Conservative Versus Operative Treatment of Stable Thoracolumbar Burst Fractures in Neurologically Intact Patients

Abstract

Study Design. Nonrandomized, retrospective, comparative, and single-center trial. Objective. The aim of this study is to compare the long-term clinical and radiographic results of thoracolumbar burst fractures in neurologically intact patients, treated surgically or nonsurgically with the aim to optimize their management. Summary of Background Data. There is an ongoing controversy regarding the treatment of thoracolumbar burst fractures (TLBF) (A3, A4) in neurologically intact patients. Surgical treatment as well as conservative treatment methods are advised to this specific group of patients, while contrasting results exist in the literature. Methods. Forty-five neurologically intact patients with TLBF (A3 or A4) (2010–2016) were included. Twenty-one patients with a mean age of 34.3 and a mean follow-up period of 63.1 months were treated surgically with short segment posterior fixation (group 1), while 24 patients with a mean age of 45.7 and a mean follow-up period of 67.1 months were treated conservatively (group 2) with thoracolumbosacral orthesis. Results. At the final follow-up groups 1 and 2 had an average segmental kyphosis of 4.09°/11.65° (P = 0.027), an average loss of kyphosis of 2.04°/4.03° (P = 0.038), an average loss of anterior/posterior vertebral body height of %12.89/%2.84/%17.94/%7.62 (P = 0.027/ P = 0.03), a median JOA score of (16.6/16.75) (P = 0.198), a median ODI score of (11.7/12.1) (P = 0.25), a median VAS score of (1.9/2.3) (P = 0.3), SF-36 PCS of (56.74/56.67) (P = 0.25), SF-36 MCS of (55.47/55.5) (P = 0.3), mean durations of hospital stay of 9–11 days (P = 0.3), respectively. Conclusion. While there is an ongoing controversy regarding the management of stable thoracolumbar burst fractures in neurologically intact patients in the literature, this study concluded that surgical management of stable thoracolumbar burst fractures in neurologically intact patients provided better radiolographic outcomes, despite the result, that the difference between surgically and nonsurgically treated patients in terms of clinical outcome parameters and quality of life was not statistically significant. Level of Evidence: 3

Tratamiento mínimamente invasivo para fracturas toracolumbares

“…Los resultados clínicos a largo plazo en fracturas tipo estallido (A3 y A4) no parecen tener diferencias clínicamente significativas con ambos tipos de tratamiento, aunque los resultados radiológicos sean mejores en aquellos operados. 27 Asimismo, el tratamiento quirúrgico de estas lesiones se relaciona con una mejoría del dolor a corto plazo y tiempos de retorno a las actividades laborales y de la vida cotidiana más rápidos. 28 En este estudio, un subgrupo de ocho pacientes con un TLICSS <4 fue operado, con su consentimiento y el de su familia quienes optaron por este método para evitar períodos prolongados de inmovilización, reposo y dolor junto con las potenciales consecuencias de estos.…”

“…Destacamos que la mitad de nuestros pacientes fueron tratados quirúrgicamente a pesar de que el TLICSS resultara <4. Este es un punto controversial, porque la evidencia disponible 27 no es concluyente sobre el patrón de referencia terapéutico para las fracturas tipo estallido sin compromiso neurológico.…”

Effect of manual reduction and indirect decompression on thoracolumbar burst fracture: a comparison study

“…At present, most scholars at home and abroad believe that even if there is no symptom of the spinal cord or nerve compression, surgical treatment is still advocated [6]. The purpose of surgical treatment is to restore the stability of the spine and to decompress the nerve structure in patients with progressive aggravation of the spinal cord or nerve compression symptoms [7]. Some studies have shown that the bone fragments protruding into the spinal canal can be absorbed by themselves, and if the spine is kept in order, there will be no secondary spinal stenosis in the later stage.…”

Evaluation of disc degeneration adjacent to AOspine A fractures: pre- and post-operative MRI analysis

“…It is commonly accepted that considering the presence of unstable and definitive discoligamentous injuries in types B and C, performing an arthrodesis is logical in these cases [4]. However, for type A fractures which are the most common, there is no therapeutic consensus, and treatment varies according to the authors, ranging from conservative treatment with a cast to a surgical procedure with a vertebroplasty, using an open or a percutaneous fixation, and sometimes a corporectomy and a fusion are performed [5,6].…”