Work

Patient characteristics, fracture distribution and management patterns of incomplete thoracolumbar burst fractures: Results from a retrospective multicenter cohort of 982 patients

Year: 2026

Type: article

Abstract: Introduction: Management of neurologically intact AO Spine A3 fractures remains variable, and multicenter data on treatment patterns and conversion to surgery are limited. Research question: Which patient-, injury-, and center-related factors are associated with initial operative treatment and secondary conversion after initial non-operative management? Material and methods: This retrospective multicenter study included adults with neurologically intact A3 fractures from T11 to L2 treated at nine German Level 1 trauma centers between 2018 and 2022. Mixed-effects logistic regression with center as a random intercept evaluated factors associated with initial operative treatment and secondary conversion. Results: < .001), whereas sex, fracture level, additional spinal injury, adjacent fracture, and mobility-restricting injury were not. Initial operative treatment ranged from 37.8% to 65.0% across centers. Secondary conversion occurred in 66 of 486 initially non-operatively managed patients (13.6%; 95% confidence interval 10.7-17.0%); 58 were clinically documented and 8 were identified solely by timing. None of the examined characteristics was independently associated with conversion. Between-center variation was greater for conversion (intraclass correlation coefficient 0.16; median odds ratio 2.13) than for initial operative treatment (intraclass correlation coefficient 0.05; median odds ratio 1.49). Conclusion: Initial operative and non-operative strategies were used equally often, although treatment patterns varied across centers. Age was associated with initial treatment allocation, but measured patient- and injury-related characteristics did not explain the 13.6% secondary conversion rate after initial non-operative management.

Source: Brain and Spine

DOI: 10.1016/j.bas.2026.107472