A4 Thoracolumbar Fracture Class Is Associated With a Greater Degree of Vertebral Height Loss in Conservatively Managed Patients

Ashwin Ghadiyaram; Asha Krishnakumar; Janan Leppo; Megan M Rajagopal; Nora T Poulos; Charles F Opalak; William C Broaddus; Brian M Cameron

doi:10.7759/cureus.66402

A4 Thoracolumbar Fracture Class Is Associated With a Greater Degree of Vertebral Height Loss in Conservatively Managed Patients

Cureus. 2024 Aug 7;16(8):e66402. doi: 10.7759/cureus.66402. eCollection 2024 Aug.

Authors

Ashwin Ghadiyaram¹, Asha Krishnakumar¹, Janan Leppo², Megan M Rajagopal¹, Nora T Poulos¹, Charles F Opalak³, William C Broaddus¹, Brian M Cameron¹

Affiliations

¹ Department of Neurosurgery, Virginia Commonwealth University Health System, Richmond, USA.
² Department of Internal Medicine, University of California San Diego, San Diego, USA.
³ Neurosurgery, Prisma Health Southeastern Neurosurgical and Spine Institute, Greenville, USA.

Abstract

Introduction: Thoracolumbar (TL) junction fractures are common, often resulting from high-energy trauma or osteoporosis, and may lead to neurological deficits, deformities, or chronic pain. Treatment decisions for neurologically intact patients remain controversial, with nonsurgical management often favored. The AO classification system has been used to characterize thoracolumbar fractures using fracture morphology and clinical factors affecting clinical decision-making for fracture management. This study aims to assess the radiographic outcomes of utilizing a thoracolumbosacral orthosis (TLSO) brace in neurologically intact patients with TL fractures based on the AO classification system.

Methods: A retrospective analysis of 43 patients was conducted using data from the VCU Spine Database on patients with TL fractures managed conservatively with a TLSO brace from 2010 to 2019. Demographic variables and radiographic measurements of anterior height loss were analyzed and stratified by AO fracture class.

Results: Significant differences were observed in anterior height loss between AO fracture classes, with A4 fractures showing significantly greater anterior height loss at initial presentation (27.6 + 4.8%) compared to A1/A2 (16.1 + 2.2%; p=0.049). At follow up, A4 fractures had a significantly greater anterior height loss (40.2 + 6.6%) than both the A1/A2 (22.4 + 2.9%; p=0.029) and A3 fracture classes (20.5 + 3.6; p=0.020).

Conclusions: The study highlights significant differences in anterior height loss among AO fracture classes, suggesting varying degrees of severity and potential implications for clinical management. While conservative treatment with TLSO braces may provide pain relief, surgical intervention may offer better structural recovery, especially in more severe fractures. Conservative management of TL fractures with TLSO braces may result in greater anterior height loss, particularly in A4 fractures, emphasizing the need for individualized treatment decisions. Further research, including prospective studies, is warranted to validate these findings and guide clinical practice effectively.

Keywords: conservative management; spinal fracture; thoracolumbar fracture; thoracolumbosacral orthosis; tlso brace.