Treatment of thoracolumbar burst fractures using orthosis versus no orthosis

Thoracolumbar burst fractures without neurological deficit are relatively common presentations to orthopaedic services. There is a bimodal age distribution seen resulting from high-energy injuries in young adults and low-energy fragility injuries in more frail elderly patients. Management of these injuries is guided by the Thoracolumbar Injury Classification System (TLICS score), with scores of 4 or less generally managed non-operatively because they are stable injuries. The role of bracing in the non-operatively managed patients is contentious. This may be due to poor compliance, poor fit and functional limitation. Patients are often managed with a brace called thoracic lumbar sacral orthosis (TLSO). At our Journal Club, we discussed a long-term follow-up study1 based on an original multicentred randomised controlled trial2 investigating outcomes following thoracolumbar burst fractures treated with or without orthoses. The article was published in the Journal of Neurosurgery Spine in 2017,1 and is based on a Canadian multicentre, randomised controlled clinical trial running from 2002 to …