Medical Student Virginia Commonwealth University Department of Neurosurgery Richmond, Virginia, United States
Introduction: The thoracolumbar (TL) junction (T10-L3) is the most common site of spinal fractures, thought to be due to biomechanical stress at the transition from the rigid thoracic spine to the mobile lumbar spine. There is ongoing controversy over the treatment of neurologically intact patients with thoracolumbar fractures. This study aims to investigate the efficacy of utilizing a TLSO brace in patients with various TL fractures based on the AO classification system.
Methods: The VCU Spine Database was queried for patients who had thoracolumbar fractures that were conservatively managed with a TLSO brace between 2010 and 2019. The AOSpine Thoracolumbar Spine Injury Classification System was used to classify these patients’ injuries. Radiographic measurements of anterior height loss of the fractured vertebral body were measured for each patient at their initial visit and average follow-up visit time.
Results: A total of 43 patients were included in this study. The patients had fractures at T11 (2.3%), T12 (25.6%), L1 (55.8%), L2 (11.6%), and L3 (4.7%) levels. Cohort comparisons between AO fracture classes A1/A2, A3, and A4 revealed that there were no statistically significant differences with respect to percent height loss over time. Multivariate linear regression for predictors of percent change in anterior height loss showed a statistically significant contribution of the L3 fracture level (p = 0.025) and the anterior height loss at the time of fracture (p = 0.0039).
Conclusion : This retrospective case series studied clinical and radiographic outcomes of the use of thoracolumbosacral orthoses (TLSO) in patients with thoracolumbar fractures. Even in a TLSO brace, the data suggests fracture level and initial anterior height loss at the time of injury are associated with increased percent height loss over time. Prospective, randomized controlled studies comparing alternative methods of management of thoracolumbar fractures would be helpful to further elucidate the effectiveness of TLSO bracing.
