Thoracolumbar Incomplete Burst Fracture (A3) Without Neurological Deficit:Analysis Of Surgical Versus Non-Surgical Outcomes

Objective:The aim of this study is to compare the long-term clinical and radiographic results of thoracolumbar incomplete burst fractures(A3)in neurologically intact patients,treated surgically or conservatively with the aim to optimize their management.Methods:A total of 56 neurologically intact patients with thoracolumbar incomplete burst fracture(A3)from January 2012 to December 2018 were included and their imaging and clinical outcome data were retrospectively analyzed.The patients were divided into surgical group and conservative group according to the different treatment methods.Among them,30 patients accepted posterior short segment pedicle screw fixation,and the remaining 26 patients chose conservative treatment with bed rest and brace.For the purpose of observing and comparing the changes of VAS score,ODI score,injured vertebral Cobb angle,the anterior/posterior vertebral body height of injured vertebral before and after treatment in the two groups,the relevant imaging and clinical function data were collected at the time of admission,discharge and follow-up respectively.Results:In conservative group,the anterior/posterior height of the injured vertebral body was 20.06±1.93 mm and 24.41±1.86 mm respectively and the injured vertebral Cobb angle was 11.37±6.79°at the time of admission.In terms of the clinical outcome parameters,VAS score was 5.84±1.65 and ODI score was 58.31±7.89.At the final follow-up,the imaging results showed that the Cobb angle of injured vertebrae was significantly increased compared with that of admission,and the height of anterior and posterior of the injured vertebral body also had significant loss.But the VAS score and the ODI score decreased to 2.55±1.16 and 12.50±6.24 respectively.After conservative treatment,there were significant differences in imaging and clinical outcomes(P <0.05)。In surgical group,the anterior height of the injured vertebral body was 19.36±2.39 mm,the posterior height of the injured vertebral body was 25.45±2.21 mm and the Cobb angle was13.24±6.13°.As for the clinical outcome parameters,the VAS score was 6.36±1.54 and the ODI score was 60.53±6.12.At the final follow-up,the imaging results showed that the Cobb angle of injured vertebrae was significantly lower than that of admission,and the height of anterior and posterior of the injured vertebrae was also significantly restored.Moreover,the VAS and ODI score decreased to 2.42+0.85 and10.63±5.44 respectively.After surgical treatment,the parameters of imaging and clinical outcomes were significantly changed(P <0.05).Conclusion:1.Compared with conservative treatment,surgical treatment can provide better correction of injured vertebral Cobb angle and recovery of injured vertebral height.2.Compared with conservative treatment,surgical treatment can provide better pain relief in the early stage.3.During mid-term follow-up,conservative and surgical treatment can provide similar clinical outcomes improvement.