A Systematic Review of the Long-Term Outcomes of Surgical Versus Non-surgical Management for Types A3 and A4 Thoracolumbar Spinal Fractures With No Neurological Deficits

Thoracolumbar spinal fractures remain a significant concern in the orthopedic and neurosurgical practice and have a risk of neurological deficits in patients. However, in the majority of the cases, the neurological status remains intact. Generally, conservative management is favored for fractures of low severity and the surgical option is reserved for severe fractures. The management of types A3 and A4 thoracolumbar spinal fractures without neurological deficits still remains debatable. This systematic review aims to compare long-term outcomes of surgical versus non-surgical management in the treatment of types A3 and A4 fractures with no neurosurgical deficit. A systematic search was undertaken in various databases including PubMed, Scopus, and Web of Science to identify relevant studies. The inclusion criteria focused on patients with types A3 and A4 thoracolumbar fractures without neurological deficits. Studies published after 2010 and having a minimum follow-up period of two years were considered for inclusion. The risk of bias was assessed using the Newcastle-Ottawa Scale. A total of 1,973 potential studies were identified, out of which three studies were included in the systematic review. The mean follow-up duration of the studies was more than 2.5 years. A total of 141 patients were included in the studies, with 65 patients in the conservative and 76 patients in the surgical group. Out of three studies, two studies favored surgical management for better functional outcomes, while one study suggested better long-term outcomes with conservative management. Regarding complications, no significant complications were reported in both groups and there was no significant difference between the groups. The risk of bias was low across most studies. Although two of the three studies included in the systematic review favored the surgical approach in the management of types A3 and A4 fractures, there is still a lack of conclusive evidence that favors either approach.