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Treatment strategies for incomplete burst fractures (AO Spine A3) at the thoracolumbar junction -results of a nationwide German survey

Year: 2025

Type: article

Abstract: Introduction: Incomplete burst fractures (A3 AO Spine) of the thoracolumbar junction (TLJ) are among the most common injuries of the thoracolumbar spine. Various treatment strategies are still the subject of controversial debate among spine surgeons. Research question: What are the current treatment trends for incomplete burst fractures at the TLJ within the German Spine Society. Methods: An online survey was conducted via the email distribution list of the German Spine Society (DWG). Ten representative cases with A3 fractures of varying severity at the TLJ were demonstrated. Five radio-morphological parameters were displayed for each of the ten cases. Results: 131 spine surgeons responded. In 41 % of cases a dorsal approach was recommended, a dorsoventral approach in 33 % and conservative treatment in 26 %. Immobilizing pain was the decisive reason for conversion from an initially recommended conservative treatment to surgery in 46 %. The monosegmental endplate angle (EPA) was the most important parameter for surgical treatment recommendation (p < 0.05), with a significant threshold of 12°. The combination of vertebral body destruction (VD) > 50 % and EPA >12° increased the recommendation for a combined posterior and anterior procedure significantly (p = 0.048). Discussion and conclusion: To our knowledge, there are no comparable surveys that provide an overview of the current treatment strategy for A3 fractures. The most common treatment recommendation is posterior stabilization. Local kyphosis and immobilizing pain are significant triggers for surgery.

Source: Brain and Spine

DOI: 10.1016/j.bas.2025.105903

Authors: G. Gaudin, D. Laue, L. Wurm, C. Jaeger, K.J. Schnake