Early mobilisation of thoracolumbar burst fractures without neurology A NATURAL HISTORY OBSERVATION

Aims The authors present the results of a cohort study of 60 adult patients presenting sequentially over a period of 15 years from 1997 to 2012 to our hospital for treatment of thoracic and/or lumbar vertebral burst fractures, but without neurological deficit. Method All patients were treated by early mobilisation within the limits of pain, early bracing for patient confidence and all progress in mobilisation was recorded on video. Initial hospital stay was one week. Subsequent reviews were made on an outpatient basis. Results The mean duration from admission to final follow-up was three months, and longer follow-up was undertaken telephonically. The mean kyphosis deformity on arrival was 17.4 degrees (5 degrees to 29 degrees); mean kyphosis at final discharge three months later was 19.5 degrees (1 degrees to 28 degrees). Spinal canal encroachment had no influence on successful functional recovery. Discussion Pain has not been a significant problem for any patient, irrespective of the degree of kyphosis and no patient has a self-perception of clinical deformity. In all, 11 patients took occasional analgesia. All patients returned to their original work level or better. Two patients died 2.5 years after treatment, from unrelated causes. Take home message: The natural history of thoracolumbar burst fractures without neurology would appear to be benign.