{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T09:05:33Z","timestamp":1780131933316,"version":"3.54.0"},"reference-count":98,"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 Thoracolumbar spine injuries are commonly encountered in patients with trauma, accounting for almost 90% of all spinal fractures. Thoracolumbar burst fractures comprise a high percentage of these traumatic fractures (45%), and approximately half of the patients with this injury pattern are neurologically intact. However, a debate over complication rates associated with operative versus nonoperative management of various thoracolumbar fracture morphologies is ongoing, particularly concerning those patients presenting without a neurological deficit.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A MEDLINE search for pertinent literature published between 1966 and December 2013 was conducted by 2 authors (G.G. and R.D.), who used 2 broad search terms to maximize the initial pool of manuscripts for screening. These terms were \u201coperative lumbar spine adverse events\u201d and \u201cnonoperative lumbar spine adverse events.\u201d<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n In an advanced MEDLINE search of the term \u201coperative lumbar spine adverse events\u201d on January 8, 2014, 1459 results were obtained. In a search of \u201cnonoperative lumbar spine adverse events,\u201d 150 results were obtained. After a review of all abstracts for relevance to traumatic thoracolumbar spinal injuries, 62 abstracts were reviewed for the \u201coperative\u201d group and 21 abstracts were reviewed for the \u201cnonoperative\u201d group. A total of 14 manuscripts that met inclusion criteria for the operative group and 5 manuscripts that met criteria for the nonoperative group were included.<\/jats:p>\n There were a total of 919 and 436 patients in the operative and nonoperative treatment groups, respectively. There were no statistically significant differences between the groups with respect to age, sex, and length of stay. The mean ages were 43.17 years in the operative and 34.68 years in the nonoperative groups. The majority of patients in both groups were Frankel Grade E (342 and 319 in operative and nonoperative groups, respectively). Among the studies that reported the data, the mean length of stay was 14 days in the operative group and 20.75 in the nonoperative group.<\/jats:p>\n The incidence of all complications in the operative and nonoperative groups was 300 (32.6%) and 21 (4.8%), respectively (p = 0.1065). There was no significant difference between the 2 groups with respect to the incidence of pulmonary, thromboembolic, cardiac, and gastrointestinal complications. However, the incidence of infections (pneumonia, urinary tract infection, wound infection, and sepsis) was significantly higher in the operative group (p = 0.000875). The incidence of instrumentation failure and need for revision surgery was 4.35% (40 of 919), a significant morbidity, and an event unique to the operative category (p = 0.00396).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Due to the limited number of high-quality studies, conclusions related to complication rates of operative and nonoperative management of thoracolumbar traumatic injuries cannot be definitively made. Further prospective, randomized studies of operative versus nonoperative management of thoracolumbar and lumbar spine trauma, with standardized definitions of complications and matched patient cohorts, will aid in properly defining the risk-benefit ratio of surgery for thoracolumbar spine fractures.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2014.4.focus1467","type":"journal-article","created":{"date-parts":[[2014,7,1]],"date-time":"2014-07-01T11:06:02Z","timestamp":1404212762000},"page":"E8","source":"Crossref","is-referenced-by-count":41,"title":["Operative and nonoperative adverse events in the management of traumatic fractures of the thoracolumbar spine: a systematic review"],"prefix":"10.3171","volume":"37","author":[{"given":"George M.","family":"Ghobrial","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher M.","family":"Maulucci","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitchell","family":"Maltenfort","sequence":"additional","affiliation":[{"name":"Rothman Institute, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard T.","family":"Dalyai","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander R.","family":"Vaccaro","sequence":"additional","affiliation":[{"name":"Rothman Institute, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael G.","family":"Fehlings","sequence":"additional","affiliation":[{"name":"University Health Network, Toronto, Ontario;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Street","sequence":"additional","affiliation":[{"name":"University of British Columbia, Vancouver, British Columbia, Canada; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul