Operative Compared With Nonoperative Treatment of a Thoracolumbar Burst Fracture Without Neurological Deficit

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

“…Of the cases where work status was reported in the RCTs [45,51], return to work rates were 67% for the nonoperative group and 70% in the operative group. Pooled results from RCTs showed no difference (p = 0.76) in total return to work rates (odds ratio [OR] = 1.6; 95% CI, 0.07-38.7; I 2 = 87%).…”

“…We identified four trials that satisfied our inclusion criteria: two RCTs [45,51], one quasiRCT [45], and one controlled clinical trial [26] (Fig. 1).…”

“…In another multicenter RCT [51], the mode of operation was at the discretion of the surgeon, and consisted of anterior or posterior arthrodesis and instrumentation, and autologous bone grafting, without formal attempt at decompression. The posterior operative approach involved two to five levels of posterolateral spinal arthrodesis with pedicle screw-hook instrumentation and autologous iliac crest bone grafting, whereas the anterior approach involved two-level fibular and rib-strut construct arthrodesis with local autologous bone grafting and instrumentation.…”

“…Moreover, allocation concealment and blinding were unclear. Individual patient data were available from two RCTs [45,51], in which 79 patients (41 operative, 38 nonoperative) were identified (Table 3). This does not include data for those lost to followup.…”

“…Similarly, the review by Yi et al [55] included only one randomized control trial (RCT), thus limiting its power and clinical utility. They also did not use available supplemental data [51] detailing individual patient outcomes, radiographic features, and baseline characteristics.…”