Bracing of thoracic and lumbar spine fractures

A prospective study of the non-operative management of 33 thoracic and lumbar fractures and dislocations was undertaken examining factors such as duration of bed rest and brace prescription. Outcome was assessed using Frankel's grading system and serial radiological examination. Bed rest for 6 to 8 weeks followed by 16 weeks of immobilisation in a thoraco-lumbar orthosis (either a moulded plastazote lined polythene brace or a Taylor brace) resulted in less than 15 degrees kyphus in 85% of patients and less than 20% kyphus in 94%. One patient with a T12/L1 dislocation who had an early decompressive laminectomy showed persistent instability and required internal fixation. One patient with an L1 fracture who initially wore a Hexalite brace developed late instability (at 12 months after injury) and required spinal osteotomy and fusion. Neurological improvement was observed in 50% of patients, and no permanent neurological deterioration occurred. A non-operative regimen of treatment of fractured thoracic and lumbar vertebrae as described is an alternative to prolonged immobilisation in bed, or early operative fusion.