title: 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: BACKGROUND
  Studies comparing operative with nonoperative treatment of a stable burst fracture of the thoracolumbar junction in neurologically intact patients have not shown a meaningful difference at early follow-up. To our knowledge, longer-term outcome data have not before been presented.
  
  
  METHODS
  From 1992 to 1998, forty-seven consecutive patients with a stable thoracolumbar burst fracture and no neurological deficit were evaluated and randomized to one of two treatment groups: operative treatment (posterior or anterior arthrodesis) or nonoperative treatment (a body cast or orthosis). We previously reported the results of follow-up at an average of forty-four months. The current study presents the results of long-term follow-up, at an average of eighteen years (range, sixteen to twenty-two years). As in the earlier study, patients at long-term follow-up indicated the degree of pain on a visual analog scale and completed the Roland and Morris disability questionnaire, the Oswestry Disability Index (ODI) questionnaire, and the Short Form-36 (SF-36) health survey. Work and health status were obtained, and patients were evaluated radiographically.
  
  
  RESULTS
  Of the original operatively treated group of twenty-four patients, follow-up data were obtained for nineteen; one patient had died, and four could not be located. Of the original nonoperatively treated group of twenty-three patients, data were obtained for eighteen; two patients had died, and three could not be located. The average kyphosis was not significantly different between the two groups (13° for those who received operative treatment compared with 19° for those treated nonoperatively). Median scores for pain (4 cm for the operative group and 1.5 cm for the nonoperative group; p = 0.003), ODI scores (20 for the operative group and 2 for the nonoperative group; p <0.001) and Roland and Morris scores (7 for the operative group and 1 for the nonoperative group; p = 0.001) were all significantly better in the group treated nonoperatively. Seven of eight SF-36 scores also favored nonoperative treatment.
  
  
  CONCLUSIONS
  While early analysis (four years) revealed few significant differences between the two groups, at long-term follow-up (sixteen to twenty-two years), those with a stable burst fracture who were treated nonoperatively reported less pain and better function compared with those who were treated surgically.
authors.affiliation: Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Yawkey OCC #3800 Boston, MA 02114. E-mail address for K.B. Wood: kbwood@partners.org.
authors.forename: Kirkham B
authors.initials: KB
authors.lastname: Wood
authors.affiliation: Midwest Spine Institute, 1950 Curve Crest Boulevard West, Suite 100, Stillwater, MN 55082.
authors.forename: Glenn R
authors.initials: GR
authors.lastname: Buttermann
authors.affiliation: Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Yawkey OCC #3800 Boston, MA 02114. E-mail address for K.B. Wood: kbwood@partners.org.
authors.forename: Rishabh
authors.initials: R
authors.lastname: Phukan
authors.affiliation: Bone and Joint Clinic of Baton Rouge, 7301 Hennessy Boulevard, Suite 300, Baton Rouge,‎ LA‎ 70808.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Harrod
authors.affiliation: Twin Cities Spine Center, Piper Building, 913 East 26th Street, Suite 600, Minneapolis, MN 55404.
authors.forename: Amir
authors.initials: A
authors.lastname: Mehbod
authors.affiliation: Sharon Regional Hospital, 740 East State Street, Sharon, PA 16146.
authors.forename: Brian
authors.initials: B
authors.lastname: Shannon
authors.affiliation: Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 15 Francis Street, Boston, MA 02115.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Bono
authors.affiliation: Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 15 Francis Street, Boston, MA 02115.
authors.forename: Mitchel B
authors.initials: MB
authors.lastname: Harris
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002370:Casts, Surgical; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D009989:Orthotic Devices; D010147:Pain Measurement; D011446:Prospective Studies; D016103:Spinal Fractures / Q000150:complications / Q000601:surgery / Q000628:therapy*; D013123:Spinal Fusion; D013904:Thoracic Vertebrae; D020196:Trauma, Nervous System / Q000209:etiology; D016896:Treatment Outcome