Comparison of operative versus nonoperative treatment of lumbar burst fractures

The outcomes of traumatic two- and three-column lumbar burst fracture patients treated operatively and nonoperatively were investigated with respect to treatment complications, resumption of employment, and quality of life. Data were obtained from hospital records, radiographs, and written questionnaires. Of 93 patients diagnosed with lumbar fracture between January 1987 and December 1989, 22 met the criteria for study (12 operative, ten nonoperative). Exclusion was based on single-column compression or chance fractures, neurologic compromise, and nontraumatic fractures. The patient groups had distinctly different fracture patterns based on degree of anterior column compression (ACC). Trends toward significant differences in kyphotic angulation and canal compromise were noted. There were no preoperative complications. Varying modes of external immobilization were used in both groups. One patient in each group used narcotic medications for pain at final follow-up evaluation. When comparing the operatively and nonoperatively treated lumbar burst fracture patients in this study group, no significant difference in treatment outcome was established. Nonoperative treatment remains a viable alternative to operative intervention in selected lumbar burst fracture patterns.