{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T06:35:21Z","timestamp":1789799721485,"version":"4.0.1"},"reference-count":130,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2014,7]]},"abstract":"\n Object<\/jats:title>\n The overall evidence for nonoperative management of patients with traumatic thoracolumbar burst fractures is unknown. There is no agreement on the optimal method of conservative treatment. Recent randomized controlled trials that have compared nonoperative to operative treatment of thoracolumbar burst fractures without neurological deficits yielded conflicting results. By assessing the level of evidence on conservative management through validated methodologies, clinicians can assess the availability of critically appraised literature. The purpose of this study was to examine the level of evidence for the use of conservative management in traumatic thoracolumbar burst fractures.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A comprehensive search of the English literature over the past 20 years was conducted using PubMed (MEDLINE). The inclusion criteria consisted of burst fractures resulting from a traumatic mechanism, and fractures of the thoracic or lumbar spine. The exclusion criteria consisted of osteoporotic burst fractures, pathological burst fractures, and fractures located in the cervical spine. Of the studies meeting the inclusion\/exclusion criteria, any study in which nonoperative treatment was used was included in this review.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n One thousand ninety-eight abstracts were reviewed and 447 papers met inclusion\/exclusion criteria, of which 45 were included in this review. In total, there were 2 Level-I, 7 Level-II, 9 Level-III, 25 Level-IV, and 2 Level-V studies. Of the 45 studies, 16 investigated conservative management techniques, 20 studies compared operative to nonoperative treatments, and 9 papers investigated the prognosis of conservative management.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n There are 9 high-level studies (Levels I\u2013II) that have investigated the conservative management of traumatic thoracolumbar burst fractures. In neurologically intact patients, there is no superior conservative management technique over another as supported by a high level of evidence. The conservative technique can be based on patient and surgeon preference, comfort, and access to resources. A high level of evidence demonstrated similar functional outcomes with conservative management when compared with open surgical operative management in patients who were neurologically intact. The presence of a neurological deficit is not an absolute contraindication for conservative treatment as supported by a high level of evidence. However, the majority of the literature excluded patients with neurological deficits. More evidence is needed to further classify the appropriate burst fractures for conservative management to decrease variables that may impact the prognosis.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2014.4.focus14159","type":"journal-article","created":{"date-parts":[[2014,7,1]],"date-time":"2014-07-01T11:06:02Z","timestamp":1404212762000},"page":"E1","source":"Crossref","is-referenced-by-count":66,"title":["Evidence-based management of traumatic thoracolumbar burst fractures: a systematic review of nonoperative management"],"prefix":"10.3171","volume":"37","author":[{"given":"Joshua","family":"Bakhsheshian","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nader S.","family":"Dahdaleh","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shayan","family":"Fakurnejad","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin K.","family":"Scheer","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary A.