Is conservative treatment really the best option for all thoracolumbar injury patients with a thoracolumbar injury classification and severity scale score<4?

Abstract Objectives: The conservative treatment recommendation for patients with thoracolumbar burst fractures with a TLICS score<4 has always been controversial. This retrospective review was conducted to investigate the reliability and validity of thoracolumbar injury classification and severity scale(TLICS) recommendations for thoracolumbar burst fracture patients with a score<4. Methods: A retrospective analysis was conducted from Jan. 2010 through Jun. 2018 for patients with thoracolumbar fractures in a single local institute; patients with a TLICS score <4 were enrolled and grouped according to the therapeutic strategy (surgical or nonsurgical). Imaging and clinical data were collected and compared between the two groups before and after treatment. Results: In total, 119 patients were enrolled (75 in the nonsurgical group and 44 in the surgical group). There was no significant difference between the two groups with regard to both the VAS and ODI values ( p =0.91 and 0.79, respectively) at the last follow-up. Importantly, despite no improvements in the local sagittal angle (LSA, α) of the spine( p =0.09),a worsened regional sagittal angle (RSA, β) ( p =0.03)was observed in the nonsurgical group, while significant improvements in the LSA and RAS were both observed in the surgical group( p <0.01). Conclusions: There were no clinical quantifiable benefits (VAS pain and ODI scores) between nonsurgical and surgical patients with comminuted thoracolumbar fractures (TLICS score<4). However, this type of patient deserves a very careful preoperative evaluation if a nonoperative decision is made; a close follow-up is mandatory due to the high likelihood of long-term kyphotic deformities.