Evidence-Based Recommendations for Spine Surgery

Alexander R. Vaccaro, MD, PhD, MBA; Charles G. Fisher, MD; Srinivas K. Prasad, MD; Alpesh A. Patel, MD, FACS; John Chi, MD, MPH; Kishore Mulpuri, MBBS, MHSc; Kenneth C. Thomas, MD, MHSc; Peter G. Whang, MD, FACS


Spine. 2020;45(21):E1441-E1448. 

In This Article

Study Summary

The authors conducted a randomized, single-blind controlled trial involving subjected enrolled from a single center. A total of 50 patients who had sustained thoracolumbar injuries which were assigned a TLICS score of 4 were included in the analysis, randomly divided to either the operative or nonoperative cohorts (25 per arm). Nonoperative treatment consisted of bedrest for at least 5 days, physical therapy, bracing, and activity modification (i.e., no strenuous physical activity). For the operative group, the specific surgical procedures performed were dictated by the type of fracture and the status of the patient but typically entailed a posterior instrumented arthrodesis. The primary outcomes were the local and regional sagittal angles (LSA and RSA, respectively) measured on radiographs, but demographic information and relevant clinical data including VAS back pain scores were also collected at baseline as well as at 3, 6, 9, and 12 months.

According to this analysis, the RSA was significantly lower in the operative cohort compared with the nonsurgical group at all time points, as were the average VAS scores. Likewise, it is reported that patients undergoing surgery for their fractures returned to work significantly sooner relative to those who were treated conservatively. Given these improvements in radiographic appearance, pain scores, and time to return to work, the authors concluded that surgical stabilization of thoracolumbar fractures with a TLICS score of 4 may be preferable to nonoperative care for the treatment of these injuries.