Efficacy and Safety of Conservative Treatment Compared With Surgical Treatment for Thoracolumbar Fracture With Score 4 Thoracolumbar Injury Classification and Severity (TLICS) A Systematic Review and Meta-analysis

Clin Spine Surg, 2024 · DOI: 10.1097/BSD.0000000000001503 · Published: June 1, 2024

Spinal Cord Injury Research Methodology & Design Musculoskeletal Medicine

Simple Explanation

This study compares surgery and non-surgical treatments for a specific type of spinal fracture. These fractures, called thoracolumbar fractures, are given a score of 4 on the TLICS scale, which means they are in a 'gray zone' where it's unclear which treatment is best. The researchers looked at multiple studies to see if surgery or non-surgical treatment leads to better outcomes. They analyzed factors like how long it took patients to return to work, pain levels, and complications. The study found that surgery may be better in the short term for pain and preventing spinal deformity. However, more research is needed to confirm these findings with larger, more rigorous studies.

Study Duration

Not specified

Participants

555 patients

Evidence Level

Systematic review and meta-analysis

Key Findings

1
Surgical treatment resulted in a shorter length of returning to work compared to nonsurgical treatment.
2
Patients who underwent surgery had lower pain scores (VAS) at 1, 3, and 6 months post-treatment.
3
Surgery was associated with a lower Cobb angle (less spinal deformity) at various follow-up points (6, 12, and >24 months).

Research Summary

This meta-analysis compared surgical and conservative treatments for thoracolumbar fractures with a TLICS score of 4. The study found that surgical treatment may offer benefits in terms of faster return to work, lower early pain scores, and reduced spinal deformity. The authors conclude that current evidence suggests surgical treatment is superior at early follow-up, but further high-quality studies are needed to verify these findings.

Practical Implications

Treatment Decisions

Surgeons can consider these findings when deciding whether to operate on patients with TLICS score of 4 fractures.

Patient Expectations

Patients should be informed that surgery may lead to a quicker return to work and less early pain.

Future Research

Highlights the necessity for multicenter, double-blind, large-sample randomized controlled trials to validate the findings.

Study Limitations

1
Subjectivity in pooled results due to varying doctor experience.
2
Predominance of retrospective studies, potentially affecting results.
3
Heterogeneity due to age, race, and vertebral differences among included studies.

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