Abstract
BackgroundThe treatment of AOSpine A3 and A4 fractures is controversial with no consensus regarding their management in the absence of neurologic deficits. While conservative management with spinal orthosis is a reasonable treatment option, it is believed to run the risk of progressive segmental kyphosis.MethodologyA retrospective chart review was conducted of all patients undergoing treatment for thoracolumbar burst fractures from T11 to L2. Patients treated with conservative management with lumbar orthosis were included. Upright radiographs at the time of presentation and the one-year follow-up were compared.ResultsIn total, 112 patients were evaluated as being treated with thoracolumbar orthosis. Of these, 61 patients presented with A3 fractures compared with 51 who presented with A4 fractures. Of these, two patients in each group failed conservative management and required surgical intervention. At the one-year follow-up, A3 fractures demonstrated an average change in Cobb angle of 4.1 degrees compared with 6.1 degrees in A4 fractures (p = 0.021). In addition, A4 fractures demonstrated a significantly worse kyphotic angle and Gardner angle at the one-year follow-up (p = 0.05 and p = 0.026, respectively).ConclusionsA3 and A4 fractures can be safely treated with orthosis with overall low rates for failure; however, A4 fractures result in significantly worse segmental kyphosis at the one-year follow-up.
Highlights
Burst fractures account for approximately 10-20% of all spine fractures, with approximately two-thirds of these fractures occurring at the thoracolumbar junction [1,2]
112 patients were evaluated as being treated with thoracolumbar orthosis
61 patients presented with A3 fractures compared with 51 who presented with A4 fractures
Summary
Burst fractures account for approximately 10-20% of all spine fractures, with approximately two-thirds of these fractures occurring at the thoracolumbar junction [1,2]. Given the variability in the treatment of burst fractures, several classification systems have been developed. While the Thoracolumbar Injury Classification and Severity (TLICS) score is popular given its recommendation for a treatment option, it is often criticized for its ambiguity regarding burst fractures without neurologic deficit. The AOSpine Classification system is more descriptive; it does not provide treatment recommendations for surgical versus conservative management [3,4]. We evaluate AOSpine A3 and A4 burst fractures without neurologic deficits treated with an orthosis. The treatment of AOSpine A3 and A4 fractures is controversial with no consensus regarding their management in the absence of neurologic deficits. While conservative management with spinal orthosis is a reasonable treatment option, it is believed to run the risk of progressive segmental kyphosis
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
