Weight-bearing radiographs in thoracolumbar fractures - Do they influence management?

Study Design. Prospective observational study. Objective. Our objective was to compare supine and erect (weight-bearing) radiographs in patients with thoracolumbar fractures without a neurologic deficit and to determine whether the erect radiographs alter the deformity and the management plan. Summary of Background Data. Nonoperative treatment for thoracolumbar fracture without a neurologic deficit is safe and effective. There are some guidelines in the literature that provide objective standards to identify the patients that are suitable for nonoperative treatment. These guidelines are based on measurements on supine radiographs. The role of weight-bearing radiographs in influencing the management plan of these injuries has not been explored. Methods. Fractures between T11 and L2 in 28 patients were considered suitable for nonoperative treatment initially. Radiographic measurements included anterior and posterior vertebral body heights, interpedicular distance, and the Cobb angle on the supine and erect radiographs. A change in the treatment from the initial nonoperative management plan, based on the radiographic findings, was recorded. Results. Mean supine Cobb angle of 11degrees increased to 18degrees on weight-bearing films. The mean anterior vertebral compression increased from 34% to 46%. No change was noted between the posterior vertebral heights and the interpedicular distance. Seven of the 28 patients were subjected to surgical stabilization based on these findings. Conclusion. Performing erect radiographs in patients with thoracolumbar fractures without a neurologic deficit provides additional information and did alter the management plan in a significant proportion (25%) of our patients.