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Review
. 2015 Feb;5(1):73-82.
doi: 10.1055/s-0034-1396047. Epub 2014 Nov 24.

Evidence-Based Medicine of Traumatic Thoracolumbar Burst Fractures: A Systematic Review of Operative Management across 20 Years

Justin K Scheer  1 , Joshua Bakhsheshian  1 , Shayan Fakurnejad  1 , Taemin Oh  1 , Nader S Dahdaleh  1 , Zachary A Smith  1
Affiliations
Review

Evidence-Based Medicine of Traumatic Thoracolumbar Burst Fractures: A Systematic Review of Operative Management across 20 Years

Justin K Scheer et al. Global Spine J. 2015 Feb.

Abstract

Study Design Systematic literature review. Objective The management of traumatic thoracolumbar burst fractures (TLBF) remains challenging, and analyzing the levels of evidence (LOEs) for treatment practices can reform the decision-making process. However, no review has yet evaluated the operative management of traumatic thoracolumbar burst fractures with particular attention placed on LOE from an established methodology. The objective of the present study was to characterize the literature evidence for TLBF, specifically for operative management. Methods A comprehensive search of the English literature over the past 20 years was conducted using PubMed (MEDLINE). The inclusion criteria consisted of (1) traumatic burst fractures (2) in the thoracic or lumbar spine. Exclusion criteria included (1) osteoporotic burst fractures, (2) pathologic burst fractures, (3) cervical fractures, (4) biomechanical studies or those involving cadavers, and (5) computer-based studies. Studies were assigned an LOE and those meeting level 1 or 2 were included. Results From 1,138 abstracts, 272 studies met the criteria. Twenty-three studies (8.5%) met level 1 (n = 4, 1.5%) or 2 (n = 19, 7.0%) criteria. All 23 studies were reported. Conclusions The literature contains a high LOE to support the operative management of traumatic thoracolumbar burst fractures. For patients who are neurologically intact, a high LOE demonstrated similar functional outcomes, lower complication rates, and less costs with conservative management when compared with surgical management. There is a high LOE for short- or long-segment pedicle instrumentation without fusion and less invasive (percutaneous and paraspinal) approaches. Furthermore, the posterior approaches are associated with lower complications as opposed to the anterior or combined approaches.

Keywords: burst fracture; level of evidence; spine; thoracolumbar; trauma.

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Conflict of interest statement

Funding No funding was used for this study. Disclosures Justin K. Scheer, none Joshua Bakhsheshian, none Shayan Fakurnejad, none Taemin Oh, none Nader S. Dahdaleh, none Zachary A. Smith, none

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