{"id":"efe28622-1313-45bc-b236-19f99ba0a80b","slug":"closed-therapy-of-thoracic-and-lumbar-vertebral-body-fractures-in-trauma-patients","title":"Closed therapy of thoracic and lumbar vertebral body fractures in trauma patients","authors":["Jarvis W. Walters","Tammy R. Kopelman","Arpan A. Patel","Patrick J. O’Neill","Poya Hedayati","Paola G. Pieri","Sydney J. Vail","Salvatore C. Lettieri","Iman Feiz-Erfan"],"abstract":"Background: The failure rate for the closed/non-surgical treatment of thoracic and lumbar vertebral body fractures (TLVBF) in trauma patients has not been adequately evaluated utilizing computed tomography (CT) studies. Methods: From 2007 to 2008, consecutive trauma patients, who met inclusion criteria, with a CT diagnosis of acute TLVBF undergoing closed treatment were assessed. The failure rates for closed therapy, at 3 months post-trauma, were defined by progressive deformity, vertebral body collapse, or symptomatic/asymptomatic pseudarthrosis. The Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification was utilized to classify the fractures (groups A1 and non-A1 fractures) and were successively followed with CT studies. Results: There were 54 patients with 91 fractures included in the study; 66 were A1 fractures, and 25 were non-A1 fractures. All had rigid bracing applied with flat and upright X-ray films performed to rule out instability. None had sustained spinal cord injuries. Thirteen patients (24%) failed closed therapy [e.g. 13 failed fractures (14%) out of 91 total fractures]. Five failed radiographically only (asymptomatic), and eight failed radiographically and clinically (symptomatic). A1 fractures had a 4.5% failure rate, while non-A1 fractures failed at a rate of 40%. Conclusion: Failure of closed therapy for TLVBF in the trauma population is not insignificant. Non-A1 fractures had a much higher failure rate when compared to A1 fractures. We recommend close follow-up particularly of non-A1 fractures treated in closed fashion using successive CT studies.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/efe28622-1313-45bc-b236-19f99ba0a80b/featured/hero-1782420890074.png","publishDate":"2017-11-20T00:00:00.000Z","doi":"10.4103/sni.sni_336_17","categories":["Spine","Original Article"],"fullTextUrl":"http://surgicalneurologyint.com/wp-content/uploads/2017/11/8678/SNI-8-283.pdf"}