M.","family":"Arnold","sequence":"additional","affiliation":[{"name":"University of Kansas, Kansas City, Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James S.","family":"Harrop","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus1467","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-focus1467","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-focus1467","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":"b4-focus1467","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":"b5-focus1467","series-title":"J Neurosurg Spine","first-page":"295","article-title":"Comparison of thoracolumbosacral orthosis and no orthosis for the treatment of thoracolumbar burst fractures: interim analysis of a multicenter randomized clinical equivalence trial. Clinical article","volume":"11","author":"Bailey","year":"2009"},{"issue":"112","key":"b6-focus1467","series-title":"Clin Orthop Relat Res","first-page":"27","article-title":"Treatment of thoracolumbar dislocation and fractures with paraplegia","author":"Bedbrook","year":"1975"},{"issue":"3","key":"b7-focus1467","series-title":"Neurosurg Focus","first-page":"E14","article-title":"Postoperative wound infections of the spine","volume":"15","author":"Beiner","year":"2003"},{"key":"b8-focus1467","series-title":"J Bone Joint Surg Br","first-page":"72","article-title":"The management of thoracic and thoraco-lumbar injuries of the spine with neurological involvement","volume":"58","author":"Burke","year":"1976"},{"key":"b9-focus1467","series-title":"World Neurosurg","first-page":"395","article-title":"Early complications related to approach in thoracic and lumbar spine surgery: a single center prospective study","volume":"73","author":"Campbell","year":"2010"},{"issue":"4","key":"b10-focus1467","series-title":"Neurosurg Focus","first-page":"E10","article-title":"Complications related to instrumentation in spine surgery: a prospective analysis","volume":"31","author":"Campbell","year":"2011"},{"key":"b11-focus1467","series-title":"World Neurosurg","first-page":"363","article-title":"Early complications related to approach in cervical spine surgery: single-center prospective study","volume":"74","author":"Campbell","year":"2010"},{"key":"b12-focus1467","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":"b13-focus1467","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":"b14-focus1467","series-title":"J Neurosci Nurs","first-page":"185","article-title":"The relationship between extended periods of immobility and decubitus ulcer formation in the acutely spinal cord-injured individual","volume":"24","author":"Curry","year":"1992"},{"issue":"382","key":"b15-focus1467","series-title":"Clin Orthop Relat Res","first-page":"119","article-title":"Remodeling of the spinal canal after thoracolumbar burst fractures","author":"Dai","year":"2001"},{"key":"b16-focus1467","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":"b17-focus1467","series-title":"J Bone Joint Surg Am","first-page":"1324","article-title":"An analysis of conservative (non-surgical) management of thoracolumbar fractures and fracture-dislocations with neural damage","volume":"62","author":"Davies","year":"1980"},{"key":"b18-focus1467","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":"b19-focus1467","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":"b20-focus1467","series-title":"Saudi Med J","first-page":"689","article-title":"Treatment of thoracolumbar fractures","volume":"23","author":"El-Awad","year":"2002"},{"key":"b21-focus1467","series-title":"Spine (Phila Pa 1976)","first-page":"667","article-title":"Evaluation of surgical treatment for burst fractures","volume":"15","author":"Esses","year":"1990"},{"key":"b22-focus1467","series-title":"PLoS ONE","first-page":"e32037","article-title":"Early versus delayed decompression for traumatic cervical spinal cord injury: results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS)","volume":"7","author":"Fehlings","year":"2012"},{"key":"b23-focus1467","series-title":"Paraplegia","first-page":"179","article-title":"The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia","volume":"7","author":"Frankel","year":"1969"},{"key":"b24-focus1467","series-title":"J Neurosurg Spine","first-page":"331","article-title":"Comparative effectiveness and cost-benefit analysis of local application of vancomycin powder in posterior spinal fusion for spine trauma. Clinical article","volume":"19","author":"Godil","year":"2013"},{"key":"b25-focus1467","series-title":"Evid Based Med","first-page":"67","article-title":"EBM resources on the new CEBM website","volume":"14","author":"Heneghan","year":"2009"},{"issue":"293","key":"b26-focus1467","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":"b27-focus1467","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":"b28-focus1467","series-title":"Orthop Clin North Am","first-page":"161","article-title":"Conservative treatment of fractures of the thoracic and lumbar