Spine Backpain

To examine the relationships between well-being and different levels of both low back pain intensity and disability in women living in the community.

METHODS:
A detailed, self-administered questionnaire was mailed to 542 community-dwelling women, aged 24-80 years. Participants provided demographic data and completed the Chronic Pain Grade Questionnaire and Psychological General Well-being Index (PGWB).

RESULTS:
A total of 506 participants (93.4%) returned completed questionnaires. Multivariate analysis revealed associations between lower total PGWB scores and both low (odds ratio (OR) -5.53; 95% confidence interval (CI) -9.01, -2.06) and high pain intensity (OR -8.36; 95% CI -13.8, -2.92) compared with no pain intensity, after adjusting for confounders.

Lower total scores on the PGWB were also associated with low (OR -4.72; 95% CI -9.04, -0.41) and high disability (OR -9.26; 95% CI -15.2, -3.30), compared with no disability. There were also statistically significant associations between lower scores on the PGWB subdomains and low and high pain intensities, and low and high disabilities.

CONCLUSIONS:
We found that it is not only women with high pain intensity and disability who experience reduced well-being, but also those with low levels of pain and disability. Longitudinal investigation is needed to investigate the predictive nature of both low and high levels of pain and disability in determining poor well-being in community-based women.



"Are low levels of low back pain intensity and disability associated with reduced well-being in community-based women?"
Climacteric. 2009 Jun; 12(3): 266-75Urquhart DM, Shortreed S, Davis SR, Cicuttini FM, Bell RJ

To evaluate the preliminary clinical outcomes of percutaneous endoscopic lumbar discectomy (PELD) for patient with discogenic chronic low back pain (CLBP) and failing to respond to conservative treatment.

METHODS:
From June 2007 to May 2008, 52 patients with CLBP and failing to respond to conservative treatment were treated, including 15 males and 37 females aged 29-46 years old (average 38.2 years old). Those patients were diagnosed with discogenic pain by low pressure discography. Duration of CLBP was 6-110 months with an average of 32.1 months.

MRI exam revealed 108 "black intervertebral discs" low in signal on T2 image, including 3 discs of L2,3, 17 of L3,4, 48 of L4,5 and 40 of L5-S1. Pressure-controlled discography showed positive response, fluoroscopy or intraoperative CT confirmed annulus fibrosus tears of posterior intervertebral disc in 79 discs. PELD was performed. Visual analogue scale (VAS) was evaluated before operation, 1 month after operation and at the final follow-up. The clinical outcome was determined by modified Macnab criteria at the final follow-up.

RESULTS:
The average operation time of each disc was 30.7 minutes (range 21-36 minutes), and the mean length of postoperative hospital stay was 3.7 days (range 2-5 days). No complications such as infection and the injury of blood vessels and nerves occurred. Transient paralysis of nerve occurred in 5 cases on operation day, and those symptoms were disappeared at the final follow-up visit without special treatment.

Fifty-two cases were followed up for 3-15 months (average 7.3 months). VAS score before operation, 1 month after operation and at the final follow-up was (7.34 +/- 1.52), (3.62 +/- 0.92) and (1.57 +/- 0.48) points, respectively, indicating there were significant differences compared with preoperative score (P < 0.01). According to the modified Macnab criteria, 11 cases were graded as excellent, 23 as good, 13 as fair, 5 as bad, and the excellent and good rate was 65.38%.

CONCLUSION:
Preliminary study suggests that PELD is safe and effective in treating patient with discogenic CLBP and failing to respond to conservative treatment.



"Percutaneous endoscopic lumbar discectomy for treatment of chronic discogenic low back pain"
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2009 Apr; 23(4): 400-3Wang J, Zhou Y, Li C, Zhang Z, Zhang N

To investigate the causes and preventive methods of the bone cement leakage in percutaneous kyphoplasty (PKP) for osteoporotic vertebral body compression fracture (OVCF).

METHODS:
From April 2003 to November 2007, 116 patients with OVCF were treated with PKP, including 57 males and 59 females aged 65-92 years old (average 67.7 years old). All the patients suffered from trauma and the course of disease was 1-14 days (average 5.7 days).

There were 159 compressed and fractured vertebral bodies, including one vertebral body in 83 cases, two vertebral bodies in 24 cases, three vertebral bodies in 8 cases, and four vertebral bodies in 1 case.

The diagnosis of OVCF was confirmed by imaging examination before operation. All the patients had intact posterior vertebral walls, without symptoms of spinal and nerve root injury. During operation, 3.5-7.1 mL bone cement (average 4.8 mL) was injected into single vertebral body.

