Surgical versus Non-Surgical Treatment of Thoracolumbar Burst Fractures in Neurologically Intact Patients: A Prospective International Multicentre Cohort Study.

IF 2.6 3区 医学 Q2 CLINICAL NEUROLOGY
Marcel F Dvorak, Cumhur F Öner, Charlotte Dandurand, Klaus John Schnake, Richard J Bransford, Eugen Cezar Popescu, Mohammed El-Sharkawi, Shanmuganathan Rajasekaran, Lorin M Benneker, Greg D Schroeder, Jin W Tee, John C France, Jérôme Paquet, Richard Allen, William F Lavelle, Miguel Hirschfeld, Spyros Pneumaticos, Emiliano Vialle, Alexander R Vaccaro
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引用次数: 0

Abstract

Study designProspective cohort study.ObjectivesTreatment for thoracolumbar (TL) burst fractures in neurologically intact patients remains controversial. The goal of this study was to utilize the international equipoise to determine whether surgery leads to a more rapid improvement of disability measured by minimal clinically important difference (MCID) in Oswestry Disability Index (ODI).MethodsThe primary endpoint was time to achieve an improvement in ODI of more than 12.8 points within 1 year after baseline (MCID). A post hoc analysis was conducted to assess time to minimal disability (ODI of <20). Time-to-event analyses were applied, including log rank test for equality of survivor functions, Kaplan Meier survival curves and Cox proportional hazard models.ResultsOne hundred and ninety-eight patients were included (122 surgical and 76 non-surgical patients). Median time to achieve MCID in ODI (12.8 points) from baseline was similar between the two groups (25.0 days vs 25.5 days, P = 0.517). Post hoc analysis showed a potential trend towards a short time to achieve minimal disability for the surgical group (69.0 days vs 82.0 days, P = 0.057). Similar results were obtained when excluding all patients with suspected PLC injury.ConclusionSurgically and non-surgically treated patients with thoracolumbar burst fractures without neurological injury were similar in terms of time to reaching MCID in ODI at 1 year. Surgical patients may reach minimal disability faster than nonsurgical patients, but additional large scale studies are warranted.Level of EvidenceTherapeutic Prospective Comparative Cohort Study Level II.

神经系统完整患者胸腰椎爆裂性骨折的手术与非手术治疗:一项前瞻性国际多中心队列研究。
研究设计前瞻性队列研究。目的神经系统完整的胸腰椎爆裂性骨折的治疗仍存在争议。本研究的目的是利用国际平衡来确定手术是否能更快地改善Oswestry残疾指数(ODI)中的最小临床重要差异(MCID)。方法主要终点为基线后1年内ODI改善超过12.8点(MCID)的时间。进行事后分析以评估达到最小残疾的时间(ODI P = 0.517)。事后分析显示,手术组在短时间内达到最小残疾的潜在趋势(69.0天vs 82.0天,P = 0.057)。当排除所有疑似PLC损伤的患者时,得到了类似的结果。结论胸腰椎爆裂性骨折无神经损伤,手术治疗与非手术治疗在ODI 1年达到MCID的时间相似。手术患者可能比非手术患者更快达到最小残疾,但需要进一步的大规模研究。证据水平:治疗前瞻性比较队列研究II级。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Global Spine Journal
Global Spine Journal Medicine-Surgery
CiteScore
6.20
自引率
8.30%
发文量
278
审稿时长
8 weeks
期刊介绍: Global Spine Journal (GSJ) is the official scientific publication of AOSpine. A peer-reviewed, open access journal, devoted to the study and treatment of spinal disorders, including diagnosis, operative and non-operative treatment options, surgical techniques, and emerging research and clinical developments.GSJ is indexed in PubMedCentral, SCOPUS, and Emerging Sources Citation Index (ESCI).
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