Nonoperative versus operative treatment for thoracolumbar junction burst fracture without neurologic defict

THESES

Nonoperative versus operative treatment for thoracolumbar junction burst fracture without neurologic defict (Abstract)^*. Thesis. Sao Paulo, 2006.

Alexandre José Reis Elias^**

OBJECTIVES: Review the current, extensive, literature on this topic in order to analyze whether the radiographic criteria mentioned in several studies (kyphosis, wegding of the vertebra, spinal canal compression, and ligament lesion) can be used to indicate instability of the burst fracture and the need for surgical treatment in patients without neurological deficit.

METHODS: We performed online searches of the Medline, LILACS, and Cochrane Library. Studies that were classified as being of interest were those that met the following inclusion criteria: adult patients; Dennis burst-type or Magerl A3 fracture affecting the thoracolumbar spinal segments; single level, non-pathological or osteoporotic fracture; and normal neurological examination.

RESULTS: The final selection included 80 studies that discuss conservative or surgical treatment. Identified 2 presenting Class II evidence in the comparison between conservative and surgical treatment. In the first study, at the end of the 24-month follow-up period, the functional result was the same in both groups. In the second study, the functional capacity was evaluated using of the Roland and Morris index, and the unoperated patients presented higher indices.

CONCLUSIONS: Regardless of the radiographic parameters analyzed, there is no evidence, in the studies we reviewed, that surgical treatment is more beneficial than is conservative treatment in individuals with thoracolumbar burst fracture and presenting no neurological deficit. Such studies should involve patients presenting burst fractures that are radiographically characterized as stable.

Key words: burst fracture, thoracolumbar spine, systematic review, treatment.

*

Revisão Sistemática comparando o tratamento conservador e o cirúrgico nos pacientes com fratura da coluna toracolombar, tipo explosão com exame neurológico normal (Resumo). Tese de Mestrado, Universidade Federal de São Paulo (Área: Neurocirurgia). Orientador: Mirto N. Prandini

**

Address: Avenida Faria Lima, 2413 / 22, 01452-000 São Paulo SP, Brasil.

Publication Dates

• Publication in this collection
  11 Apr 2008
• Date of issue
  Sept 2007