Surgical versus Non-Surgical Treatment of Thoracolumbar Burst Fractures in Neurologically Intact Patients: A Prospective International Multicentre Cohort Study
Marcel F. Dvorak, F. Cumhur Öner, Charlotte Dandurand, Klaus John Schnake, Richard J. Bransford, Eugen Cezar Popescu, Mohammad El‐Sharkawi, Shanmuganathan Rajasekaran, Lorin M. Benneker, Greg D. Schroeder, Jin Tee, John C. France, Jérôme Paquet, R. T. Allen, William F. Lavelle, Miguel Hirschfeld, Spyros G Pneumaticos, Emiliano Vialle, Alexander R. Vaccaro
Abstract
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.