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

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>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.</jats:p></jats:sec>

Anterior versus posterior approach for treatment of thoracolumbar burst fractures: a meta-analysis

“…Although many studies have obtained good results with nonoperative treatment of thoracolumbar burst fractures [6][7][8], most authors agree that surgical treatment is required for symptomatic, unstable burst fractures [9,10]. Surgical intervention can decompress neural elements, restore vertebral body height, correct angular deformity and stabilize the spine.…”

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

“…Patients with such fractures may be treated with either nonoperative or operative modalities. Nonoperative treatment may include the use of a brace, cast, bed rest, and analgesics [7,11,12,14,34,46,47]. Operative treatment usually involves instrumented intervertebral fusion, with or without spinal decompression.…”

“…Several systematic reviews of nonoperative versus operative treatment for thoracolumbar burst fractures without a neurologic deficit have been published [18,46,48,55]. However, Dai et al [18], Thomas et al [46], and van der Roer et al [48], based their conclusions primarily on descriptive summaries, included observational studies, and did not perform meta-analyses.…”

“…However, Dai et al [18], Thomas et al [46], and van der Roer et al [48], based their conclusions primarily on descriptive summaries, included observational studies, and did not perform meta-analyses. Similarly, the review by Yi et al [55] included only one randomized control trial (RCT), thus limiting its power and clinical utility.…”

Fratura toracolombar do tipo explosão: correlação entre a cifose residual e função após o tratamento cirúrgico

“…Observational studies on neurologically intact patients have not shown any differences in the long-term functional results among patients with this type of lesion, independent of whether they underwent surgical treatment or not (2,3,10) . However, the surgical method is generally proposed for patients whose fractures have led to loss of 50% of the height of the vertebral body and kyphosis greater than 30°, because of inadequate functional results.…”