A review of the management of thoracolumbar burst fractures.
BACKGROUND
Burst fractures account for more than half of all thoracolumbar fractures, which often cause a neurologic deficit and present a significant economic burden to the family and society. Accepted methods of treatment of thoracolumbar burst fractures include conservative therapy, posterior reduction and instrumentation, and anterior decompression and instrumentation. However, the management of thoracolumbar burst fractures has been the subject of much controversy.


METHODS
Publications reporting clinical data relating to the thoracolumbar burst fractures were reviewed. These articles were determined via review of the results of PubMed searches and articles gathered through compilation of references from those articles.


RESULTS
There exist different criteria for the choice of the management based on the severity of kyphotic deformity, canal compromise, vertebral height loss, and neurologic status. To our knowledge, none of the existing criteria for the treatment of thoracolumbar burst fractures are generally accepted.


CONCLUSIONS
In thoracolumbar burst fractures without a neurologic deficit, there is no superiority of conservative therapy over operative therapy. When the neurologic involvement is significant, the choice of operative management is advised. Also, there is no obvious superiority of one approach over the other.
Dai
Li-Yang
LY
Department of Orthopedic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China. chinaspine@163.com
Jiang
Sheng-Dan
SD
Wang
Xiang-Yang
XY
Jiang
Lei-Sheng
LS
D017281:Cost of Illness; D019299:Decompression, Surgical / Q000295:instrumentation*; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries* / Q000601:surgery*; D016103:Spinal Fractures / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation; D013904:Thoracic Vertebrae / Q000293:injuries* / Q000601:surgery*