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus14159","series-title":"Cochrane Database Syst Rev","first-page":"CD005079","article-title":"Surgical versus non-surgical treatment for thoracolumbar burst fractures without neurological deficit","volume":"6","author":"Abudou","year":"2013"},{"key":"b2-focus14159","series-title":"Eur Spine J","first-page":"536","article-title":"Nonoperative treatment of burst-type thoracolumbar vertebra fractures: clinical and radiological results of 29 patients","volume":"14","author":"A\u011fu\u015f","year":"2005"},{"key":"b3-focus14159","series-title":"J Spinal Disord Tech","first-page":"410","article-title":"Patterns of collapse in thoracolumbar burst fractures","volume":"18","author":"Al-Khalifa","year":"2005"},{"key":"b4-focus14159","series-title":"Spine (Phila Pa 1976)","first-page":"2425","article-title":"Course of nonsurgical management of burst fractures with intact posterior ligamentous complex: an MRI study","volume":"29","author":"Alanay","year":"2004"},{"key":"b5-focus14159","series-title":"Acta Orthop Belg","first-page":"279","article-title":"Functional outcome of burst fractures of the thoracolumbar spine managed non-operatively, with early ambulation, evaluated using the load sharing classification","volume":"68","author":"Aligizakis","year":"2002"},{"key":"b6-focus14159","series-title":"Orthopedics","first-page":"422","article-title":"Thoracolumbar burst fractures: a systematic review of management","volume":"33","author":"Alpantaki","year":"2010"},{"key":"b7-focus14159","series-title":"Orthopedics","first-page":"367","article-title":"Low lumbar burst fractures: comparison between conservative and surgical treatments","volume":"15","author":"An","year":"1992"},{"key":"b8-focus14159","series-title":"J Bone Joint Surg Am","first-page":"1156","article-title":"Burst fractures of the second through fifth lumbar vertebrae. Clinical and radiographic results","volume":"78","author":"Andreychik","year":"1996"},{"key":"b9-focus14159","series-title":"Spine J","article-title":"Orthosis versus no orthosis for the treatment of thoracolumbar burst fractures without neurologic injury: a multicenter prospective randomized equivalence trial","author":"Bailey","year":"2013"},{"key":"b10-focus14159","series-title":"J Spinal Disord Tech","first-page":"229","article-title":"Conservative management of burst fractures of the fifth lumbar vertebra","volume":"18","author":"Blanco","year":"2005"},{"key":"b11-focus14159","series-title":"Spine (Phila Pa 1976)","first-page":"443","article-title":"The management and functional outcome of isolated burst fractures of the fifth lumbar vertebra","volume":"32","author":"Butler","year":"2007"},{"key":"b12-focus14159","series-title":"Int Orthop","first-page":"51","article-title":"Functional outcome of burst fractures of the first lumbar vertebra managed surgically and conservatively","volume":"29","author":"Butler","year":"2005"},{"key":"b13-focus14159","series-title":"Spine (Phila Pa 1976)","first-page":"971","article-title":"Nonoperative management of stable thoracolumbar burst fractures with early ambulation and bracing","volume":"18","author":"Cantor","year":"1993"},{"key":"b14-focus14159","series-title":"Spine (Phila Pa 1976)","first-page":"320","article-title":"Nonoperative treatment in burst fractures of the lumbar spine (L2-L5) without neurologic deficits","volume":"18","author":"Chan","year":"1993"},{"key":"b15-focus14159","series-title":"Spine (Phila Pa 1976)","first-page":"2170","article-title":"Functional outcome of thoracolumbar burst fractures managed with hyperextension casting or bracing and early mobilization","volume":"21","author":"Chow","year":"1996"},{"key":"b16-focus14159","series-title":"Spine (Phila Pa 1976)","first-page":"2536","article-title":"Conservative treatment of thoracolumbar burst fractures: a long-term follow-up results with special reference to the load sharing classification","volume":"33","author":"Dai","year":"2008"},{"key":"b17-focus14159","series-title":"Surg Neurol","first-page":"221","article-title":"A review of the management of thoracolumbar burst fractures","volume":"67","author":"Dai","year":"2007"},{"key":"b18-focus14159","series-title":"Spine (Phila Pa 1976)","first-page":"1057","article-title":"Spontaneous remodeling of the spinal