Indications for Nonsurgical Treatment of Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations

Abstract

Thoracolumbar spine is the most injured spinal region in blunt trauma. Literature on the indications for nonoperative treatment of thoracolumbar fractures is conflicting. The purpose of this systematic review is to clarify the indications for nonsurgical treatment of thoracolumbar fractures. We conducted a systematic literature search between 2010 to 2020 on PubMed/MEDLINE, and Cochrane Central. Up-to-date literature on the indications for nonoperative treatment of thoracolumbar fractures was reviewed to reach an agreement in a consensus meeting of WFNS (World Federation of Neurosurgical Societies) Spine Committee. The statements were voted and reached a positive or negative consensus using the Delphi method. For all of the questions discussed, the literature search yielded 1,264 studies, from which 54 articles were selected for full-text review. Nine studies (4 trials, and 5 retrospective) evaluating 759 participants with thoracolumbar fractures who underwent nonoperative/surgery were included. Although, compression type and stable burst fractures can be managed conservatively, if there is major vertebral body damage, kyphotic angulation, neurological deficit, spinal canal compromise, surgery may be indicated. AO type B, C fractures are preferably treated surgically. Future research is necessary to tackle the relative paucity of evidence pertaining to patients with thoracolumbar fractures.

The AO Spine Thoracolumbar Injury Classification System and Treatment Algorithm in Decision Making for Thoracolumbar Burst Fractures Without Neurologic Deficit

“…[4][5][6] On one hand, some have argued that there are equivalent functional outcomes between operative and non-operative treatment thereby inherently favoring the avoidance of surgical management and its attendant complications. [7][8][9] On the other hand, surgical stabilization affords immediate surgical correction of spine alignment and obviates the purported delayed risks of post-traumatic deformity. 10,11 Gertzbein et al argued there was a clear improvement between the degree of kyphotic deformity and subsequent functional outcomes with surgical stabilization and this was shown with good effect by Schnake et al 12,13 However, Thomas et al found that there was no clear link between posttraumatic kyphosis and clinical outcomes.…”

Efficacy of a novel percutaneous pedicle screw fixation and vertebral reconstruction versus the traditional open pedicle screw fixation in the treatment of single-level thoracolumbar fracture without neurologic deficit

“…Thoracolumbar fractures account for more than 50% of all spinal fractures (1), and pose a huge economic burden to the society and families. Patients with stable spine fractures can be treated conservatively, while surgery is needed for severe damage of the vertebral column, kyphotic deformity, or neurological disorders (2). At present, operative indications of type A thoracolumbar fracture without neurologic deficit include: (1) kyphotic deformity > 15-20°( compared with normal angle); (2) the loss of vertebral body height > 50%.…”

Epidemiological study of thoracolumbar spine fracture patients reported to tertiary care center of Central India

“…1 Anatomically and functionally thoracolumbar spine is divided into regid thoracic spine (T1-10), transitional thoracolumbar junction (T10-L2), and Flexible lumbar spine (L3-L5). 2 Thoracic spine being regid needs greater amount of force to produce fracture or dislocations, also narrow spinal canal at this region leads to high incidence of spinal cord involvement. 1 Lumbar spine being flexible with greater diameter of canal predisposing it to lesser incidence of neurological injuries.…”

“…5,6 Thoracolumbar spine fractures account for 90% of all spine fractures recorded. 2 Such injuries are very common among young people, between 20 and 40 years old, and the most common causes of such spine trauma are motor vehicle accidents, falls, and gunshot injuries. 7 The probability of developing a neurological deficit will depend on the type of fracture.…”

“…7 The probability of developing a neurological deficit will depend on the type of fracture. 2 Based on x-ray, CT, and MRI investigations, these injuries can have any of the following morphologies: Compression, burst, translation or rotation, and distraction. 8 For these patients, after resuscitation in the emergency room and subsequent care, all efforts must be made to immobilize spinal injury patients safely and intermittently log roll to prevent pressure sore formation.…”