A study of operative and non - operative management of dorsolumbar spine fracture (A study OF 40 cases)

Abstract

In an epidemiological study traumatic injury to the thoracolumbar area constitute of 75% of total back skeletal injuries. Most of these injuries comprises of thoracolumbar segment of the spine (t10 to l2), also high incidence of neurological deficits is associated with thoracolumbar fractures. Numerous classifications were proposed on an anatomical basis to guide the management of TL fractures and define the indications for surgery but none of these classification systems have taken into account the stabilizing effect of para- spinal muscles. The aim of this article is to review the present literature on evidence of management of TL fractures using operative versus conservative techniques. 40 patients with dorsolumbar spine injuries falling into inclusion criteria were managed with conservative and operative intervention between December 2008 to January 2010. 16 patients were treated with operative intervention with short or long segmented fixation & fusion with bone grafts.24 patients were treated non operatively with DLSO brace and kept immobilised for 4-6 weeks. The maximum period of follow up was 18 to 24 months with a minimum period of follow up of 9 to 12 months. At follow up on regular check of neurological status, 50% of operatively treated patients were showing improvement. Patients treated non operatively had no or occasional pain according to pain score. 10 patients had excellent score treated operatively while 12 patients had good score. 8 patients treated non operatively had good to fair score according to grading for neurological improvement by SRS (scoliosis research society). Surgical intervention should be advocated in cases of unstable burst fractures of the dorsolumbar region, irrespective of status of neurological damage, but might be restricted in the patients with incomplete spinal cord injuries.