Nonoperative Treatment Versus Posterior Fixation for Thoracolumbar Junction Burst Fractures Without Neurologic Deficit

Abstract

Short-segment posterior fixation provides partial kyphosis correction and earlier pain relief, but the functional outcome at 2 years is similar. Early activity to the point of pain tolerance can be safely allowed.

Nonoperative versus Operative Treatment for Thoracolumbar Burst Fractures Without Neurologic Deficit: A Meta-analysis

“…Sensitivity analysis including pain and functional results from the pseudoRCT [43] also showed no between-group difference in pain (MD = 0.2; p = 0.97; 95% CI, À22.1-21.7; I 2 = 77%).…”

“…If reported data were inadequate, we attempted to contact authors for supplementary information. We contacted Shen et al [43] and Hitchon et al [26] to obtain individual patient data, and Siebenga et al [45] regarding the outcomes of patients who had neurologic complications in the nonoperative group, but we received data from only the latter. Data were extracted using an intention-to-treat basis to include original study participants, where possible.…”

“…The study group also was heterogeneous, with patients having multiple-level and single-level fractures, and multiple treatment options. In a pseudoRCT [43], short-segment posterior fixation (using pedicle screws above and below the fracture), autogenous bone grafting, and facetectomy were compared with a hyperextension brace (3 months). Autogenous bone was grafted from the posterior iliac crest and the bone inserted between the laminae and between adjacent transverse processes.…”

Biomechanical efficacy of monoaxial or polyaxial pedicle screw and additional screw insertion at the level of fracture, in lumbar burst fracture: An experimental study

“…The advantages of this technique include less surgical dissection, blood loss, and time in surgery, and as a result, decreased perioperative morbidity. However, loss of reduction and instrumentation failure associated with this technique is well described in the literature 15–9. These failures have been attributed to poor bone quality, inadequate anterior column support, and insufficient points of fixation.…”

“…Short-segment spinal instrumentation has been beneficial in the management of thoracolumbar spinal fractures for better correction of kyphotic deformity, greater initial stability, early painless mobilization, and indirect decompression of the spinal canal 5–7. Despite the advantages of this approach, it is also associated with loss of reduction and instrumentation failure in some cases 4–9. In an attempt to achieve stiffer short-segment constructs, some surgeons add pedicle screws at the fractured vertebra.…”