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Review Question - QID 8008

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QID 8008 (Type "8008" in App Search)
A 35-year-old rock climber sustains an L1 burst fracture from a 30-foot fall while climbing. He sustained no other fractures or serious injuries. He is neurologically intact and has minimal posterior tenderness without increased spinous process separation on examination. Radiographs reveal kyphosis of 20 degrees between T12 and L2 with 30% vertebral height loss. A CT scan shows 55% canal compromise. What is the most appropriate management?

Bed rest for 6 weeks, followed by a thoracolumbosacral orthosis (TLSO) until the fracture is healed

4%

45/1280

TLSO and or body cast for 3 to 6 months with mobilization when comfortable

58%

741/1280

Posterior spinal fusion and instrumentation

20%

255/1280

Anterior decompression with spinal fusion and instrumentation

9%

110/1280

Anterior decompression and anterior-posterior spinal fusion and instrumentation

9%

120/1280

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Wood and associates have shown that the use of a TLSO or a body jacket was equally effective as surgery for the treatment of thoracolumbar burst fractures without neurologic deficit. The only difference in any of the measured parameters (including pain, functional outcome, residual canal compromise, and kyphosis) was a decreased complication rate in the nonsurgical group compared with the surgical group. The maximum time to mobilization in the nonsurgical group was 5 days.

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