[Non-operative treatment of thoracolumbar spinal fractures. Long-term clinical results over 16 years].

Non-operative treatment of thoracolumbar fractures remains the standard treatment option for stable and slightly unstable spinal injuries at the level of the lower thoracic and lumbar spine. The purpose of the present retrospective study was to determine the outcome and long-term results of patients treated conservatively using either one of the two major non-operative treatment modalities: (1) functional, or (2) closed reduction and immobilisation by cast. The average follow-up time for the 43 patients reviewed was 16.3 years. They showed a radiologic increase in the average kyphosis angle of 5.2 degrees compared to the time of injury. No difference was noted between early functional therapy and treatment with closed reduction and immobilisation by cast. Patients with initial neurologic impairment showed a significant improvement ( P<0.05) in their neurologic status during the follow-up period. Results of validated psychometric questionnaires (SF-36, FSR, VAS-Spinescore) showed the characteristic pattern of a population with chronic back pain. In conclusion, a radiologic increase in the traumatic kyphotic deformity in patients with a non-operative treatment protocol has to be expected. Measurable negative physical and social long-term consequences can be anticipated after sustaining a type-A fracture of thoracolumbar vertebral bodies. Any correlation between radiologic and functional results has not been observed.