Comparison of operative and nonoperative treatment for thoracolumbar burst fractures in patients without neurological deficit: a systematic review

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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.

Article Information

Address reprint requests to: Charles Fisher, M.D., D6 Heather Pavilion, 2733 Heather Street, Vancouver General Hospital, Vancouver, British Columbia, V5Z 3J5, Canada. email:

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  • 1

    Akbarnia BACrandall DGBurkus KMatthews T: Use of long rods and a short arthrodesis for burst fractures of the thoracolumbar spine. A long-term follow-up study. J Bone Joint Surg Am 76A:162916351994

  • 2

    Alanay AAcaroglu EYazici MAksoy CSurat A: The effect of transpedicular intracorporeal grafting in the treatment of thoracolumbar burst fractures on canal remodeling. Eur Spine J 10:5125162001

  • 3

    Alanay AAcaroglu EYazici MOznur ASurat A: Short-segment pedicle instrumentation of thoracolumbar burst fractures. Does transpedicular intracorporeal grafting prevent early failure?. Spine 26:2132172001

  • 4

    Aligizakis AKatonis PStergiopoulos KGalanakis IKarabekios SHadjipavlou A: Functional outcome of burst fractures of the thoracolumbar spine managed non-operatively, with early ambulation, evaluated using the load sharing classification. Acta Orthop (Belg) 68:2792872002

  • 5

    Aligizakis AKatonis PStergiopoulos KKatsamouris AGalanakis IHadjipavlou A: Conservative management of thoracolumbar burst spine fractures using Gertzbein and Load Shearing classification. Eur J Orthop Surg Traumatol 12:36412002

  • 6

    Andress HJBraun HHelmberger TSchurmann MHertlein HHartl WH: Long-term results after posterior fixation of thoracolumbar burst fractures. Injury 33:3573652002

  • 7

    Bailey CSFisher CGDvorak MF: Type II Error in the spine surgical literature. Spine 29:114611492004

  • 8

    Been HD: Anterior decompression and stabilization of thoracolumbar burst fractures by the use of the Slot-Zielke device. Spine 16:70771991

  • 9

    Been HDBouma GJ: Comparison of two types of surgery for thoracolumbar burst fractures: combined anterior and posterior stabilization vs. posterior instrumentation only. Acta Neurochir (Wien) 141:3493571999

  • 10

    Briem DLehmann WRueckner AHWindolf JRueger JMLinhart W: Factors influencing the quality of life after burst fractures of the thoracolumbar transition. Arch Orthop Trauma Surg 124:4614682004

  • 11

    Butler JSWalsh AO’Byrne JO: Functional outcome of burst fractures of the first lumbar vertebrae managed surgically and conservatively. Int Orthop 29:51542005

  • 12

    Cantor JBLebwohl NHGarvey TEismont FJ: Nonoperative management of stable thoracolumbar burst fractures with early ambulation and bracing. Spine 18:9719761993

  • 13

    Chan DPKSeng NKKaan KT: Nonoperative treatment in burst fractures of the lumbar spine (L2–L5) without neurologic deficits. Spine 18:3203251993

  • 14

    Chow GHNelson BJGebhard JSBrugman JLBrown CWDonaldson DH: Functional outcome of thoracolumbar burst fractures managed with hyperextension casting or bracing and early mobilization. Spine 21:217021751996

  • 15

    Cook DJSackett DLSpitzer WO: Methodologic guidelines for systematic reviews of randomized controlled trials in health care from the Potsdam consultation on meta-analysis. Potsdam Consultation Report. J Clin Epidemiol 48:1671711995

  • 16

    Counsell CFormulating questions and locating primary studies for inclusion in systematic reviews. Mulrow CCook DJ: Systematic Reviews: Synthesis of Best Evidence for Health Care Decisions PhiladelphiaAmerican College of Physicians1998. 6779

  • 17

    Danisa OAShaffrey CIJane JAWhitehill RWang GJSzabo TA: Surgical approaches for the correction of unstable thoracolumbar burst fractures: a retrospective analysis of treatment outcomes. J Neurosurg 83:9779831995

  • 18

    Davies HTOCrombie IK: What is a systematic review?. What Is...? 1:52003. ( [Accessed 22 February 2006]

