Spinal Cord Alignment in Patients with Thoracolumbar Burst Fracture

Abstract

Objective To evaluate the spinopelvic alignment in patients with thoracolumbar burst fracture (TBF) without neurological deficit treated nonsurgically and surgically in a tertiary reference trauma hospital. Method Retrospective cross-sectional study of patients with single level, type A3 and A4 AOSpine TBF only of the thoracolumbar region. Analysis of clinical data, low back pain (visual analogue scale [VAS]), Denis Pain Scale, quality of life (SF-36), sagittal (TC, TLC, LL, SVA) and spinopelvic (IP, PV, SI, PI-LL) radiographic parameters of patients treated surgically and nonsurgically. Results A total of 50 individuals with an average age of 50 years old with a mean followup of 109 months (minimum of 19 and maximum of 306 months) were evaluated. There was a significant difference between treatments for the Denis Work Scale (p=0.046) in favor of nonsurgical treatment. There was no significant difference between the treatments for lower back pain VAS and Denis Pain Scale (p=0.468 and p=0.623). There was no significant difference between treatments in any of the domains evaluated with the SF-36 (p>0.05). Radiographic parameters were not different between the analyzed groups; however, all radiographic parameters showed significant difference between the population considered asymptomatic, except for pelvic incidence (p<0.005). Conclusions The spinopelvic alignment was normal in patients with TBF without neurological deficit treated nonsurgically and surgically after a minimum follow-up of 19 months. However, they presented a higher mean pelvic version and discrepancy between lumbar lordosis and pelvic incidence when compared with the reference values of the Brazilian population.