• Ulrich J Spiegl, Klaus Fischer, Jörg Schmidt, Jörg Schnoor, Stefan Delank, Christoph Josten, Tobias Schulte, and Christoph-Eckhardt Heyde.
• Department of Orthopedics, Trauma Surgery and Plastic Surgery, University Hospital of Leipzig, Leibzig, Germany; Department of Physical and Rehabilitation Medicine, BG Hospital Bergmannstrost, Halle, Germany; Reha Assist Deutschland GmbH, Berlin, Germany; Collm Klinik Oschatz GmbH, Oschatz, Germany; Department of Orthopedic, Trauma and Reconstructive Surgery, University Hospital of Halle, Halle, Germany; Department of General Orthopedic and Spine Surgery, St. Josef-Hospital Bochum, University Hospital of the Ruhr University of Bochum, Bochum, Germany.
• Dtsch Arztebl Int. 2018 Oct 19; 115 (42): 697704697-704.

BackgroundThe conservative treatment of traumatic thoracolumbar vertebral fractures is often not clearly defined.MethodsThis review is based on articles retrieved by a systematic search in the PubMed and Web of Science databases for publications up to February 2018 dealing with the conservative treatment of traumatic thoracolumbar vertebral fractures. The search initially yielded 3345 hits, of which 35 were suitable for use in this review.ResultsIt can be concluded from the available original clinical research on the subject, including three randomized controlled trials (RCTs), that the primary diagnostic evaluation should be with plain x-rays, in the standing position if possible. If a fracture is suspected on the plain films, computed tomography (CT) is indicated. Magnetic resonance imaging (MRI) is additionally advisable if there is a burst fracture. The spinal deformity resulting from the fracture should be quantified in terms of the Cobb angle. The choice of a conservative or operative treatment strategy is based on the primary stability of the fracture, the degree of deformity, the presence or absence of disc injury, and the patient's clinical state. Our analysis of the three RCTs implies that early functional therapy without a corset should be performed, although treatment in a corset may be appropriate to control pain. Follow-up x-rays should be obtained after mobilization and at one week, three weeks, six weeks, and twelve weeks.ConclusionFurther comparative studies of the indications for surgery and specific conservative treatment modalities would be desirable.

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