RESULTS:
The operation time was 30-90 minutes (average 48 minutes). Obvious pain relief was achieved in all the patients after operation. X-rays examination 2 days after operation revealed that the injured vertebral bodies were well replaced without further compression and deformation, and the bone cement was evenly distributed.

Fourteen vertebral bodies had bone cement leakage (4 of anterior leakage, 4 of lateral leakage, 3 of posterior leakage, 2 of intervertebral leakage, 1 of spinal canal leakage). The reason for the bone cement leakage included the individuality of patient, the standardization of manipulation and the time of injecting bone cement.

During the follow-up period of 12-30 months (average 24 months), all the patients got their normal life back, without pain, operation-induced spinal canal stenosis, obvious height loss of injured vertebral bodies and other complications.

CONCLUSION:
For OVCF, PKP is a mini-invasive, effective and safe procedure that provides pain relief and stabilization of spinal stability. The occurrence of bone cement leakages can be reduced by choosing the suitable case, improving the viscosity of bone cement, injecting the proper amount of bone cement and precise location during operation.


"Prevention and treatment of bone cement leakage in percutaneous kyphoplasty for osteoporotic vertebral body compression fracture"
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2009 Apr; 23(4): 404-7Zhao L, Wang L, Wang G, Xu J, Zeng Y, Zheng S, Jiang C, Gui J

Ann Plast Surg. 2009 Sep 4; Mavili ME, Canter HI, Saglam-Aydinatay BAlthough the use of rigid fixation of bony segments in orthognathic surgery has become a standard of care, the question remains, 'With use of rigid fixation has stability of common orthognathic surgical procedures improved?' Because of the problems with various methods of osteosynthesis for the osteotomies commonly used in orthognathic surgery, we have developed our own way of semirigid fixation method to stabilize the osteotomized fragments for bone healing with enough flexibility to avoid the problems arising from absolute rigid fixation. The purpose of this article is to review the existing data to determine whether our method of semirigid fixation yields enough short-term and long-term stability after orthognathic surgery procedures.The study was designed as a retrospective trial. A total of 23 patients with double jaw surgery and 12 patients with mandibular set back surgery were reviewed. Preoperative lateral cephalometric radiographs obtained 1 month before the surgery, early postoperative cephalometric radiographs obtained after intermaxillary fixation was opened and late postoperative cephalometric radiographs were evaluated. Pog-McNamara vertical (mm) was used to measure the anteroposterior movement of mandible. Facial axis ( degrees ) was used to measure the vertical movement of the anterior part of the mandible. A-McNamara vertical (mm) was used to measure the anteroposterior movement of maxilla. Maxillary height ( degrees ) was used to measure rotational movement of the osteotomized maxillary segment in vertical dimension. The raw data obtained from cephalometric analysis were evaluated by using the computerized statistical program SPSS version 11.5 for Windows. The differences in linear and angular measurements between time intervals were tested for statistical significance, using repeated measures analysis of variance. A value of P < 0.05 was considered significant.None of the patients had infection at maxillary osteotomy side. Unilateral local infection at osteotomy side was seen in only one patient after double jaw surgery. Condylar malpositioning was not observed in any of the patients. Although postoperative maxillaomandibular fixation with elastics was applied routinely to all patients for 15 days, none of the patients had complaint related with temporomandibular joint discomfort, such as pain, restricted joint motion, etc. There is significant difference in anteroposterior movement of mandible in all time intervals. In terms of facial axis, the differences at T1 and T2 and at T2 and T3 are significant, while the difference at T1 and T3 is not significant. There is significant difference in anteroposterior movement of maxilla in all time intervals. In terms of maxillary height, the differences at T1 and T2 and at T2 and T3 are significant, while the difference at T1 and T3 is not significant.Method of semirigid fixation with 2 plates for maxillary fixation and 2 screws for mandibular fixation provide enough stability after LeFort I and bilateral sagittal split osteotomy procedures where mainly anteroposterior linear displacements were performed. There was no significant clinical short-term or long-term relapse. Stability in rotational movements needs to be further evaluated.

