Nonoperative Management of Isolated Thoracolumbar Flexion Distraction Injuries: A Single-Center Study

Article Figures & Data

Download figure
Open in new tab
Download powerpoint
Figure 1
Patient flow chart.
Download figure
Open in new tab
Download powerpoint
Figure 2
Lumbar Cobb angles following the intervention as measured radiographically (±95% CI). Positive equals local lordosis and negative equals local kyphosis. The asterisk denotes statistical significance at P < 0.05.

Table 1

Comparison of patient, injury, and treatment characteristics by treatment group.

Variable	Operative (n = 14)	Nonoperative (n = 13)	P
Age, y	34.4 (12.7)	31.2 (13.9)	0.538
Body mass index	27.7 (5.6)	27.9 (6)	0.956
Sex
Men	5 (36%)	3 (23%)	0.678
Women	9 (64%)	10 (77%)
Tobacco use status^{^a}
Nonsmoker	5 (38%)	6 (50%)	0.695
Active smoker	8 (62%)	6 (50%)
Diabetes	1 (7%)	3 (23%)	0.326
High energy mechanism of injury	14 (100%)	12 (92%)	0.482
Intra-abdominal injury	3 (21%)	2 (15%)	>0.99
Laparotomy	0 (0%)	1 (8%)	0.482
Location
Mid-thoracic (T6–9)	1 (7%)	0 (0%)	0.206
Low-thoracic (T10–1)	1 (7%)	5 (38%)
Thoracolumbar junction (T12–L1)	7 (50%)	6 (46%)
Upper lumbar (L2–3)	2 (14%)	0 (0%)
Lower lumbar (L4–5)	3 (21%)	2 (15%)
Concomitant injuries
Extremity fractures	4 (29%)	3 (23%)
Axial fractures	8 (57%)	5 (38%)
Sternal fractures	1 (7%)	1 (7%)
Head injuries	4 (29%)	6 (46%)

Note: Data presented as mean (SD) for continuous variables and n (%) for categorical variables.
↵a Smoker status was missing for 1 patient in each cohort.

Table 2

Treatment characteristics and clinical outcomes by treatment group.

Characteristic	Operative (n = 14)	Nonoperative (n = 13)	P
Surgical technique
Posterior spinal instrumentation and fusion	11 (79%)	-	-
MIS posterior spinal instrumentation	3 (21%)	-	-
Decompression	1 (7%)	-	-
Levels of surgical intervention
2	9 (64%)	-
3	1 (7%)	-
4	4 (29%)	-
Brace (thoracolumbar-sacral orthosis) prescribed	-	13 (100%)	-
Brace duration, d (n = 10)	-	54.6 (14.4)^{^a}	-
Complications/unintended reoperations	1 (7%)	0 (0%)	>0.99
Length of stay, d	7.6 (6.2)	4.3 (4.3)	0.12
Return to work, wk	20.5 (15.9)^{^b}	11.8 (6.8)^{^c}	0.154
Follow-up duration, wk	43.3 (53.2)	10.8 (6.5)	0.02^{^d}

Abbreviation: MIS, minimally invasive surgery.
Note: Data presented as mean (SD) for continuous variables and n (%) for categorical variables.
↵a n = 10.
↵b n = 8.
↵c n = 9.
↵d Kruskal-Wallis test used. Statistically significant at P < 0.05.

Table 3

Comparison of radiographic outcomes.

Variable	Operative (n = 14)	Nonoperative (n = 13)	P
Initial Cobb angle (°)	−5° ± 20.5° (−43.5 to 33)	−13° ± 13.4° (−31.8 to 14.1)	0.225^{^a}
First follow-up
Days at first follow-up	40.7 ± 21.9 (17–97)	39.7 ± 16 (16–64)	0.892
Cobb angle at first follow-up (°)	2.6° ± 17° (−15.1 to 42)	−13.9° ± 15° (−34 to 16.8)	0.015 ^{^a}
Change in Cobb angle from presentation (°)	7.6° ± 10.9° (−8.3 to 34.8)	−0.9° ± 5.1° (−13.7 to 6.1)	0.029^{^a}
Second follow-up
Patients lost prior to second follow-up	3 (21%)	5 (38.5%)	0.42
Days at second follow-up	148.3 ± 126.6 (45–430)	86.6 ± 49.9 (40–166)	0.212
Cobb angle at second follow-up (°)	3.6° ± 18.4° (−16 to 43)	−12° ± 15.8° (−32.4 to 16.3)	0.07^{^a}
Change in Cobb angle from presentation (°)	4.1° ± 8.9° (−14.6 to 12.4)	−1.4° ± 3.1° (−5.1 to 2.8)	0.117^{^a}
Change in Cobb angle from first follow-up (°)	−1.2° ± 2.3° (−6.2 to 2.1)	−1.1° ± 2.4° (−4.8 to 2.1)	0.869^{^a}

Note: Data presented as mean ± SD (range) or n (%). A negative value and negative change indicates the presence of kyphosis or the addition of kyphosis. Boldface indicates a statistically significant difference.
↵a Kruskal-Wallis test employed; Kyphosis° (kyphosis angle).