Efficacy and Safety of Conservative Treatment in Patients with Neurologically Intact Thoracolumbar Burst Fractures: A Meta-Analysis

Abstract Objective: To conduct a systematic review and meta-analysis of studies focused on conservative treatment for thoracolumbar burst fractures (TLBF), and to determine efficacy and safety of this method in these patients. Materials and Methods: The study was performed following PRISMA guidelines. Inclusion criteria were: 1) full-text articles in English and Russian; 2) A3 or A4 type fractures according AOSpine classification; 3) absence of neurological deficit; 4) patients aged over 18 years; 5) detailed description of treatment outcomes or complications; 6) a follow-up of at least one year. Results: A total of 29 studies, including 1107 patients, were analyzed. Initial assessments showed a pooled mean for Cobb angle of 13.6⁰ (95%CI, 10.8 – 16.5), vertebral body compression percentage of 39.9% (95%CI, 27.7 – 52.0), and spinal canal stenosis of 41.7% (95%CI, 29.2 – 54.2). Follow-up assessments indicated a significant increase in Cobb angle by 3.7⁰ and vertebral body compression by 3.7%. The pooled prevalence for neurological deficit development and progression of TLBF instability were 5.8% (95%CI, 4.1 - 8.1) and 6.5% (95%CI, 4.5 - 9.3) respectively. Work status according to Denis scale was as follows: 1) W1 and W2, 74.7% (95%CI, 63.9 - 83.1); 2) W3, 14.1% (95%CI, 10.2 - 19.3); 3) W4 and W5, 14.8% (95%CI, 8.8 - 23.9). Conclusion: Conservative therapy is an effective and safe option for patients with TLBF without neurological deficits and with initial kyphotic deformity up to 16°, vertebral body compression percentage up to 52%, and spinal canal stenosis up to 54.2%. The incidence of radiculopathy or myelopathy under conservative treatment is 5.8%. Orthopedic intervention may be required in 6.5% of patients. Over 90% of patients return to full-time work, either in their previous roles or under modified conditions. Future comparative studies between conservative and surgical treatments are needed to establish clear guidelines for managing patients with neurologically intact TLBF.