BMC Complement Altern Med. 2009 Sep 7; 9(1): 33Sundberg T, Petzold M, Wandell P, Ryden A, Falkenberg TABSTRACT: BACKGROUND: A model for integrative medicine (IM) adapted to Swedish primary care was previously developed. The aim of this study was to explore the feasibility of a pragmatic randomised clinical trial to investigate the effectiveness of the IM model versus conventional primary care in the management of patients with non-specific back/neck pain. Specific objectives included the exploration of recruitment and retention rates, patient and care characteristics, clinical differences and effect sizes between groups, selected outcome measures and power calculations to inform the basis of a full-scale trial. METHODS: Eighty patients with back/neck pain of at least two weeks duration were randomised to the two types of care. Outcome measures were standardised health related quality of life (the eight domains of SF-36) complemented by a set of exploratory "IM tailored" outcomes targeting self-rated disability, stress and well-being (0-10 scales); days in pain (0-14); and the use of analgesics and health care over the last two weeks (yes/no). Data on clinical management were derived from medical records. Outcome changes from baseline to follow-up after 16 weeks were used to explore the differences between the groups. RESULTS: Seventy-five percent (80/107) of screened patients in general practice were eligible and feasible to enrol into the trial. Eighty-two percent (36/44) of the integrative and 75% (27/36) of the conventional care group completed follow-up after 16 weeks. Most patients had back/neck pain of at least three months duration. Conventional care typically comprised advice and prescription of analgesics, occasionally complemented with sick leave or a written referral to physiotherapy. IM care generally integrated seven treatment sessions from two different types of complementary therapies with conventional care over ten weeks. The study was underpowered to detect any statistically significant differences between the groups. One SF-36 domain showed a clinically relevant difference between groups that was also supported by a small distribution based effect size, i.e. vitality (-7.3 points, Cohen's d -0.34) which was in favour of IM. There was a clinical trend between groups showing that IM contributed to less use of prescription and non-prescription analgesics (-11.7 and - 9.7 percent units respectively) compared to conventional care. Exploring clinically relevant differences and the SF-36 as the basis for a main outcome measure showed that the sample sizes needed per arm to adequately power a full-scale trial depended on the target domain, i.e. ranging from 60 (vitality) to 339 (role emotion). CONCLUSIONS: This pilot study investigated the implementation of IM in the primary care management of non-specific back and neck pain. Recruiting patients and implementing IM in routine clinical practice was feasible. The results warrant further exploration into different perspectives and relevant combinations of outcome measures including the use of health resources, drugs and cost-effectiveness to help understand the relevance of IM in primary care. Future research should prioritise larger scale studies considering variability, pain duration and small to moderate treatment effects. Trial registration: Clinical trials NCT00565942.

Spine (Phila Pa 1976). 2009 Sep 1; 34(19): E712-5Apostolopoulos V, David KM, Malcolm A, King ASTUDY DESIGN: Case Report. OBJECTIVE: To share our experience about the unique histological appearances of a calcified intradural, extramedullary lesion involving a nerve root. SUMMARY OF BACKGROUND DATA: A 53-year-old man presented with a long history of low back pain and a few months of occasional left groin pain with no neurological deficit. Imaging of the spine revealed a calcified intradural extramedullary lesion at L1, separate from vertebrae. Intraoperatively, the lesion was found to involve closely one of the roots and was heavily calcified but relatively easy to excise. The histology revealed calcifying fibroblastic proliferation associated with a nerve root. This is an unusual pathological entity, which appears distinct from the rare but occasionally reported reactive process known, as heterotopic bone formation in a nerve or "neuritis ossificans," and it is important to distinguish it from other calcified intradural neoplasms. METHODS: The histology of an excised calcified intradural extramedullary lesion was initially reviewed by our local neuropathologist. A second opinion was requested from Prof. Malcolm, who is a histopathologist and bone specialist. The unique histological features of the lesion were confirmed. The literature (no date limitations) was reviewed. RESULTS: A calcified intradural extramedullary lesion, closely related to nerve root was found to have unique histological features, not reported in the literature so far. CONCLUSION: The histological features of the calcified lesion that we report here have not been described before. It is highly likely they represent a reactive process. We think these features are useful to be added to the differential diagnosis of a calcified intradural extramedullary lesion involving a nerve root.

