Retrospective Study: Outcomes of Percutaneous Pedicular Screw Fixation VS Conservative Management in Unstable Burst Fracture Patients in Tertiary Care Center in Eastern Thailand
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Abstract
BACKGROUND: Nowadays management of patients with thoracolumbar burst fracture who have the Thoracolumbar Injury Classification and Severity (TLICS) score equal to 4 are still controversial.
OBJECTIVE: To determine the outcome of patients who undergo surgical intervention and conservative management.
METHODS: Retrospective study was designed, and fifty patients who had thoracolumbar burst fracture and a TLICS score of 4 between 2023-2025 at Phrapokklao hospital were enrolled. The surgical and non-surgical groups were assigned. The data was collected via previous medical records. Demographic data, time to return to work, visual analog scale (VAS), Cobb angle and anterior vertebral body height loss were all collected. The data was analyzed by multivariable Gaussian linear regression.
RESULTS: The majority of participants were female (56%). The mean age of the patients was 50.7 years old. The most common level of injury was L1 (58%) and the main cause was from falling from heights (74%). The surgical group showed clinical outcomes demonstrating a significant reduction in time to return to work, with an adjusted mean difference of −18.84 days (95% CI: −35.37 to −2.32, p=0.027). A significant reduction in the Cobb angle was also observed, with an adjusted mean difference of −10.67 (95% CI: −14.64 to −6.70, p<0.001). Similarly, anterior height loss was significantly reduced with an adjusted mean difference of −23.16 (95% CI: −29.50 to −16.81, p<0.001). In contrast, there was no statistically significant difference in pain scores at 3 months, as measured by the Visual Analogue Scale (adjusted mean difference = −0.51, 95% CI: −1.66 to 0.63, p=0.37).
CONCLUSION: Surgical management for thoracolumbar burst fracture with a TLIC score equal to 4 resulted in better time to return to work and improve the Cobb angle and anterior vertebral body height loss within a 3-month period of the injury.
Thaiclinicaltrials.org number, TCTR20260316006
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