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Burst Fracture

From WikiSM

Other Names

  • Thoracolumbar Burst Fractures
  • Thoracic Burst Fracture
  • Lumbar Burst Fracture
  • Vertebral burst fracture
  • Spinal burst fracture
  • Thoracolumbar burst fracture
  • Thoracic burst fracture
  • Lumbar burst fracture
  • Compression burst fracture
  • Axial load vertebral fracture

Background

History

  • First described by Holdsworth in 1963[1]
  • In 1983, Francis Denis introduced the three-column model[2]
  • The increasing use of CT in the 1980s and 1990s allowed clinicians to better identify retropulsed fragments and canal compromise
  • The development of modern classification systems, including the AO Spine Classification, refined the understanding of burst fractures[3]

Epidemiology

  • 90% of spinal fractures occur within the thoracolumbar spine[4]
  • As many as 60% are burst fractures[5]
  • Specific data on burst fractures is limited

Introduction

Burst fracture. (a) Lateral radiograph of the thoracic spine shows a complex fracture of T12 (arrows). (b) Computed tomographic (CT) scan better demonstrates the " burst " appearance of the vertebral fracture (arrows).[6]
Subtype A3\u2014Incomplete burst: Fracture with any involvement of the posterior wall of the vertebral body. Only a single endplate fractured. Vertical fracture of the lamina is usually present and does not indicate a tension band failure[7]
Complete burst fracture[8]
Incomplete burst fracture[8]

General

  • Burst fractures are spinal injuries characterized by failure of both the anterior and middle columns
  • They occur in the spine following axial compression loads, often associated with flexion[9]
  • They predominantly affect the thoracolumbar junction (T10-L2), where the relatively fixed thoracic spine transitions to the mobile lumbar spine.

Etiology

  • Involves compression with axial load, typically with flexion
    • High energy vertical impact loads cause vertebral failure
    • Force through anterior and middle column with posterior force vector
    • This causes retropulsion of bone into canal
    • Majority occur at the thoracolumbar junction, a transition point from the kyphotic thorax to lordotic lumbar spine
  • Stability of fracture is controversial
  • Radiographic parameters are used to evaluate stability
    • kyphotic angle, anterior vertebral height, posterior vertebral height, and canal compromise
    • Presence/ absence of neurological symptoms

Three-Column Theory

Anatomy of the Vertebral Body

  • Primary weight bearing structure, transmits axial loads through the spine
  • Composed of spongy bone that absorbs compressive forces and distributes load
  • Thin outer layer of dense bone providing structural strength and resistance to deformation
  • Intervertebral Discs allow load transmission and spinal mobility

Associated Neurological Injuries

  • Spinal Cord Injury (SCI)/ Neurological Deficits
    • Retropulsion of bony fragments into the canal can cause cord compression, especially in the thorax[2]
    • Neurological deficit in 50-60% of thoracolumbar burst fractures[9]
    • Can see complete, partial spinal cord injuries with complete loss of sensory, motor function in lower extremities
    • Patients can also experience urinary, fecal incontinence, paraplegia
  • Cauda Equina Syndrome
    • More common in lumbar burst fractures due to compression of nerve roots rather than the cord[11]
    • Occurs in approximately 12% of thoracolumbar and lumbar burst fractures[12]
  • Head Trauma
  • Intracranial bleeding

Associated Spinal Structural Injuries

  • Posterior ligamentous complex (PLC) injury
    • Disruption of the supraspinous, interspinous, and ligamentum flavum structures contributes to instability[3]
  • Laminar Fractures
    • Ppresent in 95% of patients with cauda equina herniation
  • Traumatic spinal Canal stenosis
    • From retropulsed bone fragments
  • Adjacent vertebral fractures
    • High-energy mechanisms often result in multi-level spinal injuries.[13]
  • Wedge compression fractures
    • May occur at adjacent levels or represent part of a spectrum of axial load injuries.[14]
  • Translational/rotational spinal injuries
    • Severe trauma may produce combined injury patterns involving displacement and instability[13]
  • Kyphotic deformity
    • Loss of anterior column height can lead to progressive kyphosis, especially if untreated or unstable[11]

