Thoracolumbar spine fractures after conservative and surgical treatment. Dependence of correction loss on fracture level

Question. This retrospective study presents results after conservative and operative treatment of thoracolumbar fractures as function of its localization. Methodology. In 2 years 70 patients with A1/A2 fracture were conservatively treated, 38 patients with A3/B/C injury were treated by internal fixtor. For evaluation 3 vertebral sections (Th5-10,Th11-L2, L3-5) were defined. Follow-up took place 1 year after implant removal or end of conservative treatment. Results. The correction-loss was highest in thoracic, lowest in lumbar region. After conservative therapy, correction-loss was located to 3/4 in vertebra itself, after operative treatment especially in adjacent disc spaces. There was no general correlation to complaints. Conclusion. In consequence of these results A1/A2-fractures in the upper thoracic spine (< Th10) with kyphosis > 15degrees will be stabilized anteriorly, in other regions functional treated. A3-fractures of thoracic spine and thoracolumbar junction will be operated from anterior, in lower lumbar spine (> L3) from dorsal. B- and C-injuries should be instrumented with a combined dorsoventral procedure.