The influence of brace immobilization on the remodeling potential of thoracolumbar impaction fractures in children and adolescents

Abstract

Purpose: Different treatment methods including immediate mobilization with or without brace, bed rest or immobilization using thoracolumbosacral orthosis have been applied for stable compression fractures of the pediatric spine. The aim of this study was to evaluate the influence of bracing on the remodeling capacity of pediatric thoracolumbar type A 1.2 impaction fractures. Additionally, the prevalence of pain and functional disabilities were assessed. Methods: All children treated conservatively between 2000 and 2011 with impaction fractures of the thoracolumbar spine (A 1.2) were included and re-invited for a clinical [including VAS 0–100, Oswestry disability index (ODI)] and radiological follow-up examination. Changes of the sagittal index (SI) at the time of the accident, the latest control visit and at the follow-up examination were analyzed. Results: Seventy-two patients with a mean age of 12 years (1.8–18 years) and a total number of 133 fractured vertebrae were included. The mean SI at the time of injury was 0.76 (range 0.45–0.94, SD 0.08); 34 patients with 67 fractured vertebrae were included in the follow-up examination after a mean of 7.9 years (2.4–13.1 years). The mean SI of the 67 affected vertebrae at follow-up significantly increased to 0.92 (range 0.74–1, SD 0.06). The initial treatment regimen (brace vs no brace) did not influence the remodeling capacity. More than half of the patients (n = 18, 53 %) complained about occasional back-related pain which was not associated with the remodeling process. The mean ODI was 5.8 (range 0–26, SD 6.6) and the mean VAS of the re-evaluated patients was 87 (range 53–100, SD 14). Conclusions: A significant remodeling capacity of thoracolumbar vertebral impaction fractures sustained in childhood is demonstrated. Bracing does not seem to influence the long-term outcome of these injuries. More studies have to be performed to define the role of bracing in these fractures.