CONSERVATIVE TREATMENT FOR THORACOLUMBAR SPINE BURST FRACTURES

A systematic review was conducted from April 2014 to June 2015, selecting articles according to their prospective design, related to thoracolumbar spine burst fractures and their treatment. These studies were published in the electronic bibliographic databases from January 2009 to January 2015.

Results:

A total of 9,504 articles were found in a free search, of which 7 met the selection criteria and were included for analysis in a study of a total of 435 patients, of whom 72 underwent surgical treatment and 363 received some type of conservative treatment, showing predominantly level of evidence "1b", with strength of recommendation type "A".

Conclusions:

According to the evidence obtained, the conservative treatment is a choice for patients with stable burst fracture in a single level of thoracolumbar spine and with no neurological injury.

Keywords:
Spinal fractures; Lumbar vertebrae; Thoracic vertebrae; Kyphosis.

Inclusion criteria	Non inclusion Criteria	Exclusion Criteria
Articles related to thoracolumbar spine burst fractures.	Articles that could not be accessed.	Articles published in languages other than English or Spanish.
Articles related to the conservative treatment of burst type fractures of the thoracolumbar spine.	Articles in non medical magazines.	Articles that do not comply with international bioethics rules.
Articles related to conservative treatment versus surgical treatment of burst type fractures of the thoracolumbar spine.
Articles related to conservative treatment versus surgical treatment for burst type fractures of the thoracolumbar spine, with respect to recovery time, persistence, and/or recurrence of the symptomatology, number of days of hospitalization required, and complications from the treatment. Original articles from indexed magazines.	Summarized articles, with no option to obtain the complete version.	Articles with insufficient description or inadequate methodology.
Articles published from January 2009 through January 2015.
Articles published in English or Spanish.	Unindexed magazine articles.
Articles related to the handling of burst fractures of the thoracolumbar spine selected according to their design, i.e., the clinical trials, the pre-experiment studies, prospective cohort studies.

Code	Keyword
#1	Burst fracture
#2	Thoracolumbar treatment
#3	Thoracolumbar conservative
#4	Thoracolumbar rehab
#5	Thoracolumbar surgery treatment
#6	Burst fracture Indications
#7	Burst fracture Treatment
#8	Burst fracture and Thoracolumbar treatment
#9	Burst fracture and Thoracolumbar conservative
#10	Burst fracture and Thoracolumbar surgery treatment
#11	Burst fracture or Thoracolumbar treatment or Thoracolumbar conservative or Thoracolumbar rehab or Thoracolumbar surgery treatment

Author/ year	Design	Effectiveness of Tx	Number of days in the hospital	Recovery	Recurrence of symptomatology	Complications from the treatment	Time since the start of Tx
Bailey C, Urquart J, et al. 2014	Multicenter blind clinical trial GR: A LE: 1b	- Conservative Tx with orthosis (TLSO) and conservative Tx without orthosis, equally reliable and effective at 3 months follow up	- 2.5 days for patients with conservative Tx based on orthosis. - 2.6 days for patients with conservative Tx without orthosis	No data	No data	- Radicular pain - Back pain (lumbar) - Need for surgical stabilization for pain - Need for osteotomy in one patient with severe kyphosis	No data
Kumar A, Aujla R, Lee C, et al. 2015	Prospective cohort GR: B LE: 2b	- Minimally invasive surgery is more effective than open surgical treatment and conservative treatment	- Conservative treatment: 36 (10-104) days - Open surgical treatment: 4 (2-7) days - Minimally invasive surgery: 2 (1-4) days - Value of p<0.05, for any surgical vs. conservative Tx - Value of p<0.05, open surgical Tx vs. minimally invasive	- Time to return to work (months): Conservative Tx 9 (3-24 months) Open surgical Tx 4 (0.5-9 months) *Minimally invasive surgery 2 (0.1-6 months)	No data	- Conservative treatment: Posterior correction of kyphosis via surgical approach - Surgical treatment: None	No data
Shamji M, Roffey D, et al. 2014	Randomized blind clinical trial GR: A LE: 1b	- Conservative Tx with orthosis (TLSO) and conservative Tx without orthosis, showed no difference in the functional results, after 6 months of follow up.	- The TLSO group had 6.3 (+- 2.1) days of hospitalization. - Patients without orthosis had 2.8 (+- 3) days of hospitalization	No data	No data	- Of the patients who received TLSO, 2 needed to be transferred to the rehabilitation service 48 hours after the beginning of treatment. - None of the patients who received treatment without orthosis had to be transferred to the rehabilitation service after the beginning of treatment. - No patient required surgical treatment. - No neurological damage was reported. - There were no hospital complications.	No data

Author/ year	Design	Effectiveness of Tx	Number of days in the hospital	Recovery	Recurrence of symptomatology	Complications from the treatment	Time since the start of Tx
Bailey C, Fleming J, Gurr K, et al. 2013	Randomized clinical trial GR: A LE: 1b	- Conservative treatment has poor results in patients with initial kyphosis greater than 25^o. For this reason, a surgical option should be included for them	No data	No data	No data	- Presence of kyphosis	No data
Wood K, Buttermann G, et al. 2015	Randomized clinical trial GR: A LE: 1b	- No clinical difference was between conservative treatment and surgical treatment was reported after 4 years of follow up; however, after 20 years of follow up, the patients who received conservative treatment reported less back pain and better function as compared to those who received surgical treatment.	No data	- 74% of the patients who underwent conservative treatment returned to work 6 months after starting treatment. - 43% of the patients who underwent surgical treatment returned to work 6 months after starting treatment.	No data	- In the patients treated surgically, there were 19 complications during 24 months of follow up (they were not specified). - Among the patients with conservative treatment, there were 2 complications during 24 months of follow up (they were not specified). -Long term back pain. - After 20 years of follow up, evaluations using the Oswestry, Roland-Morris, analog for pain scales showed better conditions in patients who received conservative treatment when compared to those who received surgical Tx (p<0.05).	No data
Stadhouder A, Buskens E, et al. 2009	Randomized clinical trial GR: A LE: 1b	- Same effectiveness among the different conservative treatments: 1. Just rehabilitation 2. Orthosis 3. Fixation with cast	No data	No data	- Long term pain (3 years) with any type of conservative treatment	No data	From 3 to 5 days
Bailey C, Dvorak M, Aludino A, Rosas-Arellano M, et al. 2011	Multicenter experiment GR: A LE: 1b	- There were no statistically significant differences between patients who received conservative treatment with orthosis and those who received conservative treatment without orthosis.	- 4.7 days for patients with Tx based on orthosis. - 5 days for patients with conservative Tx without orthosis.	No data	No data	No data	No data

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[1] Correspondence: UMAE "Dr. Victorio de la Fuente Narváez" IMSS, Av. Eje Fortuna S/N, Esq. Instituto Politécnico Nacional, Col. Magdalena De Las Salinas, Delegación Gustavo A. Madero. 07760, México, D.F. raybarvan@gmail.com

Study Variables
Independent variable	Dependent variable
Treatment	Effectiveness
	Number of days in the hospital
	Recovery time
	Recurrence of symptomatology
	Complications from the treatment
	Time since the beginning of treatment