Does conservative management for thoracolumbar burst fractures of scores 4 and 5 provide a safe house for patients who refuse surgical treatment?

Abstract

Background: Thoracolumbar burst fractures are severe spinal injuries often managed surgically. This study evaluated clinical and radiological outcomes of conservative management for thoracolumbar burst fractures (types A3 and A4) with Thoracolumbar AO Spine Injury Scores (TL AOSIS) of 4 and 5 in patients refusing surgical treatment. Methods: This retrospective study examined 36 patients with thoracolumbar fractures (TL AOSIS 4-5) who declined surgery. Conservative management included bracing for 3-6 weeks with early mobilization. Clinical evaluation used the Visual Analogue Score (VAS) for pain and the Oswestry Disability Index (ODI) for disability. Radiological assessment focused on spinal alignment and union. Results: The mean age was 36.2 years, with 58.33% male patients. Falls were the predominant injury mechanism (80.56%). The mean injury score was 4.5. The mean Cobb angle progressed from 7.2° pre-treatment to 9.7° at the final follow-up. The mean deformity progression was 2.8°. Median VAS improved significantly from 6 pre-treatment to 1 post-treatment (p