canal after conservative management of thoracolumbar burst fractures","volume":"23","author":"de Klerk","year":"1998"},{"key":"b19-focus14159","series-title":"Acta Orthop Belg","first-page":"226","article-title":"Factors influencing neurological recovery in burst thoracolumbar fractures","volume":"61","author":"Dendrinos","year":"1995"},{"key":"b20-focus14159","series-title":"Spine (Phila Pa 1976)","first-page":"817","article-title":"The three column spine and its significance in the classification of acute thoracolumbar spinal injuries","volume":"8","author":"Denis","year":"1983"},{"issue":"189","key":"b21-focus14159","series-title":"Clin Orthop Relat Res","first-page":"142","article-title":"Acute thoracolumbar burst fractures in the absence of neurologic deficit. A comparison between operative and nonoperative treatment","author":"Denis","year":"1984"},{"key":"b22-focus14159","series-title":"J Bone Joint Surg Am","first-page":"398","article-title":"Burst fracture of the fifth lumbar vertebra","volume":"74","author":"Finn","year":"1992"},{"key":"b23-focus14159","series-title":"Spine (Phila Pa 1976)","first-page":"528","article-title":"Scoliosis Research Society. Multicenter spine fracture study","volume":"17","author":"Gertzbein","year":"1992"},{"key":"b24-focus14159","series-title":"Clin Orthop Relat Res","first-page":"567","article-title":"Nonoperative versus operative treatment for thoracolumbar burst fractures without neurologic deficit: a meta-analysis","volume":"470","author":"Gnanenthiran","year":"2012"},{"issue":"323","key":"b25-focus14159","series-title":"Clin Orthop Relat Res","first-page":"210","article-title":"A clinical study of the natural remodeling of burst fractures of the lumbar spine","author":"Ha","year":"1996"},{"key":"b26-focus14159","series-title":"Paraplegia","first-page":"73","article-title":"Non-operative treatment of thoracolumbar fractures","volume":"33","author":"Hartman","year":"1995"},{"key":"b27-focus14159","series-title":"BMJ","first-page":"1179","article-title":"Optimal search strategies for retrieving scientifically strong studies of treatment from Medline: analytical survey","volume":"330","author":"Haynes","year":"2005"},{"key":"b28-focus14159","series-title":"Surg Neurol","first-page":"619","article-title":"Management options in thoracolumbar burst fractures","volume":"49","author":"Hitchon","year":"1998"},{"key":"b29-focus14159","series-title":"The 2011 Oxford CEBM Levels of Evidence (Introductory Document)","author":"Howick","year":"2011"},{"key":"b30-focus14159","series-title":"Explanation of the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence (Background Document)","author":"Howick","year":"2011"},{"key":"b31-focus14159","series-title":"The Oxford Levels of Evidence 2","author":"Howick","year":"2011"},{"key":"b32-focus14159","series-title":"Spine (Phila Pa 1976)","first-page":"492","article-title":"Epidemiology of incident spinal fracture in a complete population","volume":"21","author":"Hu","year":"1996"},{"key":"b33-focus14159","series-title":"Spine J","first-page":"1760","article-title":"Retrospective evaluation of the validity of the Thoracolumbar Injury Classification System in 458 consecutively treated patients","volume":"13","author":"Joaquim","year":"2013"},{"key":"b34-focus14159","series-title":"Paraplegia","first-page":"58","article-title":"Conservative treatment of burst fractures of the thoracolumbar and lumbar spine","volume":"31","author":"Kinoshita","year":"1993"},{"issue":"293","key":"b35-focus14159","series-title":"Clin Orthop Relat Res","first-page":"112","article-title":"Comparison of operative versus nonoperative treatment of lumbar burst fractures","author":"Knight","year":"1993"},{"key":"b36-focus14159","series-title":"Eur Spine J","first-page":"1073","article-title":"Long-term investigation of nonsurgical treatment for thoracolumbar and lumbar burst fractures: an outcome analysis in sight of spinopelvic balance","volume":"17","author":"Koller","year":"2008"},{"key":"b37-focus14159","series-title":"J Orthop