Treatment of T12 Burst Fractures
Initial Decision: Operative vs. Nonoperative Management
- For neurologically intact patients, the decision between surgical versus nonoperative treatment should be based on fracture characteristics and clinical judgment, as the evidence is conflicting 3, 4
- For patients with neurological deficits, surgical intervention is generally pursued to decompress neural elements, restore alignment, and stabilize the spine 3
Surgical Approach Selection
- Instrumentation without fusion is the evidence-based standard for T12 burst fractures requiring surgical intervention, with a Grade A recommendation 1, 2, 4
- The posterior approach is most commonly used due to surgeon familiarity and lower complication rates, with equivalent clinical and neurological outcomes to anterior and combined approaches 4, 6
Surgical Technique: Open vs. Percutaneous
- Both open and percutaneous pedicle screw techniques achieve equivalent clinical outcomes, with a Grade B recommendation 1, 2, 4
- Percutaneous instrumentation offers reduced blood loss and operative time 1, 6
Why Fusion Should Be Omitted
- Fusion does not improve clinical outcomes for T12 burst fractures, according to Grade A evidence 1, 2, 4
- Fusion does not improve radiological outcomes for T12 burst fractures, according to Grade A evidence 1, 6
- Fusion increases operative time and blood loss for T12 burst fractures 1, 6
Nonoperative Management Protocol
- For stable fractures in neurologically intact patients, external bracing and close outpatient follow-up within 1-2 weeks are recommended 5
- Serial imaging is necessary to monitor for progressive deformity in nonoperatively managed cases 5