Clinical and radiological outcome of non-surgical management of thoracic and lumbar spinal fracture-dislocations — a historical analysis in the era of modern spinal surgery

The Journal of Spinal Cord Medicine, 2020 · DOI: 10.1080/10790268.2018.1474692 · Published: January 1, 2020

Healthcare Trauma Musculoskeletal Medicine

Simple Explanation

This paper reviews older studies on how doctors used to treat severe spinal dislocations (AO Type C injuries) without surgery. The main non-surgical treatment was prolonged bed rest, often for 10-13 weeks. The review aims to compare these older non-surgical outcomes with modern surgical results. The goal is to see if surgery offers better results than the historical practice of bed rest for these injuries. The analysis suggests that surgery is now preferred because it reduces the risk of lasting pain and spinal deformities. It also allows patients to start rehabilitation sooner since they don't need long periods of bed rest.

Study Duration

Not specified

Participants

Historical analysis of three retrospective studies

Evidence Level

Level III, Retrospective Review

Key Findings

1
Non-surgical management often resulted in residual spinal deformity and a high rate of post-treatment pain syndromes.
2
Neurological deterioration was rare with non-surgical management, and some patients showed improvement, but most had persistent, severe deficits.
3
Surgery for type C injuries reduces the chances of post-operative pain and late spinal deformity compared to historical non-surgical care.

Research Summary

The study reviews historical literature on non-surgical management of thoracolumbar fracture dislocations, mainly involving bed rest and postural reduction, to compare with modern surgical outcomes. Results from the reviewed studies showed that non-surgical treatment often led to residual deformity, post-treatment pain, and prolonged immobilization, although neurological deterioration was rare. The authors conclude that surgery for type C injuries is recommended due to decreased post-operative pain, reduced late spinal deformity, and the ability to start early rehabilitation, making it potentially more cost-effective.

Practical Implications

Surgical Recommendation

Surgery is strongly recommended for AOSpine Thoracolumbar type C injuries (fracture-dislocations) based on historical data.

Early Rehabilitation

Early rehabilitation is possible with surgical treatment, avoiding prolonged bed rest and its associated complications.

Ethical Considerations

Ethical issues may prevent a randomized controlled trial comparing non-surgical versus surgical management due to the demonstrated benefits of surgery.

Study Limitations

1
Retrospective nature of the included studies.
2
Lack of recent comparative studies between surgical and non-surgical management.
3
Potential underestimation of severe spinal deformity rates in historical studies.

Your Feedback

Was this summary helpful?

Back to Healthcare