The first prospective RCT comparing operative (posterior or anterior arthrodesis with instrumentation) versus nonoperative treatment (body cast or TLSO) for stable thoracolumbar burst fractures in neurologically intact patients. 47 patients followed an average of 44 months across both radiographic and patient-reported outcomes.
When you see a neurologically intact patient with a stable thoracolumbar burst fracture, this paper supports offering nonoperative treatment — cast followed by TLSO — as the primary option: expect similar kyphosis, equivalent or better function, spontaneous canal remodeling, fewer complications, and a fraction of the cost compared to surgery.
The first prospective RCT comparing operative (posterior or anterior arthrodesis with instrumentation) versus nonoperative treatment (body cast or TLSO) for stable thoracolumbar burst fractures in neurologically intact patients. 47 patients followed an average of 44 months across both radiographic and patient-reported outcomes.
When you see a neurologically intact patient with a stable thoracolumbar burst fracture, this paper supports offering nonoperative treatment — cast followed by TLSO — as the primary option: expect similar kyphosis, equivalent or better function, spontaneous canal remodeling, fewer complications, and a fraction of the cost compared to surgery.