Components of Conservative Treatment Immobilization:
Bracing: Thoracolumbosacral orthosis (TLSO) or Jewett brace for 8–12 weeks to restrict motion and allow healing. Goal: Maintain alignment and stability during the healing process. Early mobilization with bracing to prevent deconditioning. Activity Modification:
Limit activities that stress the spine (e.g., lifting, twisting, bending). Encourage walking and light activities as tolerated while braced. Pain Management:
NSAIDs or acetaminophen for pain relief. Avoid opioids unless absolutely necessary. Physical Therapy:
Initiated after initial healing phase (6–12 weeks). Focus on core strengthening and spinal stabilization exercises. Gradual reintroduction to activities. Monitoring and Follow-Up:
Regular clinical evaluations for pain, function, and neurological status. Repeat imaging (X-rays, CT, or MRI) to ensure no progression of deformity or instability. Outcomes Conservative treatment can yield good results in stable thoracolumbar burst fractures with proper patient selection. Complications may include progressive kyphotic deformity, persistent pain, or late instability, which would necessitate surgical intervention. Red Flags for Surgery Transition to surgical treatment is considered if:
Neurological deterioration develops. Severe pain persists despite conservative measures. Progressive spinal deformity or instability occurs.