Spine (Phila Pa 1976). 2009 Sep 1; 34(19): 2060-5Ferguson SA, Marras WS, Burr DL, Woods S, Mendel E, Gupta PSTUDY DESIGN: Repeated measures study design. OBJECTIVE: Determine a meaningful change in low back functional impairment as measured with the lumbar motion monitor. SUMMARY OF BACKGROUND DATA: A quantitative functional performance probability (P(n)) measure has been developed and is scored from 0.00 to 1.00. Previous research has shown that a 0.5 cut-off provides excellent sensitivity and specificity for identifying impaired and healthy low back function. However, a meaningful change in the P(n) measure has not been defined. METHODS: The lumbar motion monitor was used to repeatedly measure P(n) in 3 groups of subjects including (1) asymptomatic, (2) recovering low back pain (LBP) and, (3) nonrecovering LBP. The asymptomatic group had 20 subjects. The recovering and nonrecovering LBP had 18 and 8 subjects, respectively. The asymptomatic group was tested 5 times at 1-week intervals. The 2 LBP groups were tested every 2 weeks for 3 months (6 evaluations). RESULTS: The P(n) in the asymptomatic group did not significantly change over the observed period. On the basis of the variability in the asymptomatic group it was hypothesized that a meaningful change in P(n) was 0.14. The defined meaningful change was evaluated in 2 patient with LBP populations. The P(n) in the recovered LBP group significantly improved during the 3 month observation period and there was a corresponding reduction of symptoms. In the recovering LBP group the within subject standard deviation was 0.14 and all patients had at least 1 visit to visit change greater than 0.14. Furthermore, 11 of the 18 recovering patients with LBP had a meaningful change between the first 2 visits. In contrast, none of the nonrecovering LBP group had a meaningful change between the first 2 visits. CONCLUSION: A meaningful change in P(n) was defined as 0.14.

Int J Nurs Stud. 2009 Sep 4; Chen YH, Lin LC, Watson RBACKGROUND: Several behaviourally observed tools have been developed to assess pain among cognitively impaired older people with communication difficulty. However, no adequate pain observation instrument is available for this group in Taiwan. OBJECTIVE: The study was undertaken to translate the French version of the Doloplus-2 scale into Chinese and to evaluate the psychometric properties and the clinical feasibility of the translated instrument. DESIGN: A prospective, descriptive design was used. SETTINGS: Five dementia special care units in the Northern Taiwan were used. PARTICIPANTS: Two hundred and forty-one residents with dementia and 14 registered nurses in charge of these residents were recruited. METHODS: The Doloplus-2 scale was translated into Chinese using the back-translation technique and pilot testing was performed to determine the comprehensibility and the initial psychometric characteristics. Internal consistency and inter-rater reliability were evaluated by Cronbach's alpha and intra-class correlation coefficient, respectively. Based on the known correlated validity model, the association between C-Doloplus-2 and empirically supported correlates of pain such as the past pain history, the presence of pain related condition, functional disability, agitation and depression were examined using Pearson's correlation coefficient for validating the construct validity. Furthermore, factor structure was investigated using Principal Components Analysis. RESULTS: The internal consistency was adequate for the total scale (alpha 0.74) and the subscales (alpha range 0.67-0.87). The intra-class correlation coefficient of the total scale was 0.81 and of the subscales ranged from 0.60 to 0.81. The association between pain latent variable and disability or depression was demonstrated, partially supporting the construct validity. Three factors were extracted to confirm the original three-dimensional structure perfectly, accounting 65% of the total variance. CONCLUSIONS: The psychometric qualities of Chinese Doloplus-2 were supported. Further research is needed to assess the clinical value of the translated scale performed in the institutions.

Spine (Phila Pa 1976). 2009 Sep 1; 34(19): 2008-13Murata Y, Kato Y, Miyamoto K, Takahashi KSTUDY DESIGN: Randomized control trial (RCT) for L2 spinal nerve infiltration (L2 block) in clinical cases. OBJECTIVES: To confirm or refute the effect of L2 block using RCT, and to study the pathway of low back pain (LBP) and radicular pain in clinical cases. SUMMARY OF BACKGROUND DATA: It has been reported in animal experiments that one of the main pathways of pain originating from the lumbar spine is the sympathetic trunk through the L2 spinal nerve rootvia sympathetic afferents. METHODS: To evaluate the effectiveness of L2 block, patients who had LBP and were treated with nonsteroidal anti-inflammatory drugs for at least 2 weeks were then randomized to the L2 block or control block groups. The intensities of LBP and radicular pain were measured using visual analog scale and face scale before and at 5 minutes and 7 days after the injection. These values were compared, and the effects of the injections on the pain pathway were studied. RESULTS: The average visual analog scale scores for LBP before and at 5 minutes and 7 days after the injection were 69, 14, and 44 mm in the L2 block group and 68, 62, and 59 mm in the control block group, respectively. After L2 block, 28 patients reported adequate therapeutic effect at 10 weeks, and the effect lasted for more than 24 weeks in 10 of these patients. After control block, 9 patients reported adequate therapeutic effect at 10 and 24 weeks. CONCLUSION: The LBP and radicular pain pathways were likely interrupted by L2 block. An L2 block is useful in reducing LBP due to the disorders of L2 spinal nerve-innervated structures, such as the disc, facet joint, and sacroiliac joint. However, the therapeutic value of an L2 block may be occasionally insufficient to alleviate pain completely because of the short duration of its' effect.

