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Meta-Analysis
. 2013 Jun 6;2013(6):CD005079.
doi: 10.1002/14651858.CD005079.pub3.

Surgical versus non-surgical treatment for thoracolumbar burst fractures without neurological deficit

Minawaer Abudou  1 , Xueyi Chen, Xiangyu Kong, Taixiang Wu
Affiliations
Meta-Analysis

Surgical versus non-surgical treatment for thoracolumbar burst fractures without neurological deficit

Minawaer Abudou et al. Cochrane Database Syst Rev. .

Abstract

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 immobilisation once the acute symptoms have settled. Surgical treatment involves either anterior or posterior stabilisation of the fracture, sometimes with decompression involving the removal of bone fragments that have intruded into the vertebral canal. This is an update of a review first published in 2006.

Objectives: To compare the outcomes of surgical with non-surgical treatment for thoracolumbar burst fractures without neurological deficit.

Search methods: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (October 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 8), MEDLINE (1946 to October 2012), EMBASE (1980 to October 2012) and the Chinese Biomedical Literature Database (1978 to October 2012). We also searched trial registers and reference lists of articles.

Selection criteria: Randomised or quasi-randomised controlled trials comparing surgical with non-surgical treatment of thoracolumbar burst fractures without neurological deficit.

Data collection and analysis: Two review authors independently assessed risk of bias and extracted data independently. Only limited pooling of data was done.

Main results: We included two trials that compared surgical with non-surgical treatment for patients with thoracolumbar burst fractures without neurological deficit. These recruited a total of 87 participants and reported outcomes for 79 participants at follow-up of two years or more. Both trials were judged at unclear risk of selection bias and at high risk of performance and detection biases, resulting from lack of blinding.The two trials reported contrasting results for pain and function-related outcomes at final follow-up, and numbers returning to work. One trial found less pain (mean difference (MD) -15.09 mm, 95% CI -27.81 to -2.37; 100 mm visual analogue scale), and better function based on the Roland and Morris disability questionnaire results (MD -5.87, 95% CI -10.10 to -1.64; 24 points = maximum disability) in the surgical group. Based on the same outcome measures, the other trial found the surgical group had more pain (MD 13.60 mm, 95% CI -0.31 to 27.51) and worse function (MD 4.31, 95% CI 0.54 to 8.08). Neither trial reported a statistically significant difference in return to work. There were greater numbers of participants with complications in the surgical group of both trials (21/41 versus 6/38; RR 2.85, 95% CI 0.83 to 9.75; 2 trials), and only participants of this group had subsequent surgery, involving implant removal either for complications or as a matter of course. One trial reported that surgery was over four times more costly than non-surgical treatment.

Authors' conclusions: The contradictory evidence provided by two small and potentially biased randomised controlled trials is insufficient to conclude whether surgical or non-surgical treatment yields superior pain and functional outcomes for people with thoracolumbar burst fractures without neurological deficit. It is likely, however, that surgery is associated with more early complications and the need for subsequent surgery, as well as greater initial healthcare costs.

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Conflict of interest statement

None known.

Figures

1
1
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Surgical versus non‐surgical treatment, Outcome 1 Visual Analogue Pain Scores (0 to 100 mm: worst) at follow‐up.
1.2
1.2. Analysis
Comparison 1 Surgical versus non‐surgical treatment, Outcome 2 Roland and Morris Questionnaire at follow‐up (0 to 24: worst result).
1.3
1.3. Analysis
Comparison 1 Surgical versus non‐surgical treatment, Outcome 3 Visual Analogue Scale Spine Score (0 to 100 mm: best) at follow‐up.
1.4
1.4. Analysis
Comparison 1 Surgical versus non‐surgical treatment, Outcome 4 Oswestry Questionnaire at minimum 24 months follow‐up.
1.5
1.5. Analysis
Comparison 1 Surgical versus non‐surgical treatment, Outcome 5 Return to work.
1.6
1.6. Analysis
Comparison 1 Surgical versus non‐surgical treatment, Outcome 6 Subsequent surgery (for complications).
1.7
1.7. Analysis
Comparison 1 Surgical versus non‐surgical treatment, Outcome 7 Complications.
1.8
1.8. Analysis
Comparison 1 Surgical versus non‐surgical treatment, Outcome 8 Kyphosis at follow‐up (degrees).
1.9
1.9. Analysis
Comparison 1 Surgical versus non‐surgical treatment, Outcome 9 Degree of canal compromise (% occlusion) at 2 years.
See this image and copyright information in PMC

