My aging father had a car accident (his fault) and suffered a burst fracture at the L1 vertebra. The doctors say he won’t need surgery — just a few weeks on bedrest, then a brace, and rehab to recover strength and mobility. Does this sound like the right plan to you? Why wouldn’t they do surgery if the bone is fractured?

Thoracolumbar burst fractures occur in the spine where the end of the 12 thoracic vertebrae meet the start of the five lumbar vertebrae. A high-energy load through the spine causes the vertebra to break or shatter into many tiny pieces. That’s why they call them burst fractures.

Burst fractures are most often caused by car accidents or by falls. The danger of these fractures is that the bone fragments can shift and press into the spinal cord or spinal nerve roots causing temporary and even permanent neurologic damage.

Surgery isn’t always needed for this type of injury. Surgeons can use a special classification system called the Load Sharing Classification to determine if surgery is needed and what kind of surgical approach to take. Studies have shown that even when the fracture is unstable and the patient has neurologic symptoms, conservative care can still be very successful.

Using the Load Sharing Classification, the surgeon can predict which patients will have a good outcome. A program of bed rest with proper positioning and/or traction to realign the vertebrae is the first step. The patient’s pain dictates how long bed rest must be followed.

When the surgeon permits upright posture and walking, a supportive brace is worn. The patient can expect at least a three-month period of time using the brace. The goal is to maintain good spinal position during the healing process.

Vertebral fractures of this type often affect the front of the vertebral body. Collapse of this portion of the spine results in a kyphotic deformity. Kyphosis means the spine curves forward. If the treatment is not successful in maintaining spinal alignment during and after healing, the patient can become bent over as a result. This effect is referred to as loss of kyphosis correction.

X-rays may be used to monitor the position of the spine and observe for any signs that there is a spinal deformity developing. According to one large study recently published, the recovery rate for patients following this treatment protocol is very high (93 per cent).

The Load Sharing score taken from X-rays and CT scans right after the injury occurred did correlate with the angle of kyphosis (correction maintenance or loss) at the end of the study. Patients with good correction of the kyphosis deformity had less severe pain and better overall function (including return to work).

The results of this large study indicate that conservative care for thoracolumbar burst fractures is both safe and effective.