Thoracolumbar Burst Fracture without Neurological Deficit: Review of Controversies and Current Evidence of Treatment.

Abstract

Thoracolumbar burst fracture without neurological deficit is a common spinal injury. The ideal classification for the diagnosis and the optimal management strategies, including conservative management, surgical approach, implant constructs, need for spinal fusion, and implant removal, are controversial and currently being investigated. This article reviews the current literature to provide updated evidence on these topics. Posterior ligamentous complex integrity plays an important role in the classification and decision-making process of treatment. A brace is not necessarily required in conservatively treated patients. Regarding surgical management, current evidence advocates posterior-only short segment instrumentation with intermediate screw. Cementoplasty is another option for vertebral augmentation at the fractured level. Spinal fusion is not necessary for this type of injury. Minimally invasive surgery techniques provide equivalent outcomes and can safely replace open approaches. Implant removal after stabilization may provide some benefits, especially in younger patients.