Spine (Phila Pa 1976). 2009 Sep 1; 34(19): 2090-5Monticone M, Baiardi P, Ferrari S, Foti C, Mugnai R, Pillastrini P, Vanti C, Zanoli GSTUDY DESIGN: Evaluation of the psychometric properties of a translated, culturally adapted questionnaire. OBJECTIVE: Translating, culturally adapting, and validating the Italian version of the Oswestry Disability Index (ODI-I), allowing its use in Italian-speaking patients with low back pain inside and outside Italy. SUMMARY OF BACKGROUND DATA: Growing attention is devoted to standardized outcome measures to improve interventions for low back pain. A translated form of the ODI in patients with low back pain has never been validated within the Italian population. METHODS: The ODI-I questionnaire was developed involving forward-backward translation, final review by an expert committee and test of the prefinal version to establish as better as possible proper correspondence with the original English latest version (2.1a). Psychometric testing included factor analysis, reliability by internal consistency (Cronbach alpha) and test-retest repeatability (Intraclass Coefficient Correlation), concurrent validity by comparing the ODI-I to Visual Analogue Scale, (Pearson correlation), and construct validity by comparing the ODI-I to Roland Morris Disability Questionnaire, RMDQ, and to Short Form Health Survey, Short Form Health Survey-36 (Pearson correlation). RESULTS: The authors required a 3-month period before achieving a shared version of the ODI-I. The questionnaire was administered to 126 subjects, showing satisfying acceptability. Factor analysis demonstrated a 1-factor structure (45% of explained variance). The questionnaire showed high internal consistency (alpha = 0.855) and good test-retest reliability (ICC = 0.961). Concurrent validity was confirmed by a high correlation with Visual Analogue Scale (r = 0.73, P < 0.001), Construct validity revealed high correlations with RMDQ (r = 0.819, P < 0.001), and with Short Form Health Survey-36 domains, highly significant with the exception of Mental Health (r = -0.139, P = 0.126). CONCLUSION: The ODI outcome measure was successfully translated into Italian, showing good factorial structure and psychometric properties, replicating the results of existing language versions of the questionnaire. Its use is recommended in research practice.

Spine (Phila Pa 1976). 2009 Sep 1; 34(19): 2085-9Carreon LY, Glassman SD, McDonough CM, Rampersaud R, Berven S, Shainline MSTUDY DESIGN: Cross-sectional cohort. OBJECTIVE: The purpose of this study is to provide a model to allow estimation of utility from the Short Form (SF)-6D using data from the Oswestry Disability Index (ODI), Back Pain Numeric Rating Scale (BPNRS), and the Leg Pain Numeric Rating Scale (LPNRS). SUMMARY OF BACKGROUND DATA: Cost-utility analysis provides important information about the relative value of interventions and requires a measure of utility not often available from clinical trial data. The ODI and numeric rating scales for back (BPNRS) and leg pain (LPNRS), are widely used disease-specific measures for health-related quality of life in patients with lumbar degenerative disorders. The purpose of this study is to provide a model to allow estimation of utility from the SF-6D using data from the ODI, BPNRS, and the LPNRS. METHODS: SF-36, ODI, BPNRS, and LPNRS were prospectively collected before surgery, at 12 and 24 months after surgery in 2640 patients undergoing lumbar fusion for degenerative disorders. Spearman correlation coefficients for paired observations from multiple time points between ODI, BPNRS, and LPNRS, and SF-6D utility scores were determined. Regression modeling was done to compute the SF-6D score from the ODI, BPNRS, and LPNRS. Using a separate, independent dataset of 2174 patients in which actual SF-6D and ODI scores were available, the SF-6D was estimated for each subject and compared to their actual SF-6D. RESULTS: In the development sample, the mean age was 52.5 +/- 15 years and 34% were male. In the validation sample, the mean age was 52.9 +/- 14.2 years and 44% were male. Correlations between the SF-6D and the ODI, BPNRS, and LPNRS were statistically significant (P < 0.0001) with correlation coefficients of 0.82, 0.78, and 0.72, respectively. The regression equation using ODI, BPNRS,and LPNRS to predict SF-6D had an R of 0.69 and a root mean square error of 0.076. The model using ODI alone had an R of 0.67 and a root mean square error of 0.078. The correlation coefficient between the observed and estimated SF-6D score was 0.80. In the validation analysis, there was no statistically significant difference (P = 0.11) between actual mean SF-6D (0.55 +/- 0.12) and the estimated mean SF-6D score (0.55 +/- 0.10) using the ODI regression model. CONCLUSION: This regression-based algorithm may be used to predict SF-6D scores in studies of lumbar degenerative disease that have collected ODI but not utility scores.

