Operative Compared with Nonoperative Treatment of a Thoracolumbar Burst Fracture without Neurological Deficit

• Published in: Journal of bone and joint surgery. American volume 2015-01, Vol.97 (1), p.3-9
• Main Authors: Wood, Kirkham B, Buttermann, Glenn R, Phukan, Rishabh, Harrod, Christopher C, Mehbod, Amir, Shannon, Brian, Bono, Christopher M, Harris, Mitchel B
• Format: Article
• Language: English
• ISSN: 0021-9355
• DOI: 10.2106/JBJS.N.00226

Background:Studies comparing operative with nonoperative treatment of a stable burst fracture of the thoracolumbar junction in neurologically intact patients have not shown a meaningful difference at early follow-up. To our knowledge, longer-term outcome data have not before been presented.Methods:From 1992 to 1998, forty-seven consecutive patients with a stable thoracolumbar burst fracture and no neurological deficit were evaluated and randomized to one of two treatment groups: operative treatment (posterior or anterior arthrodesis) or nonoperative treatment (a body cast or orthosis). We previously reported the results of follow-up at an average of forty-four months. The current study presents the results of long-term follow-up, at an average of eighteen years (range, sixteen to twenty-two years). As in the earlier study, patients at long-term follow-up indicated the degree of pain on a visual analog scale and completed the Roland and Morris disability questionnaire, the Oswestry Disability Index (ODI) questionnaire, and the Short Form-36 (SF-36) health survey. Work and health status were obtained, and patients were evaluated radiographically.Results:Of the original operatively treated group of twenty-four patients, follow-up data were obtained for nineteen; one patient had died, and four could not be located. Of the original nonoperatively treated group of twenty-three patients, data were obtained for eighteen; two patients had died, and three could not be located. The average kyphosis was not significantly different between the two groups (13 degree for those who received operative treatment compared with 19 degree for those treated nonoperatively). Median scores for pain (4 cm for the operative group and 1.5 cm for the nonoperative group; p = 0.003), ODI scores (20 for the operative group and 2 for the nonoperative group; p