Does Operative or Nonoperative Treatment Achieve Better Results in A3 and A4 Spinal Fractures Without Neurological Deficit?

Abstract

Study Design:Systematic literature review with meta-analysis.Objective:Thoracolumbar (TL) fractures can be treated conservatively or surgically. Especially, the treatment strategy for incomplete and complete TL burst fractures (A3 and A4, AOSpine classification) in neurologically intact patients remains controversial. The aim of this work was to collate the clinical evidence on the respective treatment modalities.Methods:Searches were performed in PubMed and the Web of Science. Clinical and radiological outcome data were collected. For studies comparing operative with nonoperative treatment, the standardized mean differences (SMD) for disability and pain were calculated and methodological quality and risk of bias were assessed.Results:From 1929 initial matches, 12 were eligible. Four of these compared surgical with conservative treatment. A comparative analysis of radiological results was not possible due to a lack of uniform reporting. Differences in clinical outcomes at follow-up were small, both between studies and between treatment groups. The SMD was 0.00 (95% CI −0.072, 0.72) for disability and −0.05 (95% CI −0.91, 0.81) for pain. Methodological quality was high in most studies and no evidence of publication bias was revealed.Conclusions:We did not find differences in disability or pain outcomes between operative and nonoperative treatment of A3 and A4 TL fractures in neurologically intact patients. Notwithstanding, the available scores have been developed and validated for degenerative diseases; thus, their suitability in trauma may be questionable. Specific and uniform outcome parameters need to be defined and enforced for the evaluation of TL trauma.

Efficacy of percutaneous short segment fixation on the treatment of Magerl A3 thoracolumbar fractures: a retrospective study

“…Currently, conservative therapy for Magerl A0, A1, and A2 TL fractures and surgical therapy for Magerl B and C is generally accepted, however, no general consensus exists for Magerl A3 and A4 fractures without neurological de cits (16,17). In fact, few in vitro studies evaluated the e cacy of PSSF in treating TL fractures accompanied with low BMD.…”

Preoperative manual on-table-traction for the reduction of thoracolumbar burst fractures: A technical note

“…Thoracolumbar fractures are no exception to this rule, and this is also one of the main reasons why most of the fractures can still today spark a heated discussion between experts as to what the most suitable treatment should be. [ 1 2 ]…”

“…The optimal treatment for specific subtypes of thoracolumbar burst fractures still generates debate. [ 1 2 ]…”

Konservative Behandlung von Wirbelfrakturen in BWS und LWS – was geht wie?

“…Die Therapieempfehlung und die Schwellenwerte wurden durch mehrere Studien und eine große Metaanalyse aus dem Jahr 2017 untermauert [5]. Sie ergaben für A3-und A4-Frakturen keinen Unterschied zwischen einer operativen und nicht operativen Behandlung in Bezug zur Schmerzintensität und funktionelle Einschränkung.…”