Traumatic canal stenosis should not be an indication for surgical decompression in thoracolumbar burst fracture

Thoracolumbar burst fracture (TLBF) is a common type of spinal injuries and frequently causes spinal cord injury. The frequency of neurological deficits in all TLBF can reach up to 50-60%. The typical TLBF images seen on axial computerized tomography are the bone fragment projected into the spinal canal, which always persuade surgeons that the narrowed canal must compress the neural content and therefore is responsible for neurological deficits, with the corollary that surgical decompression of spinal canal is an essential therapeutic strategy for functional recovery. We hypothesize that in TLBF, traumatic canal stenosis is a predictive factor for neurological dysfunction and the surgical decompression is vital to the recovery of neurological function. After a review of the available evidences, we conclude that spinal canal stenosis is poorly correlated with neurological dysfunction in TLBF, and surgical decompression is not vital to the neurological recovery. Therefore, traumatic canal stenosis should not be an isolated indication for surgical decompression in TLBF.