Impact of Treatment Modalities and Fracture Stability on Survival in Thoracolumbar Fractures: A 5-Year Observational...

Background/Objectives: Thoracolumbar fractures are a significant health burden, commonly caused by trauma, osteoporosis, or degenerative conditions, and can severely reduce quality of life and survival. These fractures, classified by the AO Spine Classification System, range from stable to unstable and require tailored management strategies. This study aims to evaluate clinical outcomes and survival probabilities in patients aged 50+ with AO A1-A4 fractures, comparing conservative treatment, percutaneous vertebroplasty (PVP), and surgical stabilization, including minimally invasive spine surgery (MISS). Methods: This retrospective study analyzed 1356 patients treated for thoracolumbar fractures at Hungary's largest trauma center (2014-2019). Patients aged 50+ with low-impact trauma-induced AO A1-A4 fractures were included. Fractures were categorized into stable (A1-A2) and unstable (A3-A4) groups. Treatments included conservative management, PVP, and surgical stabilization. Survival probabilities were analyzed using Cox proportional hazards models, and outcomes between open and MISS techniques were compared. Results: Spine stability is a crucial factor in determining patient outcomes. MISS enabled stabilization in older patients, reducing hospital stays compared to open surgery (median 6 vs. 10 days). Minimally invasive techniques increased surgical likelihood for unstable fractures, especially in patients over 70 years. Older age and male sex were associated with higher mortality. Conclusions: MISS offers reduced recovery time and broader surgical eligibility, making it effective for managing unstable thoracolumbar fractures in older patients. Tailored management strategies are essential for improving survival outcomes, particularly in elderly and frail populations.