Long-term results still favor nonoperative treatment of stable thoracolumbar burst fractures: commentary on an article by Kirkham B. Wood, MD, et al.: "Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit. A prospective randomized study with follow-up at sixteen to twenty-two years".

Abstract

Burst fractures of the thoracolumbar spine are common, but no consensus has been reached as to the best treatment. Although all burst fractures are characterized by the common finding of retropulsion of the posterior vertebral body wall into the spinal canal, burst fractures vary in severity with respect to amount of comminution, canal narrowing, associated neurologic deficit, and involvement of posterior structures. The latter structures are of primary importance in defining stability. To determine the best treatment, the authors conducted a randomized clinical trial from 1992 to 1998 in which they compared the outcomes of forty-seven patients who received either surgical or nonoperative treatment of a stable thoracolumbar burst fracture. This type of fracture has an intact posterior osteoligamentous complex. Nonoperative care consisted of bracing or casting. The surgical group was treated by anterior corpectomy and fusion with a plate or short-segment (two to four-level) posterior pedicle-screw instrumentation and arthrodesis. The …