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Case series
Traumatic compression fractures in thoracic-lumbar junction: vertebroplasty vs conservative management in a prospective controlled trial
  1. Salvatore D'Oria1,
  2. Mariagrazia Dibenedetto1,2,
  3. Eleonora Squillante3,
  4. Carlo Somma1,
  5. Cathal John Hannan4,
  6. David Giraldi1,
  7. Vincenzo Fanelli1
  1. 1Neurosurgery, Ente Ecclesiastico Ospedale Generale Regionale Francesco Miulli, Acquaviva delle Fonti, Italy
  2. 2Neurosurgery, Azienda Ospedaliera Policlinico di Bari, Bari, Italy
  3. 3Ospedale San Giovanni Bosco, Napoli, Campania, Italy
  4. 4Salford Royal NHS Foundation Trust, Salford, Salford, UK
  1. Correspondence to Dr Salvatore D'Oria, Neurosurgery, Ente Ecclesiastico Ospedale Generale Regionale Francesco Miulli, Acquaviva delle Fonti, Italy; asalvatoredoria{at}gmail.com

Abstract

Background Both surgery and conservative management are well established treatments for compression fractures of the thoraco-lumbar spine without neurological compromise. This article aims to compare the outcomes of conservative management to those of vertebroplasty, a relatively safe and simple procedure.

Methods 102 patients were admitted to our neurosurgical unit between January 2012 and February 2016, presenting with a single-level, post-traumatic A1 or A2 Mager l type fracture, affecting the thoracic-lumbar spine without any neurological deficits. After description of both treatment options, the patients were asked to choose between vertebroplasty or conservative treatment. Accordingly, the patients were allocated into two groups and a prospective non-randomized controlled trial was carried out. The first group (Group A) included 52 patients, treated with bed rest and an orthosis. The second group (Group B) of 50 patients underwent a percutaneous vertebroplasty. Pain intensity (assessed via visual analog scale (VAS)), disability degree (assessed via Oswestry Disability Index), ability to resume work (assessed via Denis work Scale), vertebral body height loss rate, regional kyphosis angle (Cobb’s angle), duration of hospitalization and treatment-associated complications, were prospectively recorded in a database and analyzed. Follow ups were planned at 1, 6, and 12 months after the injury.

Results Group B, compared with group A, showed a faster improvement in VAS score as well as functional ability and return to work. Cobb’s angle progression was significantly less in the surgical group. Morbidity, mortality, and complication rate were similar and comparable in both groups without a statistical difference (P<0.05)

Conclusions Vertebroplasty is a safe and effective treatment in post-traumatic thoracic-lumbar fractures compared with conservative management.

  • spine
  • trauma
  • device

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Footnotes

  • Collaborators N/A.

  • Contributors Contributorship Statement: the manuscript has been read and approved by all the authors, that the requirements for authorship as stated earlier in this document have been met, and each author believes that the manuscript represents honest work. The first author had the idea for the article, wrote the article, and is the guarantor, the second and the third the literature search, the fourth and the sixth collected data, and the fifth reviewed grammar and syntax.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval Human participants custom question on the online form: ID 53–156. Each institutional review board approved the protocol and the informed consent form. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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