Trauma","first-page":"541","article-title":"Functional outcome of thoracolumbar burst fractures without neurological deficit","volume":"10","author":"Kraemer","year":"1996"},{"key":"b38-focus14159","series-title":"Spine (Phila Pa 1976)","first-page":"2079","article-title":"Reliability of magnetic resonance imaging in detecting posterior ligament complex injury in thoracolumbar spinal fractures","volume":"25","author":"Lee","year":"2000"},{"key":"b39-focus14159","series-title":"Spine J","first-page":"422","article-title":"Assessment of injury to the thoracolumbar posterior ligamentous complex in the setting of normalappearing plain radiography","volume":"7","author":"Lee","year":"2007"},{"key":"b40-focus14159","series-title":"Levels of Evidence for Primary Research Question","year":"2013"},{"key":"b41-focus14159","series-title":"Eur Spine J","first-page":"184","article-title":"A comprehensive classification of thoracic and lumbar injuries","volume":"3","author":"Magerl","year":"1994"},{"key":"b42-focus14159","series-title":"Spine (Phila Pa 1976)","first-page":"564","article-title":"Weight-bearing radiographs in thoracolumbar fractures: do they influence management?","volume":"29","author":"Mehta","year":"2004"},{"key":"b43-focus14159","series-title":"Spine (Phila Pa 1976)","first-page":"1878","article-title":"Burst fractures of the fifth lumbar vertebra","volume":"18","author":"Mick","year":"1993"},{"key":"b44-focus14159","series-title":"Spinal Cord","first-page":"295","article-title":"Does neurological recovery in thoracolumbar and lumbar burst fractures depend on the extent of canal compromise?","volume":"40","author":"Mohanty","year":"2002"},{"key":"b45-focus14159","series-title":"Spine J","first-page":"701","article-title":"Nonoperatively treated burst fractures of the thoracic and lumbar spine in adults: a 23- to 41-year follow-up","volume":"7","author":"Moller","year":"2007"},{"key":"b46-focus14159","series-title":"Spine (Phila Pa 1976)","first-page":"955","article-title":"Thoracolumbar burst fractures. The clinical efficacy and outcome of nonoperative management","volume":"18","author":"Mumford","year":"1993"},{"key":"b47-focus14159","series-title":"Acta Orthop Traumatol Turc","first-page":"373","article-title":"Early mobilization with customized TLSO brace in thoracolumbar burst fractures","volume":"46","author":"\u00d6zt\u00fcrk","year":"2012"},{"key":"b48-focus14159","series-title":"Spine (Phila Pa 1976)","first-page":"654","article-title":"Orthotic stabilization of thoracolumbar injuries. A biomechanical analysis of the Jewett hyperextension orthosis","volume":"15","author":"Patwardhan","year":"1990"},{"key":"b49-focus14159","series-title":"Acta Orthop Belg","first-page":"389","article-title":"Long-term functional outcome after type A3 spinal fractures: operative versus non-operative treatment","volume":"75","author":"Post","year":"2009"},{"issue":"Suppl 1","key":"b50-focus14159","series-title":"Eur Spine J","first-page":"S40","article-title":"Thoracolumbar burst fractures without neurological deficit: the role for conservative treatment","volume":"19","author":"Rajasekaran","year":"2010"},{"key":"b51-focus14159","series-title":"J Orthop Sci","first-page":"437","article-title":"Interrater reliability of identifying indicators of posterior ligamentous complex disruption when plain films are indeterminate in thoracolumbar injuries","volume":"12","author":"Schweitzer","year":"2007"},{"key":"b52-focus14159","series-title":"Spine (Phila Pa 1976)","first-page":"2154","article-title":"Functional outcome of low lumbar burst fractures. A multicenter review of operative and nonoperative treatment of L3-L5","volume":"24","author":"Seybold","year":"1999"},{"key":"b53-focus14159","series-title":"Spine (Phila Pa 1976)","first-page":"1038","article-title":"Nonoperative treatment versus posterior fixation for thoracolumbar junction burst fractures without neurologic deficit","volume":"26","author":"Shen","year":"2001"},{"key":"b54-focus14159","series-title":"Spine (Phila Pa 