spine","volume":"17","author":"Krompinger","year":"1986"},{"key":"b29-focus1467","series-title":"J Bone Joint Surg Br","first-page":"774","article-title":"Neurological injury in thoracolumbar burst fractures","volume":"77","author":"Limb","year":"1995"},{"key":"b30-focus1467","series-title":"Spine (Phila Pa 1976)","first-page":"631","article-title":"The management of burst fractures of the thoracic and lumbar spine. Experience in 53 patients","volume":"10","author":"McEvoy","year":"1985"},{"issue":"Suppl 4","key":"b31-focus1467","series-title":"Eur Spine J","first-page":"S476","article-title":"Prophylactic intraoperative powdered vancomycin and postoperative deep spinal wound infection: 1,512 consecutive surgical cases over a 6-year period","volume":"21","author":"Molinari","year":"2012"},{"key":"b32-focus1467","series-title":"Eur Spine J","first-page":"284","article-title":"Treatment of thoracolumbar burst fractures without neurologic deficit by indirect reduction and posterior instrumentation: bisegmental stabilization with monosegmental fusion","volume":"8","author":"M\u00fcller","year":"1999"},{"key":"b33-focus1467","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":"b34-focus1467","series-title":"Spine J","first-page":"641","article-title":"Reduced surgical site infections in patients undergoing posterior spinal stabilization of traumatic injuries using vancomycin powder","volume":"11","author":"O'Neill","year":"2011"},{"key":"b35-focus1467","series-title":"Chir Organi Mov","first-page":"129","article-title":"The results of the surgical and conservative treatment of non-neurologic comminuted thoracolumbar fractures","volume":"85","author":"Ramieri","year":"2000"},{"key":"b36-focus1467","series-title":"J Spinal Disord","first-page":"406","article-title":"Treatment of thoracolumbar trauma: comparison of complications of operative versus nonoperative treatment","volume":"12","author":"Rechtine","year":"1999"},{"key":"b37-focus1467","series-title":"J Trauma","first-page":"1188","article-title":"The nonoperative treatment of burst fractures of the thoracolumbar junction","volume":"28","author":"Reid","year":"1988"},{"key":"b38-focus1467","series-title":"Acta Orthop","first-page":"461","article-title":"A review of the TLICS system: a novel, user-friendly thoracolumbar trauma classification system","volume":"79","author":"Rihn","year":"2008"},{"key":"b39-focus1467","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":"b40-focus1467","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":"b41-focus1467","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":"b42-focus1467","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":"b43-focus1467","series-title":"Spine (Phila Pa 1976)","article-title":"Decreased risk of wound infection after posterior cervical fusion with routine local application of vancomycin powder","author":"Strom","year":"2013"},{"key":"b44-focus1467","series-title":"Clin Neurol Neurosurg","first-page":"1766","article-title":"Lumbar laminectomy and fusion with routine local applica tion of vancomycin powder: decreased infection rate in instrumented and non-instrumented cases","volume":"115","author":"Strom","year":"2013"},{"key":"b45-focus1467","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":"b46-focus1467","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":"b47-focus1467","series-title":"Eur Spine J","first-page":"527","article-title":"Management of traumatic thoracolumbar fractures: a systematic review of the literature","volume":"14","author":"van der Roer","year":"2005"},{"key":"b48-focus1467","series-title":"Spine (Phila Pa 1976)","first-page":"33","article-title":"Thoracolumbar \u201cburst\u201d fractures treated conservatively: a long-term follow-up","volume":"13","author":"Weinstein","year":"1988"},{"key":"b49-focus1467","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":"b1-focus1467","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-focus1467","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-focus1467","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":"b4-focus1467","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":"b5-focus1467","series-title":"J Neurosurg Spine","first-page":"295","article-title":"Comparison of thoracolumbosacral orthosis and no orthosis for the treatment of thoracolumbar burst fractures: interim analysis of a multicenter randomized clinical equivalence trial. Clinical article","volume":"11","author":"Bailey","year":"2009"},{"issue":"112","key":"b6-focus1467","series-title":"Clin Orthop Relat Res","first-page":"27","article-title":"Treatment of thoracolumbar dislocation and fractures with paraplegia","author":"Bedbrook","year":"1975"},{"issue":"3","key":"b7-focus1467","series-title":"Neurosurg Focus","first-page":"E14","article-title":"Postoperative wound infections of the spine","volume":"15","author":"Beiner","year":"2003"},{"key":"b8-focus1467","series-title":"J Bone Joint