Nonoperative Management of Stable Thoracolumbar Fracture with Bracing in Old Age

Kim, Jong Oh

Abstract

Fourteen neurologically intact patients with stable fractures at the thoracolumbar junction above 60yrs old age were treated with early ambulation in a total contact orthosis, Jewett Brace, Knight-Taylor Brace and had followed up greater than one year. Spinal orthosis have been traditionally used in the management of thoracolumbar junction treated with or without surgical stabilization However, the orthotic treatment modality in the management of spinal fractures remain subjective, especially old age. since few objective data are available on the effectiveness of orthosis in stabilizing injuried segments. At minimum follow up of one year, an overall outcome evaluation involved verbal numerical scale ( VNS ) and radilogical assessment. Approxiamately 80% of the patient had under 3 points in the verbal numerical scale, serial roentgenograms documented significant progressing in body collapse which averaged 9.6% compression,5.2 in Cobbs angle, not correlate with type of brace. Mainly body collapse and increasing Cobbs angle at the fracture site developed within posttraumatic 3 months. Degree of osteoporosis did not correlate with change in deformity. Initial radiographic severity of injury or residual deformity following closed management did not correlate with symptoms at follow-up. This pattern of results suggested comportable brace treatment such as Jewett and Knight-Taylor Brace, as the preferred treatment in stable thoracolumbar fracture in old age.