MANAGEMENT OF THORACOLUMBAR FRACTURES

Abstract

Thoracolumbar fractures are the most common spinal injuries encountered in practice, they are most commonly traumatic due to fall from height, road traffic accident and sports injuries, or less commonly spontaneous non traumatic pathological fractures. The aim of different treatment modalities is achieve early ambulation and regain of normal physical activity. The goal of surgery is to decompress neural structures and stabilize the spine. The goal of conservative treatment is regain of normal life and avoidance of surgery related complications in patients with stable thoracolumbar fractures. The aim of this prospective study is to evaluate the indications and results of different methods of treatment of thoracolumbar fractures and to evaluate the clinical outcome of different treatment modalities. Forty patients were involved in this study, twenty patients undergone conservative management and twenty patients undergone surgery most of them posterior transpedicular fixation with or without laminectomy and followed over aperiod of 2 years. The fractured level was highest in D12 and L1 (each 35%) followed by L2 (25%) and was least in D11 (5%). Most of cases are caused by falling from height (50 %) followed by road traffic accident (42.5 %) and least due to osteoporotic spontaneous fracture (7.5 %). Most of fracture type was wedge fracture (50 %) followed by Burst (27.5%) followed by shear (15 %) and the least was hyperextension fracture (7.5 %). Most of cases were neurologically intact (77.5 %) at the time of insult the rest of patients had impaired ASIA scale. No statistical difference was found between conservative and surgical groups regarding impairment scale after the follow up. The neurological status was not affected by treatment and was affected by the insult and proper and early surgical decompression. Gradual pain reduction was equal in both surgical and conservative group after follow up.