  • 19

    Davies HTOCrombie IK: What is meta-analysis?. What Is...? 1:52003. ( [Accessed 22 February 2006]

  • 20

    Denis FArmstrong GWDSearls KMatta L: Acute thoracolumbar burst fractures in the absence of neurologic deficit. A comparison between operative and nonoperative treatment. Clin Orthop Relat Res 189:1421491984

  • 21

    Kirkpatrick JSWilber RGLikavec MEmery SEGhanayem A: Anterior stabilization of thoracolumbar burst fractures using the Kaneda device: a preliminary report. Orthopedics 18:6736781995

  • 22

    Kraemer WJSchemitsch EHLever JMcBroom RJMcKee MDWaddell JP: Functional outcome of thoracolumbar burst fractures without neurological deficit. J Orthop Trauma 10:5415441996

  • 23

    Kramer DLRodgers WBMansfield FL: Transpedicular instrumentation and short-segment fusion of thoracolumbar fractures: a prospective study using a single instrumentation system. J Orthop Trauma 9:4995061995

  • 24

    Kulali ABaykut LRahnmanli Ö: Three-stage procedure for the fractured lumbar spine using Harrington posterior instrumentation and anterior interbody fusion. Neuro-Orthopedics 11:43591991

  • 25

    Laursen MHoy KHansen ESGelineck JChristensen FBBunger CE: Recombinant bone morphogenetic protein-7 as an intracorporal bone growth stimulator in unstable thoracolumbar burst fractures in humans: preliminary results. Eur Spine J 8:4854901999

  • 26

    Limb DShaw DLDickson RA: Neurological injury in thoracolumbar burst fractures. J Bone Joint Surg Br 77:7747771995

  • 27

    Liu CLWang STLin HJKao HCYu WKLo WH: AO fixateur interne in treating burst fractures of the thoracolumbar spine. Chin Med J (Taipei) 62:619251999

  • 28

    McAlister FAClark HDvan Walraven CStraus SELawson FMEMoher D: The medical review article revisited: has the science improved?. Ann Intern Med 131:9479511999

  • 29

    Mumford JWeinstein JNSpratt KFGoel VK: Thoracolumbar burst fractures. The clinical efficacy and outcome of nonoperative management. Spine 18:9559701993

  • 30

    Ruan DKShen GBChui HX: Shen instrumentation for the management of unstable thoracolumbar fractures. Spine 23:132413321998

  • 31

    Sanderson PLFraser RDHall DJCain CMOsti OLPotter GR: Short segment fixation of thoracolumbar burst fractures without fusion. Eur Spine J 8:4955001999

  • 32

    Sasso RCCotler HB: 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. Spine 18:4504601993

  • 33

    Schnee CLAnsell LV: Selection criteria and outcome of operative approaches for thoracolumbar burst fractures with and without neurological deficit. J Neurosurg 86:48551997

  • 34

    Shen WJLiu TJShen YS: Nonoperative treatment versus posterior fixation for thoracolumbar junction burst fractures without neurologic deficit. Spine 26:103810452001

  • 35

    Shen WJShen YS: Nonsurgical treatment of three-column thoracolumbar junction burst fractures without neurologic deficit. Spine 24:4124151999

  • 36

    Shiba KKatsuki MUeta TShirasawa KOhta HMori E: Transpedicular fixation with Zielke instrumentation in the treatment of thoracolumbar and lumbar injuries. Spine 19:194019491994

  • 37

    Sochacki MABrantigan JW: Surgical treatment of L1 burst fracture: a case report. Nebr Med J 80:3543561995

  • 38

    van Tulder MWAssendelft WJJKoes BWBouter LM: 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. Spine 22:232323331997

  • 39

    Verlaan JJDiekerhof CHBuskens Evan der Tweel IVerbout AJDhert WJA: Surgical treatment of traumatic fractures of the thoracic and lumbar spine. A systematic review of the literature on techniques, complications, and outcome. Spine 29:8038142004

  • 40

    Wood KButterman GMehbod AGarvey TJhanjee RSechriest V: Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit: a prospective, randomized study. J Bone Joint Surg Am 85:7737812003




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