The Effect of Early Mobilisation on the Sagittal Alignment and Clinical Outcome Following Conservative Treatment of the AO A3 and A4 Thoracolumbar Spine Fracture in Comparison to A1 Fractures. A Retrospective Study

Author(s): Mahmoud Elshamly, Stefan Toegel, Josef Georg Grohs

Background: The aim of the study was to correlate the clinical and radiological outcomes following the conservative treatment of neurologically intact patients with AO A4, A3, and A1 thoracolumbar (TL) fractures.

Methods: Retrospective study included 3 cohorts of conservatively treated patients with AO A4, A3, and A1 TL fracture without the use of bracing or casting. At the final follow up Segmental Kyphotic Angle (SKA), Regional Lordotic Angle (RLA), Lordosis Gap (LG), Pelvic Incidence (PI), Pelvic Tilt (PT), Sacral Slope (SS), Sagittal Vertical Axis (SVA), Lumbar Lordosis (LL), Thoracic Kyphosis (TK), and Femoral Obliquity Angle (FOA), and the Oswestry Disability Index (ODI) were assessed. Data were analyzed using descriptive statistics, non-parametric inferential statistics, and Spearman correlation analyses.

Results: Age was significantly higher in A4 group than in A1 group (p=0.04). The median 1ry SKA of the A3 group (15 ± 3) was significantly higher than in A1 group (7 ± 7, p=0.04). The median of total ODI in the A4 group (42 ± 53) and A3 group (31.3 ± 27) was clinically higher than in A1 group (11.1 ± 25), however, this difference was not statistically significant. Age as well as SVA correlated significantly with PT, FOA, and SKA at the follow up, and the total ODI.

Conclusions: Age of the patient is a significant confounder that has an important impact on the type of fracture, sagittal malalignment, its compensatory mechanisms, and the resulting clinical outcome following conservative treatment of AO A4 and A3 TL fracture.