Spontaneous remodeling of the spinal canal after conservative management of thoracolumbar burst fractures

Study Design. Forty-two conservatively treated patients with a burst fracture of the thoracic, thoracolumbar, or lumbar spine with more than 25% stenosis of the spinal canal were reviewed more than 1 year after injury to investigate spontaneous remodeling of the spinal canal. Objectives. To investigate the natural development of the changes in the spinal canal after thoracolumbar burst fractures. Summary of the Background Data. Surgical removal of bony fragments from the spinal canal may restore the shape of the spinal canal after burst fractures. However, it was reported that restoration of the spinal canal does not affect the extent of neurologic recovery. Methods. Using computerized tomography, the authors compared the least sagittal diameter of the spinal canal at the time of injury with the least sagittal diameter at the follow-up examination. Results. Remodeling and reconstitution of the spinal canal takes place within the first 12 months after injury. The mean percentage of the sagittal diameter of the spinal canal was 50% of the normal diameter (50% stenosis) at the time of the fracture and 75% of the normal diameter (25% stenosis) at the follow-up examination. The correlation was positive between the increase in the sagittal diameter of the spinal canal and the initial percentage stenosis. There was a negative correlation between the increase of the sagittal diameter of the spinal canal was not influenced by the presence of a neurologic deficit. Conclusion. Conservative management of thoracolumbar burst fractures is followed by a marked degree of spontaneous redevelopment of the deformed spinal canal. Therefore, this study provides a new argument in favor of the conservative management of thoracolumbar burst fractures.