anterior corpectomy with decompression and staged 4 level posterior instrumented fusion

124/3734

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The clinical presentation is consistent with a lumbar burst fracture in a patient who is neurologically intact and has no evidence of radiographic instability. Spinal orthosis and early mobilization is the most appropriate treatment.

Butler et al. retrospectively reviewed 14 cases of L5 isolated burst fractures without neurological defect (10 nonoperative and 4 operative treatment). The nonoperative group showed superior radiographic (coronal/sagittal balance) and clinical results including pain, work restrictions, and overall satisfaction.

Seybold et al. conducted a retrospective review of 42 patients treated for burst fractures of L3,4, or L5 with and without neurological deficit and found that no patient showed neurological deterioration, regardless of method of treatment. Patients with L3 fractures tended to loose sagittal balance height without change in patient related functional outcome. The overall ability to return to work and achieve good to excellent results did not differ in the patient cohorts. In addition, the rate of repeat surgery was 41% in the surgical cohort, suggesting that surgical management may actually be detrimental to the long term spine health of the patient.