TY - JOUR
T1 - Surgical versus Non-Surgical Treatment of Thoracolumbar Burst Fractures in Neurologically Intact Patients
T2 - A Prospective International Multicentre Cohort Study
AU - Dvorak, Marcel F.
AU - Öner, Cumhur F.
AU - Dandurand, Charlotte
AU - Schnake, Klaus John
AU - Bransford, Richard J.
AU - Popescu, Eugen Cezar
AU - El-Sharkawi, Mohammed
AU - Rajasekaran, Shanmuganathan
AU - Benneker, Lorin M.
AU - Schroeder, Greg D.
AU - Tee, Jin W.
AU - France, John C.
AU - Paquet, Jérôme
AU - Allen, Richard
AU - Lavelle, William F.
AU - Hirschfeld, Miguel
AU - Pneumaticos, Spyros
AU - Vialle, Emiliano
AU - Vaccaro, Alexander R.
N1 - Publisher Copyright:
© The Author(s) 2025. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
PY - 2026/1
Y1 - 2026/1
N2 - Study design: Prospective cohort study. Objectives: Treatment for thoracolumbar (TL) burst fractures in neurologically intact patients remains controversial. The goal of this study was to utilize the international equipoise to determine whether surgery leads to a more rapid improvement of disability measured by minimal clinically important difference (MCID) in Oswestry Disability Index (ODI). Methods: The primary endpoint was time to achieve an improvement in ODI of more than 12.8 points within 1 year after baseline (MCID). A post hoc analysis was conducted to assess time to minimal disability (ODI of <20). Time-to-event analyses were applied, including log rank test for equality of survivor functions, Kaplan Meier survival curves and Cox proportional hazard models. Results: One hundred and ninety-eight patients were included (122 surgical and 76 non-surgical patients). Median time to achieve MCID in ODI (12.8 points) from baseline was similar between the two groups (25.0 days vs 25.5 days, P = 0.517). Post hoc analysis showed a potential trend towards a short time to achieve minimal disability for the surgical group (69.0 days vs 82.0 days, P = 0.057). Similar results were obtained when excluding all patients with suspected PLC injury. Conclusion: Surgically and non-surgically treated patients with thoracolumbar burst fractures without neurological injury were similar in terms of time to reaching MCID in ODI at 1 year. Surgical patients may reach minimal disability faster than nonsurgical patients, but additional large scale studies are warranted. Level of Evidence: Therapeutic Prospective Comparative Cohort Study Level II.
AB - Study design: Prospective cohort study. Objectives: Treatment for thoracolumbar (TL) burst fractures in neurologically intact patients remains controversial. The goal of this study was to utilize the international equipoise to determine whether surgery leads to a more rapid improvement of disability measured by minimal clinically important difference (MCID) in Oswestry Disability Index (ODI). Methods: The primary endpoint was time to achieve an improvement in ODI of more than 12.8 points within 1 year after baseline (MCID). A post hoc analysis was conducted to assess time to minimal disability (ODI of <20). Time-to-event analyses were applied, including log rank test for equality of survivor functions, Kaplan Meier survival curves and Cox proportional hazard models. Results: One hundred and ninety-eight patients were included (122 surgical and 76 non-surgical patients). Median time to achieve MCID in ODI (12.8 points) from baseline was similar between the two groups (25.0 days vs 25.5 days, P = 0.517). Post hoc analysis showed a potential trend towards a short time to achieve minimal disability for the surgical group (69.0 days vs 82.0 days, P = 0.057). Similar results were obtained when excluding all patients with suspected PLC injury. Conclusion: Surgically and non-surgically treated patients with thoracolumbar burst fractures without neurological injury were similar in terms of time to reaching MCID in ODI at 1 year. Surgical patients may reach minimal disability faster than nonsurgical patients, but additional large scale studies are warranted. Level of Evidence: Therapeutic Prospective Comparative Cohort Study Level II.
KW - burst
KW - fractures
KW - neurologically intact
KW - surgery
KW - thoracolumbar
UR - https://www.scopus.com/pages/publications/105013328101
U2 - 10.1177/21925682251356910
DO - 10.1177/21925682251356910
M3 - Article
C2 - 40605521
AN - SCOPUS:105013328101
SN - 2192-5682
VL - 16
SP - 628
EP - 638
JO - Global Spine Journal
JF - Global Spine Journal
IS - 1
ER -