Comparing conservative treatment with surgery for people with fractures of the spine where fragments of fractured thoracolumbar vertebral bodies have protruded into the vertebral canal but not caused any obvious nerve damage

The thoracolumbar vertebral column (T11 to L2) is a common site of spinal injury. Motor vehicle accidents are the commonest cause of injury, followed by falls and sports-related injuries. Fractures can be associated with acute back pain, limited motion, and swelling at the fracture site. Pain may not be felt immediately but may begin hours later. If the nerve root or spinal cord is damaged, partial or complete loss of sensory and motor function in the legs, urinary and fecal incontinence may result. Although many injuries do not cause paralysis they may leave an unstable spinal segment and later paralysis. People are treated in hospital either conservatively by being placed in a lying position that reduces strain on that part of the spine followed by fitting a cast or brace and moving around or by surgically placing instrumentation with screws to stabilize the affected part of the spine. The review authors found only one trial from the US in which 53 adults with stable thoracolumbar burst fracture were randomized to either wearing a body cast or undergoing surgery. The people treated conservatively had less pain one to two years later at the last follow-up examination. There was no difference between the two treatment strategies in the number of people returning to work or with respect to a hunching deformity of the back. The average duration of hospitalization was not significantly different between groups although the average charges related to hospitalization and treatment was more in the surgery group and rate of complications was higher. This review was limited by only one small trial being available for stable burst fractures.