1976)","first-page":"412","article-title":"Nonsurgical treatment of three-column thoracolumbar junction burst fractures without neurologic deficit","volume":"24","author":"Shen","year":"1999"},{"key":"b55-focus14159","series-title":"Spine (Phila Pa 1976)","first-page":"2881","article-title":"Treatment of traumatic thoracolumbar spine fractures: a multicenter prospective randomized study of operative versus nonsurgical treatment","volume":"31","author":"Siebenga","year":"2006"},{"key":"b56-focus14159","series-title":"J Orthop Trauma","first-page":"588","article-title":"Nonoperative treatment of thoracic and lumbar spine fractures: a prospective randomized study of different treatment options","volume":"23","author":"Stadhouder","year":"2009"},{"key":"b57-focus14159","series-title":"Int Orthop","first-page":"78","article-title":"Conservative treatment of fractures of the thoracolumbar spine","volume":"29","author":"Tezer","year":"2005"},{"key":"b58-focus14159","series-title":"J Neurosurg Spine","first-page":"351","article-title":"Comparison of operative and nonoperative treatment for thoracolumbar burst fractures in patients without neurological deficit: a systematic review","volume":"4","author":"Thomas","year":"2006"},{"key":"b59-focus14159","series-title":"Spine (Phila Pa 1976)","first-page":"2459","article-title":"Functional and radiographic outcome of thoracolumbar and lumbar burst fractures managed by closed orthopaedic reduction and casting","volume":"28","author":"Tropiano","year":"2003"},{"key":"b60-focus14159","series-title":"Spine (Phila Pa 1976)","first-page":"2325","article-title":"A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status","volume":"30","author":"Vaccaro","year":"2005"},{"key":"b61-focus14159","series-title":"Arch Orthop Trauma Surg","first-page":"207","article-title":"Conservative management of thoracolumbar and lumbar spine compression and burst fractures: functional and radiographic outcomes in 136 cases treated by closed reduction and casting","volume":"129","author":"Weninger","year":"2009"},{"key":"b62-focus14159","series-title":"Instr Course Lect","first-page":"457","article-title":"Spinal stability: evaluation and treatment","volume":"30","author":"White","year":"1981"},{"key":"b63-focus14159","series-title":"J Bone Joint Surg Am","first-page":"773","article-title":"Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit. A prospective, randomized study","volume":"85-A","author":"Wood","year":"2003"},{"key":"b64-focus14159","series-title":"J Spinal Disord","first-page":"409","article-title":"Spinal canal remodeling in burst fractures of the thoracolumbar spine: a computerized tomographic comparison between operative and nonoperative treatment","volume":"9","author":"Yazici","year":"1996"},{"issue":"4","key":"b65-focus14159","series-title":"Cochrane Database Syst Rev","first-page":"CD005079","article-title":"Operative versus non-operative treatment for thoracolumbar burst fractures without neurological deficit","author":"Yi","year":"2006"},{"key":"b1-focus14159","series-title":"Cochrane Database Syst Rev","first-page":"CD005079","article-title":"Surgical versus non-surgical treatment for thoracolumbar burst fractures without neurological deficit","volume":"6","author":"Abudou","year":"2013"},{"key":"b2-focus14159","series-title":"Eur Spine J","first-page":"536","article-title":"Nonoperative treatment of burst-type thoracolumbar vertebra fractures: clinical and radiological results of 29 patients","volume":"14","author":"A\u011fu\u015f","year":"2005"},{"key":"b3-focus14159","series-title":"J Spinal Disord Tech","first-page":"410","article-title":"Patterns of collapse in thoracolumbar burst fractures","volume":"18","author":"Al-Khalifa","year":"2005"},{"key":"b4-focus14159","series-title":"Spine (Phila Pa 1976)","first-page":"2425","article-title":"Course of nonsurgical management of burst fractures with intact posterior ligamentous complex: an MRI study","volume":"29","author":"Alanay","year":"2004"},{"key":"b5-focus14159","series-title":"Acta Orthop