Evidence for the treatment of thoracolumbar burst fractures

Surgical indications and optimal techniques for treating thoracolumbar burst fractures remain controversial. This review covers the most recent advances in classification and treatment. The continued validation of the Thoracolumbar Injury Classification and Severity Score (TLICS) has made this the most widely used instrument to guide clinical decision making in thoracolumbar trauma. Based on fracture morphology, neurologic status, and posterior ligamentous complex integrity, this system is excellent in guiding a surgeon to surgical or nonsurgical management. While surgical indications have become clearer, controversy remains as to the optimal surgical treatment. Techniques and concepts that have been the focus of recent studies include vertebral body augmentation, with and without short-segment posterior instrumentation, minimally invasive stabilization, and the need for anterior surgery. While the ability to predict which patients will benefit from surgical intervention has increased significantly with a more reliable classification system, the evidence to support an optimal treatment for each injury remains weak. As novel treatments that are less invasive continue to evolve, it will be increasingly important to have methodologically sound research to evaluate each option.