Other Associated Injuries

  • Intra-abdominal injuries
    • Common in high-energy mechanisms (e.g., MVC, falls), including solid organ injury.[2]
  • Thoracic injuries
    • Rib fractures, pulmonary contusions, and pneumothorax frequently coexist with thoracic burst fractures[13]
  • Pelvic fractures
    • High-energy axial load and deceleration injuries can involve both the spine and pelvis[3]
  • Long bone fractures
    • Extremity injuries (e.g., femur, tibia) are commonly seen in polytrauma patients with burst fractures[11]

Risk Factors

Demographic and Lifestyle[15]

Traumatic/Mechanical[9]

  • Motor vehicle accidents (most common cause)
  • Falls from height
  • Sports-related injuries
  • High-energy trauma

Anatomic

  • Thoracolumbar junction location (T10-L2)
    • Most vulnerable region due to transition zone between rigid thoracic and mobile lumbar spine
  • Basivertebral foramen: creates structural weakness in posterior vertebral body
  • Central and superior vertebral body regions: lowest trabecular bone quality adjacent to basivertebral foramen

Bone Health[16]

  • Low bone mineral density (BMD)
  • Prevalent vertebral fractures: strong predictor of subsequent fractures
  • Prevalent nonvertebral fractures (in men)
  • Densitometric Osteoporosis

Medication-Related[17]

  • Current glucocorticoid use
  • Past glucocorticoid use
  • Recent discontinuation of anti-osteoporotic treatment, particularly denosumab
  • Aromatase inhibitor use

Medical Comorbidities (Secondary Osteoporosis)

  • Glucocorticoid-induced osteoporosis
  • Non-malignant hemopathies
  • Primary hyperparathyroidism
  • Hypercorticism
  • Anorexia nervosa
  • Pregnancy and lactation-associated osteoporosis

Other

  • Functional Status Risk Factors
    • Walking aid use
  • Iatrogenic Risk Factors
    • Previous vertebroplasty procedure

Differential Diagnosis

Differential Diagnosis Back Pain

Clinical Features

Back exam: areas of palpation[18]
Back exam: dermatomes of the lower extremity[19]

History

  • It is important to characterize the mechanism of injury
  • Most patients will present with acute back pain
    • Characterize timing, onset of symptoms
    • Was the patient ambulatory after the injury
  • Are there any associated symptoms including
    • Neurological: weakness, numbness, paresthesia
    • Bowel or bladder dysfunction
  • A comprehensive trauma examination should be performed
    • Up to 50% of patients have associated injuries[9]

Physical Exam: Physical Exam Back

  • Look for swelling or external signs of trauma
    • Back bruising (sensitivity 6.9%, specificity 98.6%)[20]
  • Palpation
    • Midline tenderness (sensitivity 62.1%, specificity 91.5%)[20]
    • Palpable midline step (sensitivity 13.8%, specificity 100%)[20]
    • Spinous process tenderness and gaps
  • Range of motion is often limited
    • Excessive range of motion should be avoided in the acute setting
  • Strength
    • Should document by myotome from L1 to S1
    • Abductor hallucis (AbH) motor function (predictive of outcome)[21]
  • Sensory testing
    • Dermatomal sensory testing (light touch and pinprick)
    • Sacral sensation (S4-S5 dermatomes - predictive of outcome)
    • Perianal sensation
  • Reflexes
    • Deep tendon reflexes (patellar, Achilles)
    • Ankle spasticity (predictive of outcome)
    • Bulbocavernosus Reflex
    • Anal wink reflex
  • Sphincter Function
    • Rectal tone on digital rectal examination
    • Urethral sphincter function (assess for urinary retention)