Belg","first-page":"279","article-title":"Functional outcome of burst fractures of the thoracolumbar spine managed non-operatively, with early ambulation, evaluated using the load sharing classification","volume":"68","author":"Aligizakis","year":"2002"},{"key":"b6-focus14159","series-title":"Orthopedics","first-page":"422","article-title":"Thoracolumbar burst fractures: a systematic review of management","volume":"33","author":"Alpantaki","year":"2010"},{"key":"b7-focus14159","series-title":"Orthopedics","first-page":"367","article-title":"Low lumbar burst fractures: comparison between conservative and surgical treatments","volume":"15","author":"An","year":"1992"},{"key":"b8-focus14159","series-title":"J Bone Joint Surg Am","first-page":"1156","article-title":"Burst fractures of the second through fifth lumbar vertebrae. Clinical and radiographic results","volume":"78","author":"Andreychik","year":"1996"},{"key":"b9-focus14159","series-title":"Spine J","article-title":"Orthosis versus no orthosis for the treatment of thoracolumbar burst fractures without neurologic injury: a multicenter prospective randomized equivalence trial","author":"Bailey","year":"2013"},{"key":"b10-focus14159","series-title":"J Spinal Disord Tech","first-page":"229","article-title":"Conservative management of burst fractures of the fifth lumbar vertebra","volume":"18","author":"Blanco","year":"2005"},{"key":"b11-focus14159","series-title":"Spine (Phila Pa 1976)","first-page":"443","article-title":"The management and functional outcome of isolated burst fractures of the fifth lumbar vertebra","volume":"32","author":"Butler","year":"2007"},{"key":"b12-focus14159","series-title":"Int Orthop","first-page":"51","article-title":"Functional outcome of burst fractures of the first lumbar vertebra managed surgically and conservatively","volume":"29","author":"Butler","year":"2005"},{"key":"b13-focus14159","series-title":"Spine (Phila Pa 1976)","first-page":"971","article-title":"Nonoperative management of stable thoracolumbar burst fractures with early ambulation and bracing","volume":"18","author":"Cantor","year":"1993"},{"key":"b14-focus14159","series-title":"Spine (Phila Pa 1976)","first-page":"320","article-title":"Nonoperative treatment in burst fractures of the lumbar spine (L2-L5) without neurologic deficits","volume":"18","author":"Chan","year":"1993"},{"key":"b15-focus14159","series-title":"Spine (Phila Pa 1976)","first-page":"2170","article-title":"Functional outcome of thoracolumbar burst fractures managed with hyperextension casting or bracing and early mobilization","volume":"21","author":"Chow","year":"1996"},{"key":"b16-focus14159","series-title":"Spine (Phila Pa 1976)","first-page":"2536","article-title":"Conservative treatment of thoracolumbar burst fractures: a long-term follow-up results with special reference to the load sharing classification","volume":"33","author":"Dai","year":"2008"},{"key":"b17-focus14159","series-title":"Surg Neurol","first-page":"221","article-title":"A review of the management of thoracolumbar burst fractures","volume":"67","author":"Dai","year":"2007"},{"key":"b18-focus14159","series-title":"Spine (Phila Pa 1976)","first-page":"1057","article-title":"Spontaneous remodeling of the spinal canal after conservative management of thoracolumbar burst fractures","volume":"23","author":"de Klerk","year":"1998"},{"key":"b19-focus14159","series-title":"Acta Orthop Belg","first-page":"226","article-title":"Factors influencing neurological recovery in burst thoracolumbar fractures","volume":"61","author":"Dendrinos","year":"1995"},{"key":"b20-focus14159","series-title":"Spine (Phila Pa 1976)","first-page":"817","article-title":"The three column spine and its significance in the classification of acute thoracolumbar spinal injuries","volume":"8","author":"Denis","year":"1983"},{"issue":"189","key":"b21-focus14159","series-title":"Clin Orthop Relat Res","first-page":"142","article-title":"Acute thoracolumbar burst fractures in the absence of neurologic deficit. 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