Surg Br","first-page":"72","article-title":"The management of thoracic and thoraco-lumbar injuries of the spine with neurological involvement","volume":"58","author":"Burke","year":"1976"},{"key":"b9-focus1467","series-title":"World Neurosurg","first-page":"395","article-title":"Early complications related to approach in thoracic and lumbar spine surgery: a single center prospective study","volume":"73","author":"Campbell","year":"2010"},{"issue":"4","key":"b10-focus1467","series-title":"Neurosurg Focus","first-page":"E10","article-title":"Complications related to instrumentation in spine surgery: a prospective analysis","volume":"31","author":"Campbell","year":"2011"},{"key":"b11-focus1467","series-title":"World Neurosurg","first-page":"363","article-title":"Early complications related to approach in cervical spine surgery: single-center prospective study","volume":"74","author":"Campbell","year":"2010"},{"key":"b12-focus1467","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":"b13-focus1467","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":"b14-focus1467","series-title":"J Neurosci Nurs","first-page":"185","article-title":"The relationship between extended periods of immobility and decubitus ulcer formation in the acutely spinal cord-injured individual","volume":"24","author":"Curry","year":"1992"},{"issue":"382","key":"b15-focus1467","series-title":"Clin Orthop Relat Res","first-page":"119","article-title":"Remodeling of the spinal canal after thoracolumbar burst fractures","author":"Dai","year":"2001"},{"key":"b16-focus1467","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":"b17-focus1467","series-title":"J Bone Joint Surg Am","first-page":"1324","article-title":"An analysis of conservative (non-surgical) management of thoracolumbar fractures and fracture-dislocations with neural damage","volume":"62","author":"Davies","year":"1980"},{"key":"b18-focus1467","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":"b19-focus1467","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":"b20-focus1467","series-title":"Saudi Med J","first-page":"689","article-title":"Treatment of thoracolumbar fractures","volume":"23","author":"El-Awad","year":"2002"},{"key":"b21-focus1467","series-title":"Spine (Phila Pa 1976)","first-page":"667","article-title":"Evaluation of surgical treatment for burst fractures","volume":"15","author":"Esses","year":"1990"},{"key":"b22-focus1467","series-title":"PLoS ONE","first-page":"e32037","article-title":"Early versus delayed decompression for traumatic cervical spinal cord injury: results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS)","volume":"7","author":"Fehlings","year":"2012"},{"key":"b23-focus1467","series-title":"Paraplegia","first-page":"179","article-title":"The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia","volume":"7","author":"Frankel","year":"1969"},{"key":"b24-focus1467","series-title":"J Neurosurg Spine","first-page":"331","article-title":"Comparative effectiveness and cost-benefit analysis of local application of vancomycin powder in posterior spinal fusion for spine trauma. Clinical article","volume":"19","author":"Godil","year":"2013"},{"key":"b25-focus1467","series-title":"Evid Based Med","first-page":"67","article-title":"EBM resources on the new CEBM website","volume":"14","author":"Heneghan","year":"2009"},{"issue":"293","key":"b26-focus1467","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":"b27-focus1467","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":"b28-focus1467","series-title":"Orthop Clin North Am","first-page":"161","article-title":"Conservative treatment of fractures of the thoracic and lumbar spine","volume":"17","author":"Krompinger","year":"1986"},{"key":"b29-focus1467","series-title":"J Bone Joint Surg Br","first-page":"774","article-title":"Neurological injury in thoracolumbar burst fractures","volume":"77","author":"Limb","year":"1995"},{"key":"b30-focus1467","series-title":"Spine (Phila Pa 1976)","first-page":"631","article-title":"The management of burst fractures of the thoracic and lumbar spine. Experience in 53 patients","volume":"10","author":"McEvoy","year":"1985"},{"issue":"Suppl 4","key":"b31-focus1467","series-title":"Eur Spine J","first-page":"S476","article-title":"Prophylactic intraoperative powdered vancomycin and postoperative deep spinal wound infection: 1,512 consecutive surgical cases over a 6-year period","volume":"21","author":"Molinari","year":"2012"},{"key":"b32-focus1467","series-title":"Eur Spine J","first-page":"284","article-title":"Treatment of thoracolumbar burst fractures without neurologic deficit by indirect reduction and posterior instrumentation: bisegmental stabilization with monosegmental fusion","volume":"8","author":"M\u00fcller","year":"1999"},{"key":"b33-focus1467","series-title":"Spine (Phila Pa 1976)","first-page":"955","article-title":"Thoracolumbar burst fractures. 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