Special Tests

  • There are no widely accepted, evidenced based special tests to evaluate for Burst Fracture

Evaluation

Lateral view of the lumbar spine shows comminuted L4 vertebral body with posterior displacement of the bone fragment into the spinal canal[22]
Axial (A) and sagittal (B) CT scans show L3 burst fracture with green stick laminar fracture (arrow) in 22 year-old man who fell from height[23]
Preoperative MRI images showing the three types of burst fracture according to the Magerl classification system. (A) Superior-type patient with superior incomplete burst fracture (arrow). (B) Inferior-type patient with inferior incomplete burst fracture (arrow). (C) Complete-type patient with complete burst fracture (arrow). Arrowheads indicate regions of collapse[24]

Radiographs

  • Consider: Standard Thoracic Spine Radiographs, Standard Lumbar Spine Radiographs
    • Standard projections: Anteroposterior (AP) and lateral
    • Consider "Swimmers Lateral" if upper thorax is obscured
  • Diagnostic performance
    • Sensitivity: 49-62% for thoracic spine fractures, 67-82% for lumbar spine fractures[25]
    • Accuracy improves with observer experience
    • Clinical significance of fractures missed on radiographs is uncertain
  • Radiographic Findings
    • Moderate to marked anterior wedging of the vertebral body
    • Increased interpedicular distance (IPD): Present in 95% of burst fractures[26]
    • Narrowing of the spinal canal from displaced vertebral body fragments
    • Posterior vertebral body line disruption
    • AP: widening of pedicals, deformity in coronal plane
    • Lateral: retropulsion into canal, kyphosis
  • Limitations of Plain Radiography[27]
    • Qualitatively acceptable but quantitatively inadequate for treatment planning
    • Underestimates vertebral body comminution compared to CT
    • Cannot reliably assess: spinal canal, posterior ligamentous complex, disc, spinal cord

CT

  • General[28]
    • ACR Appropriateness Criteria recommend CT as the primary imaging modality
    • Better evaluation of osseous pathology
    • Sensitivity: 94-100% for identifying thoracolumbar spine fractures
    • Superior to radiographs for evaluating bone anatomy, especially in polytrauma patients
  • CT Findings in burst fractures
    • Vertebral body: comminution, fragmentation, retropulsion, loss of height, saggital split
    • Spinal canal space is measured in sagittal transverse
    • Posterior element: lamina, spinous process, facet joint, interspinous widening[29]
    • Kyphotic deformity

MRI

  • Indications[30]
    • Neurological deficit or suspected spinal cord injury
    • Indeterminate PLC status on CT (single positive CT finding)
    • May influence management in up to 25% of patients with thoracolumbar fractures
    • CT findings suggesting soft tissue injury: Canal compromise >19%, Local kyphosis >14°
  • Useful to evaluate
    • Spinal Cord, thecal scal
    • Soft tissue structures
    • Posterior Ligament complex
  • MRI findings in burst fractures
    • Evaluate the posterior ligament complex (91% sensitivity, 100% specific)[31]
    • Disc injuries including herniation, extrusion, annular tears, endplate disruption, widening
    • Spinal canal and neural elements: cord (compression, contusion, hemorrhage), nerve root, epidural
    • Bone marrow: indicates acute fractures (vertebral body), posterior element may indicate occult fracture

Classification

Denis Classification

  • Type A
    • Fracture of both end-plates
    • Bone is retropulsed into the canal.
  • Type B
    • Fracture of the superior end-plate
    • Common, occurs due to a combination of axial load with flexion.
  • Type C
    • Fracture of the inferior end-plate.
  • Type D
    • Burst rotation
    • May be misdiagnosed as a fracture-dislocation
    • Mechanism: axial load and rotation.
  • Type E
    • Burst lateral flexion