Update of

Comment in

References

References to studies included in this review

Siebenga 2006 {published data only}
    1. Siebenga J, Leferink VJM, Segers MJM, Elzinga MJ, Bakker FC, Haarman HJTM, et al. Treatment of traumatic thoracolumbar spine fractures: a multicenter prospective randomised study of operative versus non‐surgical treatment. Spine 2006;31(25):2881‐90. - PubMed
Wood 2003 {published data only}
    1. Eismont FJ. Commentary & Perspective on "Operative compared with non‐operative treatment of a thoracolumbar burst fracture without neurological deficit. A prospective, randomised study". eJBJS Commentary & Perspective available at http://www.jbjs.org/Comments/2003/cp_may03_eismont.shtml 2003.
    1. Wettstein M, Mouhsine E. Operative compared with non‐operative treatment of a thoracolumbar burst fracture without neurological deficit [comment]. Journal of Bone & Joint Surgery ‐ American Volume 2004;86(3):651‐2. - PubMed
    1. Wood K, Buttermann G, Mehbod A, Garvey T, Jhanjee R, Sechriest V. Operative compared with non‐operative treatment of a thoracolumbar burst fracture without neurological deficit. A prospective, randomised study. Journal of Bone and Joint Surgery ‐ American Volume 2003;85‐A(5):773‐81. [MEDLINE: ] - PubMed
    1. Wood KB, Jhanjee R, Buttermann GR, Garvey TA, Kane RS, Sechreist VF. Operative versus non‐operative treatment of thoracolumbar burst fractures without neurological deficit [abstract]. American Academy of Orthopaedic Surgeons 68th Annual Meeting. 2001 Feb 27‐Mar 4; San Francisco (CA).

References to studies excluded from this review

Shen 2001 {published data only}
    1. Shen WJ, Liu TJ, Shen YS. Nonoperative treatment versus posterior fixation for thoracolumbar junction burst fractures without neurologic deficit. Spine 2001;26(9):1038‐45. [MEDLINE: ] - PubMed
Wan 2005 {published data only}
    1. Wan CH, Wang P, Shao M. Relative investigation of treatment to thoracolumbar burst fracture with no nervous lesion. Academic Journal of PLA Postgraduate Medical School 2005;26(6):431‐2.

