Sagittal range of motion after a spinal fracture: does ROM correlate with functional outcome?

Literature regarding the effect of a spinal fracture and its treatment in terms of resulting spinal range of motion (ROM) is scarce. However, there is need for data regarding sagittal spinal ROM, since many patients who sustain a spinal fracture are concerned about the back mobility they will have after treatment. In addition, the relationship between ROM and impairment is not clear. The literature gives conflicting results. To study spinal ROM after a spinal fracture, we measured thoracolumbar ROM in operatively and non-operatively treated patients (n=76, average 3.7 years follow-up) as well as controls (n=41). In order to study the relation between ROM and subjective back complaints, we calculated the correlation between thoracolumbar ROM and scores derived from the VAS spine score and RMDQ. To assess impairment after a spinal fracture, we compared RMDQ and VAS scores between operatively and non-operatively treated patients and healthy controls. Operatively treated patients were found to have lower thoracolumbar ROM than controls (56.7 degrees vs 70.0 degrees , respectively; p<0.01). There was no difference between operatively treated and non-operatively treated patients (56.7 degrees vs 62.7 degrees , respectively); nor was a difference found between non-operatively treated patients and controls. Correlation between ROM and subjective impairment was very weak and only significant for ROM and RMDQ scores in the whole study group (rho= -0.25; p<0.01). Patients were more impaired than controls, there was no difference between operatively and non-operatively treated patients (VAS score 76.3 vs 72.6; RMDQ score 4.5 vs 4.4, respectively). We conclude that patients treated operatively for a thoracolumbar spinal fracture have a lower thoracolumbar ROM than controls. Spinal ROM, however, does not influence impairment. A spinal fracture results in impairment, no matter what therapy is chosen.