Treatment of thoracolumbar trauma: comparison of complications of operative versus nonoperative treatment.

The complications from the acute hospital stays of 235 patients with unstable thoracolumbar fractures were reviewed and compared based on patients who underwent surgical stabilization and those treated with an aggressive nonoperative course of 6 weeks on a kinetic bed. Complications such as deep venous thromboses, pulmonary emboli, and decubitus occur in patients with spine trauma. The perception is that surgical intervention decreases such complications and allows for earlier mobilization. The authors sought to determine the actual rate of occurrence and compare the groups for surgical and nonoperative complications. Two hundred thirty-five charts were reviewed. One hundred seventeen patients were treated with surgical stabilization, and 118 patients were treated with a nonoperative course of 6 weeks on a kinetic bed. Complications were assessed from the medical record. There was no significant difference in the occurrence of decubitus, deep venous thromboses, pulmonary emboli, or mortality between the two groups. Deep wound infections occurred in 8% of the operative cases. The length of stay was 24 days longer in the nonoperative group. Both operative and nonoperative treatments of thoracolumbar fractures are viable alternatives. The complication rates are similar, with the exception of wound infection. The length of hospital stay is longer in the nonoperative group. The selection of treatment method remains a matter of controversy.