Thoracolumbar Injury Classification and Severity Score

  • Injury morphology
    • Compression (+1 point)
    • Burst (+1)
    • Rotation/translation (+3)
    • Distraction (+4)
  • Neurologic status
    • Intact (+0 point)
    • Nerve root (+2)
    • Incomplete Spinal cord or conus medullaris injury (+3)
    • Complete Spinal cord or conus medullaris injury (+2)
    • Cauda equina syndrome (+3)
  • Posterior ligamentous complex integrity
    • Intact (+0 point)
    • Suspected/indeterminate (+2 point)
    • Disrupted (+3 point)

Management

Thoracolumbosacral Orthosis

A 24-year-old man with an L3-4 burst fracture (group A: early removal group; mean implant removal time, 8.5 months). Preoperative plain radiograph (A) and computed tomography scan (B) showing 48% anterior vertebral height loss (L4) with posterior ligamentous complex injury (C). (D) Immediate postoperative plain radiograph showing restoration of anterior vertebral height ratio and Cobb angle. (E, F) The range of motion was 11.2° on the flexionextension view after implant removal at 6 months after surgery.[32]
Surgical fixation. a Coronal and b Sagittal images showing the mechanism of "Pivot ligamentotaxis"[33]

Goals

  • Management is somewhat controversial, especially without neurological benefit
  • Treatment goals
    • Stabilize the spine
    • Prevent short, long-term deformity
    • Prevent neurological decline
  • Nonoperative advantages
    • Avoid risks of surgical intervention
    • Decreased costs
  • Surgical advantages[34]
    • Better correction of kyphotic deformity
    • Greater initial stability
    • Opportunity to perform direct or indirect decompression of neural elements
    • Decreased requirements for external immobilization
    • Earlier return to work

Nonoperative

  • Indications
    • Must be neurologically intact
    • Intact posterior ligament complex
    • Consider with kyphosis <30°, vertebral body lost <50% height
    • 2- and 3-column injured Denis type A, B, and C thoracolumbar burst fractures with intact facet joints[35]
    • Single-level closed burst fracture and no fracture dislocations or pedicle fractures[36]
  • Conservative treatment consists of combination of:

Operative

  • Indiocations
    • Neurological deficits
    • Unstable fracture pattern including injury to posterior ligament complex, kyphosis
  • Technique
    • Posterior spinal fusion
    • Anterior decompression, stabilization
    • Posterior decompression, fusion
    • Posterior corpectompy, ventral decompression

Rehab and Return to Play

Burst fracture recovery and rehab
Burst fracture return to play

Nonoperative Rehabilitation Protocol

  • Phase 1: Acute (Weeks 0–2)
    • Goals: Pain control, neuro monitoring, early mobilization
    • Multimodal analgesia, ice
    • Early mobilization (avoid bed rest >48–72 hrs)
    • Log-roll for bed mobility
    • TLSO optional (6–12 weeks if used)
    • Serial neuro exams, monitor radicular symptoms
  • Phase 2: Early Rehab (Weeks 2–6)
    • Goals: Improve mobility, initiate core stability
    • Progressive ambulation, ADLs as tolerated
    • Avoid lifting >5–10 lbs, bending/twisting
    • Gentle ROM, isometric core, LE strengthening
    • Posture + breathing work
    • Wean TLSO as tolerated
  • Phase 3: Intermediate (Weeks 6–12)
    • Goals: Restore strength, endurance
    • Gradual return to activities, lift 10–20 lbs
    • Low-impact cardio (walk, bike)
    • Core strengthening, dynamic stabilization
    • Proprioception + flexibility
    • Discontinue brace when pain-free
  • Phase 4: Advanced (Weeks 12–24)
    • Goals: Return to full function
    • Return to work/sport progression
    • Resistance training + functional movements
    • Plyometrics if appropriate
    • Criteria: Pain-free, Full/near-full ROM, Strength ≥80–90% baseline, No functional compensation

