Indications and principles of conservative treatment in injuries affecting the vertebral column

Abstract Fractures of the vertebral column are extremely common and mostly affect the thoracolumbar junction as this is the transitional area between the rigid thoracic and flexible lumbar spine where increased loads can be concentrated. The majority of these injuries can be successfully managed conservatively. A large number include insufficiency fractures due to osteoporosis but thoracolumbar fractures can also occur after high-energy injuries such as a fall from height or road traffic collisions. This article considers the principles of spinal stability and how it underpins the assessment of patients with thoracolumbar injuries. Classification and scoring systems based on the concept of spinal stability have been developed and help to guide surgical decision-making. This is particularly useful with burst fractures where there is no clear benefit of surgical over non-operative treatment. The methods of conservative treatment are discussed along with their outcomes and how these compare with surgical stabilization.