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Review
. 2024 Mar;14(2):740-749.
doi: 10.1177/21925682231181875. Epub 2023 Jun 9.

Surgical Versus Non-Surgical Treatment for Thoracolumbar Burst Fractures Without Neurological Deficit: A Systematic Review and Meta-Analysis

Tzu-Yi Chou  1 , Fon-Yih Tsuang  2   3 , Yu-Lun Hsu  1 , Chung Liang Chai  4   5
Affiliations
Review

Surgical Versus Non-Surgical Treatment for Thoracolumbar Burst Fractures Without Neurological Deficit: A Systematic Review and Meta-Analysis

Tzu-Yi Chou et al. Global Spine J. 2024 Mar.

Abstract

Study design: A systematic review and meta-analysis.

Objective: To update the systematic review comparing the outcomes between surgical and non-surgical treatment for thoracolumbar burst fractures without neurological deficit.

Methods: We registered a protocol in PROSPERO (ID: CRD42021291769) and searched Medline, Embase, Web of Science, and Google Scholar databases. Surgical and non-surgical treatments were compared in patients with thoracolumbar burst fractures without neurological deficits. Predefined outcomes at ≥6 months included pain (defined as a visual analog scale [VAS] of 0-100), functional outcomes (Oswestry Disability Index [ODI] of 0-50 and Roland-Morris Disability Questionnaire [RMDQ] of 0-24), and kyphotic angulation.

Results: Nineteen studies involving 1056 patients were included in the analyses. For outcomes at ≥6 months, little to no difference was found in pain VAS score (mean difference, .95 [95% confidence interval {CI}, -6.02 to 7.92]; 827 participants; 15 studies; I2 = 92%), ODI (mean difference, -1.40 [95% CI, -5.11 to 2.31]; 446 participants; 7 studies; I2 = 79%), and RMDQ (mean difference, -.73 [95% CI, -5.13 to 3.66]; 216 participants; 5 studies; I2 = 77%). The kyphotic angulation in the surgery group was 6.35° lower than that in the non-surgery group (mean difference, -6.56° [95% CI, -10.26° to -2.87°]; 527 participants; ten studies; I2 = 86%). The trial sequential analysis indicated all outcomes reached adequate statistical power. The certainty of the evidence for all 4 outcomes was very low. For the analysis of minimally invasive procedures compared to traditional open surgeries, a statistically significant subgroup difference was found for VAS and ODI (P < .01 and P < .04, respectively).

Conclusion: Surgical and non-surgical treatments showed little or no difference in outcomes at ≥6 months. This review provides a conclusion with adequate statistical power by including non-randomized studies. However, non-randomized studies also lowered the certainty of the evidence to a very low level.

Keywords: non-surgery; surgery; thoracolumbar burst fractures.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
PRISMA 2020 flow-chart.
Figure 2.
Figure 2.
Pain VAS. (A) Forest plot. (B) Trial sequential analysis. (C) Meta-regression with study-level age as the covariate.
Figure 3.
Figure 3.
ODI. (A) Forest plot. (B) Trial sequential analysis. (C) Meta-regression with study-level age as the covariate.
Figure 4.
Figure 4.
RMDQ. (A) Forest plot. (B) Trial sequential analysis. (C) Meta-regression with study-level age as the covariate.
Figure 5.
Figure 5.
Kyphotic angulation. (A) Forest plot. (B) Trial sequential analysis. (C) Meta-regression with study-level age as the covariate.
See this image and copyright information in PMC

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