Sex-Based Representation and Outcome Reporting in Thoracolumbar Burst Fracture Research: A PRISMA-ScR Scoping Review

Background/Objectives: Thoracolumbar burst fracture research has traditionally been male-skewed, but it remains unclear how often women are represented and whether outcomes are reported separately for women and men. This scoping review mapped sex-based representation and outcome reporting in clinical studies of adult traumatic thoracolumbar burst fractures. Methods: We conducted a prospectively planned scoping review in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). MEDLINE, Embase, CINAHL, Global Health, CENTRAL, ClinicalTrials.gov, and ICTRP were searched initially on 8 October 2024 and updated on 8 January 2026. Randomized, prospective, and retrospective clinical reports of adult traumatic thoracolumbar burst fractures were eligible. Reports of pathologic or osteoporotic fractures, pediatric cohorts, nonoriginal reports, protocols without results, and reports with fewer than 11 participants were excluded. Data were charted descriptively, with particular attention to the number and proportion of women, sex-related reporting, and reports identifying differences between women and men. Results: Of 8285 records identified, 491 reports were included, representing an aggregate reported sample of 44,147 participants. Most reports were retrospective (296/491, 60.3%) and evaluated operative techniques (410/491, 83.5%). The number or proportion of women was available in 461 reports (93.9%). The median report-level proportion of women was 36.0% (interquartile range, 29.9-43.3%), and 300 of 461 reports (65.1%) included fewer than 40% women. Only 52 of 491 reports (10.6%) reported any sex-related result, and 10 of 491 reports (2.0%) reported a between-sex treatment-outcome difference. Conclusions: Women are routinely counted but rarely analyzed separately in thoracolumbar burst fracture reports. The available sex-related outcome data are sparse, heterogeneous, and primarily hypothesis-generating. Future studies should report outcomes separately for women and men.