Spinopelvic alignment in patients with thoracolumbar burst fracture Thesis by Lucas Miotto Jose. Advisor: Robert Meves

Introduction: The thoracolumbar burst fracture (TEF) is characterized by comminution of the vertebral body, thoracolumbar kyphosis (CTL) and bone fragment projected into the vertebral canal. The goals of treatment are to provide stability, prevent deformity, and optimize neurological recovery. Most systematic reviews and meta-analyses on thoracolumbar fractures showed that the increase in CTL was related to chronic pain, worsening of function and quality of l ife. Few studies have analyzed spinopelvic parameters of patients with exclusive FTE. Our hypothesis is that the spinopelvic alignment of individuals who had FTE are altered in relation to the asymptomatic population due to the increase in CTL. Objective: To evaluate spinopelvic alignment in patients with exposure-type thoracolumbar fracture without neurological deficit, treated non-operatively and operatively in a tertiary trauma referral hospital. Material and Method: Retrospective cross-sectional study of patients with TEF, only in the thoracolumbar region, single level, type A3 and A4 AOSpine. Clinical data analysis of low back pain (VAS), Denis Scale, quality of life (SF-36), sagittal (CT, CTL, LL, EVS) and spinopelvic (IP, VP, IS, IP-LL) radiographic parameters of patients operatively and nonoperatively. Results: A total of 50 individuals with a mean age of 50 years, with a mean follow-up of 109 months (minimum of 19 and maximum of 306). There was a significant difference between treatments for Denis work (p=0.046) in favor of nonoperative treatment. There was no significant difference between treatments for VAS low back pain and Denis pain (p=0.468 and p=0.623). There was no significant difference between treatments in any of the evaluated domains of the SF-36 (p>0.05). Radiographic parameters were not different between the groups analyzed; however, all radiographic parameters showed a significant difference between the population considered asymptomatic, except for pelvic incidence (P<0.005). Conclusions: Spinopelvic alignment in patients with exposure-type thoracolumbar fractures without
neurological deficit, treated nonoperatively and operatively after a minimum follow-up of 19 months was normal, however, they had a higher mean pelvic version and discrepancy between lumbar lordosis and pelvic incidence when compared to the reference values of the Brazilian population.

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