Operative versus non‐operative treatment for thoracolumbar burst fractures without neurological deficit

BACKGROUND: Spinal burst fractures result from the failure of both the anterior and the middle columns of the spine under axial compression loads. Conservative management is through bed rest, and immobilization with a brace once the acute symptoms have settled. Surgical treatment involves either anterior or posterior stabilization of the fracture with screws, often with decompression, an operation to remove bone fragments which have intruded into the vertebral canal. OBJECTIVES: To compare operative with non-operative treatment for thoracolumbar burst fractures without neurological deficit. SEARCH METHODS: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialized Register (May 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2, 2005), MEDLINE (January 1966 to April 2005), EMBASE (January 1988 to April 2005), and the Chinese Biomedical Literature Database (CBM) available at http://cbm.imicams.ac.cn (January 1978 to April 2005). We also searched reference lists of articles, handsearched journals and conference proceedings, and contacted authors where necessary. SELECTION CRITERIA: Randomized controlled trials (RCTs) comparing operative with non-operative treatment of thoracolumbar burst fractures without neurological deficit. DATA COLLECTION AND ANALYSIS: Two review authors assessed trial quality and extracted data independently. Pooling of data was not carried out as only one small, poor quality trial was included. MAIN RESULTS: We included one trial comparing operative with non-operative treatment (53 participants). There was no statistically significant difference in pain and function-related outcomes, rates of return to work, radiographic findings or average length of hospitalization at final follow up. The rate of complications was higher for the patients treated operatively. The degree of kyphosis or the percentage of correction lost did not correlate with any clinical symptoms at the time of the final follow up. Average costs related to hospitalization and treatment in the operative group appeared to be more than in the non-operative group. AUTHORS' CONCLUSIONS: There was no statistically significant difference on the functional outcome two years or more after therapy between operative and non-operative treatment for thoracolumbar burst fractures without neurological deficit. However, this review was able to include only one randomized controlled trial with a small sample size and poor quality, which precluded firm conclusions. More research with high quality trials is needed.