Burst Fracture Rehab Program PDFs

Return to Play

  • Prerequisites
    • Pain-free at rest and with activity
    • Normal neurological exam
    • Full strength (baseline/contralateral)
    • Full, pain-free ROM
    • Radiographic stability
    • Completed rehab progression
  • Timeline
    • Nonoperative: Non-contact (8–12 weeks), Contact (3–6 months)
    • Operative: Contact (6–12+ months, longer with fusion)
    • Sport Risk: Low (3–6 months), Moderate (6–9 months), High (≥9–12 months)
  • Progression
    • Phase 1: sport specific, drills, agility, conditioning, no contact (12-16 weeks)
    • Phase 2: non contact practice, team drills, simulated play (16-20 weeks)
    • Phase 3: limited, controlled contact, protective equipment required (20-24 weeks)
    • Phase 3: full return to play (24+ weeks)

Prognosis and Complications

Prognosis

  • Neurological intact patients
    • Most patients do well if neurologically intact initially, regardless of treatment modality[37]
    • Nonoperative: most investigators have found rare or no neurologic deterioration in initially neurologically intact patients[38]
    • No significant differences in outcomes at 2-year follow-up between surgical and nonsurgical groups[37]
  • Patients with neurological deficits
    • Prognosis depends on severity of initial neurological injury, specific fracture morphology[39]
    • Complete injuries havee limited neurological recovery potential, incomplete injuries show variable improvement[40]
  • Factors predicting failure of non surgical management[41]
    • Greater initial kyphosis (8° vs 3° in successful nonoperative cases)
    • Higher canal stenosis (52% vs 37%)
    • Higher load-sharing classification scores (6.9 vs 5.8)
    • Greater vertebral body fragmentation

Complications

  • Neurological deterioation
    • Includes neuropathies and myelopathies
    • Incidence: 0-3% in most modern series of nonoperatively treated patients[42]
    • Development of radicular pain with mobilization occurs in approximately 6% of patients[43]
    • Risk factors: greater canal stenosis, posterior ligament complex disruption, specific fracture patterns.
  • Progressive Kyphosis
    • More common with nonoperative treatment
    • Average kyphosis progression is modest (4-5° loss of correction in nonoperative group)
  • Chronic Pain
    • Occurs in both operative and nonoperative groups
    • Long-term studies suggest nonoperatively treated patients may have less chronic pain[11]
    • Pain limiting mobilization is the most common reason for failure of nonoperative management (25% of cases)
  • Structural
    • Kyphosis
    • Scoliosis
    • Loss of normal lumbar lordosis
  • Typical surgical complications
    • Overall complication rates are higher in surgical groups (21/41 vs 6/38 in pooled analysis)

