Philipp Georg Schnadthorst1, Celine Lankes2, Christoph Schulze3,2. 1. Zentrum für Sportmedizin der Bundeswehr, Dr.-Rau-Allee 32, 48231, Warendorf, Deutschland. philippschnadthorst@bundeswehr.org. 2. Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Doberaner Str. 142, 18057, Rostock, Deutschland. 3. Zentrum für Sportmedizin der Bundeswehr, Dr.-Rau-Allee 32, 48231, Warendorf, Deutschland.
Abstract
BACKGROUND: Trauma-related fractures of the thoracic and lumbar spine occur after exposure to high kinetic energy. To assign patients to the correct kind of treatment the AO spine classification is used. OBJECTIVE: The aim was to describe the role of orthotic devices in the treatment of thoracic and lumbar fractures in the nondegenerative spine. MATERIAL AND METHODS: A review of the literature was carried out according to the PRISMA protocol (Preferred Reporting Items for Systematic reviews and Meta-Analyses) in PubMed, ScienceDirect, Cochrane and Google.Scholar. A total of 118 potentially important publications were found and 16 studies with a prospective study design could be included in this analysis. RoB 2 (Cochrane Risk of Bias tool in the second Version) in the case of randomized studies and the ROBINS‑I (Risk Of Bias In Nonrandomised Studies of Interventions) for nonrandomized studies were used to assess publication quality. The level of evidence was determined according to AHCPR (Agency for Health Care Policy and Research). RESULTS: In the case of fractures (AO types A0-A3) without degenerative changes in the bone structure of the thoracic and lumbar spine without indications for operative procedure, conservative treatment with analgesia, physiotherapy and early mobilization is recommended and orthotic treatment is not superior. Surgical treatment, even in cases where conservative treatment was possible, led to improved functionality and pain sensation faster but there were no differences in the long-term results. Assessing the neurological functional deficit, the functional success of the treatment and the kyphosis angle were measured in different ways, reducing the extent of comparability. Although mainly a level of evidence Ib-IIa could be assigned, nearly all included studies had a high risk of bias. CONCLUSION: In individual cases treatment with an orthotic device could be a helpful add-on in conservative treatment of fractures in the thoracic and lumbar spine. A treatment with orthotic devices alone cannot be recommended in these cases.
BACKGROUND: Trauma-related fractures of the thoracic and lumbar spine occur after exposure to high kinetic energy. To assign patients to the correct kind of treatment the AO spine classification is used. OBJECTIVE: The aim was to describe the role of orthotic devices in the treatment of thoracic and lumbar fractures in the nondegenerative spine. MATERIAL AND METHODS: A review of the literature was carried out according to the PRISMA protocol (Preferred Reporting Items for Systematic reviews and Meta-Analyses) in PubMed, ScienceDirect, Cochrane and Google.Scholar. A total of 118 potentially important publications were found and 16 studies with a prospective study design could be included in this analysis. RoB 2 (Cochrane Risk of Bias tool in the second Version) in the case of randomized studies and the ROBINS‑I (Risk Of Bias In Nonrandomised Studies of Interventions) for nonrandomized studies were used to assess publication quality. The level of evidence was determined according to AHCPR (Agency for Health Care Policy and Research). RESULTS: In the case of fractures (AO types A0-A3) without degenerative changes in the bone structure of the thoracic and lumbar spine without indications for operative procedure, conservative treatment with analgesia, physiotherapy and early mobilization is recommended and orthotic treatment is not superior. Surgical treatment, even in cases where conservative treatment was possible, led to improved functionality and pain sensation faster but there were no differences in the long-term results. Assessing the neurological functional deficit, the functional success of the treatment and the kyphosis angle were measured in different ways, reducing the extent of comparability. Although mainly a level of evidence Ib-IIa could be assigned, nearly all included studies had a high risk of bias. CONCLUSION: In individual cases treatment with an orthotic device could be a helpful add-on in conservative treatment of fractures in the thoracic and lumbar spine. A treatment with orthotic devices alone cannot be recommended in these cases.
Authors: Steven Boonen; Jan Van Meirhaeghe; Leonard Bastian; Steven R Cummings; Jonas Ranstam; John B Tillman; Richard Eastell; Karen Talmadge; Douglas Wardlaw Journal: J Bone Miner Res Date: 2011-07 Impact factor: 6.741
Authors: Christopher S Bailey; Jennifer C Urquhart; Marcel F Dvorak; Melissa Nadeau; Michael C Boyd; Ken C Thomas; Brian K Kwon; Kevin R Gurr; Stewart I Bailey; Charles G Fisher Journal: Spine J Date: 2013-10-31 Impact factor: 4.166
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