Rehabilitation of patients with noncomplicated trauma of the thoracic and lumbar spine

The expediency of conducting conservative therapy for uncomplicated compression fractures of the thoracic and lumbar spine is one of the most controversial in the scientific medical literature. Domestic protocols for the treatment of spinal cord injury do not provide clear recommendations for the conservative treatment of this category of patients. Foreign protocols consider the possibility of in the case of minor degrees of kyphosis and compression of the vertebral body. Thus, to date, a large number of studies have been published on the use of the method of conservative therapy for uncomplicated fractures of the thoracic and lumbar spine. Summing up all the available data, the main indications for its implementation are compression-comminuted fractures of type A according to the AOSpine classification, with compression of the lumen of the spinal canal less than 50 % and kyphotic deformation less than 30–35°.

1. Krylov V.V., Grin A.A., Lutsik A.A. et al. An advisory protocol for treatment of acute complicated and uncomplicated spinal cord injury in adults (Association of neurosurgeons of the Russian Federation). Part 3. Zhurnal Voprosy neirokhirurgii im. N.N. Burdenko = Burdenko’s Journal of Neurosurgery 2015; 79(2):97–110. (In Russ.). DOI: 10.17116/neiro201579297-110

2. Hoh D.J., Qureshi S., Anderson P.A. et al. Congress of neurological surgeons systematic review and evidence-based guidelines on the evaluation and treatment of patients with thoracolumbar spine trauma: nonoperative care. Neurosurgery 2019;84(1):E46–E49. DOI: 10.1093/neuros/nyy369

3. Post R.B., Keizer H.J.E., Leferink V.J.M., van der Sluis C.K. Functional outcome 5 years after non-operative treatment of type A spinal fractures. Eur Spine J 2006;15(4):472–8. DOI: 10.1007/s00586-005-0887-5

4. Salle H., Tran G.V., Faure P. et al. Treatment of A3.2 and A2 traumatic thoracolumbar spine compression fractures using vertebral body stenting: a 63-patient series. J Neurointerv Surg 2023;15(1):86–90. DOI: 10.1136/neurintsurg-2021-018628

5. De Iure F., Cappuccio M., Paderni S. et al. Minimal invasive percutaneous fixation of thoracic and lumbar spine fractures. Minim Invasive Surg 2012;2012:141032. DOI: 10.1155/2012/141032

6. Grin’ A.A., Kordonskiy A.Yu., Abdukhalikov B.A. et al. Outcomes of surgical treatment of patients with thoracolumbar junction injury using minimally invasive technologies. In: The role of emergency hospitals and research institutes in reducing preventable mortality among the population: Proceedings of the 4th Congress of Emergency Medicine Doctors with International Participation (Moscow, October 19–20, 2018). Moscow, 2018. Pp. 114–15. (In Russ.).

7. Siebenga J., Leferink V.J., Segers M.J. et al. Treatment of traumatic thoracolumbar spine fractures: a multicenter prospective randomized study of operative versus nonsurgical treatment. Spine (Phila Pa 1976) 2006;31(25):2881–90. DOI: 10.1097/01.brs.0000247804.91869.1e

8. Wood K., Buttermann G., Mehbod A. et al. Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit. A prospective, randomized study. J Bone Joint Surg Am 2003;85(5):773–81. DOI: 10.2106/00004623-200305000-00001

9. Shen W.J., Liu T.J., Shen Y.S. Nonoperative treatment versus posterior fixation for thoracolumbar junction burst fractures without neurologic deficit. Spine (Phila Pa 1976) 2001;26(9):1038–45. DOI: 10.1097/00007632-200105010-00010

10. Hitchon P.W., Torner J.C., Haddad S.F., Follett K.A. Management options in thoracolumbar burst fractures. Surg Neurol 1998;49(6):619–26; discussion 626–7. DOI: 10.1016/s0090-3019(97)00527-2

11. Azhari S., Azimi P., Shahzadi S. et al. Decision-making process in patients with thoracolumbar and lumbar burst fractures with thoracolumbar injury severity and classification score less than four. Asian Spine J 2016;10(1):136–42. DOI: 10.4184/asj.2016.10.1.136

12. Liu Y.-J., Chang M.-C., Wang S.-T. et al. Flexion-distraction injury of the thoracolumbar spine. Injury 2003;34(12):920–23. DOI: 10.1016/s0020-1383(02)00396-0

