From the Research
The initial management for a stable L2 burst fracture with retropulsion and moderate central canal stenosis typically involves conservative treatment without the need for bracing, as evidenced by a study showing similar outcomes with or without bracing 1. This approach prioritizes minimizing morbidity, mortality, and optimizing quality of life. Key aspects of conservative management include:
- Initial bed rest with gradual mobilization as tolerated
- Pain management using acetaminophen, NSAIDs (if not contraindicated), and short-term opioids for breakthrough pain
- Early initiation of physical therapy focusing on core strengthening and proper body mechanics
- Regular follow-up imaging to monitor fracture healing and spinal stability
The decision to avoid bracing is supported by the study 1, which found no significant differences in radiographic or clinical outcomes between patients treated with or without a thoracolumbosacral orthosis (TLSO) brace. Additionally, the study 2 suggests that neurological damage in burst fractures occurs at the time of injury, questioning the need for surgical decompression solely to remove fragments from the canal. However, it's crucial to monitor the patient's condition closely, as the development of new neurological symptoms, increasing pain, or progressive kyphosis may necessitate surgical intervention. The goal of treatment remains to maintain spinal alignment, allow the fracture to heal, and prevent further neurological compromise, prioritizing the patient's morbidity, mortality, and quality of life.