Treatment of thoracolumbar spine burst fracture with a neurologically intact patient is controversial, with advocates of operative and nonoperative approaches. Of 404 patients in a prospective spinal
trauma study, 21 had burst fractures, were neurologically intact, and had greater than 1-year followup. This group was analyzed to evaluate treatment with
early mobilization using a thoracolumbar total contact
orthosis. The average time in a
brace was 6 months. Two patients had pulmonary
embolus treated successfully with
anticoagulants. No patient required subsequent surgery for increasing
kyphosis or
neurologic deficit. Change in K angle at followup was 4.6 degrees (+/- 5.7) and change in anterior vertebral height was 6.1 degrees (+/- 10). All patients had a satisfactory
pain score and most individuals returned to full employment. It is concluded that it is not necessary to routinely treat patients operatively with burst fractures if they fulfill the following criteria: 1) neurologically intact; 2)
kyphosis angle less than 35 degrees; 3) other
injuries do not preclude the use of a total contact
orthosis; and 4) the patient is capable of understanding and cooperating with the treatment regime. These criteria are irrespective of the CT findings of posterior vertebral retropulsion and spinal canal narrowing.