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Rometsch E, Spruit M, Härtl R, et al. Does Operative or Nonoperative Treatment Achieve Better Results in A3 and A4 Spinal Fractures Without Neurological Deficit?: Systematic Literature Review With Meta-Analysis. Global Spine J. 2017;7(4):350-372doi: 10.1177/2192568217699202.
Rometsch, E., Spruit, M., Härtl, R., McGuire, R. A., Gallo-Kopf, B. S., Kalampoki, V., & Kandziora, F. (2017). Does Operative or Nonoperative Treatment Achieve Better Results in A3 and A4 Spinal Fractures Without Neurological Deficit?: Systematic Literature Review With Meta-Analysis. Global spine journal, 7(4), 350-372. https://doi.org/10.1177/2192568217699202
Rometsch, Elke, et al. "Does Operative or Nonoperative Treatment Achieve Better Results in A3 and A4 Spinal Fractures Without Neurological Deficit?: Systematic Literature Review With Meta-Analysis." Global spine journal vol. 7,4 (2017): 350-372. doi: https://doi.org/10.1177/2192568217699202
Rometsch E, Spruit M, Härtl R, McGuire RA, Gallo-Kopf BS, Kalampoki V, Kandziora F. Does Operative or Nonoperative Treatment Achieve Better Results in A3 and A4 Spinal Fractures Without Neurological Deficit?: Systematic Literature Review With Meta-Analysis. Global Spine J. 2017 Jun;7(4):350-372. doi: 10.1177/2192568217699202. Epub 2017 Jul 07. PMID: 28815163; PMCID: PMC5546683.
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Global Spine J. 2017 Jun;7(4):350-372. doi: 10.1177/2192568217699202. Epub 2017 Jul 07.

Does Operative or Nonoperative Treatment Achieve Better Results in A3 and A4 Spinal Fractures Without Neurological Deficit?: Systematic Literature Review With Meta-Analysis.

Global spine journal

Elke Rometsch, Maarten Spruit, Roger Härtl, Robert Alton McGuire, Brigitte Sandra Gallo-Kopf, Vasiliki Kalampoki, Frank Kandziora

Affiliations

  1. AO Foundation, AO Clinical Investigation and Documentation (AOCID), Dübendorf, Switzerland.
  2. St Maartenskliniek Nijmegen, Ubbergen, Netherlands.
  3. NY Presbyterian Hospital-Weill Cornell Medical College, NY, USA.
  4. University of Mississippi Medical Center, Jackson, MS, USA.
  5. BGU Klinik Frankfurt am Main, Frankfurt, Germany.

PMID: 28815163 PMCID: PMC5546683 DOI: 10.1177/2192568217699202

Abstract

STUDY DESIGN: Systematic literature review with meta-analysis.

OBJECTIVE: Thoracolumbar (TL) fractures can be treated conservatively or surgically. Especially, the treatment strategy for incomplete and complete TL burst fractures (A3 and A4, AOSpine classification) in neurologically intact patients remains controversial. The aim of this work was to collate the clinical evidence on the respective treatment modalities.

METHODS: Searches were performed in PubMed and the Web of Science. Clinical and radiological outcome data were collected. For studies comparing operative with nonoperative treatment, the standardized mean differences (SMD) for disability and pain were calculated and methodological quality and risk of bias were assessed.

RESULTS: From 1929 initial matches, 12 were eligible. Four of these compared surgical with conservative treatment. A comparative analysis of radiological results was not possible due to a lack of uniform reporting. Differences in clinical outcomes at follow-up were small, both between studies and between treatment groups. The SMD was 0.00 (95% CI -0.072, 0.72) for disability and -0.05 (95% CI -0.91, 0.81) for pain. Methodological quality was high in most studies and no evidence of publication bias was revealed.

CONCLUSIONS: We did not find differences in disability or pain outcomes between operative and nonoperative treatment of A3 and A4 TL fractures in neurologically intact patients. Notwithstanding, the available scores have been developed and validated for degenerative diseases; thus, their suitability in trauma may be questionable. Specific and uniform outcome parameters need to be defined and enforced for the evaluation of TL trauma.

Keywords: A3 and A4 spinal fractures; AOSpine classification; conservative therapy; functional outcome; meta-analysis; neurologically intact patients; surgical therapy; thoracolumbar burst fractures

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Three authors (

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