The Management of Burst Fractures of the Thoracic and Lumbar Spine

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Abstract
The optimal treatment of “burst” fractures is one of the more controversial topics in spinal reconstructive surgery. While it is generally considered a stable fracture, recent trends toward operative treatment of burst injuries have raised questions regarding the necessity of stabilization and decompression. A retrospective review was conducted of all patients who presented at the University of Minnesota Hospitals from 1970 to 1980 with closed thoracolumbar spinal fractures. In 354 of 399 patients, records and roentgenograms were adequate for review. Using strict x-ray criteria for classification, 59 patients were found to have burst fractures. One-year follow-up was available on 53 patients. There were 10 thoracic and 43 lumbar fractures. Thirty-one patients had associated injuries. Eleven patients had other spinal fractures. Thirty-eight patients demonstrated neurologic deficits. Twenty-two patients were initially treated nonoperatively, and 31 had early surgery. Operations included laminectomy, posterolateral decompression, posterior spinal fusion usually with Harrington rod instrumentation, and anterior spinal fusion. At follow-up, which averaged more than 3 years, neurologic improvement was found in 68% of the surgical patients who had presented initially with a neurologic deficit. Six patients treated nonoperatively later required surgery. Back pain was more common in the surgical group, disability less common. Radiographic follow-up revealed little increase in deformity in either group. The findings in this study suggest that nonsurgical treatment of patients with burst fractures and normal neurologic function is not likely to result in neurologic deterioration or progressive deformity, but in those with neural deficits, significant neurologic improvement is unlikely, and neurologic deterioration may occur. Surgical treatment in cases of incomplete neurologic deficits appears to have merit and may lead to improved neurologic function.

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