13. Vaccaro A.R., Schroeder G.D., Kepler C.K. et al. The surgical algorithm for the AOSpine thoracolumbar spine injury classification system. Eur Spine J 2016;25(4):1087–94. DOI: 10.1007/s00586-015-3982-2

14. Zhang S., Yan T.-B. Severe fracture-dislocation of the thoracic spine without any neurological deficit. World J Surg Oncol 2017;15(1):3. DOI: 10.1186/s12957-016-1070-7

15. Zeng J., Gong Q., Liu H. et al. Complete fracture-dislocation of the thoracolumbar spine without neurological deficit: a case report and review of the literature. Medicine (Baltimore) 2018;97(9):e0050. DOI: 10.1097/MD.0000000000010050

16. Hitchon P.W., Abode-Iyamah K., Dahdaleh N.S. et al. Nonoperative management in neurologically intact thoracolumbar burst fractures: clinical and radiographic outcomes. Spine (Phila Pa 1976) 2016;41(6):483–9. DOI: 10.1097/BRS.0000000000001253

17. Ağuş H., Kayali C., Arslantaş M. Nonoperative treatment of burst-type thoracolumbar vertebra fractures: clinical and radiological results of 29 patients. Eur Spine J 2005;14(6):536–40. DOI: 10.1007/s00586-004-0740-2

18. Tropiano P., Huang R.C., Louis C.A. et al. Functional and radiographic outcome of thoracolumbar and lumbar burst fractures managed by closed orthopaedic reduction and casting. Spine (Phila Pa 1976) 2003;28(21):2459–65. DOI: 10.1097/01.BRS.0000090834.36061.DD

19. Tezer M., Erturer R.E., Ozturk C. et al. Conservative treatment of fractures of the thoracolumbar spine. Int Orthop 2005;29(2):78–82. DOI: 10.1007/s00264-004-0619-1

20. Reid D.C., Hu R., Davis L.A., Saboe L.A. The nonoperative treatment of burst fractures of the thoracolumbar junction. J Trauma 1988;28(8):1188–94. DOI: 10.1097/00005373-198808000-00009

21. Vissarionov S.V., Baindurashvili A.G., Pavlov I.V. et al. Early orthotics in complex treatment of children with vertebral compression fractures of the thoracic and lumbar spine. Khirurgiya Pozvonochnika = Russian Journal of Spine Surgery 2016;13(4): 11–20. (In Russ.). DOI: 10.14531/ss2016.4.11-20

22. Dai L.Y., Jiang L.S., Jiang S.D. Conservative treatment of thoracolumbar burst fractures: a long-term follow-up results with special reference to the load sharing classification. Spine (Phila Pa 1976) 2008;33(23):2536–44. DOI: 10.1097/BRS.0b013e3181851bc2

23. Cantor J.B., Lebwohl N.H., Garvey T., Eismont F.J. Nonoperative management of stable thoracolumbar burst fractures with early ambulation and bracing. Spine (Phila Pa 1976) 1993;18(8):971–76. DOI: 10.1097/00007632-199306150-00004

24. Shen W.J., Shen Y.S. Nonsurgical treatment of three-column thoracolumbar junction burst fractures without neurologic deficit. Spine (Phila Pa 1976) 1999;24(4):412–5. DOI: 10.1097/00007632-199902150-00024

25. Epifanov A.V., Petrova M.S., Adamyan L.V. Therapeutic physical education in the medical rehabilitation system. National leadership. Moscow: GEOTAR-Media, 2022. 886 p. (In Russ.).

26. Bedbrook G.M. Treatment of thoracolumbar dislocation and fractures with paraplegia. Clin Orthop Relat Res 1975;112:27–43.

27. Hartman M.B., Chrin A.M., Rechtine G.R. Non-operative treatment of thoracolumbar fractures. Paraplegia 1995;33(2):73–6. DOI: 10.1038/sc.1995.18

28. Mumford J., Weinstein J.N., Spratt K.F., Goel V.K. Thoracolumbar burst fractures. The clinical efficacy and outcome of nonoperative management. Spine (Phila Pa 1976) 1993;18(8):955–70.

29. Willén J., Anderson J., Toomoka K., Singer K. The natural history of burst fractures at the thoracolumbar junction. J Spinal Disord 1990;3(1):39–46.

