Metaanalysis of treatment results in lower thoracic and lumbar spine burst fractures

Kostiantin Popsuishapka


There are conservative and surgical (fusion at 360°, posterior and anterior) method of treatment for burst fractures of the low­er thoracic and lumbar spine. However, each has its limitations and open questions.

Objective: to identify trends in the use of various methods of treatment of burst vertebral fractures.

Methods: meta-analysis of publications in professional journals, Medline and PubMed databases for the period 2001–2015 years.

Results: found 124 scientific articles, 16 of which were selected, corresponding to II–III level of evidence. Total the results of treatment of 692 patients with burst fractures of the lower thoracic and lumbar spine are presented in these papers. A com­parative analysis of the results of conservative and surgical treatment, transpedicular fixation (TPF) of different lengths, proved the effectiveness of anterior fusion.

Conclusions: choice of treatment for burst fractures of the lower thoracic and lumbar spine depends on injury morphology, neurological status and general condition of the patient, the surgeon’s preferences and skills. In case of damage type A classification Magerl fragmen­tation of the vertebral body to 50 %, but with a intact posterior complex recommended conservative treatment. In case of damage of the AB type fragmentation of the vertebral body to 50 % with injuries posterior support complex and longitudinal liga­ment, spinal canal stenosis of 50 % short posterior TPF without anterior reconstruction can be used. Long TPF in this group of patients provides a more effective correction of distortion and reliable stabilization. Anterior decompression and fusion alone or in combination with short TPF effective in treating compli­cated and uncomplicated burst spine fractures.


burst spinal fractures; the thoracic and lumbar spine; anterior and posterior spinal fusion; transpedicular fixation


Petrenko DE. Ventral correction and fixation of scoliotic spinal deformation. Kharkiv, 2015. 349 p.

Bhandari M, Devereaux P, Swiontkowski M. Internal fixation compared with arthroplasty for displaced fractures of the femoral neck. A meta-analysis. J Bone Joint Surg. Am. 2003:85-A:1673–1681.

Alanay A, Yazici M, Acaroglu E, Turhan E, Cila A, Surat A. Course of nonsurgical management of burst fractures with intact posterior ligamentous complex: an MRI study. Spine. 2004;29(21):2425–2431.

Dai LY, Jiang LS, Jiang SD. Conservative treatment of thoracolumbar burst fractures a long-term follow-up results with special reference to the load sharing classification. Spine. 2008;33(23):2536–2544. DOI: 10.1097/BRS.0b013e3181851bc2.

Tezer M, Erturer R, Ozturk C, et al. Conservative treatment of fractures of the thoracolumbar spine. Int. Orthop. 2005;29(2):78–82. DOI: 10.1007/s00264-004-0619-1.

Shen WJ, Liu TJ, Shen YS. Nonoperative treatment versus posterior fixation for thoracolumbar junction burst fractures without neurologic deficit. Spine. 2001;26(9):1038–1045.

Altay M, Ozkurt B, Aktekin CN, Ozturk AM, Dogan O, Tabak AY. Treatment of unstable thoracolumbar junction burst fractures with short- or long-segment posterior fixation an magerl type A fractures. Eur. Spine J. 2007;16(8):1145–1155. DOI: 10.1007/s00586-007-0310-5.

Alanay A, Acaroglu E, Yazici M, et al. Short-segment pedicle instrumentation of thoracolumbar burst fractures: does transpedicular intracorporeal grafting prevent early failure? Randomized trials. Spine. 2001;33(26):213-217.

Sasso RC, Renkens K, Hanson D, Reilly T, McGuire RA Jr, Best NM. Unstable thoracolumbar burst fractures: anterior-only versus short-segment posterior fixation. J Spinal Disord Tech. 2006;19(4):242–248. DOI: 10.1097/01.bsd.0000211298.59884.24.

Pham MH, Tuchman A, Chen TC, Acosta FL, Hsieh PC, Liu JC. Transpedicular corpectomy and cage placement in the treat¬ment of traumatic lumbar burst fractures. Clin. Spine Surg. 2016. DOI: 10.1097/BSD.0000000000000312.

Zahra B, Jodoin A, Maurais G, Parent S, Mac-Thiong JM. Treatment of thoracolumbar burst fractures by means of anterior fusion and cage. J Spinal Disord. Tech. 2012;25(1):30–37. DOI: 10.1097/BSD.0b013e31820bb0a9.

Gelb D, Ludwig S, Karp JE, Chung EH, Werner C, Kim T, Poelstra K. Successful treatment of thoracolumbar fractures with short-segment pedicle instrumentation. J Spinal Disord. Tech. 2010;23(5):293–301. DOI: 10.1097/BSD.0b013e3181af20b6.

Guven O, Kocaoglu B, Bezer M, et al. The use of screw at the fracture level in the treatment of thoracolumbar burst fractures. J Spinal Disord Tech. 2009;22(6):417–421. DOI: 10.1097/BSD.0b013e3181870385.

Shi R, Liu H, Zhao X, et al. Anterior single segmental decompression and fixation for Denis B type thoracolumbar burst fracture with neurological deficiency. Spine. 2011;36(9):598–605. DOI: 10.1097/BRS.0b013e3181e04b8f.

Sasani M, Fahir A. Single-stage posterior corpectomy and expandable cage placement for treatment of thoracic or lumbar burst fractures. Spine. 2008;34(1):E33–E40. DOI: 10.1097/BRS.0b013e318189fcfd.

Dai LY, Jiang SD. Anterior-only stabilization using plating with bone structural autograft versus titanium mesh cages for two-or three-column thoracolumbar burst fractures: a prospec¬tive randomized study. Spine. 2008;34(14):1429–1435. DOI: 10.1097/BRS.0b013e3181a4e667.

Haiyun Y, Rui G, Shucai D, Zhanhua J, Xiaolin Z, Xin L, Xue W, Gongyi L, Jiankun L. Three-column reconstruction through single posterior approach for the treatment of unstable thoracolumbar fracture. Spine. 2010;35(8):E295–T302. DOI: 10.1097/BRS.0b013e3181c392b9.

Aebi M, Arlet V, Webb J. AO spine manual principles and techniques (Vol. 1). Thieme, 2007. 663 p.

Aebi M, Arlet V, Webb J. AO Spine Manual Principles and techniques (Vol. 2). Thieme, 2007. 837 p.

Copyright (c) 2017 Konstantin Popsuishapka

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