Abstract
Fractures of the thoracolumbar spine rank among the severest injuries of the human skeleton. Especially in younger patients they often result from high-energy accidents. Recently, a shift in paradigm towards more aggressive treatment strategies including anterior procedures could be observed. However, so far only few data exist reflecting the quality of life (QoL) after such injuries. The aim of this study was to evaluate medium-term QoL and further to identify factors that influence the clinical outcome in patients with fractures of the thoracolumbar spine. Data of 906 patients who were treated during a 10-year period in our institution were evaluated retrospectively. Only patients with single-level traumatic injuries aged between 18 and 65 years without neurological deficits, concomitant injuries of other locations and internal comorbidities were included into the investigation (n = 204). Three different treatment groups (i.e. non-operative, dorsal and dorsoventral stabilisation) were compared to healthy controls as well as different pain populations. The QoL was assessed using established questionnaires (SF-36, HFAQ, VAS-Spinescore, PRQ, and PTSD). Sixty-five percent of the included patients (n = 133) were studied at an average follow-up of 5.3 ± 1.7 years after injury. All treatment groups revealed an identical gender and age distribution. More severe and unstable injuries were found in the surgical groups associated with higher treatment costs and a longer inability to work. Compared to healthy controls, QoL was compromised to the same extent in all groups. Furthermore, all patients treated in this study did significantly better than low back pain individuals with regard to QoL and pain regulation parameters. In our study, patients with thoracolumbar spine fractures showed a reduced QoL compared to healthy controls. Thus, patients do not seem to regain their former QoL. However, the level of discomfort was comparably low in all groups, even in patients with more severe injuries requiring extensive surgery. Overall, outcome and QoL after traumatic fractures of the thoracolumbar spine rather seem to be determined by the severity of injury than by pain regulation or other psychosocial factors which is likely the case in low back pain disorders.
Similar content being viewed by others
References
Been HD, Poolman RW, Ubags LH (2004) Clinical outcome and radiographic results after surgical treatment of post-traumatic thoracolumbar kyphosis following simple type A fractures. Eur Spine J 13(2):101–107
Been HD, Bouma GJ (1999) Comparison of two types of surgery for thoraco-lumbar burst fractures: combined anterior and posterior stabilisation vs. posterior instrumentation only. Acta Neurochir 141:349–357
Bergner M, Bobbit RA, Carter WB, Gilson BS (1981) The sickness impact profile: development and final revision of health status measure. Med Care 19:787–805
Blauth M, Tscherne H, Gotzen L, Haas N (1987) Results of different surgical procedures in the treatment of fresh injuries of the thoracic and lumbar spine. Unfallchirurg 90(6):260–273
Boden SD (1998) Outcome assessment after spinal fusion: why and how ? Orthop Clin North Am 29(4):717–728
Bombardier C (2000) Outcome assessments in the evaluation of treatment of spinal disorders: summary and general recommendations. Spine 25:3100–3103
Boucher M, Bhandari M, Kwok D (2001) Health-related quality of life after short segment instrumentation of lumbar burst fractures. J Spinal Disord 14:417–426
Brazier J, Roberts J, Deverill M (2002) The estimation of a preference-based measure of health from the SF-36. J Health Econ 21:271–292
Briem D, Lehmann W, Ruecker AH, Windolf J, Rueger JM, Linhart W (2004) Factors influencing the quality of life after burst fractures of the thoracolumbar transition. Arch Orthop Trauma Surg 124:461–468
Briem D, Linhart W, Lehmann W, Bullinger M, Schoder V, Meenen NM, Windolf J, Rueger JM (2003) Investigation of the health-related quality of life after a dorso ventral stabilization of the thoracolumbar junction. Unfallchirurg 106:625–632
Briem D, Rueger JM, Linhart W (2003) Osseous integration of autogenous bone grafts following combined dorso-ventral instrumentation of unstable thoracolumbar spine fractures. Unfallchirurg 106:195–203
Bullinger M (1995) German translation and psychometric testing of the SF-36 health survey: preliminary results from the IQOLA Project. International quality of life assessment. Soc Sci Med 41:1359–1366
