Nonoperative treatment versus posterior fixation for thoracolumbar junction burst fractures without neurologic deficit

Study Design. A prospective clinical trial was conducted. Objective. To compare the results of nonoperative treatment versus short-segment posterior fixation-using pedicle screws. Summary of Background Data. A previous study showed that nonoperative treatment with early mobilization produced good results, even when the posterior column was involved. Methods. This study involved 80 patients. Inclusion criteria required the following: neurologically intact patient, single-level closed burst fracture involving T11-L2, no fracture dislocations: or pedicle fractures, age of 18 to 65 years (nonpathologic adult), and no other major organ system or musculoskeletal injuries. Patients in the nonoperative group (n - 47) were allowed activity to the point of pain tolerance beginning on the day of injury using a hyperextension brace. Patients in the operative group(n = 33) underwent three:level, tone above, one at fracture level, and one below) fixation using VSP or TSRH instrumentation. The follow-up period was 2 years. Results. The surgical group had less pain up to 3 months and a better Greenough tow Back Outcome Score up to 6 months, but the outcome was similar afterward. No neurologic deficit in any patient. In the nonoperative group, the kyphosis angle worsened by 4 degrees, and the retropulsion decreased from 34% to 15%. In the operative group, there was one case of superficial infection and two cases of broken screws. The kyphosis angle was improved initially by 17 degrees, but this was: gradually lost. Hospital charges were four times higher in the operative group. Conclusions. Short-segment posterior fixation provides partial kyphosis correction and earlier pain relief, but the functional outcome at 2 years is similar. Early activity to the point of pain tolerance can be safely allowed.