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Journal of Craniovertebral Junction and Spine
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Year : 2014  |  Volume : 5  |  Issue : 1  |  Page : 25-32

Orthosis for thoracolumbar burst fractures without neurologic deficit: A systematic review of prospective randomized controlled trials

1 Department of Neurological Research, Health Sciences and Neurosciences (CISNEURO) Research Group; Department of Neurosurgery, University of Cartagena, Cartagena de Indias, Colombia
2 Department of Neurological Research, Health Sciences and Neurosciences (CISNEURO) Research Group, Colombia
3 Department of Neurology, State University of Campinas, Campinas-SP, Brazil

Correspondence Address:
Gabriel Alcala-Cerra
Health Sciences and Neurosciences Research Group, Calle 29 No. 50-50, Cartagena de Indias, Colombia

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Source of Support: Health Sciences and Neurosciences (CISNEURO) Research Group, Cartagena de Indias, Colombia, Conflict of Interest: None

DOI: 10.4103/0974-8237.135213

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Background: Traditionally, conservative treatment of thoracolumbar (TL) burst fractures without neurologic deficit has encompassed the application of an extension brace. However, their effectiveness on maintaining the alignment, preventing posttraumatic deformities, and improving back pain, disability and quality of life is doubtful. Objective: The objective was to identify and summarize the evidence from randomized controlled trials (RCTs) to determine whether bracing patients who suffer TL fractures adds benefices to the conservative manage without bracing. Materials and Methods: Seven databases were searched for relevant RCTs that compared the clinical and radiological outcomes of orthosis versus no-orthosis for TL burst fractures managed conservatively. Primary outcomes were: (1) Loss of kyphotic angle; (2) failure of conservative management requiring subsequent surgery; and (3) disability and pain outcomes. Secondary outcomes were defined by health-related quality of life and in-hospital stay. Results: Based on predefined inclusion criteria, only two eligible high-quality RCTs with a total of 119 patients were included. No significant difference was identified between the two groups regarding loss of kyphotic angle, pain outcome, or in-hospital stay. The pooled data showed higher scores in physical and mental domains of the Short-Form Health Survey 36 in the group treated without orthosis. Conclusion and Recommendation: The current evidence suggests that orthosis could not be necessary when TL burst fractures without neurologic deficit are treated conservatively. However, due to limitations related with number and size of the included studies, more RCTs with high quality are desirable for making recommendations with more certainty.

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