Cochrane in CORR(®): Surgical Versus Non-surgical Treatment for Thoracolumbar Burst Fractures Without Neurological Deficit.

Abstract

T horacolumbar burst fractures account for approximately 45% of all major thoracolumbar traumatic injuries [9]. They most commonly occur secondary to an axial compression mechanism and are characterized by failure of the anterior and middle spinal columns. Clinical features of thoracolumbar burst fractures include acute back pain and possible damage to the nerve roots or spinal cord, but more than 50% of these injuries may present without neurological deficit [9]. Characteristic radiographic findings include anterior wedging of the vertebral body, increased interpedicular distance, and narrowing of the spinal canal due to retropulsed bone. The management of thoracolumbar burst fractures in patients without neurological deficits remains controversial [3]. Surgical stabilization and possible decompression may result in earlier mobilization, reduced time to hospital discharge, and faster return to work [9], but it may also expose patients to more-frequent early complications, an increased risk for subsequent revision surgery, and greater overall healthcare costs [9]. Nonoperative management including symptomatic pain control, early mobilization, and perhaps a brace may be A Note from the Editor-In-Chief: We are pleased to publish the next installment of Cochrane in CORR, our partnership between CORR, The Cochrane Collaboration, and McMaster University’s Evidence-Based Orthopaedics Group. In it, researchers from McMaster University and other institutions will provide expert perspective on an abstract originally published in The Cochrane Library that we think is especially important. (AbudouM, Chen X, Kong X,Wu T. Surgical versus non-surgical treatment for thoracolumbar burst fractures without neurological deficit. Cochrane Database Syst Rev. 2013;6:CD005079). Copyright 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Reproduced with permission. Each author certifies that they, or any members of their immediate families, have no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR or the Association of Bone and Joint Surgeons. Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and The Cochrane Library (http:// www.thecochranelibrary.com) should be consulted for the most recent version of the review. This Cochrane in CORR column refers to the abstract available at: DOI: 10.1002/ 14651858.CD005079.pub3.