See Also

Internal

External

References

  1. ↑ Holdsworth F. Fractures, dislocations and fracture-dislocations of the spine. J Bone Joint Surg Br 1963;45:6 - 20.
  2. ↑ 2.0 2.1 2.2 Denis, Francis. “The Three Column Spine and Its Significance in the Classification of Acute Thoracolumbar Spinal Injuries.” Spine, vol. 8, no. 8, 1983, pp. 817–31.
  3. ↑ 3.0 3.1 3.2 Vaccaro, Alexander R., et al. “A New Classification of Thoracolumbar Injuries: The Importance of Injury Morphology, the Integrity of the Posterior Ligamentous Complex, and Neurologic Status.” Spine, vol. 30, no. 20, 2005, pp. 2325–33.
  4. ↑ Esses SI, Botsford DJ, Kostuik JP. Evaluation of surgical treatment for burst fractures. Spine 1990;15:667- 73.
  5. ↑ Gertzbein SD: Scoliosis Research Society. Multicenter spine fracture study. Spine (Phila Pa 1976) 17:528–540, 1992
  6. ↑ Lee, Patrick, Tim B. Hunter, and Mihra Taljanovic. "Musculoskeletal colloquialisms: how did we come up with these names?." Radiographics 24.4 (2004): 1009-1027.
  7. ↑ Vaccaro, Alexander R., et al. "AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers." Spine 38.23 (2013): 2028-2037.
  8. ↑ 8.0 8.1 Image courtesy of radiologyassistant.nl
  9. ↑ 9.0 9.1 9.2 9.3 Abudou, Minawaer, et al. "Surgical versus non‐surgical treatment for thoracolumbar burst fractures without neurological deficit." Cochrane Database of Systematic Reviews 6 (2013).
  10. ↑ Denis F. Spinal instability as defined by the three-column spine concept in acute spinal trauma. Clin Orthop 1984;189:65- 76.
  11. ↑ 11.0 11.1 11.2 11.3 Wood, Kirk B., et al. “Operative Compared with Nonoperative Treatment of a Thoracolumbar Burst Fracture without Neurological Deficit.” The Journal of Bone and Joint Surgery. American Volume, vol. 85, no. 5, 2003, pp. 773–81.
  12. ↑ Yan, Liang, et al. "Clinical case-series report of traumatic cauda equina herniation: a pathological phenomena occurring with thoracolumbar and lumbar burst fractures." Medicine 96.14 (2017): e6446.
  13. ↑ 13.0 13.1 13.2 Magerl, Friedrich, et al. “A Comprehensive Classification of Thoracic and Lumbar Injuries.” European Spine Journal, vol. 3, no. 4, 1994, pp. 184–201.
  14. ↑ Holdsworth, Frank. “Fractures, Dislocations, and Fracture-Dislocations of the Spine.” The Journal of Bone and Joint Surgery. British Volume, vol. 45, no. 1, 1963, pp. 6–20.
  15. ↑ van der Klift, Marjolein, et al. "Risk factors for incident vertebral fractures in men and women: the Rotterdam Study." Journal of Bone and Mineral Research 19.7 (2004): 1172-1180.
  16. ↑ van der Klift, Marjolein, et al. "Risk factors for incident vertebral fractures in men and women: the Rotterdam Study." Journal of Bone and Mineral Research 19.7 (2004): 1172-1180.
  17. ↑ Che, H., et al. "Vertebral fractures cascade: potential causes and risk factors." Osteoporosis International 30.3 (2019): 555-563.
  18. ↑ Almoallim, Hani, et al. "Approach to Musculoskeletal Examination." Skills in Rheumatology (2021): 17-65
  19. ↑ Ostelo, Raymond WJG. "Physiotherapy management of sciatica." Journal of physiotherapy 66.2 (2020): 83-88.
  20. ↑ 20.0 20.1 20.2 Hsu, Jeremy M., Tony Joseph, and Andrew M. Ellis. "Thoracolumbar fracture in blunt trauma patients: guidelines for diagnosis and imaging." Injury 34.6 (2003): 426-433.
  21. ↑ Dailey, Andrew T., et al. "Congress of neurological surgeons systematic review and evidence-based guidelines on the evaluation and treatment of patients with thoracolumbar spine trauma: classification of injury." Neurosurgery 84.1 (2019): E24-E27.
  22. ↑ Image courtesy of radiologymasterclass.uk
  23. ↑ An, Ki-Chan, Dae Hyun Park, and Yong-Wook Kwon. "Relationship between lamina fractures and dural tear in low lumbar burst fractures." Journal of the Korean Fracture Society 24.3 (2011): 256-261.
  24. ↑ Kohno, Motonori, et al. "Surgical intervention for osteoporotic vertebral burst fractures in middle-low lumbar spine with special reference to postoperative complications affecting surgical outcomes." Neurologia medico-chirurgica 59.3 (2019): 98-105.
