Nomogram that can predict failure of conservative treatment for thoracolumbar burst fracture was established

To identify predictors of failure of conservative management for thoracolumbar burst fracture (TBF) and to develop and validate a nomogram for risk stratification.

We analyzed 152 patients with TBF treated conservatively at our center from December 2020 to December 2024. Patients were categorized into the Successful Received Conservative Treatment (SRCT) group (n = 120) and the Converted to Surgical Treatment (CST) group (n = 32). Risk factors for conversion were assessed using univariate and multivariate logistic regression. A nomogram was constructed from the final model and internally validated with 1000 bootstrap resamples. Model performance was evaluated by discrimination [area under the receiver operating characteristic curve (AUC)], calibration, and clinical utility [decision curve analysis (DCA) and clinical impact curve (CIC)].

Age, interpedicular distance, canal compromise, and local kyphosis angle were independent predictors of CST (all p < 0.05). The nomogram showed good discrimination (AUC 0.850, 95% CI 0.774-0.926) and calibration (mean absolute error 0.02). DCA indicated clinical benefit across threshold probabilities of 0.05-0.75, and CIC supported its utility for identifying high-risk patients.

Age, interpedicular distance, canal compromise, and local kyphosis angle are independent predictors of CST. The internally validated nomogram offers individualized risk estimates and may aid early identification of patients at high risk of surgical conversion; external validation is needed.