Daniaux H, Wagner M, Kathrein A, Lang T (1999) Fractures of the thoraco-lumbar junction. Conservative management. Orthopäde 28(8):682–691
Dick W (1987) The “fixateur interne” as a versatile implant for spine surgery. Spine 12(9):882–900
Elfering A (2006) Work-related outcome assessment instruments. Eur Spine J 15(Suppl 1):S32–S43
The EuroQol Group (1990) EuroQol—a new facility for the measurement of health-related quality of life. The EuroQol Group. Health Policy 16:199–208
Gatchel RJ, Mayer T, Dersh J, Robinson R, Polatin P (1999) The association of the SF-36 health status survey with 1-year socioeconomic outcomes in a chronically disabled spinal disorder population. Spine 24:2162–2170
Glassman SD, Dimar JR, Johnson JR, Minkow R (1998) Preoperative SF-36 responses as a predictor of reoperation following lumbar fusion. Orthopedics 21:1201–1203
Greenough CG (2006) Outcome assessment: recommendations for daily practice. Eur Spine J 15(Suppl 1):S118–S123
Grevitt M, Khazim R, Webb J, Mulholland R, Shepperd J (1997) The short form-36 health survey questionnaire in spine surgery. J Bone Joint Surg Br 79:48–52
von Gumppenberg S, Vieweg J, Claudi B, Harms J (1991) Primary management of fresh injuries of the thoracic and lumbar vertebrae. Aktuelle Traumatol 21(6):265–273
Haas N, Blauth M, Tscherne H (1991) Anterior plating in thoracolumbar spine injuries. Indication, technique, and results. Spine 16(3 Suppl):S100–S111
Haase I, Schwarz A, Burger A, Kladny B (2001) Comparison of Hannover functional ability questionnaire (FFbH) and the SF-36 subscale “Physical Functioning”. Rehabilitation 40(1):40–42
Haefeli M, Elfering A (2006) Pain assessment. Eur Spine J 15(Suppl 1):S17–S24
Hansson E, Hansson T, Jonsson T (2006) Predictors for work ability and disability in men and women with low-back or neck problems. Eur Spine J 15(6):780–793
Hartwig E, Schultheiss M, Bischoff M (2002) Flat rate reimbursement system for minimally invasive management of unstable vertebral fractures. An analysis of costs and benefits. Unfallchirurg 105(8):755–758
Hiebert R, Nordin M (2006) Methodological aspects of outcomes research. Eur Spine J 15(Suppl 1):S4–S16
Hunt SM, McKenna SP, McEwen J, Williams J, Papp E (1981) The Nottingham health profile: subjective health status and medical consultations. Soc Sci Med 15:221–229
Kaneda K, Taneichi H, Abumi K, Hashimoto T, Satoh S, Fujiya M (1997) Anterior decompression and stabilization with the Kaneda device for thoracolumbar burst fractures associated with neurological deficits. J Bone Joint Surg Am 79(1):69–83
Knop C, Blauth M, Bühren V, Arand M, Egbers HJ, Hax PM, Nothwang J, Oestern HJ, Pizanis A, Roth R, Weckbach A, Wentzensen A (2001) Surgical treatment of injuries of the thoracolumbar transition-3: follow-up examination. Results of a prospective multi-center study by the “Spinal” study group of the German Society of Trauma Surgery. Unfallchirurg 104:583–600
Knop C, Fabian HF, Bastian L, Blauth M (2001) Late results of thoracolumbar fractures after posterior instrumentation and transpedicular bone grafting. Spine 26:88–99
Knop C, Oeser M, Bastian L, Lange U, Zdichavsky M, Blauth M (2001) Development and validation of the visual analogue scale (VAS) spine score. Unfallchirurg 104:488–497
Knop C, Blauth M, Bühren V, Hax PM, Kinzl L, Mutschler W, Pommer A, Ulrich C, Wagner S, Weckbach A, Wentzensen A, Wörsdorfer O (1999) Surgical treatment of injuries of the thoracolumbar transition. 1: Epidemiology. Unfallchirurg 102(12):924–935
Knop C, Blauth M, Bühren V, Hax PM, Kinzl L, Mutschler W, Pommer A, Ulrich C, Wagner S, Weckbach A, Wentzensen A, Wörsdorfer O (2000) Surgical treatment of injuries of the thoracolumbar transition. 2: Operation and roentgenologic findings. Unfallchirurg 103(12):1032–1047
Kohlmann T, Raspe H (1996) Hannover functional questionnaire in ambulatory diagnosis of functional disability caused by backache. Rehabilitation 35(1):I–VIII
Korovessis P, Baikousis A, Zacharatos S, Petsinis G, Koureas G, Iliopoulos P (2006) Combined anterior plus posterior stabilization versus posterior short-segment instrumentation and fusion for mid-lumbar (L2-L4) burst fractures. Spine 31(8):859–868
Kossmann T, Ertel W, Platz A, Trentz O (1999) Combined surgery for fractures of the thoraco-lumbar junction using the inlay-span method. Orthopäde 28(5):432–440
Kovacs FM, Llobera J, Abraira V, Lazaro P, Pozo F, Kleinbaum D (2002) Effectiveness and cost-effectiveness analysis of neuroreflexotherapy for subacute and chronic low back pain in routine general practice: a cluster randomized, controlled trial. Spine 27:1149–1159
