Surgical Management of Thoracolumbar Fractures

Indications and Techniques

The Congress of Neurological Surgeons provides Grade A evidence that arthrodesis should be omitted from instrumented fixation for thoracolumbar burst fractures, as fusion does not improve clinical or radiological outcomes and increases operative time and blood loss without benefit 1, 2
The American College of Neurological Surgeons recommends a posterior approach for most thoracolumbar fractures, as anterior, posterior, and combined approaches yield equivalent clinical and neurological outcomes (Grade B recommendation) 3, 4

The posterior approach offers greater surgeon familiarity and lower complication rates, as well as the ability to perform both decompression and stabilization through a single incision 1, 2
Percutaneous technique is an option with equivalent outcomes to open surgery (Grade B) 1, 2

The Congress of Neurological Surgeons recommends omitting fusion unless specific contraindications exist, and reserving long-segment fixation only for extreme instability not amenable to short-segment technique 1, 2