title: Decision-Making Process in Patients with Thoracolumbar and Lumbar Burst Fractures with Thoracolumbar Injury Severity and Classification Score Less than Four.
abstract: METHODS
  Cross-sectional.
  
  
  OBJECTIVE
  To develop a strategy to determine a sound method for decision-making based on postoperative clinical outcome satisfaction.
  
  
  BACKGROUND
  The ideal management of thoracolumbar and lumbar burst fractures (TLBF) without neurological compromise remains controversial.
  
  
  METHODS
  This was a prospective study. Patients with thoracolumbar injury severity and classification score (TLICS) <4 were treated nonoperatively, with bed rest and bracing until the pain decreased sufficiently to allow mobilization. Surgery was undertaken in patients with intractable pain despite an appropriate nonoperative treatment (surgery group). The Oswestry disability index (ODI) measure was observed at baseline and at the last follow-up. Clinically success was defined at least a 30% improvement from the baseline ODI scores in both the conservative and surgery groups. All case records were assessed for gender, age, residual canal and angulations at the site of the fracture in order to determine which patients benefited from surgery or conservative treatment and which did not.
  
  
  RESULTS
  In all 113 patients with T11-L5, TLBFs were treated. The patients' mean age was 49.2 years. Patients successfully completed either nonoperative (n=99) or surgical (n=14) treatment based on ODI. Clinical examinations revealed that all of the patients had intact neurology. The mean follow-up period was 29.5 months. There was a significant difference between the two groups based on age and residual canal. The mean ODI score significantly improved for both groups (p <0.01). According to the findings, a decision matrix was proposed.
  
  
  CONCLUSIONS
  The findings confirm that TLICS <4, age, and residual canal can be used to guide the treatment of TLBF in conservative decision-making.
authors.affiliation: Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Shirzad
authors.initials: S
authors.lastname: Azhari
authors.affiliation: Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Parisa
authors.initials: P
authors.lastname: Azimi
authors.affiliation: Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Sohrab
authors.initials: S
authors.lastname: Shahzadi
authors.affiliation: Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Hassan Reza
authors.initials: HR
authors.lastname: Mohammadi
authors.affiliation: Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Hamid Reza
authors.initials: HR
authors.lastname: Khayat Kashani
keywords: Nonoperative; Oswestry disability index; Outcome; Thoracolumbar and lumbar burst fractures; Thoracolumbar injury severity and classification score