Conservative versus operative treatment for thoracolumbar burst fractures without neurologic deficit

Thoracolumbar burst fractures account for up to 17% of major spinal fractures. Both conservative and operative treatments are widely used in clinical practice to manage thoracolumbar burst fractures. Previous studies showed good functional results with both treatments, but surgical approach has been associated with higher cost and risks of causing unnecessary adverse effects. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified 14 systematic reviews including 25 randomized trials. We combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded that operative treatment may decrease the risk of neurologic impairment, but in turn, could increase the risk of general complications. It is unclear whether there are differences in pain reduction, improvement in function and quality of life, need for subsequent surgery or radiographic progression of kyphosis in both groups.