{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,11]],"date-time":"2026-11-11T11:00:22Z","timestamp":1794394822006,"version":"4.9.0"},"reference-count":50,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","license":[{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,29]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The aim of this study was to compare patient-report outcome measures in patients with thoracolumbar burst fractures managed either operatively or nonoperatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A prospective multicenter observational study was conducted of neurologically intact patients who sustained traumatic thoracolumbar burst fractures managed operatively or nonoperatively. Outcome measures included scores on the EQ-5D index, EQ-5D visual analog scale (VAS), pain numerical rating scale (NRS), and AO Spine Patient Reported Outcome Spine Trauma (PROST) tool and patient satisfaction with follow-up up to 2 years. The Wilcoxon rank-sum test and Cochran-Armitage test were used to evaluate differences between continuous and ordinal variables, respectively. Mixed models for repeated measures (MMRM) were used for continuous outcomes using unstructured covariance. A generalized estimating equations (GEE) model was employed for the ordinal outcomes of anxiety and depression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>In total, 198 patients were identified. The EQ-5D index scores were similar for A3 and A4 fractures at long-term 2-year follow-up with respect to operative (p = 0.48) and nonoperative (p = 0.51) management. This was paralleled by EQ-5D VAS scores for surgical (p = 0.33) and nonsurgical (p = 0.21) treatment. The adjusted mixed-effects model for EQ-5D index and EQ-5D VAS scores showed significant improvements for both operatively and nonoperatively treated A3 and A4 fractures at all follow-up evaluations (p &lt; 0.05), except for EQ-VAS at 6 weeks in the nonsurgical group (p = 0.812). The GEE model confirmed that there was a higher proportion of patients who were less anxious or depressed among operatively managed patients with A4 fractures compared to those with A3 fractures at 2-year follow-up (OR 7.7, 95% CI 1.5\u201340.5, p = 0.02). MMRM for pain NRS and AO Spine PROST suggested that there was a significant improvement in outcome compared to discharge for both surgically and nonsurgically treated patients (p &lt; 0.05) but no significant difference between the surgical subgroups. Patient satisfaction was similar between those with A3 and A4 fractures for nonoperatively (p = 0.62) and operatively (p = 0.50) treated patients at final follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>The contemporary management of thoracolumbar burst fractures in neurologically intact patients has evolved to the extent that there is improvement in function, pain, and disability for both A3 and A4 fractures regardless of whether surgical or nonsurgical management is pursued. Patients who sustained the more severe A4 morphology experienced improved mental health outcomes at the final 2-year follow-up if operatively managed. Ultimately, patient satisfaction was similar when compared with the EQ-5D index and EQ-5D VAS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2026.1.spine251316","type":"journal-article","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:55Z","timestamp":1779840055000},"page":"287-299","source":"Crossref","is-referenced-by-count":3,"title":["Patient-reported outcomes following operative and nonoperative management of A3 versus A4 thoracolumbar burst fractures"],"prefix":"10.3171","volume":"45","author":[{"given":"Barry T. S.","family":"Kweh","sequence":"first","affiliation":[{"name":"Spine and Neurotrauma Division, National Trauma Research Institute, Melbourne, Victoria, Australia;"},{"name":"Department of Neurosurgery, The Alfred Hospital, Melbourne, Victoria, Australia;"},{"name":"Department of Neurosurgery, Royal Melbourne Hospital, Parkville, Melbourne, Victoria, Australia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Dandurand","sequence":"additional","affiliation":[{"name":"Combined Neurosurgical and Orthopedic Spine Program, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander R.","family":"Vaccaro","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus J.","family":"Schnake","sequence":"additional","affiliation":[{"name":"Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus St. Marien Erlangen, Erlangen;"},{"name":"Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"El-Sharkawi","sequence":"additional","affiliation":[{"name":"Department of Orthopedic and Trauma Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard J.","family":"Bransford","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrei Fernandes","family":"Joaquim","sequence":"additional","affiliation":[{"name":"Neurosurgery Division, Department of Neurology, State University of Campinas, Campinas-Sao Paulo, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harvinder Singh","family":"Chhabra","sequence":"additional","affiliation":[{"name":"Spine and Rehabilitation, Sri Balaji Action Medical Institute, New Delhi, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrich J. A.","family":"Spiegl","sequence":"additional","affiliation":[{"name":"Clinics of Trauma Surgery, Orthopaedics, and Reconstructive Surgery, M\u00fcnchen Klinik Harlaching, Munich, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitri","family":"Hauri","sequence":"additional","affiliation":[{"name":"AO Foundation, AO Innovation Translation Center, Clinical Evidence, Davos, Switzerland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F. Cumhur","family":"\u00d6ner","sequence":"additional","affiliation":[{"name":"Department of Spinal Surgery, University Medical Centers, Utrecht, The Netherlands; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory D.","family":"Schroeder","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin Wee","family":"Tee","sequence":"additional","affiliation":[{"name":"Spine and Neurotrauma Division, National Trauma Research Institute, Melbourne, Victoria, Australia;"},{"name":"Department of Neurosurgery, The Alfred Hospital, Melbourne, Victoria, Australia;"},{"name":"Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1_suppl","key":"b1","series-title":"Global Spine J","first-page":"32S","article-title":"The AO spine thoracolumbar injury classification system and treatment algorithm in decision making for thoracolumbar burst fractures without neurologic deficit","volume":"14","author":"Kweh BTS","year":"2024","unstructured":"Kweh BTS, Tee JW, Dandurand C,  The AO spine thoracolumbar injury classification system and treatment algorithm in decision making for thoracolumbar burst fractures without neurologic deficit. Global Spine J. 2024;14(1_suppl):32S\u201340S. doi:10.1177\/21925682231195764"},{"issue":"1","key":"b2","series-title":"Rev Rom Anat Func\u0163 Clin Macro Microsc Antropol","first-page":"25","article-title":"Thoraco-lumbar A0 A3-A4 spine fractures without neurologic deficits. Conservative or surgical treatment?","volume":"16","author":"Nanu C","year":"2017","unstructured":"Nanu C, Popescu C, Poeata I. Thoraco-lumbar A0 A3-A4 spine fractures without neurologic deficits. Conservative or surgical treatment? Rev Rom Anat Func\u0163 Clin Macro Microsc Antropol. 2017;16(1):25\u201329."},{"issue":"6","key":"b3","series-title":"Orthopedics","first-page":"422","article-title":"Thoracolumbar burst fractures: a systematic review of management","volume":"33","author":"Alpantaki K","year":"2010","unstructured":"Alpantaki K, Bano A, Pasku D,  Thoracolumbar burst fractures: a systematic review of management. Orthopedics. 2010;33(6):422\u2013429. doi:10.3928\/01477447-20100429-24"},{"issue":"11","key":"b4","series-title":"Spine J","first-page":"S19","article-title":"36. Incomplete (A3) versus complete (A4) thoracolumbar burst fractures: results from a prospective international multicenter cohort study","volume":"25","author":"Kweh B","year":"2025","unstructured":"Kweh B, Tee J, Bransford RJ,  36. Incomplete (A3) versus complete (A4) thoracolumbar burst fractures: results from a prospective international multicenter cohort study. Spine J. 2025;25(11):S19\u2013S20. doi:10.1016\/j.spinee.2025.08.218"},{"issue":"2","key":"b5","series-title":"J Spine Surg","first-page":"216","article-title":"Traumatic spinal cord injury in the elderly: predictors for mortality and functional outcomes","volume":"11","author":"Chin CWH","year":"2025","unstructured":"Chin CWH, Kweh BTS, Sher I,  Traumatic spinal cord injury in the elderly: predictors for mortality and functional outcomes. J Spine Surg. 