Additional references

Bedbrook 1975
    1. Bedbrook GM. Treatment of thoracolumbar dislocation and fractures with paraplegia. Clinical Orthopaedics and Related Research 1975;(112):27‐43. [MEDLINE: ] - PubMed
Cantor 1993
    1. Cantor JB, Lebwohl NH, Garvey T, Eismont FJ. Nonoperative management of stable thoracolumbar burst fractures with early ambulation and bracing. Spine 1993;18(8):971‐6. [MEDLINE: ] - PubMed
Chan 2004
    1. Chan AW, Hrobjartsson A, Haahr MT, Gotzsche PC, Altman DG. Empirical evidence for selective reporting of outcomes in randomised trials. Journal of American Medical Association 2004;291(20):2457‐65. - PubMed
Cheng 2013
    1. Cheng LM, Wang JJ, Zeng ZL, Zhu R, Yu Y, Li C, Wu ZR. Pedicle screw fixation for traumatic fractures of the thoracic and lumbar spine. Cochrane Database of Systematic Reviews 2013, Issue 5. [DOI: 10.1002/14651858.CD009073.pub2] - DOI - PMC - PubMed
Chow 1996
    1. Chow GH, Nelson BJ, Gebhard JS, Brugman JL, Brown CW, Donaldson DH. Functional outcome of thoracolumbar burst fractures managed with hyperextension casting or bracing and early mobilization. Spine 1996;21(18):2170‐5. [MEDLINE: ] - PubMed
Denis 1983
    1. Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine 1983;8(8):817‐31. [MEDLINE: ] - PubMed
Denis 1984
    1. Denis F, Armstrong GW, Searls K, Matta L. Acute thoracolumbar burst fractures in the absence of neurologic deficit. A comparison between operative and non‐operative treatment. Clinical Orthopaedics and Related Research 1984;(189):142‐9. [MEDLINE: ] - PubMed
Dick 1985
    1. Dick W, Kluger P, Magerl F, Woersdorfer O, Zach G. A new device for internal fixation of thoracolumbar and lumbar spine fractures: the 'fixateur interne'. Paraplegia 1985;23(4):225‐32. [PUBMED: 3900882] - PubMed
Dickson 1978
    1. Dickson JH, Harrington PR, Erwin WD. Results of reduction and stabilization of the severely fractured thoracic and lumbar spine. Journal of Bone and Joint Surgery. American Volume 1978;60(6):799‐805. [MEDLINE: ] - PubMed
Eskenazi 2000
    1. Eskenazi MS, Bendo JA, Spivak JM. Thoracolumbar spine trauma: evaluation and management. Current Opinion in Orthopaedics 2000;11(3):176‐85. [00001433‐200006000‐00004]
Gertzbein 1992
    1. Gertzbein SD. Scoliosis Research Society. Multicenter spine fracture study. Spine 1992;17(5):528‐40. [MEDLINE: ] - PubMed
Gnanenthiran 2012
    1. Gnanenthiran SR, Adie S, Harris IA. Nonoperative versus operative treatment for thoracolumbar burst fractures without neurologic deficit. A meta‐analysis. Clinical Orthopaedics and Related Research 2012;470(2):567–77. - PMC - PubMed
Higgins 2005
    1. Higgins JPT, Green S (editors). Highly sensitive search strategies for identifying reports of randomized controlled trials in MEDLINE. Cochrane Handbook for Systematic Reviews of Interventions 4.2.4 [updated March 2005]; Appendix 5b. In: The Cochrane Library, Issue 2, 2005.
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Holdsworth 1970
    1. Holdsworth F. Fractures, dislocations, and fracture‐dislocations of the spine. The Journal of Bone and Joint Surgery. American volume 1970;52(8):1534‐51. [MEDLINE: ] - PubMed
Knop 2001
    1. Knop C, Oeser M, Bastian L, Lange U, Zdichavsky M, Blauth M. Development and validation of the Visual Analogue Scale (VAS) Spine Score [Entwicklung und Validierung des VAS‐Wirbelsäulenscores]. Unfallchirurg 2001;104(6):488‐97. - PubMed
Liu 2009
    1. Liu S, Li H, Liang C, Long H, Yu B, Chen B, et al. Monosegmental transpedicular fixation for selected patients with thoracolumbar burst fractures. Journal of Spinal Disorders & Techniques 2009;22(1):38‐44. [PUBMED: 19190433] - PubMed
Marsh 2007
    1. Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, et al. Fracture and dislocation classification compendium ‐ 2007: Orthopaedic Trauma Association classification, database and outcomes committee. Journal of Orthopaeduc Trauma 2007;21(10 Suppl):S1‐133. - PubMed
McEvoy 1985
    1. McEvoy RD, Bradford DS. The management of burst fractures of the thoracic and lumbar spine. Experience in 53 patients. Spine 1985;10(7):631‐7. [MEDLINE: ] - PubMed
McLain 1993
    1. McLain RF, Sparling E, Benson DR. Early failure of short‐segment pedicle instrumentation for thoracolumbar fractures. A preliminary report. Journal of Bone and Joint Surgery. American Volume 1993;75(2):162‐7. [MEDLINE: ] - PubMed
Okuyama 1996
    1. Okuyama K, Abe E, Chiba M, Ishikawa N, Sato K. Outcome of anterior decompression and stabilization for thoracolumbar unstable burst fractures in the absence of neurologic deficits. Spine 1996;21(5):620‐5. [MEDLINE: ] - PubMed
OTA 1996
    1. Orthopaedic Trauma Association Committee (OTAC). Fracture and dislocation compendium. Orthopaedic Trauma Association Committee for Coding and Classification. Journal of Orthopaedic Trauma 1996;10(suppl.: V‐IX):1‐154. - PubMed
Price 1994
    1. Price C, Makintubee S, Herndon W, Istre GR. Epidemiology of traumatic spinal cord injury and acute hospitalisation and rehabilitation charges for spinal cord injuries in Oklahoma, 1988‐1990. American Journal of Epidemiology 1994;139(1):37‐47. [MEDLINE: ] - PubMed
Purcell 1981
    1. Purcell GA, Markolf KL, Dawson EG. Twelfth thoracic‐first lumbar vertebral mechanical stability of fractures after Harrington‐rod instrumentation. Journal of Bone and Joint Surgery. American Volume 1981;63(1):71‐8. [MEDLINE: ] - PubMed
Shikata 1990
    1. Shikata J, Yamamuro T, Iida H, Shimizu K, Yoshikawa J. Surgical treatment for paraplegia resulting from vertebral fractures in senile osteoporosis. Spine 1990;15(6):485‐9. [MEDLINE: ] - PubMed
Tezeren 2005
    1. Tezeren G, Kuru I. Posterior fixation of thoracolumbar burst fracture: short‐segment pedicle fixation versus long segment instrumentation. Journal of Spinal Disorders & Techniques 2005;18(6):485‐8. [PUBMED: 16306834] - PubMed
Vaccaro 2005
    1. Vaccaro AR, Lehman RA Jr, Hurlbert RJ, Anderson PA, Harris M, Hedlund R, et al. A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine 2005;30(20):2325‐33. - PubMed
Wang 2006
    1. Wang ST, Ma HL, Liu CL, Yu WK, Chang MC, Chen TH. Is fusion necessary for surgically treated burst fractures of the thoracolumbar and lumbar spine?: A prospective, randomized study. Spine 2006;31(23):2646‐52; discussion 2653. [PUBMED: 17077731] - PubMed
Weinstein 1988
    1. Weinstein JN, Collalto P, Lehmann TR. Thoracolumbar "burst" fractures treated conservatively: a long‐term follow‐up. Spine 1988;13(1):33‐8. [MEDLINE: ] - PubMed

References to other published versions of this review

Yi 2006
    1. Yi L, Jingping B, Gele J, Wu T, Baoleri X. Operative versus non‐operative treatment for thoracolumbar burst fractures without neurological deficit. Cochrane Database of Systematic Reviews 2006, Issue 4. [DOI: 10.1002/14651858.CD005079.pub2] - DOI - PubMed

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