Abstract
Background A standing X-ray is recommended for decision-making relative to the therapy for a
traumatic thoracolumbar fracture (TLF). However, standing X-ray management can be
demanding in elderly patients because of pain. The goal of this study was to determine
whether supine radiograph is sufficient for proper therapeutic decision-making in
patients older than 65 years with acute stable traumatic TLF.
Methods Patients older than 65 years who came to the emergency department diagnosed with
an acute and stable traumatic vertebral fracture between T10 and L3 (both included)
were included in the study. Initially, all the patients were studied with a supine
radiograph and computed tomography (CT) scan. If the TLF was stable, a standing radiograph
was performed. Segmental kyphosis (SK) and visual analog scale (VAS) score were collected
and compared in both the supine and standing X-ray projections.
Results Twenty-seven patients with a mean age of 76.39 (range: 65–93) years were included;
most were females. The mean supine SK was 10.14degrees (SD±7.22degrees). It increased
to 12.97 (SD±8.61degrees) in the standing projection (p<0.001). In 37.1% of the patients, the SK increased from 13.22degrees (SD±7.21degrees)
in supine X-ray to 19.96degrees (SD±5.34degrees) in the standing position in this
group. When the initial supine projection showed an SK of ≥10degrees, the mean SK
observed in the standing X-ray increased to 20.5degrees (SD±5.30, p=0.321).
Conclusion Stable traumatic TLF in patients older than 65 years showing ≥10degrees of SK in
supine radiography may benefit from a standing radiography to make a proper therapeutic
decision.
Keywords
stable - thoracolumbar - fracture - standing - radiograph