2025;11(2):216\u2013226. doi:10.21037\/jss-24-138"},{"issue":"4","key":"b6","series-title":"Eur Spine J","first-page":"1087","article-title":"The surgical algorithm for the AOSpine thoracolumbar spine injury classification system","volume":"25","author":"Vaccaro AR","year":"2016","unstructured":"Vaccaro AR, Schroeder GD, Kepler CK,  The surgical algorithm for the AOSpine thoracolumbar spine injury classification system. Eur Spine J. 2016;25(4):1087\u20131094. doi:10.1007\/s00586-015-3982-2"},{"issue":"6","key":"b7","series-title":"J Neurosurg Spine","first-page":"914","article-title":"Evolution of the AO Spine Sacral and Pelvic Classification System: a systematic review","volume":"37","author":"Kweh BTS","year":"2022","unstructured":"Kweh BTS, Tee JW, Oner FC,  Evolution of the AO Spine Sacral and Pelvic Classification System: a systematic review. 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J Neurosurg Spine. 2022;36(1):99\u2013112. doi:10.3171\/2021.3.SPINE201997"},{"issue":"1","key":"b9","series-title":"Global Spine J","first-page":"759","article-title":"Craniocervical junction and upper cervical spine fractures: historical systems and advancements with the AO Spine Classification","volume":"16","author":"Kweh BTS","year":"2026","unstructured":"Kweh BTS, Vaccaro AR, Schroeder G,  Craniocervical junction and upper cervical spine fractures: historical systems and advancements with the AO Spine Classification. Global Spine J. 2026;16(1):759\u2013770. doi:10.1177\/21925682251351943"},{"issue":"1","key":"b10","series-title":"Global Spine J","first-page":"806","article-title":"Thoracolumbar fractures: historical systems and advancements with the AO Spine Classification","volume":"16","author":"Kweh BTS","year":"2026","unstructured":"Kweh BTS, Vaccaro AR, Schroeder G,  Thoracolumbar fractures: historical systems and advancements with the AO Spine Classification. Global Spine J. 2026;16(1):806\u2013816. doi:10.1177\/21925682251366981"},{"issue":"2","key":"b11","series-title":"Global Spine J","first-page":"21925682251379358","article-title":"Sacral and pelvic fractures: historical systems and advancements with the AO Spine Classification","volume":"16","author":"Kweh BTS","year":"2025","unstructured":"Kweh BTS, Vaccaro AR, Schroeder G,  Sacral and pelvic fractures: historical systems and advancements with the AO Spine Classification. Global Spine J. 2025;16(2):21925682251379358. doi:10.1177\/21925682251379358"},{"issue":"1","key":"b12","series-title":"BMC Musculoskelet Disord","first-page":"373","article-title":"Healing pattern classification for thoracolumbar burst fractures after posterior short-segment fixation","volume":"21","author":"Liang C","year":"2020","unstructured":"Liang C, Liu G, Liang G,  Healing pattern classification for thoracolumbar burst fractures after posterior short-segment fixation. 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Neurospine. 2021;18(4):713\u2013724. doi:10.14245\/ns.2142390.195"},{"issue":"20","key":"b15","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\u2013L5","volume":"24","author":"Seybold EA","year":"1999","unstructured":"Seybold EA, Sweeney CA, Fredrickson BE, Warhold LG, Bernini PM. Functional outcome of low lumbar burst fractures: a multicenter review of operative and nonoperative treatment of L3\u2013L5. 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Effects of bracing on clinical and radiographic outcomes following thoracolumbar burst fractures in neurologically intact patients: a meta-analysis of randomized controlled trials. JBJS Rev. 2019;7(9):e9. doi:10.2106\/JBJS.RVW.19.00006"},{"issue":"3","key":"b20","series-title":"J Spine Surg","first-page":"224","article-title":"Spinal orthoses in osteoporotic vertebral fractures of the elderly","volume":"9","author":"Khoo B","year":"2023","unstructured":"Khoo B, Gonzalvo A, Kweh BTS. Spinal orthoses in osteoporotic vertebral fractures of the elderly. J Spine Surg. 2023;9(3):224\u2013228. doi:10.21037\/jss-23-76"},{"issue":"1","key":"b21","series-title":"Spine (Phila Pa 1976)","first-page":"33","article-title":"Thoracolumbar \"burst\" fractures treated conservatively: a long-term follow-up","volume":"13","author":"Weinstein JN","year":"1988","unstructured":"Weinstein JN, Collalto P, Lehmann TR. Thoracolumbar \"burst\" fractures treated conservatively: a long-term follow-up. 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