  25. ↑ Hassankhani, Alvand, et al. "ACR appropriateness criteria® acute spinal trauma: 2024 update." Journal of the American College of Radiology 22.5 (2025): S48-S66.
  26. ↑ Li, Yao, et al. "Correlation of interpedicular distance with radiographic parameters, neurologic deficit, and posterior structures injury in thoracolumbar burst fractures." World Neurosurgery 118 (2018): e72-e78.
  27. ↑ Izzo, Roberto, et al. "Imaging of thoracolumbar spine traumas." European journal of radiology 154 (2022): 110343.
  28. ↑ Dai, Li-Yang, et al. "Plain radiography versus computed tomography scans in the diagnosis and management of thoracolumbar burst fractures." Spine 33.16 (2008): E548-E552.
  29. ↑ Aly, Mohamed M., et al. "Multicenter external validation of the accuracy of computed tomography criteria for detecting thoracolumbar posterior ligamentous complex injury." Neurosurgery 96.6 (2025): 1236-1248.
  30. ↑ Raksin, P. B., et al. "Congress of neurological surgeons systematic review and evidence-based guidelines on the evaluation and treatment of patients with thoracolumbar spine trauma: prophylaxis and treatment of thromboembolic events." Neurosurgery 84.1 (2019): E39-E42.
  31. ↑ Pizones, Javier, et al. "Prospective analysis of magnetic resonance imaging accuracy in diagnosing traumatic injuries of the posterior ligamentous complex of the thoracolumbar spine." Spine 38.9 (2013): 745-751.
  32. ↑ Lee, Yohan, et al. "Percutaneous pedicle screw fixation in thoracolumbar fractures: comparison of results according to implant removal time." Clinics in Orthopedic Surgery 11.3 (2019): 291-296.
  33. ↑ Kim, Hyeun Sung, et al. "Acute burst fracture in Kummell’s disease with acute onset neurological deficit: a case report on role of spinal stability and technical notes on “pivot ligamentotaxis”." BMC surgery 19.1 (2019): 49.
  34. ↑ Dai, Li-Yang, et al. "A review of the management of thoracolumbar burst fractures." Surgical neurology 67.3 (2007): 221-231.
  35. ↑ Agus H, Kayali C, Arslantas M. Nonoperative treatment of burst type thoracolumbar vertebra fractures: clinical and radiological results of 29 patients. Eur Spine J 2005;14:536 - 40.
  36. ↑ Shen WJ, Liu TJ, Shen YS. Nonoperative treatment versus posterior fixation for thoracolumbar junction burst fractures without neurologic deficit. Spine 2001;26:1038- 45.
  37. ↑ 37.0 37.1 Sadiqi, Said, et al. "Functional Outcomes Between Surgical and Nonsurgical Treatment for Neurologically Intact Patients With Thoracolumbar Burst Fractures as Measured by the AO Spine PROST." Spine (2026): 10-1097.
  38. ↑ Cantor JB, Lebwohl NH, Garvey T, Eismont FJ. Nonoperative management of stable thoracolumbar burst fractures with early ambulation and bracing. Spine 1993;18:971- 6.
  39. ↑ Goulet, Julien, et al. "Morphological features of thoracolumbar burst fractures associated with neurological outcome in thoracolumbar traumatic spinal cord injury." European Spine Journal 29.10 (2020): 2505-2512.
  40. ↑ Kato, So, et al. "Does surgical intervention or timing of surgery have an effect on neurological recovery in the setting of a thoracolumbar burst fracture?." Journal of orthopaedic trauma 31 (2017): S38-S43.
  41. ↑ Hitchon, Patrick W., et al. "Nonoperative management in neurologically intact thoracolumbar burst fractures: clinical and radiographic outcomes." Spine 41.6 (2016): 483-489.
  42. ↑ Abudou, Minawaer, et al. "Surgical versus non‐surgical treatment for thoracolumbar burst fractures without neurological deficit." Cochrane Database of Systematic Reviews 6 (2013).
  43. ↑ Best, Shawn A., et al. "The neurologically intact patient with TLICS 4 or 5 burst fracture should be given a trial of nonoperative management." Medicine 103.46 (2024): e40304.
Created by:
John Kiel on 9 May 2020 22:15:47
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