Comparison Between Surgical and Conservative Treatment for AOSpine Type A3 and A4 Thoracolumbar Fractures without Neurological Deficit: Prospective Observational Cohort Study

Vialle, Emiliano Neves; Falavigna, Asdrubal; Arruda, André de Oliveira; Guasque, Joana Bretas Cabral Rondon; Pinto, Bárbara Miroski de Oliveira; Finger, Guilherme; Sfreddo, Ericson; Cecchini, André Martins de Lima

doi:10.1055/s-0042-1749623

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Revista Brasileira de Ortopedia

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Sumário

Original Article • Rev. bras. ortop. 58 (1) • Jan-Feb 2023 • https://doi.org/10.1055/s-0042-1749623 copy

Comparison Between Surgical and Conservative Treatment for AOSpine Type A3 and A4 Thoracolumbar Fractures without Neurological Deficit: Prospective Observational Cohort Study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To compare the clinical results between conservative (CS) and surgical treatment (CXS) of A3 and A4 fractures without neurological deficit.

Methods

Prospective observational study of patients with thoracolumbar fractures type A3 and A4. These patients were separated between the surgical and conservative groups, and evaluated sequentially through the numeric rating scale (NRS), Roland-Morris disability questionnaire (RMDQ), EuroQol-5D (EQ-5D) quality of life questionnaire, and Denis work scale (DWS) up to 2.5 years of follow-up.

Results

Both groups showed significant improvement, with no statistical difference in pain questionnaires (NRS: CXS 2.4 ± 2.6; CS 3.5 ± 2.6; p> 0.05), functionality (RMDQ: CS 7 ± 6.4; CXS 5.5 ± 5.2; p> 0.05), quality of life (EQ-5D), and return to work (DWS).

Conclusion

Both treatments are viable options with equivalent clinical results. There is a tendency toward better results in the surgical treatment of A4 fractures.

Keywords
internal fixation fracture; spinal fractures; treatment outcome; conservative treatment

	Treatment
Gender	CS (n = 23)	CSX (n = 36)
Female	10 (43.5%)	10 (27.8%)
Male	13 (56.5%)	26 (72.2%)
Location
L1	11 (47.8%)	20 (55.6%)
L2	2 (8.7%)	5 (13.9%)
L3	3 (13%)	3 (8.3%)
T10	1 (4.3%)	0 (0%)
T11	0 (0%)	1 (2.8%)
T12	6 (26.1%)	7 (19.4%)
Rating (A)
3	17 (73.9%)	10 (27.8%)
4	6 (26.1%)	26 (72.2%)

Comparative evaluation	P-value
Comparative evaluation	CS	CXS
Pre-treatment vs 6 weeks	0.170	0.090
Pre-treatment vs 3 months	0.004	0.040
Pre-treatment vs 6 months	0.001	0.001
Pre-treatment vs 1 year	0.002	<0.001
Pre-treatment vs 2.5 years	0.144	0.004

Comparative evaluation	P-value
Comparative evaluation	CS	CXS
Pre-treatment vs 6 weeks	0.001	<0.001
Pre-treatment vs 3 months	<0.001	<0.001
Pre-treatment vs 6 months	<0.001	<0.001
Pre-treatment vs 1 year	0.001	<0.001
Pre-treatment vs 2.5 years	0.068	0.003

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] Address for correspondence Emiliano Neves Vialle, Alameda Princesa Izabel, 605, Mercês, Curitiba, PR, 80430-210, Brazil (e-mail: evialle@hotmail.com).