Observational studyEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026
Acute thoracolumbar burst fractures (AO types A3/A4) with and without concomitant posterior ligamentous complex injury: treatment outcomes in surgically and nonsurgically managed patients. A multi-center prospective study.
Observational study in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02827214 (Thoracolumbar Burst Fractures), which is not on this map. Not yet cited in PubMed.
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The trial behind it
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Thoracolumbar Burst Fractures (AOSpine A3, A4) in Neurologically Intact Patients: An Observational, Multicenter Cohort Study Comparing Surgical Versus Non-surgical Treatment
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26 authors.
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Abstract
purposeTreatment of neurologically intact thoracolumbar burst fractures (AO types A3/A4) is controversial. Furthermore, the impact that concomitant posterior ligamentous complex (PLC) injuries have on patient reported outcome measures (PROMs) is not well-established. This analysis compared outcomes between patients with A3/A4 injuries with and without concomitant B1/B2 injuries and between patients treated with operative versus nonoperative management.
methodsData from a prospective multicenter cohort study (ClinicalTrials.gov: NCT02827214) was used. Adults with AO type A3/A4 burst fractures (T10-L2), with or without concomitant B1/B2 injuries, were included. PROMs included Oswestry Disability Index (ODI), Pain NRS, EQ-5D, and AOSpine Patient Reported Outcome Spine Trauma (PROST) score. Isolated A3/A4 injuries were compared to combined A3/A4 and B1/B2 injuries-patients were then sub-analyzed by treatment.
results198 patients were included (34 with combined A3/A4 and B1/B2 injuries). Patients with combined injuries had similar baseline but different 1-year postoperative (12.9 ± 12.8 vs. 7.3 ± 9.9;p = 0.024) ODI scores compared to patients with isolated injuries. After subdividing by treatment, both operatively and nonoperatively treated patients with combined injuries had higher rates of suspected/indeterminate and injured PLC statuses (p < 0.001) compared to those with isolated injuries. There were no differences in 1-year postoperative ODI scores between surgically managed patients with and without concomitant PLC injuries. Patients treated nonoperatively with combined injuries had significantly worse one-year postoperative ODI (20.8 vs. 7.6;p = 0.018) and two-year postoperative Pain NRS (3 vs. 1.1;p = 0.04), and EQ-5D (0.8 vs. 0.9;p = 0.03) scores.
conclusionPatients with isolated A3/A4 injuries performed similarly compared to patients with concomitant B1/B2 injuries after surgical treatment. However, combined injuries treated nonoperatively performed worse on multiple metrics of pain and disability at final follow-up. Combined injuries were associated with a significantly higher rates of suspected/indeterminate or injured PLC status. Thus, suspicion of PLC injuries should prompt serious consideration of surgical intervention in the setting of burst fractures without neurologic deficits.
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