Kraemer WJ, Schemitsch EH, Lever J, McBroom RJ, McKee MD, Waddell JP (1996) Functional outcome of thoracolumbar burst fractures without neurological deficit. J Orthop Trauma 10:541–544
Krismer M, Auckenthaler T, Gruber R, Wimmer C, Sterzinger W, Ogon M (1997) Lumbar fusion in adults-dorsal or combined ventral/dorsal approach ? Orthopäde 26(6):568–571
Leferink VJ, Keizer HJ, Oosterhuis JK, van der Sluis CK, ten Duis HJ (2003) Functional outcome in patients with thoracolumbar burst fractures treated with dorsal instrumentation and transpedicular cancellous bone grafting. Eur Spine J 12:261–267
Leferink VJ, Zimmerman KW, Veldhuis EF, ten Vergert EM, ten Duis HJ (2001) Thoracolumbar spinal fractures: radiological results of transpedicular fixation combined with transpedicular cancellous bone graft and posterior fusion in 183 patients. Eur Spine J 10(6):517–523
Mannion AF, Elfering A (2006) Predictors of surgical outcome and their assessment. Eur Spine J 15(Suppl 1):S93–S108
Mercado AC, Carroll LJ, Cassidy JD, Cote P (2005) Passive coping is a risk factor for disabling neck or low back pain. Pain 117:51–57
Müller U, Roder C, Greenough CG (2006) Back related outcome assessment instruments. Eur Spine J 15(Suppl 1):S25–S31
Németh G (2006) Health related quality of life outcome instruments. Eur Spine J 15(Suppl 1):S44–S51
Pape HC, Mahlke L, Schaefer O, Krettek C (2003) Thoughts on the economic aspects of management of severely injured patients with reference to “diagnostic related groups” (DRG). An initiative of the Specialized Committee of the German Health Care System. Unfallchirurg 106(10):869–873
Post RB, Keizer HJ, Leferink VJ, van der Sluis CK (2005) Functional outcome 5 years after non-operative treatment of type A spinal fractures. Eur Spine J 15(4):472–478
Reinhold M, Knop C, Lange U, Bastian L, Blauth M (2003) Non-operative treatment of thoracolumbar spinal fractures. Long-term clinical results over 16 years. Unfallchirurg 106(7):566–576
van der Roer N, Boos N, van Tulder MW (2006) Economic evaluations: a new avenue of outcome assessment in spinal disorders. Eur Spine J 15(Suppl 1):S109–S117
Schermelleh-Engel K, Moosbrugger H (1991) Empirical validation of the “pain intensity” construct. Z Klin Psychol Psychopathol Psychother 39:369–381
Schneider S, Lipinksi S, Schiltenwolf M (2006) Occupations associated with a high risk of self-reported back pain: representative outcomes of a back pain prevalence study in the Federal Republic of Germany. Eur Spine J 15(6):821–833
Shen WJ, Shen YS (1999) Nonsurgical treatment of three-column thoracolumbar junction burst fractures without neurologic deficit. Spine 24:412–415
Sjolie AN (2002) Psychosocial correlates of low-back pain in adolescents. Eur Spine J 11:582–588
Stieglitz RD, Frommberger U, Foa EB, Berger M (2001) Evaluation of the German version of the PTSD Symptom Scale (PSS). Psychopathology 34(3):128–133
Tropiano P, Huang RC, Louis CA, Poitout DG, Louis RP (2003) Functional and radiographic outcome of thoracolumbar and lumbar burst fractures managed by closed orthopaedic reduction and casting. Spine 28(21):2459–2465
Verlaan JJ, Diekerhof CH, Buskens E, van der Tweel I, Verbout AJ, Dhert WJ, Oner FC (2004) Surgical treatment of traumatic fractures of the thoracic and lumbar spine: a systematic review of the literature on techniques, complications, and outcome. Spine 29(7):803–814
Wälchli B, Heini P, Berlemann U (2001) Loss of correction after dorsal stabilization of burst fractures of the thoracolumbar junction. The role of transpedicular spongiosa plasty. Unfallchirurg 104(8):742–747
Ware J Jr (2000) SF-36 health survey update. Spine 25:3130–3139
Ware J Jr, Kosinski M, Keller SD (1996) A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 34:220–233
Wilke HJ, Kemmerich V, Claes LE, Arand M (2001) Combined anteroposterior spinal fixation provides superior stabilisation to a single anterior or posterior procedure. J Bone Joint Surg Br 83(4):609–617
Wood K, Buttermann G, Mehbod A, Garvey T, Jhanjee R, Sechriest V, Butterman G (2003) Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit. A prospective, randomized study. J Bone Joint Surg Am 85:773–781
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Briem, D., Behechtnejad, A., Ouchmaev, A. et al. Pain regulation and health-related quality of life after thoracolumbar fractures of the spine. Eur Spine J 16, 1925–1933 (2007). https://doi.org/10.1007/s00586-007-0395-x
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-007-0395-x