30. Öztürk I., Ertürer E., Sönmez M.M. et al. Early mobilization with customized TLSO brace in thoracolumbar burst fractures. Acta Orthop Traumatol Turc 2012;46(5):373–8.

31. Aligizakis A., Katonis P., Stergiopoulos K. et al. Functional outcome of burst fractures of the thoracolumbar spine managed non-operatively, with early ambulation, evaluated using the load sharing classification. Acta Orthop Belg 2002;68(3):279–87.

32. Karjalainen M., Aho A.J., Katevuo K. Painful spine after stable fractures of the thoracic and lumbar spine. What benefit from the use of extension brace? Ann Chir Gynaecol 1991;80(1):45–8.

33. Bailey C.S., Urquhart J.C., Dvorak M.F. et al. Orthosis versus no orthosis for the treatment of thoracolumbar burst fractures without neurologic injury: a multicenter prospective randomized equivalence trial. Spine J 2014;14(11):2557–64. DOI: 10.1016/j.spinee.2013.10.017

34. Shamji M.F., Roffey D.M., Young D.K. et al. A pilot evaluation of the role of bracing in stable thoracolumbar burst fractures without neurological deficit. J Spinal Disord Tech 2014;27(7): 370–5. DOI: 10.1097/BSD.0b013e31826eacae

35. Lantz S.A., Schultz A.B. Lumbar spine orthosis wearing. I. Restriction of gross body motions. Spine (Phila Pa 1976) 1986;11(8):834–7. DOI: 10.1097/00007632-198610000-00019

36. Rubery P.T., Brown R., Prasarn M. et al. Stabilization of 2-column thoracolumbar fractures with orthoses: a cadaver model. Spine (Phila Pa 1976) 2013;38(5):E270–5. DOI: 10.1097/BRS.0b013e3182804c73

37. Alcalá-Cerra G., Paternina-Caicedo A.J., Díaz-Becerra C. et al. Orthosis for thoracolumbar burst fractures without neurologic deficit: a systematic review of prospective randomized controlled trials. J Craniovertebr Junction Spine 2014;5(1):25–32. DOI: 10.4103/0974-8237.135213

38. Stadhouder A., Buskens E., Vergroesen D.A. et al. Nonoperative treatment of thoracic and lumbar spine fractures: a prospective randomized study of different treatment options. J Orthop Trauma 2009;23(8):588–94. DOI: 10.1097/BOT.0b013e3181a18728

39. Andersen P.T., Horlyck E. Fracture of the spine. Follow-up on a material treated by early mobilization. Acta Orthop Scand 1969;40(5):653–63. DOI: 10.3109/17453676908989531

40. Kürschner J., Schauwecker F., Nieder P. Advantages of early functional treatment of fractures of the thoracolumbar vertebrae without paresis compared with functional treatment after Magnus. Aktuelle Traumatol 1980;10(5):247–9.

41. Hides J.A., Lambrecht G., Richardson C.A. et al. The effects of rehabilitation on the muscles of the trunk following prolonged bed rest. Eur Spine J 2011;2(5):808–18. DOI: 10.1007/s00586-010-1491-x

42. Kuzʼmanin S.A., Nazarov E.A., Ryabova M.N. Possibilities of magnetic therapy in the treatment of acute skeletal trauma. Sovremennye problemy nauki i obrazovaniya = Modern problems of science and education 2019;4. (In Russ.). Available at: https://science-education.ru/ru/article/view?id=29093

43. Physiotherapy and balneology. Book 3. Ed by V.M. Bogolyubov. Moscow: Binom, 2016. 312 p. (In Russ.).

44. Tan T., Huang M.S., Rutges J. et al. Rate and predictors of failure in the conservative management of stable thoracolumbar burst fractures: a systematic review and meta-analysis. Global Spine J 2022;12(6):1254–66. DOI: 10.1177/21925682211031207

45. Alimohammadi E., Bagheri S.R., Ahadi P. et al. Predictors of the failure of conservative treatment in patients with a thoracolumbar burst fracture. J Orthop Surg Res 2020;15(1):514. DOI: 10.1186/s13018-020-02044-3

46. Hitchon P.W., He W., Viljoen S. et al. Predictors of outcome in the non-operative management of thoracolumbar and lumbar burst fractures. Br J Neurosurg 2014;28(5):653–7. DOI: 10.3109/02688697.2013.872226