gms | German Medical Science

Objectives: There is ongoing debate regarding the management of complete burst fractures of the thoracolumbar spine, this ranges from no bracing to circumferential operative stabilisation. Surgery has traditionally been favoured to prevent kyphotic deformity. However, it is questionable as to how much the reduction is maintained, and if patient satisfaction is higher.

This study aims to review the existing literature and outline the current knowledge on operative vs. non-operative treatment of thoracolumbar burst fractures.

Methods: On November 15th, 2022 a systematic review and meta-analysis was performed searching the MEDLINE/Pubmed, Cochrane Central Register of Controlled Trials and EMBASE database. The search term was [burst fracture] and inclusion criteria consisted of randomized control trials in German, English and French analyzing the necessity of surgery compared to nonoperative treatment for thoracolumbar burst fractures as well as the necessity of bracing if non operative treatment was favored. A total of 2,231 abstracts were found of which 8 articles met inclusion criteria; 3 articles investigated surgical vs. nonoperative treatment for burst fractures and a further 5 studies analyzed the necessity of bracing.

Results and conclusion: Within the surgery vs. non surgical group a total of 164 patients (76 vs. 88 patients) were found. In the surgical group posterior stabilisation was the method of choice in 97.4%.No significant differences in fracture pattern, age, gender (male 60.8% vs. 58.5%, p=0.535) or follow-up time (130.0±121.6 vs. 136±131.2 months; p=0.962) was found. Likewise no difference in VAS score immediately after accident was found (4.3±1.5 vs. 4.3±2.4, p=1.000), where as in long term patients undergoing non operative treatment had better outcomes (3.0±1.1 vs. 1.6±0.2 p=0.102). The kyphosis angle after accident was 14.4±7.5° in the surgical group compared to 14.5±5.6° in the non operative group which improved in the surgical group in short run (7.3±4.0 compared to 13.9±8.7°; p=0.300). In long term the average kyphosis angle was 13.0° in the operative group respectively 13.9±0.14° in the non operative one (p=0.432).

Comparing the bracing with no bracing in 114 patients (57 vs. 47) with a mean follow up of 69.1±36.4 respectively 70.7±34.1 months no significant findings were observed for VAS score (1.9±0.6 vs. 2.0±0.5, p=0.877). For sagittal alignment this was comparable in both groups with 6.2±2.5° (brace group) vs. 3.1±0.7° (no brace group) (p=0.236) in long term.

Despite the ongoing research, the literature remains largely inconclusive for surgical stabilisation or bracing in burst fractures. Although the kyphosis angle improves after surgery in short term, in long term no significant difference could be found whereas the VAS score was slightly better in the nonoperative group.