An Pediatr (Barc). 2009 Aug 31; Tapia Moreno R, Espinosa Fernández MG, Martínez León MI, González Gómez JM, Moreno Pascual PINTRODUCTION: Spondylodiscitis is an uncommon disease in children. It is often misdiagnosed or the diagnosis is made late in the course of illness. OBJECTIVES: To review the clinical, analytical and radiological characteristics of children with spondylodiscitis in the Materno-Infantil Hospital of Malaga. PATIENTS AND METHODS: Retrospective cohort study on children diagnosed with spondylodiscitis, during a period of 11 years. RESULTS: Eighteen patients were included in the study. Spondylodiscitis was more frequent in patients younger than 3 years old and older than 12 years old. The average time of delay in diagnosis was 26.9 days. In 8 cases the diagnosis was missed initially. Three clinical patterns appeared: in children under 3 years of age, refusing to walk and sit (100%) and irritability (42%); between 3 and 12 years of age, limb (100%) and abdominal pain (100%); in adolescents, back pain (75%). Fever was present in 38% of the cases, and low-grade fever in 8 (44%). A total of 50% of the patients had a moderate leucocytosis, and a slight increase in ESR; the most frequent location was L3-L4. X-ray diagnosis was pathological in 88% of the cases. The initial MRI diagnosed 100% of the cases. In addition, nerve roots damage (5 cases), inflammatory masses/paravertebral abscesses (5), epidural abscess (1) and psoas abscesses (2) were detected. A total of 94% of the children received antibiotics and 100% of the children underwent immobilization. All patients recovered early after the beginning of treatment, with the exception of those affected by psoas abscesses. The radiological follow-up was done in 17 patients (12 by MRI). After a mean of 14 months (rank 1-48), persistent diminution of disc space was seen in 100% of the children, and improvement of soft-tissue inflammation. Clinically (follow-up only in 11 patients) all patients regained normal mobility and only 27% had moderate pain. CONCLUSION: Spondylodiscitis, whose delay in the diagnosis is frequent, is a serious illness. Complications include abscesses and nerve root damage. MRI is the study of choice to determine the extension to neighbouring tissues.

J Orthop Trauma. 2009 Sep; 23(8): 588-94Stadhouder A, Buskens E, Vergroesen DA, Fidler MW, de Nies F, Oner FCOBJECTIVES: To evaluate and compare nonoperative treatment methods for traumatic thoracic and lumbar compression fractures and burst fractures. DESIGN: Prospective randomized controlled trial with long-term follow-up. SETTING: Two general hospitals in the Netherlands. PATIENTS/PARTICIPANTS: Patients with a traumatic thoracic or lumbar spine fracture, without neurologic damage, with less than 50% loss of height of the anterior column and less than 30% reduction of the spinal canal were included. INTERVENTION: Patients in the compression group were randomized to physical therapy and postural instructions, a brace for 6 weeks, or a Plaster of Paris cast for 6 or 12 weeks. Patients in the burst group received a brace or a Plaster of Paris cast, both for 12 weeks. MAIN OUTCOME MEASUREMENTS: Follow-up examinations included radiographs, Visual Analogue Scores for toleration of treatment and persistent pain, and an Oswestry Disability Index at long-term follow-up. RESULTS: There were 133 patients: 108 in the compression group and 25 in the burst group. For compression fractures, physical therapy and brace were considered the most tolerable. Brace therapy scored significantly better on the Visual Analogue Scores for residual pain and on the Oswestry Disability Index. None of the treatments had any significant effect on the residual deformity measurements. For burst fractures, no significant differences were found. CONCLUSIONS: Brace treatment with supplementary physical therapy is the treatment of choice for patients with compression fractures of the thoracic and lumbar spine. Furthermore, more than 20% of all patients had moderate or severe back pain at long-term follow-up.