Despite extensive published research on thoracolumbar burst fractures, controversy still surrounds which is the most appropriate treatment. The objective of this study was to evaluate the scientific literature on operative and nonoperative treatment of patients with thoracolumbar burst fractures and no neurological deficit.
In their search of the literature, the authors identified all possible relevant studies concerning thoracolumbar burst fracture without neurological deficit. Two independent observers performed study selection, methodological quality assessment, and data extraction in a blinded and objective manner for all papers identified during the search. In a synthesis of the literature, the authors obtained evidence for both operative and nonoperative treatments.
There is a lack of evidence demonstrating the superiority of one approach over the other as measured using generic and disease-specific health-related quality of life scales. There is no scientific evidence linking posttraumatic kyphosis to clinical outcomes. The authors found that there is a strong need for improved clinical research methodology to be applied to this patient population.
Abbreviations used in this paper: HRQOL = health-related quality of life; ODI = Oswestry Disability Index; PS = pedicle screw; RCT = randomized controlled trial; RMDS = Roland–Morris Disability Scale; SF-36 = 36-Item Short Form Health Survey; TLSO = thoracolumbosacral orthosis; VAS = visual analog scale; VB = vertebral body.
AligizakisAKatonisPStergiopoulosKGalanakisIKarabekiosSHadjipavlouA: Functional outcome of burst fractures of the thoracolumbar spine managed non-operatively, with early ambulation, evaluated using the load sharing classification. Acta Orthop (Belg)68:279–2872002
BeenHDBoumaGJ: Comparison of two types of surgery for thoracolumbar burst fractures: combined anterior and posterior stabilization vs. posterior instrumentation only. Acta Neurochir (Wien)141:349–3571999
CookDJSackettDLSpitzerWO: Methodologic guidelines for systematic reviews of randomized controlled trials in health care from the Potsdam consultation on meta-analysis. Potsdam Consultation Report. J Clin Epidemiol48:167–1711995
CounsellCFormulating questions and locating primary studies for inclusion in systematic reviews. MulrowCCookDJ: Systematic Reviews: Synthesis of Best Evidence for Health Care DecisionsPhiladelphiaAmerican College of Physicians1998. 67–79
DanisaOAShaffreyCIJaneJAWhitehillRWangGJSzaboTA: Surgical approaches for the correction of unstable thoracolumbar burst fractures: a retrospective analysis of treatment outcomes. J Neurosurg83:977–9831995
DenisFArmstrongGWDSearlsKMattaL: Acute thoracolumbar burst fractures in the absence of neurologic deficit. A comparison between operative and nonoperative treatment. Clin Orthop Relat Res189:142–1491984
KramerDLRodgersWBMansfieldFL: Transpedicular instrumentation and short-segment fusion of thoracolumbar fractures: a prospective study using a single instrumentation system. J Orthop Trauma9:499–5061995
LaursenMHoyKHansenESGelineckJChristensenFBBungerCE: Recombinant bone morphogenetic protein-7 as an intracorporal bone growth stimulator in unstable thoracolumbar burst fractures in humans: preliminary results. Eur Spine J8:485–4901999
SassoRCCotlerHB: Posterior instrumentation and fusion for unstable fractures and fracture-dislocations of the thoracic and lumbar spine. A comparative study of three fixation devices in 70 patients. Spine18:450–4601993
van TulderMWAssendelftWJJKoesBWBouterLM: the Editorial Board of the Cochrane Collaboration Back Review Group: Method guidelines for systematic reviews in the Cochrane Collaboration back review group for spinal disorders. Spine22:2323–23331997
VerlaanJJDiekerhofCHBuskensEvan der TweelIVerboutAJDhertWJA: Surgical treatment of traumatic fractures of the thoracic and lumbar spine. A systematic review of the literature on techniques, complications, and outcome. Spine29:803–8142004
WoodKButtermanGMehbodAGarveyTJhanjeeRSechriestV: Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit: a prospective, randomized study. J Bone Joint Surg Am85:773–7812003