Conservative management of thoracolumbar burst spine fractures using Gertzbein and Load Shearing classification

The purpose of this prospective study was to assess the efficacy of the Gertzbein classification and the Load Shearing classification in the conservative treatment of thoracolumbar burst spinal fractures. From 1997 to 1999, 30 consecutive patients with single-level thoracolumbar spinal injury with no neurological impairment were classified according to the Gertzbein classification and the Load Shearing scoring, and were treated conservatively. A custom-made thoracolumbosacral orthosis was worn in all patients for 6 months and several radiologic parameters were evaluated, while the Denis Pain and Work Scale were used to assess the clinical outcome. The average follow-up period was 24 months (range 12–39 months). During this period radiograms showed no improvement of any radiologic parameter. However, the clinical outcome was satisfactory in 28 of 30 patients with neither pseudarthrosis, nor any complications recorded on completion of treatment. This study showed that thoracolumbar burst fractures Gertzbein A3 with a load shearing score 6 or less can be successfully treated conservatively. Patient selection is a fundamental component in clinical success for these classification systems.