흉요추 방출성 골절의 보존적 치료 또는 후방기기술 후 치료 결과에 미치는 인자들 = Prognostic Factors to Final Results after Conservative or Surgical Treatment of Thoracolumbar Burst Fractures

다국어 초록 (Multilingual Abstract)

Study Design : This study assessed the final functional results after treatment of thoracolumbar burst fractures and compared the relationship between the results and the parameters of reduction and state of the fractures.
Objectives : To define prognostic factors affecting the final results and to present some precautions to minimize the treatment failure.
Summary of Literature Review : In the treatment of the thoracolumbar burst fractures in which flexion loads are predominant, the sagittal contour is crucial to achieve permanent pain-free stability, but definitive therapeutic guidelines have remained a controversal topic.
Materials and Methods : We reviewed 37 thoracolumbar burst fractures with an average follow up period of 1.8 years: group I consisting of 20 cases treated conservatively and group 2 consisting of 17 cases treated surgically with posterior instrumentation. Finally functional results were analyzed with the Denis' pain and work scores, and were compared between groups on anterior body height and local kyphosis.
Results : A satisfactory pain score less than or equal to P3 was in 15(75%) in group 1 and 15(88.2%) in group 2(p>0.05), but satisfactory work score less than or equal to W3 was in 12(60%) in group I and in 14(82.4%) in group 2(p<0.05). But, some loss of body height and local kyphosis in group 1 was not reversely related with functional outcomes. Eight cases in group 1 showing unsatisfactory result in work scores were analyzed as 4 osteoporosis(Jikei grade I, Ⅱ /Ⅲ), 3 associated compression fracture of the contiguous vertebra and one combined osteoporosis and compression fracture, showing significant loss of vertebral height and increase of kyphosis(p<0.01).
Conclusions : Functional results of group 1 showing loss of vertebral height less than 50% and increased kyphosis less than 200 were comparable to those of group 2. The osteoporosis and associated compression fracture of adjacent vertebra were the risk group to develop posttraumatic kyphosis and might be added to the surgical indication of the thoracolumbar burst fractures.